Demographic and clinical factors correlating with high levels of psychological distress in HIV-positive women living in Ontario,Canada

The concept of psychological distress includes a range of emotional states with symptoms of depression and anxiety and has yet to be reported in HIV-positive women living in Ontario, Canada, who are known to live with contributing factors. This study aimed to determine the prevalence, severity, and correlates of psychological distress among women accessing HIV care participating in the Ontario HIV Treatment Network Cohort Study using the Kessler Psychological Distress Scale (K10). The K10 is a 10-item, five-level response scale. K10 values range from 10 to 50 with values less than or equal to 19 categorized as not clinically significant, scores between 20 and 24 as moderate levels, 25–29 as high, and 30–50 as very high psychological distress. Correlates of psychological distress were assessed using the Pearson's chi-square test and univariate and multivariate logistic regression analysis. Moderate, high, and very high levels of psychological distress were experienced by 16.9, 10.4, and 15.1% of the 337 women in our cohort, respectively, with 57.6% reporting none. Psychological distress levels greater than 19, correlated with being unemployed (vs. employed/student/retired; AOR = 0.33, 95% CI: 0.13–0.83), living in a household without their child/children (AOR = 2.45, 95% CI: 1.33–4.52), CD4 counts < 200 cells/mm³ (AOR = 2.07, 95% CI: 0.89–4.80), and to a lesser degree an education of some college or less (vs. completed college or higher; AOR=1.71, 95% CI: 0.99–2.95). Age and ethnicity, a priori variables of interest, did not correlate with psychological distress. Findings suggest that socioeconomic factors which shape the demography of women living with HIV in Ontario, low CD4 counts, and losing the opportunity to care for their child/children has a significant relationship with psychological distress. Approaches to manage psychological distress should address and make considerations for the lived experiences of women since they can act as potential barriers to improving psychological well-being.     

Urinary incontinence and psychological distress in community-dwelling older adults

OBJECTIVES: To examine the relationship between urinary incontinence (UI) and psychological distress in older adults. We hypothesized that persons with UI associated with condition-specific functional loss would be most likely to report psychological distress. DESIGN: A population-based longitudinal survey. SETTING: Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981. PARTICIPANTS: Persons aged 50 and older (n=781) at follow-up interviews conducted between 1993 and 1996 for whom complete data were available. MEASUREMENTS: Participants were classified as incontinent if they reported any uncontrolled urine loss within the 12 months preceding the 13-year follow-up interview. Condition-specific functional loss secondary to UI was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) at interviews in 1981 and at the 13-year follow-up. RESULTS: Persons with UI were more likely to experience psychological distress as measured by the GHQ than were persons without UI (unadjusted odds ratio (OR)=1.74, 95% confidence interval (CI)=1.13-2.68). Persons with condition-specific functional loss secondary to UI were substantially more likely to have psychological distress as measured by the GHQ than were persons without UI (unadjusted OR=4.02, 95% CI=1.86-8.70). In multivariate models that controlled for potentially influential characteristics such as age, gender, ethnicity, and chronic medical conditions the association between condition-specific functional loss secondary to UI and psychological distress remained statistically significant. Among people with UI, persons with persistently elevated GHQ scores were much more likely to report condition-specific functional impairment from UI (adjusted OR=6.55, 95% CI=1.94-22.12). CONCLUSION: Individuals with UI, especially when incontinence was associated with condition-specific functional loss, were more likely to have psychological distress than were other older adults. Our findings support a general conceptual model that condition-specific functional impairment mediates the relationship between a chronic medical condition and psychological distress.     

Psychological distress and cardiovascular disease: results from the 2002 National Health Interview Survey.

