Effectiveness of the Complete Health Improvement Program in a Geriatric Population.

The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65 years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level (P < .001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables (P > .05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population.

Comparison of the immunogenicity and safety of Euvichol-Plus with Shanchol in healthy Indian adults and children: an open-label, randomised, multicentre, non-inferiority, parallel-group, phase 3 trial.

Background: Considering the cholera menace in India and to seek licensure of the oral cholera vaccine (OCV), Euvichol-Plus, we conducted a clinical trial to compare the immunogenicity and safety of Euvichol-Plus with Shanchol in healthy Indian adults and children. Methods: This phase 3, open-label, multicentre, randomised, non-inferiority, parallel-group, comparative study was conducted at seven sites across India involving 416 healthy adults (aged ≥18-60 years) and children (aged ≥1 to <18 years). Healthy individuals who agreed to participate through a voluntary written informed consent form along with oral or written assent (for children aged 7-18 years) were included. No assent was required for those <7 years, as consent was given by the legally acceptable representatives (LAR). Participants were randomised 1:1 to receive two doses of either Euvichol-Plus or Shanchol orally, 14 days apart. The first dose (1.5 ml) was administered on visit 1, and the second dose at 2 weeks after the first dose during visit 2. Participants were followed up telephonically for 3 consecutive days after each visit and returned for final assessment at 2 weeks after the second dose (visit 3). Blood samples were collected for immunogenicity assessment, and safety analyses were done during all the visits. The primary immunogenicity endpoint was the percentage of participants with ≥4-fold increase in anti-Vibrio cholerae (V. cholerae) O1 Ogawa and O1 Inaba (vibriocidal) antibody titres at 2 weeks after the second dose as compared to baseline titres prior to dosing. The secondary immunogenicity endpoints included the percentage of participants with ≥4-fold increase in anti-V. cholerae O139 antibody titres at 2 weeks after the second dose as compared to baseline titres, and geometric mean titres (GMT) and geometric mean ratios (GMR) as measured by anti-V. cholerae O1 Ogawa, O1 Inaba, and O139 antibody titres at 2 weeks after the second dose as compared to baseline titres. The safety endpoints included assessment of solicited, unsolicited adverse events (AEs), and serious adverse events (SAEs). The clinical trial was registered with the Clinical Trials Registry of India (CTRI/2021/08/035344). Findings: The study was performed in two age cohorts: cohort 1 (aged ≥18-60 years, 208 participants [104 in Euvichol-Plus group and 104 in Shanchol group]), and cohort 2 (aged ≥1 to <18 years, 208 participants [104 in Euvichol-Plus group and 104 in Shanchol group]). A total of 414 participants (Euvichol-Plus: 206 and Shanchol: 208) who completed the study (intention-to-treat and per-protocol set) were analysed to compare the vibriocidal titre as an index for immunogenicity. At 2 weeks after the second dose, the percentage of participants in the Euvichol-Plus group who reported a ≥4-fold increase in anti-V. cholerae antibody titres were 68.93% (O1 Ogawa) [95% CI 62.13%-75.18%], 66.02% (O1 Inaba) [95% CI 59.11%-72.46%], and 59.71% (O139) [95% CI 52.67%-66.47%] as compared to 63.94% (O1 Ogawa) [95% CI 57.01%-70.47%], 65.87% (O1 Inaba) [95% CI 58.99%-72.28%], and 56.25% (O139) [95% CI 49.22%-63.10%] in the Shanchol group. The lower limit of 95% CI for treatment difference for all the antibody titres was ≥10% (non-inferiority margin), demonstrating that Euvichol-Plus was non-inferior to Shanchol. The post-vaccination GMT (Day 14 and 28) were more than the pre-vaccination GMT for all three serotypes in both groups. The GMR obtained for Euvichol-Plus over Shanchol for O1 Ogawa, O1 Inaba, and O139 serotypes was >1, indicating non-inferiority of Euvichol-Plus to Shanchol. The safety cohort included 416 participants. Headache was the most common solicited AE, whereas cold and cough were the most common unsolicited AEs in both groups. Interpretation: Euvichol-Plus appears to be non-inferior to Shanchol in terms of immunogenicity and safety in healthy Indian adults and children. Funding: Techinvention Lifecare Private Limited, Mumbai, India.

