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.     

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.     

Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence,risk factors and diagnostic validity

The validity of atrial fibrillation (AF) diagnoses in national registers for use as endpoints in prospective studies has not been evaluated. We studied the validity of AF diagnoses in Swedish national hospital discharge and cause of death registers and the occurrence of and risk factors for AF in a middle-aged Swedish population using these registers. Our study included the 30,447 individuals (age 44–73) who attended baseline visits in 1991–1996 of the Malmö Diet and Cancer study. Individuals with a first AF diagnosis were identified by record linkage with national registers. A subset of cases was randomly selected for validation by examination of electrocardiograms and patient records. Electrocardiograms were available in 98% of the validation sample (95% definitive AF, 3% no AF). The 2% with ECGs unavailable had probable AF. Baseline AF prevalence was 1.3%, higher in men and increased with age. During 11.2 years of follow-up 1430 first AF diagnoses occurred. Risk factors were age, hypertension, BMI, diabetes, history of heart failure, history of myocardial infarction and, in men but not women, current smoking. The strongest risk factors were history of heart failure (hazard ratio men 4.5, women 8.7) and myocardial infarction (hazard ratio men 2.0, women 1.8). The largest population attributable risks were observed for hypertension (men 38%, women 34%) and obesity (men 11%, women 10%). In conclusion, case misclassification of AF in national registers is small, indicating feasibility of use in prospective studies. Hypertension and obesity account for large portions of population risk in middle-aged individuals with low prevalence of manifest cardiac disease.     

Guys and dolls: a qualitative study of teachers’ views of gendered play in kindergarten

Drawing on data collected for a larger study investigating kindergarten teachers’ online discussions of play, the present qualitative study examines teachers’ discussions of gender. Findings suggest that teachers’ project onto their kindergarten students many of their own gender prejudices about play. These teachers reinforced gendered attitudes by encouraging the children, especially the boys, to play only with toys and in activities traditionally associated with their gender. Email interviews were then conducted with seven kindergarten teachers to further explore the main theme from the netnographic research. Findings support the contention that further research is needed to examine gendered play in kindergartens, and that kindergarten teachers could benefit from becoming aware of their unintentional teachings and in learning how better to encourage gender equity in play-based class activities.     

Are there geographic and socio-economic differences in incidence, burden and prevention of malaria? A study in southeast Nigeria

Rationale

It is not clearly evident whether malaria affects the poor more although it has been argued that the poor bear a very high burden of the disease. This study explored the socioeconomic and geographic differences in incidence and burden of malaria as well as ownership of mosquito nets.

Methods

Structured questionnaires were used to collect information from 1657 respondents from rural and urban communities in southeast Nigeria on: incidence of malaria, number of days lost to malaria; actions to treat malaria and household ownership of insecticide treated and untreated mosquito nets. Data was compared across socio-economic status (SES) quartiles and between urban and rural dwellers.

Results

There was statistically significant urban-rural difference in malaria occurrence with malaria occurring more amongst urban dwellers. There was more reported occurrence of malaria amongst children and other adult household members in better-off SES groups compared to worse-off SES groups, but not amongst respondents. The average number of days that people delayed before seeking treatment was two days, and both adults and children were ill with malaria for about six days. Better-off SES quartile and urban dwellers owned more mosquito nets (p < 0.05) (treated and untreated).

Conclusion

Malaria occurs more amongst better-off SES groups and urban dwellers in southeast Nigeria. Deployment of malaria control interventions should ensure universal access since targeting the poor and other supposedly vulnerable groups may exclude people that really require malaria control services.     

Trends and determinants of mortality in women of reproductive age in rural Guinea-Bissau,West Africa – a cohort study

Background

There are few studies reporting mortality of women of reproductive age (WRA) in developing countries. The trend and patterns of their mortality may be important for documenting the health status of the population in general.

Methods

We used a prospective open cohort of women aged 12 to 49 years living in the Bandim Health Project’s rural Health and Demographic Surveillance System (HDSS) in 5 regions of Guinea-Bissau from 1996 to 2007. Information on in- and out-migration and deaths were collected through the HDSS routine procedures. We assessed the trends in mortality and the associated determinants using Cox regression models.

Results

We followed 27,185 WRA for 141,693 person-years-at-risk (PYO) among whom 9,093 moved out and 1,006 died. Overall standardized mortality rate was 759 per 100,000 PYO. WRA mortality did not decline, but three periods could be distinguished: a stable mortality between 1996–2000 followed by 14% increase in mortality [Hazard rate ratio (HRR)?=?1.14; 95% confidence interval (CI): 0.98-1.32; p?=?0.08] between 2001–2003, and then in the last period from 2004–2007 a 25% decline (HRR?=?0.75; 95% CI: 0.64-0.87; p?<?0.001) in relation to the first period. Compared with the years 1990–1996 mortality increased in the first two periods until 2003; only in the last period did mortality reach the same level as in 1990–1996 (HRR?=?0.96; 95% CI: 0.82-1.13; p?=?0.62). The level of mortality differed between regions. In the adjusted analysis the eastern regions Bafata (HRR?=?1.79; 95% CI: 1.38-2.32; p?<?0.001) and Gabu (HRR?=?1.70; 95% CI: 1.28-2.26; p?<?0.001) had significantly higher mortality, but the hazard rate did not differ by ethnic group. As expected the rate increased with increasing age.