AIMS: The objective of this study was to examine the burden of psychological distress among individuals with different forms of heart disease in a large representative sample of adults. METHODS AND RESULTS: Data were obtained from the 2002 National Health Interview Survey, which is a large annual survey of the US non-institutionalized civilian population. Psychological distress was assessed with a standardized questionnaire (K6) and heart disease diagnoses were based on self-report. Among non-diseased individuals, the estimated prevalence of psychological distress was 2.8%, whereas the estimates were 10, 6.4, and 4.1% among those with congestive heart failure (CHF), myocardial infarction (MI), and coronary heart disease (CHD), respectively. Over 1 million individuals with one or more of these conditions are estimated to experience psychological distress. However, only 31-35% of the participants with heart disease and psychological distress have visited a mental health professional. The logistic regression model results indicate that MI (OR 2.0, 95% CI 1.4-3.0) and CHF (OR 3.1, 95% CI 1.8-5.1) are significantly associated with psychological distress. CONCLUSION: These findings imply that psychological distress is a significant comorbidity of cardiovascular disease. Other investigations have demonstrated a link between psychological distress and morbidity and mortality. Taken together, these findings provide the impetus for future investigations that assess the role that a medical and mental health care professional intervention may have in altering these outcomes when targeted at this distress.     

Blood pressure during sleep is associated with arterial stiffness and urine microalbumin to creatinine ratio in youth with type 1 diabetes

AimsTo determine whether sleep blood pressure (BP) is associated with increased cardiovascular disease (CVD) risk in youth with type 1 diabetes (T1DM).MethodsWe enrolled youth with T1DM, 12–21 years old. Carotid-femoral Pulse Wave Velocity (PWV_cf) assessed arterial stiffness, a CVD marker. Sleep systolic and diastolic BP variables were obtained from 24-hour BP Monitoring. Linear regression models analyzed the relationship of each BP variable with PWV_cf, adjusted for HbA1c. Correlation of sleep BP with urine microalbumin-to-creatinine ratio (UAC) was examined.ResultsNocturnal hypertension was found in 36% and abnormal dipping in 48% of the 25 participants, aged 17.7 ± 2.2 years old. Sleep systolic BP [beta = 0.039, 95% Confidence Interval (CI; 0.006–0.073)], diastolic BP [beta = 0.058, 95% CI (0.003–0.114)], Mean Arterial Pressure (MAP) [beta = 0.075, 95% CI (0.018–0.131)] and MAP index [beta = 3.547, 95% CI (0.867–6.227)] were significantly associated with PWV_cf. Sleep diastolic BP, load, MAP correlated with UAC.ConclusionsBlood pressure alterations during sleep are common in youth with T1DM and they are associated with arterial stiffness and UAC. Larger studies are needed to confirm our results and examine whether interventions that target sleep and night-time BP could decrease CVD risk.     

High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction

OBJECTIVES: Although the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic significance of different BP indices in post-MI. METHODS AND RESULTS: We evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n = 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidenceinterval (CI) 1.16-1.87; P = 0.001] and those with pulse pressure greater than 60 mmHg (n = 958; 8.6%) had a 35% higher risk (95% CI 1.09-1.69; P = 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48-25.88; P = 0.218). CONCLUSIONS: Our results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (< or = 80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention.     

Prevalence of high blood pressure and associated factors among adolescents and young people in Tanzania and Uganda

We conducted a cross‐sectional study among school/college students in Tanzania and Uganda to determine the prevalence of high blood pressure (BP) and associated factors. Participants were classified to have high BP if they had pre‐hypertension or hypertension. Interviews were done using the WHO STEPS instrument. Using data from both countries (n = 1596), the overall prevalence of high BP was 40% (95% CI: 37‐42). The prevalence of pre‐hypertension was 29% (95% CI: 26‐31) and that of hypertension was 11% (95% CI: 10‐13). High BP was independently associated with obesity (aOR = 6.7, 95% CI: 2.2‐20.0), male sex (aOR = 3.2, 95% CI: 2.4‐4.4), and among males aged above 20 years (aOR = 5.5, 95% CI: 2.9−10.5). Consumption of fruits/vegetables was associated with decreased odds for high BP (aOR = 0.7, 95% CI: 0.50‐0.98). The increasing burden of pre‐hypertension across age groups could explain the early onset of hypertension and cardiovascular diseases (CVDs) among young African adults. There is a need for longitudinal studies to explore the drivers of pre‐hypertension in East African adolescents.     