Beyond antibiotics: phage-encoded lysins against Gram-negative pathogens.

Antibiotics remain the frontline agents for treating deadly bacterial pathogens. However, the indiscriminate use of these valuable agents has led to an alarming rise in AMR. The antibiotic pipeline is insufficient to tackle the AMR threat, especially with respect to the WHO critical category of priority Gram-negative pathogens, which have become a serious problem as nosocomial and community infections and pose a threat globally. The AMR pandemic requires solutions that provide novel antibacterial agents that are not only effective but against which bacteria are less likely to gain resistance. In this regard, natural or engineered phage-encoded lysins (enzybiotics) armed with numerous features represent an attractive alternative to the currently available antibiotics. Several lysins have exhibited promising efficacy and safety against Gram-positive pathogens, with some in late stages of clinical development and some commercially available. However, in the case of Gram-negative bacteria, the outer membrane acts as a formidable barrier; hence, lysins are often used in combination with OMPs or engineered to overcome the outer membrane barrier. In this review, we have briefly explained AMR and the initiatives taken by different organizations globally to tackle the AMR threat at different levels. We bring forth the promising potential and challenges of lysins, focusing on the WHO critical category of priority Gram-negative bacteria and lysins under investigation for these pathogens, along with the challenges associated with developing them as therapeutics within the existing regulatory framework.

The association between COVID-19 preventive behaviors and mental health conditions.

BACKGROUND: An unintended consequence of COVID-19 quarantine preventive measures, is the increased prevalence of anxiety and depression. The purpose of this study was to examine the association between COVID-19 preventive behaviors and mental health conditions. METHODS: A cross-sectional study was conducted using secondary data collected weekly from US adults aged 18 and older nationwide as part of the COVID-19 Household Impact Survey (CIS) from the University of Chicago. Logistic regression examined associations between COVID-19 preventive behaviors (wearing a face mask, washing or sanitizing hands, and keeping six-feet distance from those outside their household), mental health conditions (self-reporting feeling nervous, anxious, or on edge, feeling lonely, and feeling hopeless about the future and a history of a mental health condition) and demographic factors. RESULTS: Majority of study participants were under 60 years (62.2%), female (55.8%), and non-Hispanic White (72.2%). Overall, participants more likely to have followed all three COVID-19 measures were those who reported high psychological distress compared to those with low distress for feeling anxious (adj. OR 1.16, 95% CI: 1.06-1.28, p = 0.002), lonely (adj. OR 1.12, 95% CI: 1.02-1.23, p = 0.019) or hopeless (adj. OR 1.10, 95% CI: 1.00-1.21, p = 0.043) for more than a day during the past 7 days. CONCLUSION: Our findings highlight that individuals with mental health conditions reported more psychological distress. Specifically, feeling depressed, anxious, lonely, and hopeless were triggered and exacerbated as a result of the pandemic and may have long-term effects on general well-being and productivity. Therefore, our findings have important implications on the need to include mental health promotion as part of pandemic response efforts. This includes developing policies and allocating funding so as to ensure sustainable mental health interventions and support, public and provider education on the importance of screening for mental health issues.

Factors Influencing COVID-19 Prevention Behaviors.

