Application of alternative anthropometric measurements to predict metabolic syndrome

OBJECTIVE:

The association between rarely used anthropometric measurements (e.g., mid-upper arm, forearm, and calf circumference) and metabolic syndrome has not been proven. The aim of this study was to assess whether mid-upper arm, forearm, calf, and waist circumferences, as well as waist/height ratio and waist-to-hip ratio, were associated with metabolic syndrome.

METHODS:

We enrolled 387 subjects (340 women, 47 men) who were admitted to the obesity outpatient department of Istanbul Medeniyet University Goztepe Training and Research Hospital between September 2010 and December 2010. The following measurements were recorded: waist circumference, hip circumference, waist/height ratio, waist-to-hip ratio, mid-upper arm circumference, forearm circumference, calf circumference, and body composition. Fasting blood samples were collected to measure plasma glucose, lipids, uric acid, insulin, and HbA1c.

RESULTS:

The odds ratios for visceral fat (measured via bioelectric impedance), hip circumference, forearm circumference, and waist circumference/hip circumference were 2.19 (95% CI, 1.30-3.71), 1.89 (95% CI, 1.07-3.35), 2.47 (95% CI, 1.24-4.95), and 2.11(95% CI, 1.26-3.53), respectively. The bioelectric impedance-measured body fat percentage correlated with waist circumference only in subjects without metabolic syndrome; the body fat percentage was negatively correlated with waist circumference/hip circumference in the metabolic syndrome group. All measurements except for forearm circumference were equally well correlated with the bioelectric impedance-measured body fat percentages in both groups. Hip circumference was moderately correlated with bioelectric impedance-measured visceral fat in subjects without metabolic syndrome. Muscle mass (measured via bioelectric impedance) was weakly correlated with waist and forearm circumference in subjects with metabolic syndrome and with calf circumference in subjects without metabolic syndrome.

CONCLUSION:

Waist circumference was not linked to metabolic syndrome in obese and overweight subjects; however, forearm circumference, an unconventional but simple and appropriate anthropometric index, was associated with metabolic syndrome and bioelectric impedance-measured visceral fat, hip circumference, and waist-to-hip ratio.     

Prevalence of metabolic syndrome and related factors in bank employees according to different defining criteria,Vitória/ES,Brazil

OBJECTIVE:

To determine the prevalence of metabolic syndrome and related factors in bank employees in the city of Vitoria/ES, Brazil.

METHODS:

This was a cross-sectional study that included 521 working men and women ≥20 years of age. Sociodemographic, lifestyle, anthropometric, biochemical, and hemodynamic characteristics were collected. Metabolic syndrome was diagnosed using the criteria of the National Cholesterol Education Program-ATPIII and the International Diabetes Federation. A logistic regression model was used to calculate the crude and adjusted OR of the variables, and the statistical level of significance was set at 5.0%.

RESULTS:

We identified 86 (17.2%) and 113 (22.6%) subjects with metabolic syndrome according to the criteria of the National Cholesterol Education Program-ATPIII and the International Diabetes Federation, respectively. The risk of developing metabolic syndrome was higher in individuals with a high school education (OR 2.6 [CI_95%, 1.1-6.1]). In overweight and obese subjects, the risks were also higher (OR 12.6 [CI_95%, 4.8-33.2, p = 0.000] and OR 43.7% [CI_95%, 16.1-118.9, p = 0.000], respectively).

CONCLUSION:

A large number of bank employees have metabolic syndrome, which can be associated with an increased risk of developing cardiovascular disease. Individuals who had college degrees had a higher prevalence of metabolic syndrome; this finding can be explained by the high rates of overweight and obesity found in subjects with college and graduate school educations.     

Early weaning and other potential risk factors for overweight among preschool children

OBJECTIVE

To investigate whether early weaning constitutes a risk factor for overweight at preschool age and to identify other factors that affect this association.

METHODS

This was a case-control study of 366 children aged 2 to 6 years (176 boys and 190 girls) from three cities. The case group comprised overweight children, as defined by body mass index (BMI) for age greater than or equal to the 85^th percentile. The main exposure analyzed was early weaning (exclusive or predominant breastfeeding for less than four months).