Role of age, sex, and obesity in the higher prevalence of arthritis among lower socioeconomic groups: a population-based survey

OBJECTIVE: To compare the prevalence of arthritis among population groups based on demographic, socioeconomic, and body mass index (BMI) characteristics; to investigate the combined influence of these factors on arthritis; and to assess the relationship between self-reported health and psychological distress and arthritis. METHODS: Data from the Victorian Population Health Survey (n = 7,500) were used in the study. Psychological distress was assessed using the Kessler Psychological Distress scale, and self-reported health was assessed by a single item. Multiple logistic regression was used to investigate the combined influence of demographic and socioeconomic factors and BMI on arthritis. RESULTS: Overall, 23% of Victorian adults (20% men and 26% women) reported having arthritis. The presence of arthritis was associated with high psychological distress (odds ratio [OR] 1.2; 95% confidence interval [95% CI] 1.1-1.4) and poor self-reported health (OR 1.9; 95% CI 1.7-2.1). Increased prevalence of arthritis was found in older age groups, lower education and income groups, and in people who were overweight or obese. Women had higher risk of arthritis, even after adjustment for age, residence, education, occupation, income, and BMI. Age and BMI independently predicted arthritis for men and women. For men, higher risk of arthritis was also associated with lower income. CONCLUSION: Arthritis is a highly prevalent condition associated with poor health and high psychological distress. Prevalence of arthritis is disproportionately high among women and individuals from lower socioeconomic backgrounds. As the prevalence of arthritis is predicted to increase, careful consideration of causal factors, and setting priorities for resource allocation for the treatment and prevention of arthritis are required.     

Factors associated with increased healthcare utilization among adults with asthma

Objective. To evaluate determinants of increased emergency room (ER) visit and hospitalization among adults with asthma, with emphasis on the role of psychological distress, self-efficacy, and obesity. Methods: For analysis 2009, 2011/2012 California Health Interview Survey was used. Adults who reported lifetime asthma were selected. Association between ER and overnight hospital stay with population characteristics were conducted using chi-square analysis. Multivariable binary logistic regression models, taking into account control variables, were utilized to assess the relationship between ER visit or overnight hospital stay with that of psychological distress, self-efficacy, and obesity. Results: Odds of ER visits were higher among those with mild-to-moderate psychological distress (adjusted odds ratio [aOR] = 1.94, 95% CI: 1.28, 2.94), and among those with serious psychological distress (aOR = 2.62, 95% CI: 1.65, 4.16). Mild-to-moderate distress was associated with two-fold increase in hospital overnight stay (aOR = 2.05, 95% CI: 1.29, 3.25). Adults with asthma who reported low self-efficacy had increased ER visits (aOR = 6.21, 95% CI: 3.63, 10.65) and hospitalization (aOR = 4.13, 95% CI: 2.63, 6.49). Finally, adults who had asthma and were obese had higher odds of ER visits (aOR = 1.60, 95% CI: 1.20, 2.13). Conclusions: Healthcare utilization is higher among asthma patients with psychological distress, low self-efficacy, and obesity. Interventions, such as incorporation of integrated care models, are critical to ensure early screening of mental health status among such patients. In addition, there is a need for patient education and improved weight management among adults with asthma.     