COVID-19 remains a public health emergency with prevention guidelines and mitigation strategies being constantly updated to curb the rapid spread of the disease. Despite proven successes of recommended preventive behaviors, there is low uptake of wearing a mask, washing of hands, and social distancing in the United States (US). The purpose of this study was to examine factors that influence COVID-19 preventive behaviors. We used data from the nationally representative COVID-19 Household Impact Survey (n = 19,815) conducted in the US from April to June 2020. Chi-square (χ2) test and bivariate analyses were performed to compare study participants who used all COVID-19 related preventive behaviors and those who did not, and multivariate logistic regressions to determine associations across demographic and social characteristics. Of the 19,815 participants, 79.2% of participants reported practicing the aforementioned COVID-19 preventive behaviors. Further, non-Hispanic white, Spanish speaking, living in urban areas, of older age (60+), being female, having an education above an undergraduate, those with income levels $100K or more, living in the urban northeast region that trust and communicate frequently with family and neighbors were more likely to use all three preventive behaviors. Findings suggest a need for continued provision of information on prevention and vaccination importance, but expand efforts to target adopters of these behaviors and encourage them to share their uptake and adherence efforts. This type of horizontal communication where information is shared within trusted social networks can shape social norms that influence the uptake of COVID-19 preventive behaviors and slowly curb communal spread.

The Impact of the Fascia Iliaca Block Beyond Perioperative Pain Control in Hip Fractures: A Retrospective Review.

Background: Geriatric hip fractures are common injuries that are associated with high morbidity and mortality. Adequate pain control remains a challenge as the altered physiology in elderly patients makes use of traditional analgesics challenging. The use of regional anesthetics, specifically the fascia iliaca compartment block (FICB), in the perioperative period has been shown to decrease opioid use in this population. This study aimed to investigate the effect the FICB had on pain control, length of stay, readmissions, and complications in a 30-day postoperative period. Methods: This was a retrospective cohort study comparing patients who sustained hip fractures; one cohort (110 patients) received a preoperative fascia iliaca block with continuous infusion (FICB), whereas the other cohort (110 patients) did not receive a block (NO-FICB). Both cohorts were from level II trauma centers. Data were collected between 2016 and 2019. Descriptive statistics was performed to describe and summarize the data. Bivariate analysis was performed using chi-square test, with 2 tailed P-values ≤ .05 were considered statistically significant. Results: The FICB group had a lower length of stay (3.9 days vs 4.8 days; P < .001), and lower pain scores on post-operative days 2 and 3 (P = .019). There was no difference in time from admission to surgery (P = .112) or narcotic use between cohorts (P = .304). However, the FICB group was more likely to discharge to a skilled nursing facility (P=.002), and more likely to be readmitted within 30 days (P = .047). There were no differences in medical complications or mortality between the 2 groups. Conclusions: The primary study endpoint, length of stay, was found to be significantly shorter in the patients who underwent the FICB vs the group who did not undergo the FICB. Pain scores on POD2 and POD3 were lower in patients who received a FICB. This study adds to the body of evidence that the FICB is an effective addition to a multimodal pain pathway. Level of Evidence: Level III Evidence - Retrospective Cohort Study.

Association between serum zinc levels and basic physical functioning: secondary data analysis of NHANES 2011-14.

BACKGROUND: Serum zinc (Zn) levels have been shown to be associated with functional status; however, it is not clear whether this association differs by other sociodemographic characteristics. We examined the association between serum Zn levels and physical functioning difficulty in a representative sample of older adults in the US. DESIGN AND METHODS: A cross-sectional study was conducted on participants 50 years and older from the 2011-12 and 2013-14 National Health and Nutrition Examination Surveys (n = 1136). Serum Zn levels were analyzed as tertiles. The main outcome of interest was physical functioning difficulty, defined as self-reported difficulty of basic physical functioning that included walking, transferring, dressing, and feeding. RESULTS: Mean Zn levels (SE) were 0.67(0.1), 0.81(0.1), and 0.98(0.1) µg/mL in the low, middle, and high Zn groups, respectively. Approximately 24.9% participants reported physical functioning difficulty. In the multivariable model, we found a significant multiplicative interaction between sex and serum Zn (P for interaction =0.028) and between education and serum Zn (P for interaction = 0.001) on basic physical functioning difficulty. The stratified analysis revealed that among men, compared to those with low serum Zn, the odds of having physical functioning difficulty were lower in men who had high serum Zn [aOR 0.43 (95% CI: 0.25-0.76)]. For women, compared to those with low serum Zn the odds of having physical functioning difficulty were higher in women who had middle serum Zn [aOR 2.67 (1.58-4.50)]. Among individuals with less than high school education, the odds of having physical functioning difficulty were lower in those who had middle serum Zn compared to those who had low serum Zn [aOR 0.48 (0.26-0.89)]. However, the odds of having physical functioning difficulty were higher in those who had middle serum Zn compared to those who had low serum Zn for individuals with high school [aOR 5.72 (1.92-17.00)] and beyond high school education [aOR 1.77 (1.05-2.97)], respectively. CONCLUSION: Sex and educational attainment interact with serum Zn levels to influence basic physical functioning difficulty in older adults.

