Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center

Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16–24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16–24 years) in pre-HEALs implementation (n?=?125) and post-HEALs implementation (n?=?126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI?<?25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; ?0.11, p?=?.03) and obese (BMI?≥?30; ?0.11, p?=?.001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.     

Changes in racial/ethnic disparities in the prevalence of Type 2 diabetes by obesity level among US adults

Objective. Ethnic minority status and obesity are two independent risk factors for Type 2 diabetes (T2D). There is no clear understanding of how they may have interacted and influenced disparities in T2D prevalence over time. This study examined the trends in racial/ethnic disparities in the prevalence of T2D by weight status among US adults.

Methods. We used nationally representative data from the National Health and Nutrition Examination Surveys I (1971–1975), II (1976–1980), and III (1988–1994), and 1999–2004 among 49,574 adults aged 20–74 years. The prevalences of diagnosed and undiagnosed T2D were estimated by race/ethnicity groups (non-Hispanic White, non-Hispanic Black, and Mexican American) and body mass index (BMI) groups (normal, 18.5–24.9; overweight, 25–29.9; obese, 30–34.9; severely obese, ≥35). We used logistic regression controlling for age, gender, and education to estimate the odds ratio of T2D across race/ethnicity and BMI groups.

Results. Trends in racial/ethnic disparities in prevalence of diagnosed T2D varied by BMI. Normal weight group saw increasing racial disparities. In the overweight group, ethnic disparities worsened as diabetes prevalence increased 33.3% in Whites, compared to 60.0% in Blacks, and 227.3% in Mexican Americans. Minimal racial/ethnic disparities were observed in obese and severely obese groups over time. In contrast to diagnosed diabetes, overall racial/ethnic disparities in undiagnosed T2D declined in all BMI groups.

Conclusions. Racial/ethnic disparities in diabetes prevalence have become most pronounced among normal and overweight groups. Eliminating racial/ethnic disparities in diabetes will require prevention efforts not only in obese minority individuals, but also in normal and overweight minority individuals.     

Surveying teens in school to assess the prevalence of problematic drug use

BACKGROUND: Illicit drug use by school‐aged teens can adversely affect their health and academic achievement. This study used a survey administered in schools to assess the prevalence of problematic drug use among teenagers in a Midwestern community. METHODS: Self‐report data were collected from 11th‐ and 12th‐grade students (N = 3974) in 16 school districts in the Dayton, Ohio, area. Students responded to a drug use survey that also included CRAFFT, a brief substance abuse screening instrument. Binomial and zero‐inflated Poisson regressions were used to examine the association between CRAFFT scores and drug use practices, including abstinence. RESULTS: More than one third of students had CRAFFT scores suggestive of problematic use. Of these, 14.1% had scores suggesting drug dependence. Although alcohol, marijuana, and tobacco were the drugs most commonly used, an array of other drugs including opioids, benzodiazepines, stimulants, hallucinogens, and dextromethorphan were also commonly used. Higher CRAFFT scores were associated with a greater number of drugs used (p < .0001). Proportionately more 12th graders than 11th graders had CRAFFT scores indicating problems (p < .0001). Among 12th graders, boys were more likely than girls to have CRAFFT scores indicating dependence (p = .01). CONCLUSIONS: The results suggest that problematic drug use among high school students is more prevalent than has been recognized previously. CRAFFT can be used easily to assess the prevalence of problematic drug use among teenagers in school settings. CRAFFT results can also inform prevention and intervention activities, particularly if the CRAFFT instrument is paired with a drug use survey.     

Toxicity characterization of environmental chemicals by the US National Toxicology Program: an overview

