Birth cohort differences in anthropometric measures in the older elderly: the Bambuí Cohort Study of Aging (1997 and 2008)

The aim of this study was to evaluate the effect of birth cohort on nutritional status among older elderly (71-81 years old) from the Bambuí Cohort Study of Aging, conducted in Brazil in 1997 and 2008. We compared the two birth cohorts--1916-1926 (older cohort) and 1927-1937 (recent cohort)--considering body mass index (BMI = weight/height2), waist circumference (WC) and prevalence of overweight (BMI 3 27 kg/m2). BMI (β = 0.09, 95%CI: 0.04, 0.15) and prevalence of overweight (PR = 1.02; 95%CI: 1.01; 1.03) were higher in the recent cohort than the earlier cohort, regardless of sex and schooling. No difference was observed in WC. Stratified by sex, similar overall trends were observed for men, and WC was higher in the recent cohort. Among women there was no difference in BMI and overweight, but WC was lower in the recent cohort. The cohort effect was greater among older men and, in the near future, may result in greater prevalence of overweight in this group.     

What is the potential for the use of clinical outcome measures to be computerised? Findings from a qualitative research study

Clinical outcome measures are used in clinical audit to monitor the quality of care provided to patients. As information technology (IT) is increasingly being integrated into the delivery of health care, computerising the use of clinical outcome measures has been proposed. However, little is known about the attitudes of health professionals towards this. Aims to understand professionals' views on adapting one clinical outcome measure--the palliative care outcome scale (POS)--for use on hand-held computers. Concludes that these results reinforce existing research on clinical outcome measures and IT in health care; identify special palliative care issues when considering the use of computerised clinical outcome measures with patients; and highlight the need for further research.     

Preconception Predictors of Birth Outcomes: Prospective Findings from the Central Pennsylvania Women’s Health Study

Objective  

To examine maternal pre-pregnancy (preconception) predictors of birthweight and fetal growth for singleton live births occurring over a 2-year period in a prospective study.     

Does health predict the reporting of racial discrimination or do reports of discrimination predict health? Findings from the National Longitudinal Study of Youth

Racial discrimination may contribute to diminished well-being, possibly through stress and restricted economic advancement. Our study examines whether reports of racial discrimination predict health problems, and whether health problems predict the reporting of racial discrimination. Data come from years 1979 to 1983 of the US National Longitudinal Study of Youth, focusing on respondents of Black (n = 1851), Hispanic (n = 1170), White (n = 3450) and other (n = 1387) descent. Our analyses indicate that reports of racial discrimination in seeking employment predict health-related work limitations, although these limitations develop over time, and not immediately. We also find that reports of discrimination at two time-points appear more strongly related to health-related work limitations than reports at one time-point. A key finding is that these limitations do not predict the subsequent reporting of racial discrimination in seeking employment. These findings inform our knowledge of the temporal ordering of racial discrimination in seeking employment and health-related work conditions among young adults. The findings also indicate that future research should carefully attend to the patterns and timing of discrimination.     

Recruitment into diabetes prevention programs: what is the impact of errors in self-reported measures of obesity?

ABSTRACT: BACKGROUND: Error in self-reported measures of obesity has been frequently described, but the effect of self-reported error on recruitment into diabetes prevention programs is not well established. The aim of this study was to examine the effect of using self-reported obesity data from the Finnish diabetes risk score (FINDRISC) on recruitment into the Greater Green Triangle Diabetes Prevention Project (GGT DPP). METHODS: The GGT DPP was a structured group-based lifestyle modification program delivered in primary health care settings in South-Eastern Australia. Between 2004-05, 850 FINDRISC forms were collected during recruitment for the GGT DPP. Eligible individuals, at moderate to high risk of developing diabetes, were invited to undertake baseline tests, including anthropometric measurements performed by specially trained nurses. In addition to errors in calculating total risk scores, accuracy of self-reported data (height, weight, waist circumference (WC) and Body Mass Index (BMI)) from FINDRISCs was compared with baseline data, with impact on participation eligibility presented. RESULTS: Overall, calculation errors impacted on eligibility in 18 cases (2.1%). Of n=279 GGT DPP participants with measured data, errors (total score calculation, BMI or WC) in self-report were found in n=90 (32.3%). These errors were equally likely to result in under- or over-reported risk. Under-reporting was more common in those reporting lower risk scores (Spearman-rho = -0.226, p-value < 0.001). However, underestimation resulted in only 6% of individuals at high risk of diabetes being incorrectly categorised as moderate or low risk of diabetes. CONCLUSIONS: Overall FINDRISC was found to be an effective tool to screen and recruit participants at moderate to high risk of diabetes, accurately categorising levels of overweight and obesity using self-report data. The results could be generalisable to other diabetes prevention programs using screening tools which include self-reported levels of obesity.     