RESULTS

Early weaning was a significant risk factor for overweight in univariate analysis (OR = 1.69; 95% CI: 1.10–2.60; p = 0.02), but not in multivariate analysis (OR = 1.42; 95% CI: 0.86–2.34; p = 0.17). Maternal overweight, birth weight ≥ 3,500 g and sedentarism were the main risk factors for overweight in multivariate analysis.

DISCUSSION

In our study, the protective effect of breastfeeding against overweight was only shown in univariate analysis; it did not persist after controlling for other variables. It is possible that breastfeeding has only a small protective role against overweight in comparison with other variables of greater importance.

CONCLUSION

Our results suggest that the potential protective effect of breastfeeding against overweight among preschool children is weaker than genetic and other environmental factors.     

Factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe; 2007

Background

Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases.

Objective

To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane.

Methods

A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities for other ailments. We interviewed 77 cases and 154 controls.

Results

Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42–20.85), relationships less than one year, OR= 9.33 (95% CI 3.53–24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64–16.25) and paying for sex OR= 23.65 (95% CI 6.23–89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02–6.04) and relationships less than one year OR=3.19 (95% CI 1.41–7.23).Significant differences in attitudes were evident among cases and controls.

Conclusion

Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women.     

Risk factors for contracting anthrax in Kuwirirana ward, Gokwe North, Zimbabwe

Background

A report of an anthrax outbreak was received at Gokwe district hospital from the Veterinary department on the 23^rd January 2007. This study was therefore conducted to determine risk factors for contracting anthrax amongst residents of Kuwirirana ward.

Methods

We conducted a 1:1 unmatched case control study. A case was any person in Kuwirirana ward who developed a disease which manifested by itching of the affected area, followed by a painful lesion which became papular, then vesiculated and eventually developed into a depressed black eschar from 12 January to 20 February 2007. A control was a person resident of Kuwirirana ward without such diagnosis during the same period.

Results

Thirty-seven cases and 37 controls were interviewed. On univariate analysis, eating contaminated meat (OR = 7.7, 95% CI 2–29.8), belonging to a household with cattle deaths (OR= 9.7, 95% CI 2.9–33), assisting with skinning anthrax infected carcasses (OR= 5.4(95% CI 1.7–17), assisting with meat preparation for drying (OR = 5(95%CI 1.9–13.9), assisting with cutting contaminated meat (OR = 4.8(95% CI 1.7–13.2), having cuts or wounds during skinning (OR = 19.5, 95% CI 2.4–159) and belonging to a village with cattle deaths (OR = 6.5(95%CI 1.3–32) were significantly associated with anthrax.

Conclusion

Anthrax in Kuwirirana resulted from contact with and consumption of anthrax infected carcasses. We recommend that the district hold regular zoonotic committee meetings and conduct awareness campaign for the community and carry out annual cattle vaccinations.     

Gender-based profiling of Quality of Life (QOL) of primary health care (PHC) attendees in central Uganda: a cross sectional analysis

Objective

To analyze gender differences in QOL of patients presenting at PHC centres and to identify the socio-demographic variables associated with poor QOL.

Methods

This was a cross-sectional study. Consecutive adult patients at outpatient departments of three PHC centres were eligible. Those selected were interviewed using the WHOQOL-BREF, a 26-item questionnaire generating four domain scores of physical, psychological, environment and social relationships.

Results

The study had 446 respondents aged 18–84 years. Female parents significantly performed poorly on the physical health domain (OR 2.47: 95 % CI: 1.32 – 4.61). Respondents reported comparable scores on the 3 WHOQOL-BREF domains, except on poor physical health where being a parent had a positive association (OR 2.12; 95% CI: 1.27 – 3.55). Belonging to an age-range of 18–29 years had a positive association with poor physical health (OR 1.74; 95% CI: 1.13 – 2.68).

Conclusion

Generally, women reported poorer physical health. Health workers need orientation and training to appreciate the role of gender in health care. There is need to appreciate the complexities affecting QOL of women that are physically ill. Interventions aimed at improving patients'' QOL at PHC centres should take a gender-based perspective that recognizes the greater vulnerability of women to poor physical health.     

Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis

Background

Influenza immunisation is recommended for all people aged ≥65 years and younger people with particular chronic diseases. The Quality and Outcomes Framework (QOF) has provided new financial incentives for influenza immunisation since 2004.

Aim

To determine the impact of the 2004 UK General Medical Services contract on the overall uptake of, and socioeconomic inequalities associated with, influenza immunisation.