The US National Toxicology Program (NTP) is an interagency program whose mission is to evaluate agents of public health concern by developing and applying the tools of modern toxicology and molecular biology. Chemicals substances or physical agents selected for toxicology and carcinogenesis evaluations by the NTP are usually studied in a series of subacute (14-day exposure), subchronic (90-day exposure) and chronic (2-year exposure) studies in rodents. The NTP has published more than 500 reports of the findings and conclusions from its toxicology and carcinogenesis studies. In more specialized studies, the NTP also evaluates adverse effects on the structure and function of the immune, reproductive, nervous, and respiratory systems. The program attempts to evaluate and appropriately incorporate new technologies to improve the way we study the toxicity of chemicals. For example, the program has extensively evaluated several transgenic mouse models for their potential use as short-term cancer screens and has been a full participant in an international effort to examine their usefulness in pharmaceutical registration. Toxicogenomics, an emerging scientific field that examines the expression of thousands of genes simultaneously in response to chemical exposure, holds promise for future application to better understand the underlying mechanisms of chemical toxicity. A number of public health issues being addressed by the NTP are not only of national importance but also have global impact, such as the potential for endocrine disruptors to influence development and carcinogenesis and the safety of herbal medicines and dietary supplements. The program participates in the preparation of national and international toxicity testing guidelines and the findings from NTP studies are widely used for risk assessments by international organizations and federal agencies. The NTP maintains databases that contain toxicity, and health and safety information on a large number of chemicals. These databases are available from the NTP web site (http://ntp-server.niehs.nih.gov) and are accessed over 100000 times a month from around the world.     

Association of racial disparities in the prevalence of insulin resistance with racial disparities in vitamin D levels: National Health and Nutrition Examination Survey (2001-2006)

We tested the hypothesis that racial differences in vitamin D levels are associated with racial disparities in insulin resistance between blacks and whites. Among 3628 non-Hispanic black and white adults in the National Health and Nutrition Examination Survey from 2001 to 2006, we examined the association between race and insulin resistance using the homeostasis assessment model for insulin resistance. We conducted analyses with and without serum 25-hydroxyvitamin D (25[OH]D). We adjusted for age, sex, educational level, body mass index, waist circumference, physical activity, alcohol intake, smoking, estimated glomerular filtration rate, and urinary albumin/creatinine ratio. Blacks had a lower mean serum 25(OH)D level compared with whites (14.6 [0.3] ng/mL vs 25.6 [0.4] ng/mL, respectively; P < .0001). Blacks had a higher odds ratio (OR) for insulin resistance without controlling for serum 25(OH)D levels (OR, 1.67; 95% confidence interval, 1.26-2.20). The association was not significant (OR, 1.28; 95% confidence interval, 0.90-1.82) after accounting for serum 25(OH)D levels. The higher burden of insulin resistance in blacks compared with whites may be partially mediated by the disparity in serum 25(OH)D levels.     

US childhood asthma prevalence estimates: the Impact of the 1997 National Health Interview Survey redesign

The 1997 redesign of the National Health Interview Survey (NHIS) affected US childhood asthma prevalence estimates. The 1997 asthma attack prevalence estimate for children 0-17 years was 5.4%. Pre-redesign NHIS childhood asthma period prevalence estimates peaked in 1995 at 7.5%. It is unclear whether the difference reflects the change in survey methodology or changing asthma prevalence. To examine the impact of the NHIS redesign on childhood asthma prevalence estimates, the authors analyzed the 1988 NHIS that contained two sets of asthma questions: the core survey used until 1996 and the Child Health Supplement (CHS) with questions more similar to those in the redesigned 1997 NHIS. The authors measured the difference between 1988 core and CHS childhood asthma prevalence estimates to calculate an inflation factor for 1997-2000 NHIS estimates. The 1988 CHS questions produced asthma prevalence estimates 19-34% lower than the 1988 core question, depending on the methodology used to assess the difference. Inflating the 1997 asthma attack prevalence estimate by these differences yielded modified 1997 estimates ranging from 6.5% (95% confidence interval: 5.6%, 7.5%) to 7.3% (95% confidence interval: 6.4%, 8.2%). The change in the 1997 NHIS asthma questions likely explains much of the difference in asthma prevalence estimates between 1995 and 1997.     

时间序列模型在广州市登革热发病趋势预测的应用

目的利用ARIMA模型对广州市登革热发病趋势进行时间序列分析和预测。方法收集广州市2015-2018年登革热每周发病数,采用2015-2017年登革热每周发病数构建ARIMA模型,通过2018年登革热发病预测值与实际值的拟合情况,评价模型预测效果。结果拟合模型ARIMA(4,1,9),残差序列为白噪声,预测值与实际值平均绝对误差为4.03,均方根误差为8.13。2018年登革热预测发病趋势与实际发病趋势较吻合。结论 ARIMA模型能较好地模拟广州市登革热的短期发病趋势,可作为预测工具。     

Peer Reviewed: Design and National Dissemination of the StrongWomen Community Strength Training Program

Background

Physical activity is essential for maintaining health and function with age, especially among women. Strength training exercises combat weakness and frailty and mitigate the development of chronic disease. Community-based programs offer accessible opportunities for strength training.