Sexual Function among Women in Midlife: Findings from the Nurses’ Health Study II

BackgroundWomen's sexual well-being is an important determinant of overall health and quality of life across the life course. Yet the factors associated with women's levels of sexual activity and sexual function in midlife are little understood. This study sought to assess the prevalence of recent sexual activity and sexual dysfunction symptoms among middle-aged women and evaluate the associations of partner status, menopause, and health status factors with sexual dysfunction.MethodsParticipants of this cross-sectional study were 68,131 women who responded to the 2013 Nurses’ Health Study II observational cohort questionnaire when they were age 48–68 years. Sexual activity and dysfunction symptoms were assessed with the Female Sexual Function Index. Age-adjusted multivariable regression models estimated risk ratios for the association of health-related factors with past month sexual dysfunction symptoms among women who were sexually active over the past month, overall and stratified by partner status.ResultsOf middle-aged women participants, 73% were sexually active (n = 49,701) and 50% of sexually active women reported symptoms of sexual dysfunction. Symptoms of sexual dysfunction were less common among unpartnered than partnered women (42% vs. 51%; p < .0001). A positive association between menopause and sexual dysfunction was greater for unpartnered women (risk ratio, 2.37, 2.99; p < .001) than partnered women (risk ratio, 1.89, 2.00; p < .001).ConclusionsDifficulty with sexual function is common among women in midlife, but less so than previously estimated. Regular monitoring of women's sexual function could enable clinicians to offer women timely, supportive interventions tailored by partner status and menopausal status.     

How Do Racial/Ethnic Groups Differ in Their Use of Neighborhood Parks? Findings from the National Study of Neighborhood Parks

The current study examined racial/ethnic differences in use of parks and park facilities and features and self-reported park use and perceptions. We conducted observations in a nationally representative sample of 193 neighborhood parks in 27 US cities over a 1-week period between April and August of 2016 using the System of Observing Play and Recreation in Communities (SOPARC). To determine the propensity of different racial/ethnic groups to use parks relative to expectation based on their representation in the surrounding neighborhood, we calculated the percentages of park users of each race/ethnicity and compared these to the percentages of racial/ethnic groups residing in the neighborhood within a 1-mile radius of the park based on 2010 U.S. Census data. In the same parks, we administered an intercept survey to assess park users’ self-reported use and perceptions of the park (N?=?1872). We examined racial/ethnic differences in self-reported use and perceptions of parks using GEE models that adjusted for several individual- and park-level covariates. Hispanics comprised a disproportionate percentage of observed park users. Racial/ethnic groups generally did not differ in their self-reported park use and perceptions, except for the social context of park visits. In adjusted models, Hispanics had significantly higher odds of visiting with a child family member (OR?=?1.44) and lower odds of visiting alone than non-Hispanic whites (OR?=?.55). Findings highlight Hispanics’ greater propensity to use parks and indicate that parks may serve a communal purpose for Hispanics that they do not serve for other racial/ethnic groups.     

Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women’s Health

Objective: To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women. Methods: Data from the Australian Longitudinal Study on Women’s Health’s (population-based cohort study) 1973–1978 cohort were used (N?=?6899, aged 37–42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression. Results: 14% of women had their first birth aged?<?24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18–27 months). Women with a low SEP had increased odds of a first birth?<?24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent’s education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval. Conclusion: As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth?<?24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.     

