The association between diet and height in the postinfancy period changes with age and socioeconomic status in Filipino youths

Whether the determinants of linear growth can have independent effects beyond the critical infancy period has been questioned. This research uses uniquely suited data from >2000 youths from the Cebu Longitudinal Health and Nutrition Study in the Philippines to examine the association between diet and height in the postinfancy period. Anthropometric, diet, and other data were collected bimonthly from 0 to 2 y, and at the mean ages of 8, 11.5, 15.5, and 18.5 y. Generalized Estimating Equations were used to quantify the mean effects of diet diversity and energy intake on height across increments demarcated by the postinfancy data (2-8.5, 8.5-11.5, 11.5-15.5, and 15.5-18.5 y). We examined whether the effects differed by socioeconomic status (SES) and age. Effects with P < 0.05 were considered significant. Each additional unit of diet variety (range 0-8 U) was associated with a significant 0.33-cm increase in height in boys. Each additional 100 kcal (4186 kJ) was associated with significant increases in height of 0.05 cm in boys, and 0.02 cm in girls. Significant interactions (P < 0.15) with SES showed that each 100 kcal increase in energy intake was associated with a 0.08-cm increase in height at low SES with no difference at high SES. In both boys and girls, the effects of energy intake decreased with age, as shown by a significant age interaction (P < 0.15). The methods used incorporate the longitudinal nature of the data to offer a unique examination of the association between diet and height in the postinfancy period.     

Pseudosyndactyly and musculoskeletal contractures in inherited epidermolysis bullosa: experience of the National Epidermolysis Bullosa Registry, 1986-2002

Mitten deformities of the hands and feet occur in nearly every patient with the most severe subtype (Hallopeau-Siemens) of recessive dystrophic epidermolysis bullosa, and in at least 40-50% of all other recessive dystrophic epidermolysis bullosa patients. Smaller numbers of patients with dominant dystrophic, junctional, and simplex types of epidermolysis bullosa are also at risk of this complication. Surgical intervention is commonly performed to correct these deformities, but recurrence and the need for repeated surgery are common. Higher numbers of epidermolysis bullosa patients also develop musculoskeletal contractures in other anatomic sites, further impairing overall function. Lifetable analyses not only better project the cumulative risk of mitten deformities and other contractures but also emphasize the need for early surveillance and intervention, since both of these musculoskeletal complications may occur within the first year of life.     