Retrospective Evaluation of an Online Diabetes Health Coaching Program: A Pilot Study.

An estimated one third of American adults have prediabetes; over 30 million have type 2 diabetes mellitus. Health and wellness coaching is an emerging tool for preventing and treating chronic disease. Mastering Diabetes (MD) promotes a low-fat, plant-based, whole-food diet, utilizing online education, day-to-day accountability and support, and video conferencing. This pilot study provides a retrospective view of the effectiveness of MD to treat diabetes. Current and former clients of MD were invited to participate in a survey. On completion of the online consent, subjects were asked a series of questions in a REDCap-based survey: age, gender, enrollment date in MD, changes in weight, HbA1c, medication use, overall health, and current level of adherence to achieved changes. Overall, 253 (8.9%) participants responded to the survey; 80.6% were females, mean age was 56 years. Most of those responding (78.4%, P < .001) reported weight loss; 68.8% (P < .001) reported decreased HbA1c; 52.4% reported decreased medication use; 86.8% reported continued health improvement since having participated in MD; and 83.5% found the online program very helpful. This study demonstrated improvement in HbA1c and weight in participants in an online health and wellness coaching. Study limitations prevent drawing generalizable conclusions; further prospective evaluation is needed.

The benefit of negative pressure dressings in vascular surgery patients with infrainguinal incisions.

OBJECTIVE: Within the vascular patient population, there is an increased risk of developing wound complications especially in infrainguinal incisions. There has been increasing interest in using closed incisional negative pressure dressings to decrease the risk of wound complications. To assess the efficacy of these incisional wound dressings, we studied surgical site infections (SSI) and seroma rates of infrainguinal incisions in our vascular patient population. METHODS: This was a multi-institutional, retrospective study from July 2015 to June 2019. In 2017, our institution began using the Prevena incisional wound system. Wound complication rates were compared with the non-Prevena group before 2017. There were a total of 100 infrainguinal incisions (left and right combined) that received the Prevena wound system and 138 infrainguinal incisions that had not. The primary end point was to assess for wound complication rates, including SSIs and seroma formation. SSIs were graded based on the American College of Surgeons National Surgical Quality Improvement Plan SSI criteria. Seroma formation was diagnosed based on clinical diagnosis, imaging studies (ultrasound examination, computed tomography scan) or needle aspiration of fluid collection. RESULTS: This analysis showed a statistically significant decrease in the rate of SSIs in the Prevena group when compared with the non-Prevena group (P = .012). There was no statistical difference between the two groups in the rate of seroma formation (P = .155). Of the 100 incisions that received the Prevena wound system, 1.2% (1/82) had a femoral SSI and 22.0% (4/18) had a popliteal SSI. For seroma formation, 24.4% (20/82) had a femoral seroma and 11.1% (2/18) had a popliteal seroma. Of the 138 incisions that did not have the Prevena wound system, 9.6% (10/104) had a femoral SSI and 8.8% (3/34) had a popliteal SSI. For seroma formation, 24.0% (25/104) had a femoral seroma and 8.8% (3/34) had a popliteal seroma. Comorbid conditions were assessed in the two study groups and there was no statistical significance regarding rates of SSIs between the groups. CONCLUSIONS: The use of an incisional negative pressure dressing decreases the rate of SSIs in infrainguinal incisions. Regarding the use of these wound systems for seromas, our study did not show a statistically significant decrease in seroma rates.