Gastroesophageal reflux disease: prevalence and associated factors

BACKGROUND: O gastroesophageal reflux is a high prevalent disease with prevalence rates ranging from 21 to 56% in different countries. OBJECTIVE: To study the epidemiology and the prevalence of gastroesophageal reflux disease among adult population (20 years and old) at the city of Pelotas, southern Brazil. METHODOLOGY: A population-based cross-sectional study was conducted. Household interviews were done between October 1999 and January 2000. Association between gastroesophageal reflux disease and age, sex, skin color, years of formal education, income per capita, marital status, psychological variables (insomnia, stressful psychosocial events in the last year, psychological distress), body mass index, smoking and weekly consumption of alcoholic beverages was assessed through logistic regression. RESULTS: Three thousands and nine-hundred thirty four (3,934) individuals were interviewed. A prevalence of 31,3% (CI 95% 29.9%-32.8%). After allowing for confounding gastroesophageal reflux disease was significantly associated with female sex, living without partner, low level of formal education, insomnia, psychological distress, reported stressful psychosocial events in the last year, obesity and overweight. CONCLUSION: Gastroesophageal reflux disease is a high prevalent disease and its main associated factors are sex, anthropometric variables and psychological characteristics.     

Knee pain and disability in the Nottingham community: association with poor health status and psychological distress

OBJECTIVE: To assess the prevalence of knee pain, disability and health status in the community, and to examine the association of pain with psychological distress. METHODS: A postal survey was sent to 4057 men and women aged 40-79 yr in Nottingham. Health status was assessed using the SF-36 instrument, with the specific dimensions of physical function and mental health used to measure disability and psychological distress. RESULTS: The overall response rate was 81.9%. The prevalence of knee pain was 28.7%, rising with age. Disability was more common in those with knee pain compared to those without pain (P < 0.001). Subjects with knee pain had lower scores for all dimensions of health. When adjusted for potential confounders, low mental health scores associated with increased odds for pain and disability (2.1, 95% CI 1.7- 2.6; and 4.7, 95% CI 3.7-6.1). CONCLUSIONS: Knee pain is common in this population and is associated with poor perceived health and significant disability. Psychological distress strongly associates with both pain and disability.      

Blood pressure variables and prevalent electrocardiographic left ventricular hypertrophy in sub‐Saharan African individuals with type 2 diabetes

Background: The aim of the present study was to investigate whether brachial blood pressure (BP) variables (systolic BP [SBP], diastolic BP [DBP], pulse [PP] and mean arterial pressure [MAP]) are similar determinants of prevalent electrocardiographic left ventricular hypertrophy (LVH) in sub‐Saharan Africans with type 2 diabetes (T2D). Methods: The study included 420 individuals (49% men) with T2D who were receiving chronic care in two main referral centers in the two major cities (Douala and Yaounde) of Cameroon. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for a standard deviation (SD) higher level of SBP (25 mmHg), DBP (13), PP (18) and MAP (20) with the risk of LVH. Discrimination was assessed and compared with c‐statistics and relative integrated discrimination improvement (RIDI; %). Results: The multivariable adjusted OR (95% CI) for prevalent LVH with each SD higher pressure variable was 1.61 (1.22–2.11) for SBP, 1.27 (0.99–1.63) for DBP, 1.62 (1.23–2.15) for PP and 1.44 (1.11–1.87) for MAP. Comparison of c‐statistics revealed no difference in the discrimination power of models with each of the BP variables (P > 0.09). However, RIDI showed enhanced discrimination in the models when other BP variables were replaced with PP. However, this enhancement was marginal for SBP. Using BP combinations modestly improved discrimination. Conclusions: The best predictors of prevalent LVH in the present study population were PP and SBP, whereas DBP was the least effective predictor. These findings have implications for cardiovascular risk stratification and monitoring of risk‐reducing therapies.     

