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1.

Purpose

This study aimed (1) to examine the role of potential correlates of HRQoL in a large representative sample of older adults, and (2) to investigate whether the relationships between HRQoL and potential factors differ as a function of HRQoL component (physical vs. mental) and/or age cohort (young-old vs. old–old).

Methods

This cross-sectional study included 802 older adults aged 60–79 years old. HRQoL was assessed using the SF-36 questionnaire. Functional fitness was assessed using the Senior Fitness Test. Physical activity was measured via the Baecke questionnaire. Demographic information, mental and health features were obtained through questionnaires.

Results

A multiple regression analysis showed that BMI (β = ?0.15, p?=?0.001), body strength (β =?0.21, p?<?0.001), aerobic endurance (β =?0.29, p?<?0.001), physical activity (β =?0.11, p?=?0.007), depressive symptoms (β = ?0.19, p?<?0.001), falls (β = ?0.19, p?<?0.001), and living alone (β = ?0.16, p?<?0.001) were all significantly related to HRQoL-SF-36 total score. The positive relation with aerobic endurance was significantly higher for the physical component of HRQoL, while the negative relation with living alone was significantly higher for the mental component. The positive relation of HRQoL with physical activity was significantly higher in old–old compared to young-old adults.

Conclusion

This data suggest that body composition, functional fitness, psycho-social factors, and falls are important correlates of HRQoL in old age. There are HRQoL-component and age-cohort differences regarding these correlates, underlying the need for specific strategies at the community level to promote HRQoL in older adults.
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2.

Objective

The authors investigated the effectiveness of a functionalized tricalcium phosphate (fTCP) combined with a low fluoride level in a mouthrinse to reharden eroded enamel lesions.

Methods

Ninety enamel slabs attached in pairs to removable appliances were randomly assigned to three treatment groups (n?=?30/group): (T1) NaF rinse (225 ppm F?+?40 ppm fTCP), (T2) NaF rinse (225 ppm F; ACT®), and (T3) no mouthrinse (saliva). While wearing the in situ appliance for 14 days, subjects brushed their teeth with 1100 ppm F toothpaste (Crest©) for 2 min, rinsed with 15 ml of water for 10s, and then rinsed with 15 ml of their assigned treatment mouthrinse. Treatment efficacy was evaluated using surface microhardness (SMH) and transverse microradiography (TMR). Intra- and intergroup comparisons (α?=?0.05) were performed using the t-test and ANOVA followed by the Tukey test (HSD).

Results

With SMH, intragroup comparison (t-test) indicated significant rehardening of the eroded lesion with exposure to T1 (p?<?0.001) and T2 (p?<?0.01) but not with T3 However, with TMR, remineralization was only significant (p?=?0.01) with T1, but not with T2 and T3. In the intergroup comparison with percentage change in SMH, T1 was significantly different from T3 (p?<?0.01; Tukey HSD) but not from T2, and T2 was significantly different from T3. Intergroup comparison based on percentage mineral gain showed that T2 (p?=?0.02) and T3 (p?=?0.01) differed significantly from fTCP, but not between each other.

Conclusion

Addition of low level fluoride to functionalized β-tricalcium phosphate promoted rehardening of eroded enamel lesions.
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3.

Background

On the brink of the opening of the first French drug consumption room in Paris, the general opinion of the local involved health care professionals and drug users was not known. The objective of this study was to determine their expectations and to search for influencing factors.

Method

We carried out a quantitative cross-sectional study. A multiple choice questionnaire was proposed to the surrounding willing general practitioners (GPs) and pharmacists, to the emergency doctors of Lariboisière hospital, and to the professionals of the harm reduction facilities and their drug users (PWUD). For each question, there was a choice between seven answers, from “??3” (very negative impact) to “+?3” (very positive impact). The influence of the characteristics of each group on its mean answers was explored by Mann-Whitney, Kruskal-Wallis, and Spearman’s tests.

Results

The median expectations among the groups of responding GPs (N =?62), other health care professionals (N =?82), and PWUD (N =?57) were mainly positive. They thought that the drug consumption room (DCR) would improve the health of PWUD, reduce their at-risk behaviors, would not increase drug use or drug dealing in the neighborhood, and would reduce nuisance in the public space. Only the group of GPs expressed that the DCR could decrease the quietness of the neighborhood, and only the group of PWUD had higher expectations that the DCR would decrease the number of arrests and the number of violent behavior. GPs’ expectations were significantly better in terms of health improvement of PWUD and reducing their precariousness if they had a previous experience in addiction medicine (Mann-Whitney, p =?0.004 and p =?0.019), with a longer practice (Spearman’s rho, p =?0.021 and p =?0.009), and if they were currently prescribing opioid substitution treatments (Mann-Whitney, p =?0.030 and p =?0.002).Among non-GPs, those who were working in addiction medicine centers had significantly better expectations than pharmacists, and the professionals of the local emergency department had intermediate expectations.