Toward Resilience: Medical Students' Perception of Social Support.

CONTEXT: There is strong evidence that social support-particularly perceived social support-functions as a protective factor for health. Few studies have investigated how medical students perceive the types of social support they experience. OBJECTIVE: To determine how osteopathic medical students perceive social support, understand the factors that influence their perceptions, and explore how group participation in a cocurricular, academic program could affect student perceptions. METHODS: In this cross-sectional study of 983 medical students at a multicampus osteopathic medical school in the Midwest, potential respondents were invited by email in March 2018 to participate in a self-reported evaluation of their perceived social support using a 40-question Interpersonal Support Evaluation List (ISEL). The demographic variables included gender, race, age, current phase in medical school, Hispanic heritage, campus assignment, and hometown population type. A total score for each type of social support and a summative score for overall perceived social support were calculated. Descriptive statistics were applied to provide a summary of the distribution of study variables. Bivariate analyses were conducted using student t test and analysis of variance (ANOVA) statistic to determine distribution of 4 social support constructs and overall social support by all the study variables; α < .05 was considered statistically significant. Linear regression analysis was performed to determine the association between all study variables and 4 social support constructs. Pairwise interactions were calculated to determine whether the association differed by any of the study variables. RESULTS: Self-esteem support was the lowest type of perceived social support overall in the total sample (mean [SD], 23.5[2.0]). Hispanic students reported lower overall mean perceived social support than those who did not identify as Hispanic (100 vs 104; P=.04). Older study participants had higher mean tangible support compared with their younger counterparts (26.25 vs. 25.60, P=.018; t [264]=1.18). Older study participants also had higher mean appraisal support compared with their younger counterparts (26.57 vs. 25.92, P=.06; t [266]=1.27). Female medical students reported lower levels of belonging support overall (mean [SD] 26.79, [2.10]). Students from rural hometowns reported a higher sense of belonging support than any other group. Female students from suburban and urban hometowns reported lower levels of belonging support compared with women from rural hometowns (Adj. ß=-0.96, P=.01). Students who participated in the rural and urban underserved program had higher self esteem support compared with those who did not participate in the rural and urban underserved program (Adj. ß=-1.30, P=.05). Students in the clinical phase of medical education reported lower levels of belonging support than students in the preclinical phase (26.14 vs. 26.69, P=.05; t[256]=1.07). CONCLUSIONS: It is critical to understand the ways medical students experience social support and the factors that contribute to it. Longitudinal studies following medical students over time would contribute to a more complete understanding of social support in medical students as they move from preclinical to the clinical phases of medical school.

Student Journal Club to Improve Cultural Humility with LGBTQ Patients.

Health degree programs provide opportunities to reduce disparities in care for LGBTQ patients by exposing students to LGBTQ communities and current health issues. However, LGBTQ content is mostly absent from medical school curricula. This mixed method assessment study, conducted during the 2018 to 2019 academic year, examined the feasibility of implementing a medical student journal club focused specifically on LGBTQ health issues as a complementary training tool to support efforts to create an inclusive educational environment. Compared to the pre-test, mean response scores increased for most of the parameters including familiarity with LGBTQ healthcare issues, confidence in the ability to identify harmful medical provider practices, and reading and assessing scientific literature. Qualitative data showed increased confidence, comfort and knowledge about LGBTQ health barriers. This study offers a framework for using a journal club to provide an effective platform for enhancing students' LGBTQ cultural humility and research literacy.

Association Between E-cigarette Use and Depression in US Adults.