Design and setting

Retrospective general-practice population database analysis in 15 general practices in Scotland, UK.

Method

Changes in influenza-immunisation uptake for those in at-risk groups between 2003–2004 and 2006–2007 were measured, and variation in uptake examined using multilevel modelling.

Results

Uptake rose from 67.9% in 2003–2004 to 71.4% in 2006–2007. The largest increases were seen in those aged <65 years with chronic disease, with uptake rising from 49.6% to 58.4%, but rates remained considerably lower than in those aged ≥65 years. Differences between practices narrowed (median odds ratio [OR] for two patients randomly selected from different practices: 2.13 (95% confidence interval [CI] = 2.00 to 2.26) in 2003–2004 versus 1.44 (95% CI = 1.40 to 1.49) in 2006–2007. However, inequalities in uptake by patient socioeconomic status did not change: adjusted OR for most deprived versus most affluent was 0.75 (95% CI = 0.70 to 0.80) in 2003–2004 versus 0.72 (95% CI = 0.68 to 0.76) in 2006–2007.

Conclusion

Overall uptake rose significantly and differences between practices narrowed considerably. However, socioeconomic and age inequalities in influenza immunisation persisted in the first 3 years of the QOF. This contrasts with other ecological analyses, which have concluded that the QOF has reduced inequalities. The impact of financial incentives on inequalities is likely to vary, and some kinds of care may require more targeted improvement activity and support.     

Methylenetetrahydrofolate Reductase C677T polymorphism and breast cancer risk in Moroccan women

Background

Methylenetetrahydrofolate (MTHFR) enzyme plays an important role in folate metabolism which is involved in DNA methylation, repair, and synthesis.

Objective

We investigated if the MTHFR C677T polymorphism modulates the risk of developing breast cancer in Moroccan women.

Methods

Genotyping was performed by PCR-RFLP method on a sample of 96 patients with breast cancer and 117 controls.

Results

A positive correlation was found between the MTHFR C677T polymorphism and progesterone receptors expression (p= 0.04). According to menopausal status, the heterozygous CT (OR = 2.29 and P = 0.03) was statistically significant in pre-menopausal women. There was a significant association between C677T polymorphism and breast cancer risk in both additive (OR = 2.2, 95% CI = 1.24–3.86, p = 0.007) and dominant (OR = 2.10, CI 95% = 1.21–3.64, p = 0.008) models. In addition, the T allele were associated with a high breast cancer risk (OR = 1.59, 95% CI = 1.04–2.44, p = 0.03).

Conclusion

In the light of our preliminary study, 677T allele and 677CT MTHFR genotype may represent a genetic determinant increasing breast cancer risk in Moroccan women. A larger study including a larger sample size and more information is needed to confirm our conclusions.     

Severe anaemia in childhood cerebral malaria is associated with profound coma

Background

Severe anaemia in children with cerebral malaria has been associated with respiratory distress secondary to lactic acidosis and/or hypoxia. The ensuing metabolic derangement may further depress the level of consciousness culminating in presentation with profound coma. This association has poorly been studied.

Objective

To determine the relationship between profound coma at presentation and the presence of severe anaemia in children with cerebral malaria.

Methods

This cross-sectional study involved 100 children with cerebral malaria who were consecutively recruited at admission in the Paediatric emergency unit of Mulago hospital in Uganda from July to December 2000. Clinical and laboratory evaluation was done using the hospital''s guidelines for the management of severe malaria. The exposure factor of interest was severe anaemia (Hb < 5.0 g/dl) and occurrence of profound coma (Blantyre coma Scale 0) was the outcome measure.

Results

Severe anaemia and profound coma were seen in 20% and 9% of the children respectively. Severe anaemia was independently associated with profound coma, adjusted OR 1.34 (CI 1.17–1.95), p = 0. 002 and age < 3 years, adjusted OR 1.42 (CI 1.13–1.54), p = 0.001). Thirty percent of those with severe anaemia had deep sighing (acidotic) breathing compared to only 15% of those with haemoglobin (Hb) > 5 g/dl, OR 1.21 (CI 0.90–1.64), p = 0.118. There was no association between the malaria parasite density and severe anaemia. A similar proportion of those with severe anaemia regained consciousness within 24 hours compared to those with Hb > 5 g/dl (30 vs 42.5 %), OR 1.56 (0.65–3.71), p = 0.307.