Conclusions

Health care professionals and drug users had a positive opinion of the to-be-created Parisian drug consumption room. Experience in addiction medicine influenced positively health professionals’ expectations.
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4.

Background

Previous studies were able to show that hazardous alcohol and substance abuse among physicians is not rare. Currently no recent data to detect risk groups are available either on the prevalence of hazardous drinking disorders and risky health behaviour among physicians or on influencing factors (age, gender, role, institution, specialization, working hours).

Methods

A 42-item online questionnaire was distributed to 38 university hospitals, 296 teaching hospitals and 1290 physicians in private practice. The questionnaire addressed health behaviour and alcohol/substance consumption as well as demographic and work-related properties.

Results

Out of 1338 a total of 920 questionnaires could be evaluated. 90% of physicians estimate their health status as satisfying. 23% of doctors consume hazard quantities of ethanol, 5% are nicotine addicted, and 8% suffer from obesity. Childlessness (p =?0,004; OR?= 1,67; KI?= 1,17-2,37) for both genders and the role of a resident for females (p =?0,046, OR?=?3,10, KI?= 1,02-9,40) poses a risk factor for hazardous alcohol consumption. Weekly working hours of more than 50 h (p =?0,009; OR?= 1,56; KI?= 1,12-2,18) and a surgical profession (p <?0,001; OR?= 2,03; KI?= 1,47-2,81) may also be a risk factor towards hazardous and risky health behaviour.

Conclusion

A more structured and frequently repeated education on help offerings and specific institutions for addicted and risk groups seems essential.
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5.

Background

The response of serum cholesterol to diet may be affected by the apolipoprotein E (APOE) ε2/ε3/ε4 polymorphism, which also is a significant predictor of variation in the risk of coronary heart disease (CHD) and CHD death. Here, we test the hypothesis that the APOE polymorphism may modulate the cholesterol-raising effect of coffee.

Objective

We determined the effect of a coffee abstention period and a daily intake of 600 mL coffee on serum cholesterol and triglycerides with respect to the APOE polymorphism.

Design

121 healthy, non-smoking men (22%) and women (78%) aged 29–65 years, took part in a study with four intervention periods: 1 and 3) a coffee free period of three weeks, 2 and 4) 600 mL coffee/day for four weeks.

Results

APOE ε 2 positive individuals had significantly lower total cholesterol concentration at baseline (4.68 mmol/L and 5.28 mmol/L, respectively, p = 0.01), but the cholesterol-raising effect of coffee was not influenced significantly by APOE allele carrier status.

Conclusions

The APOE ε 2 allele is associated with lower serum cholesterol concentration. However, the APOE polymorphism does not seem to influence the cholesterol-raising effect of coffee.
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6.

Background

Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS.

Methods

A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0–3.5 (no-moderate disability) and 4–9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p <?0.05. A multiple regression model was performed to obtain the variables associated with costs.

Results

A total of 222 patients were analyzed; mean (SD) age: 45.5 (12.5) years, 64.4% female, and 62.2% presented a diagnosis of relapsing-remitting MS. Median EDSS score was 2.5, with 68.5% of the patients with no to moderate disability. The mean annual cost per MS patient was €25,103. For no-moderate and severe disability, the ANCOVA-adjusted mean annual cost was €23,157 and €29,242, respectively (p =?0.013). Direct costs and MS disease-modifying therapy accounted for 39.4% and 31.7% of the total costs, respectively. The total costs were associated with number of relapses (β?=?0.135, p =?0.001), time since diagnosis (β?=?0.281, p =?0.023), and age (β?=?0.198, p =?0.037).

Conclusions

Multiple sclerosis imposes a substantial economic burden on the Spanish National Health System, patients and society as a whole. Costs significantly correlated with disease progression.
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7.

Objectives

The purpose of this study was to explore whether two types of emotional labor, surface acting and deep acting, are related to hair cortisol concentration among kindergarten teachers.

Methods

Surface acting and deep acting over the last month were measured with the Chinese version of the emotional labor scale in 43 kindergarten teachers. Hair samples with 1 cm in length were cut from their posterior vertex region to represent cortisol excretion over one month. Cortisol concentrations were analyzed with high-performance liquid chromatography–tandem mass spectrometry.