OBJECTIVES: Electronic cigarette (e-cigarette) use has recently increased among adults in the United States. Previous studies have identified physical health outcomes associated with e-cigarettes. Few studies have examined the relationship between e-cigarette use and mental health outcomes. This study aimed to investigate the relationship between e-cigarette use and depression. METHODS: The present cross-sectional study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) in the United States (n = 11918). RESULTS: Overall, 3.7% and 11.2% of the participants were current and former e-cigarette users, respectively. A significantly higher proportion of current e-cigarette users reported having depression (32.4%) than former users (27.3%) and non-users (16.0%). In the multivariable model, we found significant interactions between marital status, employment status, marijuana use and e-cigarette use on depression. Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among unemployed current e-cigarette users (OR = 2.85, 95% CI = 1.63, 4.97) and unemployed former e-cigarette users (OR = 1.89, 95% CI = 1.26, 2.84). Compared to people who do not use marijuana, the odds of self-reported depression were higher among marijuana users who were also current e-cigarette users (OR = 1.68, 95% CI = 1.08, 2.61) and former e-cigarette users (OR = 1.35, 95% CI = 1.07, 1.71). Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among widowed/divorced/separated participants who were current e-cigarette users (OR = 3.42, 95% CI = 1.60, 7.29) and former e-cigarette users (OR = 1.55, 95% CI = 1.03, 2.34). CONCLUSION: In a representative sample of adults in the United States e-cigarette use is associated with depression, predominantly in widowed/divorced/separated, unemployed and people who use marijuana. This association was independent of potential cofounders.

Combined Influence of Gestational Diabetes and Gestational Weight Gain on Exclusive Breastfeeding.

Background: Over half of pregnant women in the United States do not meet the recommended gestational weight gain (GWG). In addition, the prevalence of gestational diabetes mellitus (GDM) is increasing. We examined the combined influence of GDM and GWG on breastfeeding practices on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Materials and Methods: A cross-sectional study was performed on 173,603 women from the pregnancy risk assessment monitoring system, 2009-2015. Descriptive statistics and multivariable logistic regression modeling were performed. Results: The prevalence of GDM was 9.5%. Only 30.7% of women had weight gain within the Institute of Medicine (IOM) recommended guidelines. Approximately 21.7% and 10.3% of the participants exclusively breastfed their infants during the neonatal period and at 3 months postpartum, respectively. After adjusting for potential confounders, there was a significant multiplicative interaction between GWG and GDM on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Among women with normal and excessive GWG, the odds of exclusively breastfeeding during the neonatal period were lower for women with GDM compared with women without GDM (odds ratio, 95% confidence interval: 0.74, 0.64-0.85 and 0.75, 0.66-0.85, respectively). Similarly, among women with normal and excessive GWG, the odds of exclusively breastfeeding at 3 months postpartum were lower for women with GDM compared to women without GDM (0.67, 0.55-0.81 and 0.71, 0.60-0.85, respectively). Conclusion: With the increasing prevalence of GDM and weight gain outside the IOM guidelines, it is critical to identify populations at risk and to promote exclusive breastfeeding practices.

Association Between Maternal Feeding Practices and Symptoms of Anxiety and Depression Among 6-Year-Old Children.

BACKGROUND: Maternal feeding practices (MFPs) have been linked to childhood obesity and other eating disorders. However, population-based research examining the association between MFPs and children's emotional well-being is currently lacking. METHODS: We examined 1241 participants from Year 6 Follow-Up of the Infant Feeding Practices Study II, conducted from March to June 2012 in the United States. RESULTS: Approximately 57.5% and 47.8% of participants reported at least one symptom of childhood anxiety and depression, respectively. After adjusting for potential confounders, mothers who responded "yes" to "If I did not guide or regulate my child's eating, he or she would eat too much of his or her favorite food" had higher odds of having a child who has symptoms of depression and anxiety compared with mothers who responded "no" (odds ratio [OR], 95% confidence interval [CI]) (2.02; 1.47-2.78, P < .001) and (1.41, 1.05-1.91, P = .024), respectively. The odds of having a child who has symptoms of depression were lower among mothers who responded "yes" to "I make sure that my child does not eat too many sweets or junk foods" compared with mothers who responded "no" (0.49; 0.26-0.91, P = .020). Mothers who responded "yes" to "I encourage my 6 year-old to eat all of the food on his or her plate" had higher odds of having a child who has symptoms of anxiety compared with mothers who responded "no" (1.43; 1.01-2.05, P = .049). CONCLUSIONS: Controlling MFPs may influence a child's emotional well-being. Further research is needed to address the complex relationships between MFPs and psychosocial well-being in children.

