Psychosocial health and life-events – dynamical development in the short term. A follow-up study of children at four and six years of age

In this paper, (1) the psychosocial health in relation to (2) life-events was assessed among 156 children attending 20 schools by parents and teachers with the Child Behavior Checklist and the Caregiver-Teacher Report Form at the ages of four and six. Life-events were reported by parents. (1) According to the report, 93–96% children had no psychosocial problems. Parents and teachers report significant improvement of externalising (behavioural) problems and total problems in children with psychosocial problems at point of time 1. Teachers also report improvement of internalising (emotional) problems. Parents and teachers agree in 8–25% of the cases. (2) Of the children 46% experienced life events, no correlation was found with changes in psychosocial health. Findings may be explained by regular school attendance, resilience of the children and variability in the normative development. Remarkable dynamic is observed in change of psychosocial problems. Psychosocial development in early childhood is rather liable to change and life-events do not strongly influence psychosocial health.     

In fitness and health? A prospective study of changes in marital status and fitness in men and women

The authors examined the prospective associations between marital status transitions and changes in fitness in men and women. Between 1987 and 2005, a total of 8,871 adults (6,900 men) aged 45.6 (standard deviation, 9.1) years were examined at the Cooper Clinic, Dallas, Texas; the median follow-up was ～3 years. Marital transition categories (from single to married, married to divorced, divorced to remarried) were derived from self-reported marital status at baseline and follow-up. Fitness (maximal oxygen consumption) was assessed by a maximal treadmill test. Analyses were adjusted for baseline levels and changes in body mass index, physical activity, smoking, alcohol consumption, and major chronic diseases. Compared with the corresponding "control" groups (remaining single, married, or divorced), transitioning from being single to married was associated with a reduction in fitness in women (P = 0.03); divorce was associated with an increase in fitness in men (P = 0.04); and remarriage was associated with a reduction in fitness in men (P = 0.05). The authors conclude that the transitions to being married (from single to married or from divorced to remarried) are associated with a modest reduction, while divorce is associated with a modest increase in fitness levels in men. Study results suggest that these patterns may be different in women, but further research is required to confirm this.     

Protein intake during pregnancy and offspring body composition at 6 years: the Generation R Study

Purpose

Intra-uterine exposure to protein may affect body composition and may increase the prevalence of childhood adiposity. Therefore, we examined whether protein intake during pregnancy is associated with offspring body composition at the age of 6 years and whether associations differ for animal protein and vegetable protein.

Methods

We included 2694 Dutch mother–child pairs participating in a prospective population-based cohort in Rotterdam, the Netherlands. Energy-adjusted protein was measured in pregnancy using a food-frequency questionnaire and analyzed in quartiles. At a mean age of 6.1 ± 0.4 years, we measured children’s body mass index, and fat-free mass index and fat mass index using dual-energy X-ray absorptiometry. Outcomes were standardized for age and sex. BMI was used to classify children’s overweight status.

Results

After adjustment for sociodemographic and lifestyle factors, a higher maternal protein intake was associated with a higher children’s fat-free mass index [difference 0.14 standard deviation (95 % CI 0.03, 0.25) for highest vs. lowest quartile of protein intake], but not with children’s fat mass index or body mass index. Comparable associations were found for animal protein and vegetable protein. Maternal protein intake was not associated with children’s overweight.

Conclusions and relevance

This study suggests that higher protein intake during pregnancy is associated with a higher fat-free mass in children at the age of 6 years, but not with their fat mass. Our results do not suggest specific recommendations regarding maternal protein intake during pregnancy to prevent overweight in the offspring.

     

Metabolic parameters of postmenopausal women after quinoa or corn flakes intake – a prospective and double-blind study

A prospective and double-blind study was conducted on 35 women with weight excess who consumed 25 grams of quinoa flakes (QF) or corn flakes (CF) daily during a period of four consecutive weeks. At the beginning (T1) and at the end (T2) of the intervention, total calorie intake was evaluated, anthropometric assessment was performed, blood was collected for the determination of glucose, total cholesterol and fractions, oxidative stress markers, vitamin E and enterolignans. Significant reductions were detected in serum triglyceride (CF group?=?133.9?±?89.4 to 113.7?±?57?mg/dl and QF group?=?112.3?±?35 to 107.9?±?33.1?mg/dl), TBARS (CF group?=?3.2?±?0.8 to 2.9?±?0.5?µmol/l and QF group?=?3.06?±?0.6 to 2.89?±?0.5?µmol/l) and vitamin E concentrations (CF group?=?19.5?±?5 to 17.9?±?4?µM and QF group?=?17.9?±?4 to 16.9?±?3?µM) and an increase in urinary excretion of enterolignans (CF group?=?2.05?±?1.3 to 2.24?±?1.4?nm/ml and QF group?=?2.9?±?1.6 to 3.2?±?2.7?nm/l), in both study groups. The reduction of total cholesterol (191?±?35 to 181?±?28?mg/dl) and LDL-cholesterol (LDL-c) (129?±?35 to 121?±?26?mg/dl), and the increase in GSH (1.78?±?0.4 to 1.91?±?0.4?µmol/l) occurred only in the QF group, showing a possible beneficial effect of QF intake.     