Conclusions

The findings suggest that profound coma in cerebral malaria may not only result from primary malaria encephalitis but possibly also from a metabolic dysfunction due to severe anaemia.     

Nose and throat complications associated with passive smoking among Congolese school children

Objective

To assess associations between nose-throat (NT) diseases and passive smoking prevalence among school children.

Methods

A cross-sectional survey was carried out on a randomized multistage sample of 381 school children (50.9% males, aged 9.8 ± 3.5 years) from Kinshasa town. Parents and children were asked to fill in a questionnaire detailing their smoking habits. The NT symptoms and diseases were assessed by the survey NT specialist.

Results

The prevalence of passive smoking was 38.6% (n=147). Residence in peripheral areas, catholic school system, elementary level, exposure of family to passive smoking ,history of NT surgery, medicines and menthol inhaling, headache, nasal pain, dysphagia, odynophagia, dysosmia, dysphonia, pharyngeal irritation, dry throat, snooze, and chronic pharyngitis were more reported by passive smokers. After adjusting for confounding factors, passive smoking (OR=16.7 95%CI 3.3–83.3), catholic system(OR=2 95%CI 1.2–3.2), and elementary degree(OR=1.4 95%, CI 1.1–2.1) were identified as independent determinants of chronic pharyngitis.

Conclusion

Parents should not smoke in the same room used by their children.     

Prospective associations between intervention components and website engagement in a publicly available physical activity website: the case of 10,000 Steps Australia

Background

Effectiveness of and engagement with website-delivered physical activity interventions is moderate at best. Increased exposure to Internet interventions is reported to increase their effectiveness; however, there is a lack of knowledge about which specific intervention elements are able to maintain website engagement.

Objective

To prospectively study the associations of website engagement and exposure to intervention components for a publicly available physical activity website (10,000 Steps Australia).

Methods

Between June and July 2006 a total of 348 members of 10,000 Steps completed a Web-based survey to collect demographic characteristics. Website engagement was subsequently assessed over a 2-year period and included engagement data on website components; individual challenges, team challenges, and virtual walking buddies; and indicators of website engagement (average steps logged, days logging steps, and active users).

Results

On average participants logged steps on 169 (SD 228.25) days. Over a 2-year period this equated to an average of 1.6 logons per week. Binary logistic regression showed that individuals who participated in individual challenges were more likely to achieve an average of 10,000 steps per day (odds ratio [OR] = 2.80, 95% confidence interval [CI] 1.45–5.40), log steps on a higher than average number of days (OR = 6.81, 95% CI 2.87–13.31), and remain an active user (OR = 4.36, 95% CI 2.17–8.71). Additionally, those using virtual walking buddies (OR = 5.83, 95% CI 1.27–26.80) and of older age logged steps on a higher than average number of days. No significant associations were found for team challenges.

Conclusions

Overall engagement with the 10,000 Steps website was high, and the results demonstrate the relative effectiveness of interactive components to enhance website engagement. However, only exposure to the interactive individual challenge feature was positively associated with all website engagement indicators. More research is needed to examine the influence of intervention components on website engagement, as well as the relationship between website engagement and physical activity change.     

The influence of waist circumference on insulin resistance and nonalcoholic fatty liver disease in apparently healthy Korean adults

Background/Aims

Waist circumference (WC) is a risk factor for metabolic syndrome and is related to insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). The purpose of this study was to determine the association between WC and IR and NAFLD in apparently healthy Korean adults.

Methods

The volunteers included in this cross-sectional study comprised 9,159 adults (5,052 men, 4,107 women) who participated in a comprehensive health checkup program. IR was evaluated by the homeostasis model assessment of IR (HOMA-IR) and was considered to be present when the HOMA-IR score was >2. NAFLD was evaluated by ultrasound examination. Elevated alanine aminotransferase (ALT) was defined as >40 IU/L in men and >35 IU/L in women. Logistic regression was performed to determine the odds ratios (ORs) and 95% confidence intervals (95% CIs) for NAFLD, IR, and ALT according to categorized levels of WC.