Validity of self-reported diabetes and its determinants: evidences from the Bambuí study

OBJECTIVE: To assess the validity of self-reported diabetes and its determinants in the elderly. METHODS: Cross-sectional study including 1,492 subjects aged >or= 60 years, which corresponds to 86% of all residents in this age group living in the municipality of Bambuí, Southeastern Brazil, in 1997. The validity of self-reported diabetes was assessed comparing to diabetes mellitus defined by medical criteria (fasting glucose > 126 mg/dl or current treatment). Multivariate analysis was carried out to assess factors independently associated with sensitivity and specificity. RESULTS: The prevalence of diabetes mellitus and self-reported diabetes were 14.5% and 11.7%, respectively. Sensitivity and specificity of self-reported diabetes were 57.1% (95% CI: 50.3;63.8) and 96.9% (95% CI: 94.7;97.0), respectively. Medical visits in the previous two years (PR=3.78), as well as 1-3 (PR=1.90) and > 4 years (PR=1.55) of schooling were positively and independently associated with sensitivity. Medical visits in the previous two years (PR= 0.96) and female sex (PR = 0.97) were negatively and independently associated with specificity. CONCLUSIONS: The study results indicated that self-reported diabetes should not be either used to estimate the prevalence of diabetes mellitus or to identify individuals with the disease in the study population. Schooling and medical visits were determinants of the elderly awareness of being diabetics, indicating that these modifiable characteristics may play a role in secondary and tertiary prevention.     

Importance of Change Appraisal for Employee Well-being during Organizational Restructuring: Findings from the Finnish Paper Industry’s Extensive Transition

The global recession has forced the Finnish forest industry to carry out majorrestructuring activities. Employees have faced different kinds of restructuring, mainlyaimed at reducing staff and production. Many studies have shown the negative consequencesof restructuring on employee well-being by using negative, ill-health indicators. Our aimis to examine the extent to which change appraisal influences both the negative andpositive aspects of work-related well-being among employees who continue working in theorganization after the restructuring process. We also examine the role of different actors(top management, immediate supervisor, employees themselves) in how the change isappraised. The study investigated blue-collar employees working in the Finnish forestindustry during a period of extensive transition (2008–2009). All six participatingfactories underwent restructuring between baseline and the follow-up survey (n=369). Afteradjustment for gender, age and baseline well-being, negative change appraisal increasedthe risk of experiencing more stress and less work enjoyment. Negative change appraisalsthus also damaged the positive, motivational aspects of employee well-being. The resultsshowed the importance of offering employees the opportunity to participate in the planningof changes related to their work as regards positive change appraisal.     

Test-retest reliability of measures of social network in the "Pró -Saúde" Study

OBJECTIVE: To evaluate test-retest reliability of social network-related information of the" Pr -Sa de" study. METHODS: A test-retest reliability study was conducted using a multidimensional questionnaire applied to a cohort of university employees. The same questionnaire was filled out twice by 192 non-permanent employees with two weeks apart. Agreement was estimated using kappa statistics (categorical variables), weighted kappa statistics, log-linear models (ordinal variables), and intraclass correlation coefficient (discrete variables). RESULTS: Estimates of reliability were higher than 0.70 for most variables. Stratified analyses revealed no consistently varying patterns of reliability according to gender, age or schooling strata. Log-linear modelling showed that, for the study ordinal variables, the model of best fit was "diagonal agreement plus linear by linear association". CONCLUSIONS: The high level of reliability estimated in this study suggests that the process of measurement of social network-related aspects was adequate. Validation studies, which are currently being conducted, will complete the quality assessment of this information.     