Coffee or Tea? A prospective cohort study on the associations of coffee and tea intake with overall and cause-specific mortality in men versus women

Coffee and tea intake have been associated with reduced mortality, but no studies have investigated possible substitution effects. The relationship of mortality with coffee, tea, and substituting coffee with tea was investigated in the Netherlands Cohort Study. In 1986, 120,852 men and women aged 55–69 years provided information on dietary and lifestyle habits. Mortality follow-up until 1996 consisted of linkage to Statistics Netherlands. Multivariate case-cohort analyses were based on 8665 deaths and 3166 subcohort members with complete data on coffee, tea and confounders. Higher coffee intake was significantly, nonlinearly related to lower overall and cause-specific mortality in women. In men, coffee was significantly positively related to cancer and cardiovascular mortality, and inversely to respiratory and other causes of death. Tea intake was significantly, nonlinearly related to lower overall, cancer and cardiovascular mortality in men, but showed no association with mortality in women. In substitution analyses, increasing the proportion tea (replacing coffee with tea) was significantly and nonlinearly related to lower overall, cancer and cardiovascular mortality in men, but in women higher tea proportions were positively associated with overall mortality (and most causes of death). This study suggests that for men, compared to exclusive coffee drinkers, those drinking 30–50% tea showed the lowest mortality; any tea drinking seemed better than only coffee. For women, those who drank exclusively coffee or drinking up to 40% tea had the lowest mortality, but those drinking higher percentages of tea were at increased mortality risk [HR = 1.41 (95% CI 1.01–1.99) for 80–100% tea compared to exclusive coffee drinkers].     

The associations of household wealth and income with self-rated health – A study on economic advantage in middle-aged Finnish men and women

The economic resources available to an individual or a household have been hypothesised to affect health through the direct material effects of living conditions as well as through social comparison and experiences of deprivation. The focus so far has been mainly on current individual or household income, and there is a lack of studies on wealth, a potentially relevant part of household resources. We studied the associations of household wealth and household income with self-rated health, and addressed some theoretical issues related to economic advantage and health. The data were from questionnaire survey of Finnish men and women aged from 45 to 67 years, who were employed by the City of Helsinki from five to seven years before the collection of the data in 2007. We found household wealth to have a strong and consistent association with self-rated health, poor health decreasing with increasing wealth. The relationship was only partly attributable to the association of wealth with employment status, household income, work conditions and health-related behaviour. In contrast, the association of household income with self-rated health was greatly attenuated by taking into account employment status and wealth, and even further attenuated by work conditions. The results suggested a significant contribution of wealth differentials to differences in health status. The insufficiency of current income as the only measure of material welfare was demonstrated. Conditions associated with long-term accumulation of material welfare may be a significant aspect of the causal processes that lead to socioeconomic inequalities in ill health.     

A prospective study of organochlorines in adipose tissue and risk of non‑Hodgkin lymphoma

Background: Exposure to organochlorines has been examined as a potential risk factor for non-Hodgkin lymphoma (NHL), with inconsistent results that may be related to limited statistical power or to imprecise exposure measurements.Objective: Our purpose was to examine associations between organochlorine concentrations in prediagnostic adipose tissue samples and the risk of NHL.Methods: We conducted a case–cohort study using a prospective Danish cohort of 57,053 persons enrolled between 1993 and 1997. Within the cohort we identified 256 persons diagnosed with NHL in the population-based nationwide Danish Cancer Registry and randomly selected 256 subcohort persons. We measured concentrations of 8 pesticides and 10 polychlorinated biphenyl (PCB) congeners in adipose tissue collected upon enrollment. Associations between the 18 organochlorines and NHL were analyzed in Cox regression models, adjusting for body mass index.Results: Incidence rate ratios and confidence intervals (CIs) for interquartile range increases in concentrations of dichlorodiphenyltrichlorethane (DDT), cis-nonachlor, and oxychlordane were 1.35 (95% CI: 1.10, 1.66), 1.13 (95% CI: 0.94, 1.36), and 1.11 (95% CI: 0.89, 1.38), respectively, with monotonic dose–response trends for DDT and cis-nonachlor based on categorical models. The relative risk estimates were higher for men than for women. In contrast, no clear association was found between NHL and PCBs.Conclusion: We found a higher risk of NHL in association with higher adipose tissue levels of DDT, cis-nonachlor, and oxychlordane, but no association with PCBs. This is the first study of organochlorines and NHL using prediagnostic adipose tissue samples in the exposure assessment and provides new environmental health evidence that these organochlorines contribute to NHL risk.     