Program Design

The StrongWomen Program is an evidence-informed, community-based strength training program developed and disseminated to enable women aged 40 or older to maintain their strength, function, and independence. The StrongWomen Workshop and StrongWomen Tool Kit are the training and implementation tools for the StrongWomen Program. Program leaders are trained at the StrongWomen Workshop. They receive the StrongWomen Tool Kit and subsequent support to implement the program in their communities.

Dissemination

Program dissemination began in May 2003 with a three-part approach: recruiting leaders and forming key partnerships, soliciting participant interest and supporting implementation, and promoting growth and sustainability.

Assessment

We conducted site visits during the first year to assess curriculum adherence. We conducted a telephone survey to collect data on program leaders, participants, locations, and logistics. We used a database to track workshop locations and program leaders. As of July 2006, 881 leaders in 43 states were trained; leaders from 35 states had implemented programs.

Conclusion

Evidence-informed strength training programs can be successful when dissemination occurs at the community level using trained leaders. This research demonstrates that hands-on training, a written manual, partnerships with key organizations, and leader support contributed to the successful dissemination of the StrongWomen Program. Results presented provide a model that may aid the dissemination of other community-based exercise programs.     

A National Study of Mentoring Program Characteristics and Premature Match Closure: the Role of Program Training and Ongoing Support

Prevention Science - Mentoring programs are a popular approach to preventing problem behavior and promoting positive youth development. However, mentoring relationships that end prematurely may...     

Categorical and anti-categorical approaches to US racial/ethnic groupings: revisiting the National 2009 H1N1 Flu Survey (NHFS)

Intersectionality theory calls for the understanding of race/ethnicity, sex/gender and class as interlinked. Intersectional analysis can contribute to public health both through furthering understanding of power dynamics causing health disparities, and by pointing to heterogeneities within, and overlap between, social groups. The latter places the usefulness of social categories in public health under scrutiny. Drawing on McCall we relate the first approach to categorical and the second to anti-categorical intersectionality. Here, we juxtapose the categorical approach with traditional between-group risk calculations (e.g. odds ratios) and the anti-categorical approach with the statistical concept of discriminatory accuracy (DA), which is routinely used to evaluate disease markers in epidemiology. To demonstrate the salience of this distinction, we use the example of racial/ethnic identification and its value for predicting influenza vaccine uptake compared to other conceivable ways of organizing attention to social differentiation. We analyzed data on 56,434 adults who responded to the NHFS. We performed logistic regressions to estimate odds ratios and computed the area under the receiver operating characteristic curve (AU-ROC) to measure DA. Above age, the most informative variables were education and household poverty status, with race/ethnicity providing minor additional information. Our results show that the practical value of standard racial/ethnic categories for making inferences about vaccination status is questionable, because of the high degree of outcome variability within, and overlap between, categories. We argue that, reminiscent of potential tension between categorical and anti-categorical perspectives, between-group risk should be placed and understood in relationship to measures of DA, to avoid the lure of misguided individual-level interventions.     

Job characteristics in relation to the prevalence of myocardial infarction in the US Health Examination Survey (HES) and the Health and Nutrition Examination Survey (HANES).

Associations between psychosocial job characteristics and past myocardial infarction (MI) prevalence for employed males were tested with the Health Examination Survey (HES) 1960-61, N = 2,409, and the Health and Nutrition Examination Survey (HANES) 1971-75, N = 2,424. A new estimation method is used which imputes to census occupation codes, job characteristic information from national surveys of job characteristics (US Department of Labor, Quality of Employment Surveys). Controlling for age, we find that employed males with jobs which are simultaneously low in decision latitude and high in psychological work load (a multiplicative product term isolating 20 per cent of the population) have a higher prevalence of myocardial infarction in both data bases. In a logistic regression analysis, using job measures adjusted for demographic factors and controlling for age, race, education, systolic blood pressure, serum cholesterol, smoking (HANES only), and physical exertion, we find a low decision latitude/high psychological demand multiplicative product term associated with MI in both data bases. Additional multiple logistic regressions show that low decision latitude is associated with increased prevalence of MI in both the HES and the HANES. Psychological workload and physical exertion are significant only in the HANES.     

