The Impact of Physical Activity on Memory Loss and Concentration in Adults Aged 18 or Older in the U.S. in 2020.

This cross-sectional study used secondary data from the USA 2020 National Health Interview Survey database. The goal of this study is to outline the impact physical activity has on cognition and mental ability. The reason we chose to pursue this research was a result of the exponentially growing weight of economic and emotional burden caused by cognitive impairments and diseases. The main outcome was whether individuals experienced dementia symptoms such as memory loss and difficulty concentrating. The main exposure was following physical activity guidelines (none, strength only, aerobic only, both). The confounders included age, sex, region, heart disease status, smoking status, drinking status, and depression status. The sample is composed of 30,119 USA adults aged 18 or older. Of those participants, 46% were male and 54% were female. By age, 96% were 18-84 years old, and approximately 4% were 85 and older. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). There was a statistically significant association between difficulty following physical activity guidelines and cognitive difficulties. Those who met aerobic only increased the odds of cognitive difficulty by 52% (OR 1.52; 95% CI: 1.34-1.74) compared with those who met both criteria. Those who met the strength criteria had 1.7 greater odds of cognitive difficulties (OR 1.70; 95% CI: 1.42-2.02) than those who met both criteria. Those who met neither of these guidelines had almost threefold greater odds of having cognitive difficulties (OR 2.64; 95% CI: 2.36-2.96) than those who met both guidelines. Researchers and healthcare providers should collaborate to encourage meeting these guidelines and addressing barriers preventing people from being physically active, such as physical limitations and access to safe recreational spaces. Future studies should address the health disparities regarding physical activity.

Does performing a Point-Of-Care HbA1c test increase the chances of undertaking an OGTT among individuals at risk of diabetes? A randomized controlled trial.

AIMS: Early detection of type 2 diabetes mellitus is key to reducing micro and macrovascular complications associated with this disease. However, a lab-based process for diagnosis entails the risk of loss-to-follow-up. The objective of this study was to demonstrate if performing a point-of-care test of HbA1c immediately after a screening questionnaire will increase the proportion of individuals showing up for a lab-based confirmatory test as Point-of-care (POC) provides immediate availability, which is expected to reduce loss-to-follow-up. RESEARCH DESIGN AND METHODS: This trial was a two-arm, randomized controlled, open-label study. Participants were recruited using the FINDRISC Score in a primary care and community setting. All 902 eligible participants were randomized into the intervention (n=511) and control (n=391) group. The intervention group was given information on healthy lifestyles, and a Point-of-care POC-HbA1c test was performed during the same visit. The control group was only given information on healthy lifestyles. Participants in both groups received a written prescription to have an oral glucose tolerance test (OGTT) performed within the next 30 days. Follow-up phone calls were made at 30 and 90 days to check if participant had undergone the test. The total duration of the intervention was 8 months. The posterior data analysis was made by using the Kolmogorov-Smirnoff test for the quantitative variables, and the descriptive statistics were expressed as means and standard deviation, or median and interquartile range 25 %-75 %, as appropriate. RESULTS: At 30 days, 28 % of participants in the intervention group and 26.1 % in the control group undertook the OGTT (RD 1.90 %; 95 % CI -3.94; 7.73). At 90 days, 35.8 % of participants in the intervention group and 37.1 % in the control group undertook the OGTT. There was no statistically significant difference (RD - 3.17 %; 95 % CI -7.04; 0.70) between both groups. CONCLUSIONS: The data suggest that performing a POC-HbA1c test after the FINDRISC did not increase the percentage of individuals showing up for the OGTT.

Childhood obesity and comorbidities-related perspective and experience of parents from Black and Asian minority ethnicities in England: a qualitative study.

Background: Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations. Methods: Following ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study's qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents' perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis. Results: Parents' perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child's weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings. Conclusion: Minority ethnic communities' perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.

The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities.

AIMS: To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia. METHODS: This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI. CONCLUSION: Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.

Parenting Practices Are Associated With Out-of-School Physical Activity in US Adolescents in 2014.