Gestational weight gain and unplanned or emergency cesarean delivery in the United States.

BACKGROUND: In the United States, the rates of cesarean delivery are well above the World Health Organization recommended target. Although obesity is a widely established risk factor for cesarean delivery, there is limited population-based research that examines the relationship between gestational weight gain and cesarean delivery. OBJECTIVE: To determine the association between gestational weight gain and unplanned or emergency cesarean delivery. METHODS: We examined 2107 mothers from the Infant Feeding Practices Study II 2005-2007. The Institute of Medicine's current guidelines were used to define categories of gestational weight gain: inadequate (less than the recommended guideline), adequate (within the recommended guideline) and excessive (above the recommended guideline). FINDINGS: Approximately 49.3% and 13.6% of the participants had excessive weight gain and unplanned or emergency cesarean delivery, respectively. A Greater proportion of women with excessive weight gain had an unplanned or emergency cesarean delivery followed by women with adequate and inadequate weight gain, respectively (17.8%, 10.0%, 8.8%; p<0.001). In the multivariable model, compared to women with adequate weight gain, the odds of unplanned or emergency cesarean delivery were higher among women with excessive weight gain (OR 1.56, 95% CI 1.07-2.27, p=0.020). DISCUSSION: Women with excessive gestational weight gain are more likely to experience an unplanned or emergency cesarean delivery, which increases the risk for poor maternal-infant health outcomes. CONCLUSION: It is critical to identify populations at increased risk of unplanned or emergency cesarean delivery and provide preconception and prenatal counseling to achieve and maintain the recommended weight gain for optimal maternal-infant health outcomes.

The moderating role of race/ethnicity on associations between insurance status and HPV vaccination among women in the USA.

OBJECTIVE: To evaluate associations between insurance status and HPV vaccination. METHODS: The present cross-sectional study analyzed data from women aged 18-26 years who participated in the National Health and Nutritional Examination Surveys 2009-2012 in the USA. RESULTS: The study included 621 women; 424 (68.3%) had some type of insurance and 198 (30.6%) had received the HPV vaccine. In the multivariable model, we found significant interactions between race/ethnicity and insurance status on receiving HPV vaccination. Compared with individuals with no insurance, non-Hispanic black women with any type of insurance demonstrated increased likelihood of HPV vaccination (adjusted odds ratio [aOR] 3.63, 95% confidence interval [CI] 1.60-8.21; P=0.002). Among Mexican Americans, there was a negative association between having some insurance and HPV vaccination (aOR 0.35, 95% CI 0.15-0.81; P=0.007). For non-Hispanic black women, the association remained significant across all insurance types (private [aOR 4.29, 95% CI 1.67-11.00; P=0.003], Medicaid [aOR 2.86, 95% CI 1.15-7.13; P=0.025], and other [aOR 4.74, 95% CI 1.06-21.15; P=0.042]). Non-Hispanic white women with insurance other than private or Medicaid had a higher likelihood of HPV vaccination compared with uninsured individuals (aOR 8.36, 95% CI 2.79-25.05; P<0.001). CONCLUSION: The present findings help to identify at-risk populations less likely to receive the HPV vaccine.

Factors That Modify the Association of Maternal Postpartum Smoking and Exclusive Breastfeeding Rates.