Women Know Best—Findings from a Thematic Analysis of 5,214 Surveys of Abortion Care Experience

ObjectivePatient experience is an essential component of quality care. Few studies have comprehensively evaluated patient experiences of abortion care. The objectives of this study were to describe women's experiences of abortion care in their own words, and to determine themes across patient experiences.Study DesignData for this thematic analysis, a qualitative method that allows for the identification, analysis, and report of patterns or themes within data, come from a larger study of safety and quality of aspiration abortion care across 22 clinical sites. Participants completed an abortion experience survey including fixed choice questions and an open-ended question: “Is there anything you would like to tell us about your experience?” The data were then categorized by responses to another survey question: “Overall, was your experience about, better, or worse than you expected?”ResultsA total of 5,214 responses were analyzed. Women reported positive abortion care experiences with the majority of women rating their experience as better than expected (n = 3,600). Two major themes that emerged from the data include clinic- and patient-level factors that impact how patients rate their experiences. Analysis of the responses categorized in the worse than expected group (n = 136) found that women primarily faulted clinic-level factors for their negative experiences, such as pain control and management, and wait time for appointments and in clinic.ConclusionThis analysis highlights specific areas of abortion care that influence patients' experience. The few women who were disappointed by care in the clinic tended to fault readily modifiable clinical factors, and provided suggested areas of improvement to enhance positive experiences related to their abortion care.     

Predicting Continuance—Findings From a Longitudinal Study of Older Adults Using an eHealth Newsletter

While eHealth technologies are promisingly efficient and widespread, theoretical frameworks capable of predicting long-term use, termed continuance, are lacking. Attempts to extend prominent information technology (IT) theories to the area of eHealth have been limited by small sample sizes, cross-sectional designs, self-reported as opposed to actual use measures, and a focus on technology adoption rather than continuance. To address these gaps in the literature, this analysis includes empirical evidence of actual use of an eHealth technology over the course of one year. This large (n = 4,570) longitudinal study focuses on older adults, a population with many health needs and among whom eHealth use may be particularly important. With three measurement points over the course of a year, this study examined the effects of utilitarian and hedonic beliefs on the continued use of an eHealth newsletter using constructs from IT adoption and continuance theories. Additional analyses compared the relative strength of intentions compared to earlier use in predicting later use. Usage intention was strongly predicted by both hedonic beliefs and utilitarian beliefs. In addition, utilitarian beliefs had both direct effects on intention and indirect effects, mediated by hedonic beliefs. While intention predicted subsequent use, earlier use was a significantly stronger predictor of use than intention. These findings make a theoretical contribution to an emerging literature by shedding light on the complex interplay of reasoned action and automaticity in the context of eHealth continuance.     

Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study: HUNT 1

BACKGROUND: A large health survey was previously conducted in 1984-86, the Nord-Tr?ndelag Health Study (HUNT 1), and another was conducted in 1995-97 (HUNT 2). A third, HUNT 3, started in 2006. However, the physical activity (PA) questionnaires have not yet been validated. AIMS: To assess the reliability and validity of the self-reported physical activity questionnaire in the Nord-Tr?ndelag Health Study (HUNT 1). METHODS: The HUNT 1 questionnaire was administered to a random sample of 108 healthy men aged 20-39 years. Repeatability was assessed with a repeat questionnaire after one week, and validity by comparing results with direct measurement of VO(2) during maximal work on a treadmill, with ActiReg, an instrument that measures PA and energy expenditure (EE) and with the International Physical Activity Questionnaire (IPAQ). ActiReg records the main body positions (stand, sit, bent forward and lie) together with the motion of the trunk and/or one leg each second. RESULTS: The results indicated strong, significant agreement on test-retest (weighted kappa frequency, r=0.80, intensity, r=0.82, and duration, r=0.69). We found a moderate, significant correlation, r=0.48 (p< or =0.01), between the index based on questionnaire responses and VO(2max.) Metabolic equivalent (MET) values of 6 or more from ActiReg and "vigorous activity' from the IPAQ most strongly correlated with the index (r=0.39, r=0.55, respectively). Associations of other measures obtained from ActiReg with questionnaire responses were weaker. CONCLUSIONS: Our results indicate that the PA questionnaire in HUNT 1 is reproducible and provides a useful measure of leisure-time PA for men. The questionnaire is very short, and compared favourably with much longer instruments for assessment of more vigorous PA. It should be an appropriate tool for use in further epidemiological studies, particularly when the interest is in aspects of PA reflected in fitness or METs greater than 6.