Symptoms and sense of coherence – a follow-up study of personnel from workplace buildings with indoor air problems

OBJECTIVES: The aim was to study prevalence and change of symptoms in buildings with suspected indoor air problems in relation to sense of coherence (SOC), a psychological measure of a life attitude. METHODS: A cohort of 194 subjects initially working in 19 Swedish buildings with indoor environmental problems was followed from 1988 to 1998. Information on 16 symptoms compatible with sick building syndrome (SBS) was gathered by an initial questionnaire mailed between 1988 and 1992. The same symptom questionnaire, as well as Antonovsky's SOC, was administered in a postal follow-up study in 1998. The prevalence of symptoms and the change (incidence) plus reminiscence of symptoms were calculated for individual symptoms and a total symptom score (SC). Bivariate analyses, as well as multiple linear and logistic regression analyses, were applied and adjusted for age, gender, history of atopy and tobacco smoking. RESULTS: SBS was more common in women, younger subjects and those with a history of atopy. A low SOC was related to a higher prevalence of ocular, nasal, and throat symptoms, tiredness, and headache. In addition, subjects with a low SOC developed more symptoms during the follow-up period. Women had a lower SOC value, but there was no relation between SOC and age, smoking, doctor's diagnosed asthma or a history of atopy. Subjects leaving the problem buildings during the follow-up period had a decrease in symptoms and were more often non-smokers, but had the same mean SOC score as those remaining in the same workplace. CONCLUSIONS: The study indicates that SOC can detect personal vulnerability in relation to suspected environmental stress. Symptoms reported in the buildings with suspected indoor air problems are partly reversible, as indicated by the reduction of symptoms among those leaving these buildings. A multi-disciplinary approach including personality aspects, allergic disorders and indoor exposures should be applied in investigations of buildings with suspected indoor air problems.     

Maternal use of oral contraceptives and risk of hypospadias – a population-based case-control study

The aim of this population-based case-control study was to examine the risk of isolated hypospadias in boys born to mothers who have used oral contraceptives in early pregnancy. The study was based on data from the Hungarian Case-Control Surveillance of Congenital Abnormalities from 1980 to 1996, and included 3,038 boys with hypospadias (cases), 24,799 boys without congenital abnormalities (CA-free controls), and 11,881 boys with abnormalities other than hypospadias. We used unconditional logistic regression to adjust for birth order, maternal age, maternal employment status, maternal diabetes, and pre-eclampsia. When comparing cases with CA-free controls the OR for maternal use of OC was 1.21 (95% CI: 0.67–2.17). When comparing cases with boys with other abnormalities, the OR for maternal use of OC was 0.83 (95% CI: 0.46–1.50). Our data showed that self-reported maternal use of oral contraceptives during pregnancy was not associated with an increased risk of hypospadias in the offspring.     

Does decentralization influence efficiency of health units? A study of opinion and perception of health workers in Odisha

Background

Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of the most critical building blocks. In India, Rogi Kalyan Samiti (RKS) was established at every health unit as institutions of local decision making in order to improve productive efficiency and quality. Measuring efficiency of health units is a complex task. This study aimed at assessing the perception (opinion and satisfaction) of health workers about influence of RKS on improving efficiency of peripheral decision making health units (DMHU); examining differences between priority and non-priority set-ups; identifying predictors of satisfaction at work; and discussing suggestions to improve performance.

Methods

Following a cross-sectional, comparative study design, 130 health workers from 30 institutions were selected through a multi-stage stratified random sampling. A semi-structured questionnaire was administered to assess perception and opinion of health workers about influence of RKS on efficiency of decision making at local level, motivation and performance of staff, and availability of funds; improvement of quality of services, and coordination among co-workers; and participation of community in local decision making. Three districts with highest infant mortality rate (IMR), one each, from 3 zones of Odisha and 3 with lowest IMR were selected on the basis of IMR estimates of 2011. The former constituted priority districts (PD) and the latter, non-priority districts (NPD). Composite scores were developed and compared between PD and NPD. Adjusted linear regression was conducted to identify predictors of satisfaction at work.