BACKGROUND AND OBJECTIVE: Maternal postpartum smoking increases the risk for poor infant health outcomes, while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding. The objective of this study was to examine factors modifying the association between maternal postpartum smoking and exclusive breastfeeding among women in the United States. METHODS: Secondary data analysis was conducted using the 2009-2011 Pregnancy Risk Assessment Monitoring System. Stratified analyses were used to examine the associations between maternal postpartum smoking and exclusive breastfeeding by sociodemographic factors. RESULTS: The postpartum smoking rate was 17.1%. The relationship between postpartum smoking and exclusive breastfeeding at 12 weeks varied by maternal education level, race/ethnicity, Medicaid use, and pregestational or gestational diabetes. The magnitude of reduction in the odds of exclusive breastfeeding at 12 weeks postpartum among the women who smoked in the postpartum period ranges from odds ratio (95% confidence interval) 0.52 (0.37-0.74) for non-Hispanic blacks to 0.31 (0.22-0.43) for women who had <12 years of education. CONCLUSIONS: Women who smoked in the postpartum period, who also suffered from socioeconomic disadvantages, had a higher likelihood of not continuing exclusive breastfeeding. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion.

Association of Youth Characteristics and Recent Utilization of Dental Services in the United States.

Background: Oral health is important for overall health of youth, although dental service utilization is lower than national goals. The purpose of the study was to identify sociodemographic and health behavioral characteristics of youth in the United States who reported having at least one dental visit in the past 12 months. Methods: Secondary data analysis was conducted using the 2015 Youth Risk Behavior Survey (YRBS) to examine factors associated with dental care utilization using Andersen's theory-based Behavioral Model of Health Care Utilization. Results: Among 5,814 youth, nearly 78 percent reported visiting a dentist in the past 12 months. After adjusting for potential confounders, characteristics significantly associated with higher likelihood of dental care utilization were: predisposing factors of non-Hispanic white ethnicity and health behavior characteristics of not using tobacco, not using illegal substances, not drinking soda, and wearing a seat belt; enabling factor of speaking English well; and perceived health of not being overweight. Discussion: Use of the Healthcare Utilization Model identified significant factors classified as predisposing, enabling, and need-related factors associated with youth's utilization of dental care services. Findings from the theory-based population-based study informs healthcare providers of factors to consider when promoting dental care among youth.

Association Between Risky Sexual Behavior and Cervical Cancer Screening Among Women in Kenya: A Population-Based Study.

Women residing in Eastern Africa are disproportionately affected by cervical cancer. Previous studies have identified risky sexual behavior as a major risk factor for cervical cancer. However, population-based studies examining the relationship between sexual behavior and cervical cancer screening are currently lacking. This descriptive cross-sectional study utilized nationally representative secondary data from the 2014 Kenya Demographic and Health Survey (n = 6104) to examine the association between risky sexual behavior and cervical cancer screening among sexually active women. Both descriptive and inferential statistical methods were utilized. Overall, 20.2% of the study sample reported having cervical cancer examination. Approximately 13.1% of the participants reported involvement in risky sexual behavior. Significantly lower proportion of women engaged in risky sexual behavior reported having cervical cancer examination (14.5 vs. 21.0%; p = 0.001). In the multivariable model, we found a significant interaction between risky sexual behavior and marital status on cervical cancer examination. Among women who were married/living together, risky sexual behavior was negatively associated with cervical cancer examination after adjusting for potential confounders (Prevalence Ratio, 95% CI) (0.42; 0.24-0.74; p = 0.002). The prevalence of having visual inspection with VIA or VILI were lower among women who were involved in risky sexual behavior (0.39; 0.18-0.87; p = 0.022). However, we were unable to detect any significant association between risky sexual behavior and having Papanicolaou test. With increasing incidence of cervical cancer in resource-limited settings, it is critical to identify populations at increased risk of infection and provide effective screening and follow-up services.