Environmental Noise and Asthma in Children: Sex-Specific Differences

Objective. There is evidence that stress increases the risk of asthma. Chronic noise exposure is known to act as an unspecific stressor, but little is known about its effect on the risk of asthma in children. The aim of this study was to compare subjectively reported noise annoyance in 12-year-old asthmatic and non-asthmatic children with special regard to sex-specific differences. Subjects and methods. In a German multi-center birth cohort study we assessed the annoyance by different sources of environmental noise, doctor-diagnosed asthma, and potential confounders by questionnaire. The comparisons between asthmatic and non-asthmatic children were stratified by sex. Results. A total of 336 boys and 316 girls were included in the analysis. Prevalence of doctor-diagnosed asthma was 13% in boys and 5% in girls; 73% of the boys and 74% of the girls reported at least some degree of noise annoyance during the day and night time. In girls, asthma was associated with a significantly increased total noise annoyance at night (adjusted odds ratio aOR 1.5, 95%CI 1.1;2.1), for noise within the home/apartment (aOR 3.5, 95%CI 1.5;8.0), and in or around the house (aOR 3.3, 95%CI 1.7;6.3). No statistical significant effects were seen in boys. Conclusions. Noise annoyance, particularly at night or caused by domestic sources, is associated with increased asthma prevalence in girls but not boys. Further research is needed to identify underlying mechanisms of these sex-specific differences.     

Urinary incontinence (UI) and new psychological distress among community dwelling older adults

This study aimed at determining whether UI is associated with increased risk for the onset of psychological distress. This was a population based longitudinal survey of adults aged 50 and older who did not report psychological distress in 1993 and for whom complete data were available. Participants were classified as having UI if they reported uncontrolled urine loss within 12 months of the 1993 interview. Condition-specific functional loss secondary to UI was assessed by questions on participants' ability to engage in certain activities due to UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) in 2004. The continuing participants were living in East Baltimore, Maryland in 1981. Persons with UI in 1993 were more likely to experience new psychological distress in 2004 than were persons without UI in 1993 adjusting for potentially influential covariates (relative odds (RO)=2.18, 95% confidence interval (CI)=1.19-4.01). Persons with condition-specific functional loss secondary to UI were more likely to experience new psychological distress than were persons without UI adjusting for potentially influential covariates (RO=7.57, 95%CI=2.92-19.62). We conclude that UI, especially when associated with condition-specific functional loss, predicted the onset of psychological distress among community dwelling older adults.     

Maternal psychological distress during pregnancy and childhood cardio-metabolic risk factors

Background and aimsPrevious studies suggest that psychological distress during pregnancy may lead to fetal developmental adaptations, which programme cardio-metabolic disease of the offspring. We examined the associations of maternal overall psychological distress, depression and anxiety during pregnancy with cardio-metabolic risk factors in 10-year-old children and explore potential sex-specific differences.Methods and resultsIn a population-based prospective cohort study among 4,088 mothers and their children, information about overall psychological distress, including depression and anxiety was obtained through the Brief Symptom Inventory during pregnancy. We measured child blood pressure and heart rate and insulin, glucose, serum lipids and C-reactive protein blood concentrations at 10 years. Analyses were performed in the total group and in boys and girls separately. Psychological distress during pregnancy was associated with higher childhood heart rate among boys only (differences 0.34 (95% Confidence Interval (CI) 0.18, 0.50) standard deviation scores (SDS), 0.22 (95% CI 0.06, 0.38) SDS, 0.33 (95% CI 0.19, 0.48) SDS, for overall psychological distress, depression and anxiety, respectively). Maternal anxiety during pregnancy was associated with higher childhood triglycerides among girls (difference 0.35 (95% CI 0.17, 0.53) SDS). Maternal psychological distress was not associated with childhood blood pressure, cholesterol, insulin, glucose and C-reactive protein concentrations.ConclusionsMaternal psychological distress may influence their offspring heart rate and triglycerides concentrations. Further studies are needed to replicate these findings and assess the long-term cardio-metabolic consequences of maternal psychological distress.     

Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins

OBJECTIVE: To assess genetic and environmental influences on low back and neck pain in a classic twin design and to examine the extent to which these are explained by structural changes seen on magnetic resonance imaging (MRI) and psychological and lifestyle variables. METHODS: The subjects comprised 1,064 unselected women (181 monozygotic [MZ] and 351 dizygotic [DZ] twin pairs) recruited from a national registry of twin volunteers. Outcome measures included lifetime history of low back and neck pain (using a range of increasingly stringent definitions), MRI scores of disc degeneration in the lumbar and cervical spine, psychological distress as assessed by the General Health Questionnaire (GHQ), and lifestyle variables assessed by questionnaire. RESULTS: For all definitions of pain, there was a consistent excess concordance in MZ when compared with DZ twins, equating to a heritability for low back pain in the range of 52-68% and for neck pain in the range of 35-58%. The strongest associations were between low back pain and MRI change (odds ratio [OR] 3.6, 95% confidence interval [95% CI] 1.8-7.3]) and between neck pain and response on the GHQ (OR 3.3, 95% CI 2.1-5.0). These associations were mediated genetically. CONCLUSIONS: Genetic factors have an important influence on back and neck pain reporting in women. These factors include the genetic determinants of structural disc degeneration and an individual's inherited tendency toward psychological distress. MRI changes are the strongest predictor of low back pain.     

Role of age,sex, and obesity in the higher prevalence of arthritis among lower socioeconomic groups: A population‐based survey

Objective

To compare the prevalence of arthritis among population groups based on demographic, socioeconomic, and body mass index (BMI) characteristics; to investigate the combined influence of these factors on arthritis; and to assess the relationship between self‐reported health and psychological distress and arthritis.

Methods

Data from the Victorian Population Health Survey (n = 7,500) were used in the study. Psychological distress was assessed using the Kessler Psychological Distress scale, and self‐reported health was assessed by a single item. Multiple logistic regression was used to investigate the combined influence of demographic and socioeconomic factors and BMI on arthritis.

Results

Overall, 23% of Victorian adults (20% men and 26% women) reported having arthritis. The presence of arthritis was associated with high psychological distress (odds ratio [OR] 1.2; 95% confidence interval [95% CI] 1.1–1.4) and poor self‐reported health (OR 1.9; 95% CI 1.7–2.1). Increased prevalence of arthritis was found in older age groups, lower education and income groups, and in people who were overweight or obese. Women had higher risk of arthritis, even after adjustment for age, residence, education, occupation, income, and BMI. Age and BMI independently predicted arthritis for men and women. For men, higher risk of arthritis was also associated with lower income.

Conclusion

Arthritis is a highly prevalent condition associated with poor health and high psychological distress. Prevalence of arthritis is disproportionately high among women and individuals from lower socioeconomic backgrounds. As the prevalence of arthritis is predicted to increase, careful consideration of causal factors, and setting priorities for resource allocation for the treatment and prevention of arthritis are required.     

Using genetic loci to understand the relationship between adiposity and psychological distress: a Mendelian Randomization study in the Copenhagen General Population Study of 53,221 adults