A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men

OBJECTIVE: To assess the prevalence of chronic post-vasectomy testicular pain (CPTP) compared to the prevalence of chronic testicular pain in a control population of non-vasectomised men. METHODS: A retrospective postal study of 198 men who had a vasectomy more than 3 years previously at the Palatine Centre to determine the incidence of CPTP, of whom 101 (51%) replied (mean age 40.4 years, range 29-54 years, mean time since vasectomy 46.5 months). A control group of 102 men (mean age 40.2 years, range 28-55 years) who had not had a vasectomy were obtained via patients attending the community family planning clinics or associated general practitioner (GP) services in the same geographical area. RESULTS: Occasional non-troublesome discomfort was reported by 37/101 of the post-vasectomy men compared to 21/102 of the control group. Occasional discomfort which was a nuisance was felt by 10/101 of the post-vasectomy group compared with 3/102 of the control group, and 6/101 in the post-vasectomy group reported pain severe enough to seek medical advice compared to only 2/102 controls. None of the post-vasectomy men regretted having had the operation. CONCLUSIONS: Only 6% of cases (compared to 2% of controls) experienced pain severe enough to seek medical advice in the 3-4-year post-operative period. However, there was a significant difference in the prevalence of occasional testicular discomfort between post-vasectomy men and controls. Mostly these pains were not regarded as troublesome, however men attending for vasectomy counselling should be informed of the possibility of this morbidity.     

应用ARIMA模型分析湖北省乙型病毒性肝炎时间分布特征

目的 探讨ARIMA模型在湖北省乙型病毒性肝炎(乙肝)病例时间分布特征分析中的应用.方法 利用“传染病监测报告信息系统”中2005-2014年湖北省乙肝发病数据,分析病例的时间分布特征,建立ARIMA预测模型.结果 乙肝报告发病率3～8月处于较高水平,12月最低;拟合得到的最佳模型为没有常数项的ARIMA(0,1,1)(0,l,1)12模型.预测发现,未来湖北省乙肝发病水平与往年趋势大体一致,3～8月发病率处于较高水平.结论 建立的ARIMA模型能较好地预测湖北省乙肝病例的时间趋势.     

A multilevel model for cardiovascular disease prevalence in the US and its application to micro area prevalence estimates

Background  

Estimates of disease prevalence for small areas are increasingly required for the allocation of health funds according to local need. Both individual level and geographic risk factors are likely to be relevant to explaining prevalence variations, and in turn relevant to the procedure for small area prevalence estimation. Prevalence estimates are of particular importance for major chronic illnesses such as cardiovascular disease.     

A multilevel model for cardiovascular disease prevalence in the US and its application to micro area prevalence estimates

Background

Previous research has observed large inequalities in the distribution of welfare benefits. The Norwegian welfare state includes several schemes that give households with children the opportunity to apply for public income support to compensate for expenses related to chronic disease. The aims of this study were to examine the geographic distribution of children receiving compensatory cash benefits because of a chronic asthma condition and to determine whether social or geographic factors account for area variations in uptake independent of the associations with need.

Results

Considerable variation between counties was evident, with rates of benefit uptake ranging from 10.5 recipients per 1,000 children younger than nine years in the highest-ranking county, to 1.5 per 1,000 in the lowest. It is argued that the observed area-level inequalities reflect more than variations in morbidity. In particular, the chance of receiving benefits reflects variations in the ability of street-level bureaucrats to inform families about their rights. Spatial variations also reflect, in part, the fact that families with different socio-economic standing inhabit different locations and that the threshold for receiving benefits is systematically lower for families with an academic background.

Conclusion

To be able to refine the implementation of a welfare policy, a better understanding of the processes that generate the outcomes of the various welfare schemes and services is required. This can be achieved by adopting an approach to the study of outcomes of welfare policy that integrates both the social and geographic perspective, and that focuses on specific diagnoses or distributional procedures.     