Results

NAFLD was found in 2,553 (27.9%) of the participants (82.6% men, 17.4% women), while IR and elevated ALT were found in 17.2% (68.1% men, 31.9% women) and 10% (83% men, 17% women), respectively. After adjusting for confounding factors, the prevalence of NAFLD, IR, and elevated ALT was significantly associated with increases in WC quartile: highest quartile for NAFLD in men, OR=15.539, 95% CI=12.687-19.033; highest quartile for NAFLD in women, OR=48.732, 95% CI=23.918-99.288 (P<0.001); and highest quartile for IR in men, OR=17.576, 95% CI=13.283-23.255; highest quartile for IR in women, OR=11.078, 95% CI=7.813-15.708 (P<0.001); highest quartile for elevated ALT in men, OR=7.952, 95% CI=6.046-10.459; and highest quartile for elevated ALT in women, OR=8.487, 95% CI=4.679-15.395 (P<0.001).

Conclusions

WC contributes to IR and NAFLD in apparently healthy Korean adults, and thus may be an important factor in the development of IR and NAFLD.     

Short-Term Treatment with Metformin Improves the Cardiovascular Risk Profile in First-Degree Relatives of Subjects with Type 2 Diabetes Mellitus who have a Metabolic Syndrome and Normal Glucose Tolerance without Changes in C-Reactive Protein or Fibrinogen

OBJECTIVE:

To study if metformin, when administered to first-degree relatives of type 2 diabetes mellitus subjects who have metabolic syndrome and normal glucose tolerance, could improve the cardiovascular risk profile and reduce the levels of both C-reactive protein and fibrinogen.

INTRODUCTION:

Metabolic syndrome is associated with higher cardiovascular morbidity and mortality. Metformin has vasculo-protective effects even in normoglycemic subjects, and C-reactive protein and fibrinogen are considered markers of endothelial injury and inflammation.

METHODS:

Thirty-one non-diabetic first-degree relatives of type 2 diabetes mellitus subjects with metabolic syndrome were randomized (1:1) and double-blinded for placement in the placebo and metformin groups (850mg bid/±90days); 16 subjects were administered metformin (mean age 40.0 [33.5–50] years; 13 females) and 15 subjects were in the placebo group (mean age 37.0 [32–42] years; 9 females). Blood samples were collected at baseline and at the end of treatment for biochemical analyses, including an assessment of C-reactive protein and fibrinogen levels.

RESULTS:

Metformin improved the lipid profile and decreased fasting plasma glucose, systolic blood pressure, weight and body mass index without changing body composition. For those in the placebo we identified no changes in fibrinogen (282.2 [220.4–323.7] mg/L vs. 286.7 [249.6–295.1] mg/L; NS) or in C-reactive protein levels (0.68 [0.3–1.2] vs. 0.64 [0.3–1.0] mg/L; NS). The same was also observed for the levels of fibrinogen (303.9 [217.6–347.6] mg/L vs. 290.9 [251.5–301.9] mg/L; NS) and C-reactive proteins (0.78 [0.3–1.1] vs. 0.80 [0.4–0.9] mg/L; NS) in the metformin group.

CONCLUSIONS:

Metformin treatment in first-degree relatives of type 2 diabetes mellitus sufferers who have metabolic syndrome and normal glucose tolerance improved the cardiovascular risk profile without changing the levels of C-reactive protein and fibrinogen.     

Acupuncture for ��frequent attenders�� with medically unexplained symptoms: a randomised controlled trial (CACTUS study)

Background

Medically unexplained physical symptoms (MUPS) are common and difficult to treat.

Aim

To investigate the effectiveness of adding five-element acupuncture to usual care in ‘frequent attenders’ with MUPS.

Design and setting

Randomised controlled trial in four London general practices.

Method

Participants were 80 adults with MUPS, consulting GPs ≥8 times/year. The intervention was individualised five-element acupuncture, ≥12 sessions, immediately (acupuncture group) and after 26 weeks (control group). The primary outcome was 26-week Measure Yourself Medical Outcome Profile (MYMOP); secondary outcomes were wellbeing (W-BQ12), EQ-5D, and GP consultation rate. Intention-to-treat analysis was used, adjusting for baseline outcomes.