Results

Positive association of emotion labor with hair cortisol concentration was significant for surface acting (r = 0.34, p < 0.05) and not significant for deep acting (r = 0.14, p > 0.05).

Conclusions

More surface acting showed to be associated stronger with stress responses or higher HPA axis activity.
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8.

Background

This study examines the construct validity of the Areas of Worklife Short Scale, a practical instrument to measure employees’ perceptions of their work environments in the sample of secondary obligatory education teachers in Spain.

Methods

Conducted in 33 centers of secondary obligatory education in Spain (N?=?677). Confirmatory Factor analysis for 3 different models for the 29-items version and 1 model for the 18-items version was tested.

Results

Results confirmed that the short AWS short version had the best fit to the data than any other model proposed (GFI-Satorra-Bentler scaled chi-squared?=?320.19, ×?2/df?=?2.337) and good fit indices (CFI?=?0.911; RMSEA?=?0.046).

Conclusions

This analysis ultimately supports the appropriateness of AWS short version to explore areas of worklife and therefore can indicate the factors that contribute to burnout in the sample of secondary obligatory education teachers in Spain. Therefore it has been confirmed that this tool is able to assess the 6 domains of work environment of secondary schools teachers.
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9.

Background

Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement.

Objective

In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths’ participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n?=?16).

Method

A semi-structured focus group with service providers (n?=?7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two).

Results

Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program.

Conclusions

This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs.
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10.

Background

This study aimed to determine the awareness among fifth-grade girls and boys of sexually transmitted diseases (STDs), cancer, and human papillomavirus (HPV), and to determine the factors associated with intention to obtain the HPV vaccination.

Methods

A quasi experimental design was employed with Korean fifth-grade students as the subjects for this study (n=117). Prior to providing HPV education, the awareness and health beliefs regarding STDs and cancer prevention were assessed according to gender. After 2 hours of HPV education, gender comparisons were made with respect to the awareness and health beliefs, HPV knowledge, and intention to obtain the HPV vaccination, and the factors associated with that intention.

Results

Prior to the 2hours education session, only two boys knew that HPV is a virus. There were significant gender differences with respect to responses to the statements “STD is preventable” (χ2=8.76, p=0.013) and “cancer is preventable” (χ2=6.37, p=0.041), and concerns about the pain associated with vaccine injection (z=?2.44, p=0.015). After HPV education, there were no significant gender differences in HPV knowledge and intention to obtain the HPV vaccination. Awareness that “HPV vaccine can prevent cervical cancer” was significantly related to intention to obtain the HPV vaccine among both boys and girls.

Conclusions

Increased HPV knowledge could positively influence the intention to obtain the HPV vaccination among youth. Thus, HPV education at elementary school would be helpful to make students aware of HPV and the importance of HPV prevention.
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11.

Background

Recently, trimethylamine-N-oxide (TMAO) plasma levels have been proved to be associated with atherosclerosis development. Among the targets aimed to ameliorating atherosclerotic lesions, inducing bile acid synthesis to eliminate excess cholesterol in body is an effective way. Individual bile acid as endogenous ligands for the nuclear receptor has differential effects on regulating bile acid metabolism. It is unclear whether bile acid profiles are mechanistically linked to TMAO-induced development of atherosclerosis.

Methods

Male apoE?/? mice were fed with control diet containing 0.3% TMAO for 8?weeks. Aortic lesion development and serum lipid profiles were determined. Bile acid profiles in bile, liver and serum were measured by liquid chromatographic separation and mass spectrometric detection (LC-MS). Real-time PCRs were performed to analyze mRNA expression of genes related to hepatic bile acid metabolism.

Results

The total plaque areas in the aortas strongly increased 2-fold (P?<?0.001) in TMAO administration mice. The levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) in TMAO group were also significantly increased by 25.5% (P =?0.044), 31.2% (P =?0.006), 28.3% (P =?0.032), respectively. TMAO notably changed bile acid profiles, especially in serum, the most prominent inductions were tauromuricholic acid (TMCA), deoxycholic acid (DCA) and cholic acid (CA). Mechanically, TMAO inhibited hepatic bile acid synthesis by specifically repressing the classical bile acid synthesis pathway, which might be mediated by activation of small heterodimer partner (SHP) and farnesoid X receptor (FXR).

Conclusions

These findings suggested that TMAO accelerated aortic lesion formation in apoE?/? mice by altering bile acid profiles, further activating nuclear receptor FXR and SHP to inhibit bile acid synthesis by reducing Cyp7a1 expression.
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12.