Preconception Stress,Birth Weight,and Birth Weight Disparities Among US Women

Objectives. We examined the impact of preconception acute and chronic stressors on offspring birth weight and racial/ethnic birth weight disparities.Methods. We included birth weights for singleton live first (n = 3512) and second (n = 1901) births to White, Mexican-origin Latina, other-origin Latina, and Black women reported at wave IV of the National Longitudinal Study of Adolescent Health (2007–2008; ages 24–32 years). We generated factor scores for preconception acute and chronic stressors from wave I (1994–1995; ages 11–19 years) or wave III (2001–2002; ages 18–26 years) for the same cohort of women.Results. Linear regression models indicated that chronic stressors, but not acute stressors, were inversely associated with birth weight for both first and second births (b = −192; 95% confidence interval = −270, −113; and b = −180; 95% confidence interval = −315, −45, respectively), and partially explained the disparities in birth weight between the minority racial/ethnic groups and Whites.Conclusions. Preconception chronic stressors contribute to restricted birth weight and to racial/ethnic birth weight disparities.Birth weight, a marker of infant health, predicts infant survival and subsequent health status. Low birth weight, defined as weight less than 2500 grams, is associated with increased risk of developing both short-term and long-term health problems.1 The prevalence of restricted birth weight has been increasing since the 1980s in the United States,2 and marked differences in birth weight persist by race/ethnicity.3,4 Limitations of prenatal care and other pregnancy interventions to address the increase over time and disparities in prevalence of adverse birth outcomes1,5 have led to a focus on preconception health, defined broadly as health before a pregnancy (although often used in public health practice to denote health during the reproductive years) and including interconception health, or health between pregnancies.6,7 Drawing on a life course framework,8–10 the concept of preconception health suggests that infants are affected not only by maternal exposures in the 9-month prenatal period, but also by maternal development before the pregnancy.One preconception exposure of interest is stress. Pearlin’s stress process model posits that social characteristics including those surrounding race/ethnicity in the United States lead to stress exposures that affect health,11–13 and has been used to understand elevated risk of adverse health outcomes among minority groups.14,15 It is worth noting that elevated stress is not inherent to persons of minority race/ethnicity, because race/ethnicity is a social construct and not a biological one. Rather, stress results from historical and societal constraints leading to differential life chances across groups.16In studies of its health consequences, stress was defined most frequently as exposure to an inventory of life events within a specified period of time.17 These acute stressors, such as a death in the family or exposure to a crime, are relatively brief in duration but may have continued ramifications.17,18 Consistent with a life course perspective, more recent studies examined chronic stressors as a risk factor for health outcomes.18,19 These stressful life conditions, including individual and neighborhood socioeconomic disadvantage, recur or accumulate throughout a respondent’s life. However, measurement of chronic stressors is less standardized across studies than that of acute stressors; validated scales of acute events19 but not chronic conditions have been developed.Physiologic mechanisms have been hypothesized to link maternal stress to maternal and infant health.20–22 For example, cumulative stress exposure may result in accelerated aging, or “weathering,” wearing down the body’s adaptive systems.21,22 Weathering in particular was proposed as a source of racial/ethnic disparities in perinatal health, such that the higher stress experienced by African American women causes their reproductive functioning to deteriorate more rapidly than that of White women.22 Other possible pathways through which stress can lead to birth outcome disparities include infection,23 nutrition,19 and pregnancy complications.24The majority of studies assessing the effects on birth outcomes of stress and related factors have relied on prenatal measurement with mixed results.19,25,26 A smaller number of studies have examined effects of acute stressors or specific chronic stressors in the reproductive period.27–30 Although several of these analyses suggested associations, this work included limitations such as small sample sizes,27 European cohorts not generalizable to the United States,29 or retrospectively reported preconception measures.30 Furthermore, none included both acute and chronic stressors or compared racial/ethnic differences for groups besides non-Hispanic Black and non-Hispanic White.To address these gaps in the literature, the objective of this study was to examine the impact of maternal preconception acute stressors (or stressful life events) and preconception chronic stressors (or stressful life conditions) on offspring birth weight and racial/ethnic birth weight disparities. Our hypotheses were as follows: (1) acute and chronic stressors will be inversely associated with birth weight, (2) the distributions of birth weight and stress will vary by maternal race/ethnicity, and (3) stress will partially explain racial/ethnic differences in birth weight where such differences exist. Our conceptual model is shown in Figure 1.Open in a separate windowFIGURE 1—Conceptual model depicting hypothesized relationships among maternal race/ethnicity, preconception stress, and offspring birth weight: National Longitudinal Study of Adolescent Health, United States, 1994–2008.     

Constraints to caring: service to medically indigent patients by allopathic and osteopathic physicians

Most U.S. physicians limit their care of medically indigent populations, rendering millions of patients underserved. Using survey data from a national sample of 669 allopathic and osteopathic physicians, this paper explores the professional, demographic, and attitudinal correlates of care of medically indigent (Medicaid and uninsured) patients. Separate bivariate and multivariate data analyses for allopathic and osteopathic physicians generate path models of the influences of physician characteristics on care of indigent patients. For both physician groups, professional characteristics such as practice type, location, medical specialty, and perceptions of the medical system shape care of indigent patients. Differential patterns of association emerge, with care provided by osteopathic physicians most significantly influenced by private practice, while medical specialty and employment in community clinics shapes indigent care provided by allopathic physicians. Results highlight the utility of comparative analyses in discerning the mechanisms through which professional characteristics influence indigent care by diverse health providers.     