Results

Participants (80% female, mean age 50 years, mixed ethnicity) had high health-resource use. Problems were 59% musculoskeletal; 65% >1 year duration. The 26-week questionnaire response rate was 89%. Compared to baseline, the mean 26-week MYMOP improved by 1.0 (95% confidence interval [CI] = 0.4 to 1.5) in the acupuncture group and 0.6 (95% CI = 0.3 to 0.9) in the control group (adjusted mean difference: acupuncture versus control –0.6 [95% CI = –1.1 to 0] P = 0.05). Other between-group adjusted mean differences were: W-BQ12 4.4 (95% CI = 1.6 to 7.2) P = 0.002; EQ-5D index 0.03 (95% CI = –0.11 to 0.16) P = 0.70; consultation rate ratio 0.90 (95% CI = 0.70 to 1.15) P = 0.4; and number of medications 0.56 (95% CI = 0.47 to 1.6) P = 0.28. All differences favoured the acupuncture group. Imputation for missing values reduced the MYMOP adjusted mean difference to –0.4 (95% CI = –0.9 to 0.1) P = 0.12. Improvements in MYMOP and W-BQ12 were maintained at 52 weeks.

Conclusion

The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.     

The serum vitamin D level is inversely correlated with nonalcoholic fatty liver disease

Background/Aims:

A low vitamin D level has been associated with metabolic syndrome and diabetes. However, an association between a low vitamin D level and nonalcoholic fatty liver disease (NAFLD) has not yet been definitively established. This study aimed to characterize the relationship between a vitamin D level and NAFLD in Korea.

Methods:

A cross-sectional study involving 6,055 health check-up subjects was conducted. NAFLD was diagnosed on the basis of typical ultrasonographic findings and a history of alcohol consumption.

Results:

The subjects were aged 51.7±10.3 years (mean±SD) and 54.7% were female. NAFLD showed a significant inverse correlation with the vitamin D level after adjusting for age and sex [odds ratio (OR)=0.85, 95% confidence interval (CI)=0.75–0.96]. The age- and sex-adjusted prevalence of NAFLD decreased steadily with increasing vitamin D level [OR=0.74, 95% CI=0.60–0.90, lowest quintile (≤14.4 ng/mL) vs highest quintile (≥28.9 ng/mL), p for trend <0.001]. Multivariate regression analysis after adjusting for other metabolic factors revealed that NAFLD showed a significant inverse correlation with both the vitamin D level (>20 ng/mL) [OR=0.86, 95% CI=0.75-0.99] and the quintiles of the vitamin D level in a dose-dependent manner (p for trend=0.001).

Conclusions:

The serum level of vitamin D, even when within the normal range, was found to be inversely correlated with NAFLD in a dose-dependent manner. Vitamin D was found to be inversely correlated with NAFLD independent of known metabolic risk factors. These findings suggest that vitamin D exerts protective effects against NAFLD.     

Impact of lifestyle in middle-aged women on mortality: evidence from the Royal College of General Practitioners' Oral Contraception Study

Background

Although many individuals have multiple lifestyle risk factors, few studies have investigated the impact of lifestyle risk factor combinations among women.

Aim

To investigate the relationship between individual and combinations of lifestyle risk factors in middle-aged women with subsequent mortality, and to estimate the associated population attributable risks.

Design of study

Prospective cohort study.

Setting

Royal College of General Practitioners'' (RCGP) Oral Contraception Study, UK.

Method

In 1994–1995, women remaining under follow-up in the RCGP Oral Contraception Study were sent a lifestyle survey, from which modifiable risk factors were identified: pack-years smoked, physical inactivity, never drinking versus consuming at least 7 units of alcohol weekly, and being underweight, overweight, or obese. The cohort was followed to December 2006 or death. Population attributable risks were calculated.

Results

Of 10 059 women studied, 896 died. Pack-years smoked (11–20 years: adjusted hazard ratio [HR] = 1.82, 95% confidence interval [CI] = 1.46 to 2.27; >20 years: adjusted HR = 2.34, 95% CI = 2.00 to 2.74); never drinking alcohol (adjusted HR = 1.66, 95% CI = 1.34 to 2.05); being underweight (adjusted = HR 1.66, 95% CI = 1.03 to 2.68); and physical inactivity (<15 hours/week: adjusted HR = 1.73, 95% CI = 1.46 to 2.04) were significantly associated with mortality compared with their respective reference group. Women with multiple lifestyle risk factors had higher mortality risks than those reporting one factor. The population attributable risk of the combination of smoking, physical inactivity, body mass index outside normal range, and alcohol (never drinking or excess intake) was 59% (95% CI = 31% to 78%).