Abstract. Lawlor DA, Harbord RM, Tybjaerg‐Hansen A, Palmer TM, Zacho J, Benn M, Timpson NJ, Smith GD, Nordestgaard BG (MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, UK; The Department of Social Medicine, University of Bristol, UK; Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; The Copenhagen General Population Study, Herlev Hospital, Copenhagen, Denmark; Copenhagen University Hospital, Faculty of Health Sciences, University of Copenhagen, Denmark; Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark) Using genetic loci to understand the relationship between adiposity and psychological distress: a Mendelian Randomization study in the Copenhagen General Population Study of 53 221 adults. J Intern Med 2011; 269 : 525–537. Objective. We used genetic variants that are robustly associated with adiposity to examine the causal association of adiposity with psychological distress. Methods. We examined the association of adiposity with psychological distress in a large (N = 53 221) general population cohort of 20‐ to 99‐year‐old adults from Copenhagen, Denmark. Psychological distress was assessed using four questions that asked about: feeling stressed; not accomplishing very much; wanting to give up; and regular use of antidepressants/sedatives. We used the genetic loci FTO rs9939609 and MC4R rs17782313 as instrumental variables for adiposity quantified by body mass index (BMI) and waist to hip ratio (WHR). Results. In conventional multivariable analyses, BMI and WHR were positively associated with distress. For example, the odds ratio of reporting not accomplishing for each additional standard deviation increase for BMI was 1.11 (95% CI: 1.09, 1.13) and for WHR was 1.10 (95% CI: 1.08, 1.13) in the fully adjusted analyses. In contrast, instrumental variable analyses showed an inverse association of adiposity on distress; corresponding odds ratio in instrumental variable analyses was 0.64 (95% CI: 0.46, 0.89) for BMI and 0.49 (95% CI: 0.25, 0.94) for WHR (P‐values for difference between the two approaches both = 0.001). Conclusion. The inverse associations of adiposity and psychological distress when genetic variants are used as instrumental variables could be explained by biological pathways linking adiposity and distress. The positive associations of adiposity with distress in multivariable analyses might be explained by residual confounding or reverse causality.     

Uric acid and blood pressure in NHANES dated from 2009 to 2018: A cross-sectional research

Background and aimThis study aimed to explore the association between uric acid (UA) and blood pressure (BP), included systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP).Methods and resultsA cross-sectional study with 22,478 individuals aged from 12 to 80 years (11,443 males and 11,035 females) from the National Health and Nutrition Examination Survey (NHANES) was performed. Multiple linear regression analysis was applied to explore the relationship between UA and BP, Stratified analysis and interaction were performed based on gender, race, age, body mass index (BMI), and alcohol consumption. Significantly positively associations were presented in SBP(β, 0.84 [95% CI, 0.67, 1.00]), DBP(β, 0.23 [95% CI, 0.11, 0.36]), and MAP (β, 0.43 [95% CI, 0.31, 0.55]). The associations were much more stronger between UA and SBP in females (β, 1.04 [95% CI, 0.78, 1.30], p for interaction 0.0003), black group (β, 1.17 [95% CI, 0.77, 1.56], p for interaction 0.0296), age (≥45) group (β, 1.03 [95% CI, 0.68, 1.39], p for interaction <0.0001) and drinking group (β, 0.98 [95% CI, 0.75, 1.21], p for interaction <0.0001). The significant interactions were found between UA and DBP in gender and alcohol consumption (all p for interaction <0.05). In terms of MAP, the significant interactions were found in race, age, and alcohol consumption (all p for interaction <0.05).ConclusionsA significantly positively association was found between UA and BP, including SBP, DBP, and MAP.     

Effects of Single and Multiple Blood Pressure Measurement Strategies on the Prediction of Prevalent Screen‐Detected Diabetes Mellitus: A Population‐Based Survey

The authors investigated the effects of single and multiple blood pressure (BP) measurements during the same encounter on screen‐detected diabetes risk. Data for 9018 Cameroonian adults from a community‐based survey were used. Resting BP was measured three times 5 minutes apart. Logistic regressions were used to compute the odd ratio (OR) per standard deviation (SD) higher BP variables. Systolic BP, diastolic BP, and mean arterial pressure (MAP), but not pulse pressure, were related to prevalent diabetes. The highest OR (95% confidence interval [CI]) per SD higher pressure were recorded for MAP (OR, 1.16; 95% CI, 1.05–1.28) and systolic BP (OR, 1.15; 95% CI, 1.04–1.27). Estimates of the association were highest for the first, then third, and lastly the second BP measurements. Estimates from average BP measurements were not better than those from single measurement. Single BP measurement is more effective for diabetes risk screening than multiple measurements. Community‐based diabetes strategies utilizing a single measurement are simple without compromising the yield.