Results

A majority of respondents felt that RKS was efficient in decision making that resulted in improvement of all critical parameters of health service delivery, including quality; this was significantly higher in PD. Further, higher proportion of respondents from PD was highly satisfied with the current set of provisions and manners of functioning of the sample health units. Active community engagement, participation of elected representatives, selection of a pro-active Chairman, and training to RKS members were suggested as the immediate priority action points for the state government. Mean scores differed significantly between PD and NPD with regard to: influence of RKS on individual-centric, organizational-centric and patient-centric performance, and the responsibilities to be entrusted with RKS. Absenteeism was strongly associated with satisfaction and local self-governance. Work-related factors, systemic factors, local accountability and patients’ involvement were found to be the key predictors of satisfaction of health workforce.

Conclusion

The understanding on quality improvement strategies was found to be very poor among the health workers. Tailor-made capacity building measures at district and sub-district levels could be critical to equip the peripheral health units to achieve the universal health coverage goals. Work environment, systemic factors and accountability need to be addressed on priority for retention of health workforce. The hypothesized link between efficient local decision making, perception of health workers about efficiency of health units and the health status of population needs further investigation.

     

Methylphenidate reduces energy intake and dietary fat intake in adults: a mechanism of reduced reinforcing value of food?

BACKGROUND: Dopamine mediates the reinforcing value of food, and low concentrations of dopamine are related to increased feeding. Thus, administering a drug that increases dopamine may reduce energy intake, possibly by reducing food reinforcement. OBJECTIVES: We tested whether short-acting methylphenidate (MPH), a drug that increases the availability of dopamine by blocking its reuptake, reduces energy intake and alters macronutrient preference and whether these effects are due to a mechanism of reduced hunger or food reinforcement. DESIGN: Fourteen adults were given placebo or short-acting MPH (0.5 mg/kg) in a randomized, double-blind, placebo-controlled crossover fashion. One hour after ingestion, hunger and the relative reinforcing value of snack food were measured, followed immediately by energy intake and macronutrient preference during a buffet-style lunch. RESULTS: MPH reduced energy intake by 11% (P = 0.024) as well as intake of fat by 17% (P = 0.003) relative to placebo. Despite similar levels of prebuffet hunger, subjects taking MPH reduced their energy and fat intakes more than did those taking placebo, which suggests that hunger may not mediate the effects of MPH on energy intake. MPH showed a trend toward reducing the reinforcing value of high-fat food relative to placebo, but reduced food reinforcement was not significantly correlated with energy intake. CONCLUSION: MPH reduced overall energy intake with a selective reduction in dietary fat. Findings are consistent with a reward deficiency model of obesity whereby low brain dopamine predicts overeating and obesity, and administering agents that increase dopamine results in reduced feeding behavior.     

Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches

ObjectivesThe aim of this study was to investigate the relationship between maternal diet during pregnancy and lactation and development of atopic disorders in childhood.MethodsWe included studies published up to August 2011 that assessed food-based maternal dietary interventions or that examined associations between maternal dietary intake during pregnancy and/or lactation and allergic outcomes (eczema, asthma, hay fever, and sensitization) in their children.ResultsWe included 42 studies (>40 000 children): 11 intervention studies (including 7 randomized control trials), 26 prospective cohort studies, 4 retrospective cohort studies, and 1 case–control study. In the randomized control trials, no significant difference was noted overall in the prevalence of eczema and asthma in the offspring of women on diets free from common food allergens during pregnancy. The prospective cohorts investigated a large number of potential associations, but reported few significant associations between maternal dietary intake and development of allergy. Maternal diets rich in fruits and vegetables, fish, and foods containing vitamin D and Mediterranean dietary patterns were among the few consistent associations with lower risk for allergic disease in their children. Foods associated with higher risk included vegetable oils and margarine, nuts, and fast food.ConclusionThis review did not find widespread or consistent links between mothers' dietary intake and atopic outcomes in their children. However, maternal consumption of Mediterranean dietary patterns, diets rich in fruits and vegetables, fish, and vitamin D-containing foods were suggestive of benefit, requiring further evaluation.     

A two-year prospective study of the health-related quality of life of children with chronic illness – the parents’ perspective

The aim of this study was to assess prospectively changes in the health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF). One hundred and twenty-two parents of children aged 10–16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Parents described their childrens HRQL using the Child Health Questionnaire (PF98) at baseline, 6, 12, 18 and 24 months post-baseline. They reported that the general health of children with CF was significantly worse than that of children with asthma and diabetes at baseline. In other domains there were few differences between the HRQL of children in the three groups. In several domains, the HRQL of children with asthma or diabetes improved over the 2years of the study. This improvement was less evident for children with CF.