Conclusion

Assuming a causal relationship between lifestyle and mortality, avoidance of four lifestyle risk factors would have prevented 60% of the deaths. The importance of avoiding smoking and undertaking physical inactivity during midlife should continue to be emphasised.     

Predictors of eHealth Usage: Insights on The Digital Divide From the Health Information National Trends Survey 2012

Background

Recent eHealth developments have elevated the importance of assessing the extent to which technology has empowered patients and improved health, particularly among the most vulnerable populations. With noted disparities across racial and social groups in chronic health outcomes, such as cancer, obesity, and diabetes, it is essential that researchers examine any differences in the implementation, uptake, and impact of eHealth strategies across groups that bear a disproportionate burden of disease.

Objective

The goal was to examine eHealth use by sociodemographic factors, such as race/ethnicity, socioeconomic status (SES), age, and sex.

Methods

We drew data from National Cancer Institute’s 2012 Health Information National Trends Survey (HINTS) (N=3959) which is publicly available online. We estimated multivariable logistic regression models to assess sociodemographic predictors of eHealth use among adult Internet users (N=2358) across 3 health communication domains (health care, health information–seeking, and user-generated content/sharing).

Results

Among online adults, we saw no evidence of a digital use divide by race/ethnicity. However, there were significant differences in use by SES, particularly for health care and health information–seeking items. Patients with lower levels of education had significantly lower odds of going online to look for a health care provider (high school or less: OR 0.50, 95% CI 0.33-0.76) using email or the Internet to communicate with a doctor (high school or less: OR 0.46, 95% CI 0.29-0.72), tracking their personal health information online (high school or less: OR 0.53, 95% CI 0.32-0.84), using a website to help track diet, weight, and physical activity (high school or less: OR 0.64, 95% CI 0.42-0.98; some college: OR 0.67, 95% CI 0.49-0.93), or downloading health information to a mobile device (some college: OR 0.54, 95% CI 0.33-0.89). Being female was a consistent predictor of eHealth use across health care and user-generated content/sharing domains, whereas age was primarily influential for health information–seeking.

Conclusions

This study illustrates that lower SES, older, and male online US adults were less likely to engage in a number of eHealth activities compared to their counterparts. Future studies should assess issues of health literacy and eHealth literacy and their influence on eHealth engagement across social groups. Clinical care and public health communication efforts attempting to leverage Web 2.0 and 3.0 platforms should acknowledge differential eHealth usage to better address communication inequalities and persistent disparities in health.     

Sero-prevalence of herpes simplex type 2 virus (HSV-2) and HIV infection in Kampala,Uganda

Background

Prevalence of herpes simplex type 2 virus (HSV-2) is high worldwide. Previous studies in Uganda were rural or in women. We estimated age and sex-specific sero-prevalence of HSV-2 in Kampala, Uganda.

Methods

Using two-stage random sampling stratified on population density, a survey of persons 15–65 years was conducted. Type-specific serological tests for HSV-2, HSV-1(HerpeSelect2 and 1 ELISA), HIV (Rapid tests and ELISA), syphilis (RPR and TPHA) were done. Additional prevalence analysis included post-stratification weighting on the Uganda 2002 Census gender distribution.

Results

Among 1124 persons, HSV-2 prevalence was 58% (95% CI: 55, 60), HSV-1; 98% (95% CI: 97.6, 99.1), HIV; 17.7% (95% CI: 14.8, 19.2) and syphilis; 1.7% (95% CI: 1.4, 1.9). Weighted HSV-2 prevalence was 53.8% (Women; 63.8%, men; 43.2%), similar to unweighted data. Weighted HIV prevalence was 20.7% in women, 8.6% in men. Of 165 HIV infected persons, 85.4% had HSV-2. Risk factors for HSV-2 were being a woman (OR 2.0; 95% CI: 1.42, 2.78), age (OR 3.3; 95% CI: 2.43, 4.53), education (OR 1.70; 95% CI: 1.34, 2.34) and HIV (OR 4.5; 95% CI: 2.70, 7.50).

Conclusion

Prevalence of HSV-2 and HIV was high especially in women. Syphilis was rare. Awareness of herpes was low. Interventions in young people are needed.