Background

The purpose of this comprehensive meta-analysis was to assess the association of aldehyde dehydrogenase (ALDH) expression with overall survival (OS) and disease-free survival (DFS)/progression-free survival (PFS) in ovarian cancer patients.

Methods

Systematic searches of Pubmed databases was performed to identify relevant literature published before February 28, 2018. A total of 14 studies (13 articles) with 2210 ovarian cancer patients were pooled. All included studies were performed by using Immunohistochemistry (IHC) for detection of ALDH expression. Hazard ratio (HR) and 95% confidence interval (CI) were extracted from included studies to evaluate the correlation of ALDH expression with OS and DFS/PFS.

Results

High expression of ALDH was associated with worse OS (HR: 1.43; 95% CI: 1.18–1.73) and poor DFS/PFS (HR: 1.55, 95% CI: 1.12–2.14). No evidence of publication bias was observed in OS (Begg’s test, P?=?0.113; Egger’s test, P?=?0.355) and DFS/PFS (Begg’s test, P?=?0.655; Egger’s test, P?=?0.189) in ovarian cancer patients. The subgroup of studies with cut-off value of low expression showed that high expression of ALDH was correlated with poor OS (HR: 1.36; 95% CI: 1.14–1.62) and DFS/PFS (HR: 1.79; 95% CI: 1.45–2.20) in ovarian cancer patients, with no observed heterogeneity (OS: I2 =?0%, P?=?0.45; DFS/PFS: I2 =?0%, P?=?0.55).

Conclusion

In conclusion, high expression of ALDH is correlated with worse survival profiles in ovarian cancer patients, indicating that ALDH might act as a potential molecular biomarker for prognosis of ovarian cancer.
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13.
14.

Background

Home-based parenting support within youth care services is one of the key interventions provided to families encountering difficulties with child rearing and child development. However, knowledge on factors contributing to positive outcomes of home-based parenting support is limited.

Objective

The current study investigated the predictive value of (1) early parent-professional alliance and (2) change in alliance during care for outcomes of home-based parenting support.

Method

Multi-informant self-report alliance and outcome data from 146 parents (Mage?=?40.00, SD?=?7.10; range 19–57 years) and their professionals collected early and late in care were analyzed using latent growth curve modeling.

Results

Findings demonstrated that higher levels of early parent-reported alliance predicted higher levels of parent-reported satisfaction with care, and improved parent functioning. Higher levels of early professional-reported alliance predicted higher levels of parent- and professional-reported satisfaction, and improved parent functioning. Increases in professional-reported alliance during care predicted higher levels of professional-reported satisfaction and parent functioning but were not related to parent-reported outcomes. Change in parent-reported alliance was not related to outcomes.

Conclusions

Together, our findings suggest that a strong parent-professional alliance represents a key process factor in realizing positive outcomes of home-based parenting support. Consequently, efforts in research and practice are needed to investigate precursors of strong alliances and to optimize professionals’ ability to develop and maintain strong parent-professional alliances.
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15.

Background

Depression affects over 400 million people globally. The majority are seen in primary care. Barriers in providing adequate care are not solely related to physicians’ knowledge/skills deficits, but also time constraints, lack of confidence/avoidance, which need to be addressed in mental health-care redesign. We hypothesized that family physician (FP) training in the Adult Mental Health Practice Support Program (AMHPSP) would lead to greater improvements in patient depressive symptom ratings (a priori primary outcome) compared to treatment as usual.

Methods

From October 2013 to May 2015, in a controlled trial 77 FP practices were stratified on the total number of physicians/practice as well as urban/rural setting, and randomized to the British Columbia AMHPSP?a multi-component contact-based training to enhance FPs’ comfort/skills in treating mild-moderate depression (intervention), or no training (control) by an investigator not operationally involved in the trial. FPs with a valid license to practice in NS were eligible. FPs from both groups were asked to identify 3–4 consecutive patients >?18?years old, diagnosis of depression, Patient Health Questionnaire (PHQ-9) score ≥ 10, able to read English, intact cognitive functioning. Exclusion criteria: antidepressants within 5?weeks and psychotherapy within 3?months of enrollment, and clinically judged urgent/emergent medical/psychiatric condition. Patients were assigned to the same arm as their physician. Thirty-six practices recruited patients (intervention n =?23; control n =?13). The study was prematurely terminated at 6?months of enrollment start-date due to concomitant primary health-care transformation by health-system leaders which resulted in increased in-office demands, and recruitment failure. We used the PHQ-9 to assess between-group differences at baseline, 1, 2, 3, and 6?months follow-up. Outcome collectors and assessors were blind to group assignment.