The Impact of Cognitive-Behavioral Stress Management Training Program on Job Stress in Hospital Nurses: Applying PRECEDE Model

Background: Nursing is one of the most stressful jobs. The present study aimed to determine the effect of a cognitive-behavioral stress management training program based on PRECEDE model on stress reduction among nurses. Methods: In this quasi-experimental study, which was conducted in 2010, 58 female nurses in Hamadan, northwest Iran were enrolled in the study and were divided into two equal groups included 29 nurses from one Hospital and 29 nurses from the other as intervention and control groups respectively. The data collection tool was a self-administered questionnaire including demographic characteristics and nursing stress scale (NSS). In addition, a questionnaire based on PRECEDE model was used in order to assess predisposing, reinforcing and enabling factors. The intervention was a training program including five sessions during three weeks in which relaxation and problem-solving training was thought. A pre-test and a post-test were performed 1.5 months apart. The t-test, Mann Whitney and Willxocon statistical tests were used for data analysis at 95% significant level using SPSS 13. Results: The baseline score average of job stress was 113.0 and 109.8 for intervention and control groups respectively (P=0.250). After intervention, score average of job stress decreased to 94.0 in experimental group while that of control group remained relatively unchanged (109.2), (P<0.001). A significant difference was found in PRECEDE model constructs and stress management behaviors in intervention group compared to control group after training interventions (P<0.001). Conclusion: Training programs based on PRECEDE model might be effective on decreasing job stress in nurses.     

A field test of three LQAS designs to assess the prevalence of acute malnutrition

BACKGROUND: The conventional method for assessing the prevalence of Global Acute Malnutrition (GAM) in emergency settings is the 30 x 30 cluster-survey. This study describes alternative approaches: three Lot Quality Assurance Sampling (LQAS) designs to assess GAM. The LQAS designs were field-tested and their results compared with those from a 30 x 30 cluster-survey. METHODS: Computer simulations confirmed that small clusters instead of a simple random sample could be used for LQAS assessments of GAM. Three LQAS designs were developed (33 x 6, 67 x 3, Sequential design) to assess GAM thresholds of 10, 15 and 20%. The designs were field-tested simultaneously with a 30 x 30 cluster-survey in Siraro, Ethiopia during June 2003. Using a nested study design, anthropometric, morbidity and vaccination data were collected on all children 6-59 months in sampled households. Hypothesis tests about GAM thresholds were conducted for each LQAS design. Point estimates were obtained for the 30 x 30 cluster-survey and the 33 x 6 and 67 x 3 LQAS designs. RESULTS: Hypothesis tests showed GAM as <10% for the 33 x 6 design and GAM as > or =10% for the 67 x 3 and Sequential designs. Point estimates for the 33 x 6 and 67 x 3 designs were similar to those of the 30 x 30 cluster-survey for GAM (6.7%, CI = 3.2-10.2%; 8.2%, CI = 4.3-12.1%, 7.4%, CI = 4.8-9.9%) and all other indicators. The CIs for the LQAS designs were only slightly wider than the CIs for the 30 x 30 cluster-survey; yet the LQAS designs required substantially less time to administer. CONCLUSIONS: The LQAS designs provide statistically appropriate alternatives to the more time-consuming 30 x 30 cluster-survey. However, additional field-testing is needed using independent samples rather than a nested study design.     

A new approach to assess low frequency noise in the working environment

To assess high-level low frequency noise in the working environment, adverse extra-aural effects caused by the noise should be taken into account. The human body vibration induced by low frequency noise, 'noise-induced vibration', was measured on the body surface and the equal-acceleration level contours of the vibration were tentatively estimated. With these contours, we can predict the magnitude of noise-induced vibration at every measuring position on the body surface. This is helpful in relating the total dosage of low frequency noise with the physical symptoms caused by the noise. But some important points in the contours remain to be investigated and improved. When these points are dealt with, the equal-acceleration level contours will be useful for assessing high-level low frequency noise in the working environment from the standpoint of predicting the adverse extra-aural effects.     

基于有序logistic回归的全科住培医师职业倦怠影响因素分析

目的:探讨江苏省全科医学专业住院医师规范化培训医师职业倦怠影响因素,为改善其职业倦怠提供依据.方法:2019年3月-4月,采用配额抽样从江苏省各地级市抽取1家国家级住院医师规范化培训基地,并用自制的全科住培医师职业倦怠影响因素问卷对基地内所有全科住培医师进行调查,共计13家基地682名全科住培医师,利用探索性因子分析和...