Conclusions

Over the twelve-year period mortality of WRA did not decline. A stable mortality in the beginning was followed by an increase and then a return to the previous levels. Further monitoring of mortality is needed to identify the risk factors for the striking regional differences. Advantage should be taken of the HDSS to monitor progress towards the MDGs and beyond.

     

Transgender women in Malaysia,in the context of HIV and Islam: a qualitative study of stakeholders’ perceptions

Background

Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia.Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context.

Methods

In-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis.

Results

Five central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; ‘Cure’, ‘Correction’ and finally, Stigma and Discrimination.Discussion: Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations.

Conclusion

The situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in Malaysia.

     

Low back pain and lumbago–sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany

OBJECTIVES: To gain more conclusive evidence on the question of work-related low-back disorders in German nurses, a comprehensive study with several methodological approaches was performed. METHODS: As part of this project, a cross-sectional study on working conditions and prevalence of low back pain, a sample of 3,332 nurses and 1,720 clerks as reference group was investigated by a questionnaire. In this article, final results referring to a sub-sample of 2,207 nurses and 1,177 clerks who had always worked in their profession, so that we could exclude confounding effects of former occupations, will be presented. Excluding the confounding effects of several covariates by logistic regression, we computed relative risks for different pain symptoms. RESULTS: The data suggest a considerably higher risk of low back pain for nurses than for the reference population of clerks. Results, however, differ markedly when specific pain symptoms are considered. With respect to lumbago-sciatica and sciatica - which have to be regarded as indicators for possible disc herniation - the study group's relative risk is the most elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting the results for several confounders and covariates leads to still higher estimations of nurses' relative risk.     

A large‐scale longitudinal study of the utilization and effects of early childhood education and care in The Netherlands

Early childhood education and care (ECEC) services are expected to make an important contribution to the prevention of educational disadvantages stemming from social–ethnic factors. In the present study, three services are central: daycare centers, preschools, and special parent–child programs. Whether or not relations exist between the utilization of ECEC services and a number of the characteristics of the parent and the child is examined initially. Thereafter, the effects of such participation in ECEC services on the cognitive and non‐cognitive competencies of the children involved are examined. The recent data from the Dutch cohort study Elementary Education involving a total of approximately 33,500 students from 600 elementary schools are analyzed. The results show significant relations between the utilization of ECEC services and such parent characteristics as education, ethnic origin and paid employment. With regard to the effects of participation in ECEC services, only very weak associations with the cognitive and non‐cognitive competencies of the children are detected but they disappear when the relevant background characteristics of the parents are taken into consideration.     

Quantitative and qualitative approaches in the study of poverty and adolescent development: separation or integration?

This paper examines the use of quantitative and qualitative approaches to study the impact of economic disadvantage on family processes and adolescent development. Quantitative research has the merits of objectivity, good predictive and explanatory power, parsimony, precision and sophistication of analysis. Qualitative research, in contrast, provides a detailed, holistic, in-depth understanding of social reality and allows illumination of new insights. With the pragmatic considerations of methodological appropriateness, design flexibility, and situational responsiveness in responding to the research inquiry, a mixed methods approach could be a possibility of integrating quantitative and qualitative approaches and offers an alternative strategy to study the impact of economic disadvantage on family processes and adolescent development.     

Physical exercise and food habits: a study of adolescents in Cádiz

BACKGROUND: A increased number of eating disorders among teen-agers are currently being reported. Physical exercise, especially when done individually, is one of the methods chosen for losing weight. We are basing this study on the hypothesis of a larger number of eating habit disorders (EHD's) in subjects who do physical exercise alone. This study describes and compares eating habits among teen-agers that do individual exercise as opposed to athletes who work out in groups or on teams. METHOD: Cross-section study of 532 teen-agers ages 14-18 who are enrolled in school and who do physical exercise, having been selected at random by means of a two-stage, stratified sampling process. The subjects were divided into two groups according whether they did individual physical exercise alone (Number: 216) or in groups (Number: 316). The eating habits of both groups were analyzed based on a questionnaire filled out by the subjects themselves. RESULTS: In the group preferring individual sports, females were predominant (degree of males 0.44). Of these females, their being on diets in order to lose weight was 3.12 times more frequent, compulsive eating episodes being 3.73 times more frequent. As regards behaviors which might be considered to be compensatory, there is a clear concentration thereof among those who do sports individually, hence 43% stated to voluntarily undergo periods of fasting (4.96 times more than those who exercise in groups), 46% stating to have brought on vomiting at one time or another for "dieting" purposes (3.76 more) and up to 26% have used laxatives with the intention of losing weight (2.56 times more than among athletes who play on teams). CONCLUSION: The existence of EHD's seems to be associated with teen-agers who play individual sports as opposed to those who play on teams.     