Results

One hundred-and-twenty-nine patients (intervention n =?72; control n =?57) were analysed. A significant improvement in depression scores among intervention group patients emerged between 3 and 6?months, time by treatment interaction, likelihood ratio test (LR) chi2(3)?=?7.96, p =?.047.

Conclusions

This novel skill-based program shows promise in translating increased FP comfort and skills managing depressed patients into improved patient clinical outcomes?even in absence of mental health specialists availability.

Trial registration

#NCT01975948.
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16.
17.

Aim

To examine the association between maternal nutrition and lifestyle factors and offspring adiposity, using baseline and 2-year postpartum follow-up data from a randomised control trial of low glycaemic index diet.

Subject and methods

Food diaries and lifestyle questionnaires were completed during pregnancy and infant feeding and maternal lifestyle questionnaires 2 years postpartum for 281 mother and infant pairs from the ROLO study. Maternal anthropometry was measured throughout pregnancy and infant and maternal anthropometry was measured 2 years postpartum.

Results

Maternal 2 year postpartum body mass index (BMI) was positively associated with offspring BMI-for-age z-score (B?=?0.105, p?=?0.015). Trimester 2 saturated fat intake was positively associated with offspring subscapular:triceps skinfold ratio (B?=?0.018, p?=?0.001). Trimester 1 glycaemic index was also positively associated with offspring sum of subscapular and triceps skinfolds (B?=?0.009, p?=?0.029).

Conclusions

Maternal BMI 2 years postpartum was positively associated with offspring BMI. Pregnancy saturated fat intake was positively and polyunsaturated fat negatively associated with offspring adiposity. While further research is necessary, pregnancy and the postpartum period may be early opportunities to combat childhood obesity.
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18.

Background

No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide.

Objective

This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community.

Methods

An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation.

Results

There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p < .01). The pattern of results remained the same after adjusting for demographic variables (p = .01). Forty clinicians also completed a questionnaire assessing their satisfaction with the EHR alert, indicating moderate satisfaction (M = 3.01; SD = 0.63; range = 1.11–4.11).

Conclusions

EHR alerts are associated with changes in clinicians’ behavior and improved compliance with best clinical practices for at-risk youth.
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19.

Background

Research suggests that considerable individual differences may exist among preschool children in terms of emergent writing performance. However, there is no study examining this variability.

Objective

This research explored the patterns of within-group individual differences in the emergent writing skills of preschool children.

Method

Cluster analysis was employed to identify profiles of emergent writing skills in two independent samples (children from middle-socioeconomic status backgrounds N = 36; children from socioeconomically and racial/ethnically diverse backgrounds N = 367).

Results

Cluster analysis identified three emergent writing profiles: (1) highest emergent writing-strength in letter writing and spelling; (2) average emergent writing-strength in name writing; and (3) lowest emergent writing across skills. Children’s letter name knowledge and phonological awareness significantly predicted profile membership when controlling for age.

Conclusion

These findings provide evidence regarding the heterogeneity of preschool children’s emergent writing skills and suggest that different profiles of emergent writing can be explained by children’s letter name knowledge, phonological awareness, and age.
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20.

Background

Anthropometric parameters and physical activities are significant factors influencing lipid levels, but few research have demonstrated the effect of amount of activities on lipid levels. Our research analyzed and explored this relationships.

Methods

A multi-stage stratified sampling method was used to select the investigation subjects in Hubei, China. A questionnaire survey, physical measurements and biochemistry tests (including total cholesterol, high low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triacylglycerol) were conducted using CCA analysis.

Results

The first canonical correlation of the four biochemistry tests and anthropometric parameters with physical activities was 0.44 (P?<?0.0001). Grouping by sex and areas, the first canonical correlation were 0.51 (p?<?0.0001), 0.43 (p?<?0.0001), 0.39 (p?<?0.0001) and 0.45 (p?<?0.0001). By CCA, blood lipids were negatively correlated with occupation activity, and positively associated with waistline, body mass index (BMI), sleep time, static behavior, and age.

Conclusions

CCA could be an efficient method to find out the most influential factors on exposure and outcome variables. Blood lipid had significant but moderate association with physical activities and anthropometric parameters. Waistline, BMI and occupation activity function as major influences on lipids.

Trial registration

Identifying number: 2,013,001. Date of trial registry: 8st Oct 2012.
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