Infrequent chlamydial testing among young adults: financial and regional differences

OBJECTIVES: Chlamydia prevalence varies regionally but is highest in the South, which could be the result of regional differences in testing behavior. We describe the national and regional prevalence of self-reported chlamydial infection (Ct) testing and examine how financial resources might be associated with Ct testing. METHODS: We conducted a cross-sectional analysis of data from 12,334 sexually experienced young adults who participated in wave III of the National Longitudinal Study of Adolescent Health (2001-2002). We estimated the prevalence of Ct testing by region and gender, and calculated prevalence odds ratios for the relationship between income or insurance status and Ct testing. RESULTS: Among women, Ct testing in the past year was low (27.3%; 95% CI, 25.5-29.2) and lowest in the South (24.8%). Compared with publicly insured females, privately insured (OR, 0.72; 95% CI, 0.57-0.92) and uninsured females (OR, 0.63; 95% CI, 0.48-0.88) were less likely to report testing. Young women with low income were more likely to report testing than those with a higher income (OR, 1.36; 95% CI, 1.12-1.66). Men reported similar testing patterns. CONCLUSIONS: The South has the highest chlamydia prevalence and the lowest levels of Ct testing in the United States. Reducing infection prevalence and regional disparities in the burden of this infection requires region-focused funding and innovative strategies to increase testing and treatment programs.     

Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study

A cohort of 2270 white women, aged 40-69 years at baseline, were followed for an average of 8.5 years in the Lipid Research Clinics Program Follow-up Study. There were 44 deaths due to cardiovascular disease among the 1677 nonusers of estrogens and six cardiovascular disease deaths among the 593 estrogen users. The age-adjusted relative risk (RR) of cardiovascular disease deaths in users compared with nonusers was 0.34 (95% confidence limits 0.12 to 0.81). After multivariable adjustment for potential confounding factors (age, blood pressure, and smoking), the estimated RR for estrogen use was 0.37 (95% confidence limits 0.16 to 0.88). Analyses were done to explore whether these results could be due to selection bias for estrogen use. However, the prevalence of cardiovascular disease at baseline was slightly higher in estrogen users (12%) than in nonusers (10%); furthermore, the exclusion of all women with prevalent cardiovascular disease at baseline did not alter the apparent protective effect of estrogen use on cardiovascular disease mortality (RR = 0.42, 95% confidence limits 0.13 to 1.10). Additional analyses examining the complex association between estrogen use, lipoprotein levels, and cardiovascular disease mortality suggest that the protective effect of estrogen is substantially mediated through increased high-density lipoprotein levels.     

Impact of inherited epidermolysis bullosa on parental interpersonal relationships, marital status and family size

BACKGROUND: The presence in a family of a child or children with epidermolysis bullosa (EB) may have profound psychological implications for other family members. OBJECTIVES: To assess the impact of the presence of EB in one or more children on the personal relationships between their parents. METHODS: Standardized questionnaires were used. RESULTS: In general, the presence of a child severely affected with EB had profound effects on many aspects of marriage. This included a lack of interest in participating in activities as couples [junctional EB (JEB), 45%; recessive dystrophic EB (RDEB), 25%], a lack of energy to invest in such pursuits (JEB, 82%; RDEB, 50%), limitations in opportunities for sharing nonintimate physical activities (reported by most parents having children with some type of generalized EB), and negatively altered parental sex life (JEB, 55%; RDEB, 39%). This is consistent with the fact that 10%, 64%, 25% and 36% of parents of an affected child with EB simplex (EBS), JEB, dominant dystrophic EB (DDEB) and RDEB, respectively, characterized their relationships as couples as revolving almost exclusively around the day-to-day care of their affected children. The severity of disease in an affected child clearly influenced parental decisions about having more children: 24% and 64% of parents of children with JEB and RDEB, respectively, chose not to have additional children, compared with 26% and 54% of parents with children having EBS or DDEB. This choice was most often pursued via tubal ligation; less often, alternative means of surgical sterilization were chosen. Divorce was common among parents of children with EB (range: 17% in EBS to 31% in JEB) and, with the exception of parents of children with EBS, was usually directly attributed by one or both parents to the profound impact that this disease had exerted on their marriage. CONCLUSIONS: Physicians caring for children with EB need to give more consideration to the many psychological factors that may contribute to their patients' well being. They may need to assist these children's parents in seeking support and counselling to prevent destruction of the family unit.     

Neighborhood socioeconomic status,Medicaid coverage and medical management of myocardial infarction: Atherosclerosis risk in communities (ARIC) community surveillance

Background  

Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been systematically examined, even though healthcare utilization likely influences morbidity and mortality post-MI. This study aims to investigate the association between socioeconomic factors and receipt of evidence-based treatments post-MI in a community surveillance setting.