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.

     

Allergy in bakers’ apprentices and factors associated to non-participation in a cohort study of allergic sensitization

Objective To describe the prevalence of atopy and respiratory symptoms among baker apprentices at the start of the education and factors associated with non-participation in the study. Methods A total of 346 students, 22.1(0.6) years of age, mean (SD), from the food production programme of technical colleges in Denmark were invited to participate in a 3 year study. Of the students, 187 agreed to participate and filled in a physician-administered questionnaire. The presence of atopy was determined by skin prick test (SPT) and serum allergen specific IgE (SpIgE). Bronchial hyper responsiveness to methacholine (PD₂₀ ≤ 1,440 μg) was determined. Results Prevalence of atopy was 32%. The prevalence of symptoms from the lungs and nose was 19.8 and 25.5%, respectively. Significantly, more SPT reactions were seen in males compared to females (39 vs. 22%, P < 0.05). Sensitization towards flour was significantly more frequent if determined as SpIgE (7.3%) compared to SPT (0.5%). We found a positive association between atopy and lung symptoms OR 6.1 (2.8–13.2 SD) and nasal symptoms OR 3.7 (1.8–7.5 SD). The major reason for non-participation was fear of blood sampling (25.5%). Conclusion The prevalence of atopy in bakers’ apprentices was of the same magnitude in the general Danish population. Significantly, more male bakers’ apprentices had atopy. This finding has major impact on the diagnostic procedures of occupational allergy in bakery workers emphasizing the need for standardization of the clinical tests. The main reasons for non-participation were, fear of blood-sampling (57%) and the 3 years commitment to the follow-up study (39%).     

Atrial fibrillation in immigrant groups: a cohort study of all adults 45 years of age and older in Sweden

To study the association between country of birth and incident atrial fibrillation (AF) in several immigrant groups in Sweden. The study population included all adults (n = 3,226,752) aged 45 years and older in Sweden. AF was defined as having at least one registered diagnosis of AF in the National Patient Register. The incidence of AF in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status. Compared to their Swedish-born counterparts, higher incidence of AF [HR (95% CI)] was observed among men from Bosnia 1.74 (1.56–1.94) and Latvia 1.29 (1.09–1.54), and among women from Iraq 1.96 (1.67–2.31), Bosnia 1.88 (1.61–1.94), Finland 1.14 (1.11–1.17), Estonia 1.14 (1.05–1.24) and Germany 1.08 (1.03–1.14). Lower incidence of AF was noted among men (HRs ≤ 0.60) from Iceland, Southern Europe (especially Greece, Italy and Spain), Latin America (especially Chile), Africa, Asia (including Iraq, Turkey, Lebanon and Iran), and among women from Nordic countries (except Finland), Southern Europe, Western Europe (except Germany), Africa, North America, Latin America, Iran, Lebanon and other Asian countries (except Turkey and Iraq). In conclusion, we observed substantial differences in incidence of AF between immigrant groups and the Swedish-born population. A greater awareness of the increased risk of AF development in some immigrant groups may enable for a timely diagnosis, treatment and prevention of its debilitating complications, such as stroke.     

The HBSC study in Scotland: can the study influence policy and practice in schools?

This paper reviews the role of the HBSC study in Scotland and suggests that the HBSC study has growing status and relevance in Scotland for a number of reasons as it continues to provide insights for politicians, policy makers, education professionals and health promotion practitioners. The paper will set out the historical background to the HBSC study and the associated research and health promoting school developments in Scotland. It will explore the factors that have been important in its influential role in contributing to health promotion policy developments in the education and health sectors in Scotland. It is suggested that this role has been shaped by:

Joint association of obesity and hypertension with disability in the elderly—A community-based study of residents in Shanghai,China

Background

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

Methods

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor’s diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

Results

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

Conclusions

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn’t significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

     

Eating behaviors and indexes of body composition in men and women from the Québec family study

OBJECTIVE: To put into relationship the dietary and anthropometric profile of men and women with their eating behaviors (cognitive dietary restraint, disinhibition, and susceptibility to hunger) and to assess whether gender and obesity status influence these associations. RESEARCH METHODS AND PROCEDURES: Anthropometric measurements (including visceral adipose tissue accumulation), dietary profile (3-day food record), and eating behaviors (Three-Factor Eating Questionnaire) were determined in a sample of 244 men and 352 women. RESULTS: Women had significantly higher cognitive dietary restraint and disinhibition scores than men (p < 0.0001). In both genders, scores for disinhibition and susceptibility to hunger, but not for cognitive dietary restraint, were higher in obese subjects than in overweight and nonobese subjects (p < 0.05). Positive correlations were observed between rigid restraint and most of the anthropometric variables studied (0.12 相似文献