INTRODUCTION: Lack of physical activity (PA) is associated with obesity, diabetes, hypertension, cardiovascular diseases, and cancer. Parenting practices influence PA in young children. However, there is little evidence available for adolescents. We examined whether parenting practices were associated with out-of-school PA (OSPA) in US adolescents. METHODS: This cross-sectional 2019 study analyzed data from the 2014 FLASHE study, a web-based, quota-sampled survey of parent-adolescent dyads. Inclusion required survey completion and parents to live with their teen (ages 12-17 y old). Physically limited adolescents were excluded. Dyads were stratified by teen age. Exposures included parental modeling, monitoring, facilitation, restriction, guided choice, and pressure. The outcomes of interest were OSPA Youth Activity Profile scores. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated using adjusted logistic regressions. RESULTS: A total of 1109 dyads were included. Guided choice increased odds of OSPA for 15- to 17-year-olds (OR = 2.12; 95% CI, 1.17-3.84). Facilitation increased odds of OSPA for 12- to 14-year-olds (OR = 2.21; 95% CI, 1.13-4.33). Monitoring decreased odds of OSPA for 15- to 17-year-olds (OR = 0.34; 95% CI, 0.20-0.57) and 12- to 14-year-olds (OR = 0.45; 95% CI, 0.27-0.74). Friend support increased odds of OSPA in 15- to 17-year-olds (OR = 4.03; 95% CI, 2.29-7.08) and 12- to 14-year-olds (OR = 3.05; 95% CI 1.69-5.51). CONCLUSION: Future interventions should prioritize (1) shared decision making for older teens, (2) access to PA opportunities for younger adolescents, and (3) promoting peer PA and friend support for everyone.

The Association Between Lean-to-Fat Mass Ratio and Cardiometabolic Abnormalities: An Analytical Cross-Sectional Study.

Background: Cardiovascular diseases (CVDs) are a global health threat, significantly impacting Latin America. Cardiometabolic abnormalities (CAs), encompassing lipid profile, fasting plasma glucose, and blood pressure, contribute to CVD prevalence. Despite high CA incidence, research in Latin America has primarily focused on traditional adiposity indices, overlooking the intricate relationship between fat and lean body components. The study aimed to analyze the association between the lean-to-fat mass ratio (LFMR) and CAs in the adult Peruvian population. Methods: This was an analytical cross-sectional study using secondary data from the PERU MIGRANT study (2007, 989 participants). The main outcome variable was CA defined as having ≥ 2 out of six metabolic components (high triglycerides, impaired fasting glucose, high blood pressure, low high-density lipoprotein (HDL)-cholesterol, insulin resistance, and high C-reactive protein). The main exposure variable LFMR was divided into tertiles. A generalized linear model was used with log link and robust variance Poisson family to calculate crude (cPR) and adjusted prevalence ratios (aPRs) and 95% confidence intervals (95% CIs). Results: A total of 959 adults aged 30 years or older were included in the analysis (53% females). The prevalence of CA was 50.9%. Females aged 30 - 44 years old showed statistically significant inverse associations for the middle (aPR: 0.57, 95% CI: 0.42 - 0.78) and highest (aPR: 0.22, 95% CI: 0.14 - 0.35) LFMR categories. Similar trends were seen for females aged 45 - 59 years and ≥ 60 years, and males aged 30 - 44 years, while for males aged 45 - 59 years, only the middle LFMR category was associated. No statistically significant association between LFMR and CA was found among old males. Conclusions: LFMR was negatively associated with CA, among the Peruvian adult population. These findings underscore the relevance of LFMR in understanding cardiometabolic health disparities.

Epidemiology of Suicide Mortality in Paraguay from 2005 to 2019: A Descriptive Study.

Suicide is an important public health problem, fundamentally affecting the younger population and responding to multiple biological, psychological, and social causes. The objective of this study was to characterize changes in suicide mortality, suicide methods, and years of potential life lost from 2005 to 2019 in Paraguay. This observational, descriptive study used data from the Vital Statistics Information Subsystem of the Ministry of Public Health and Social Welfare. The average mortality rate from suicide was 4.9 per 100,000 inhabitants, with an increase from 4.2 between 2005 and 2009 to 5.8 from 2014 to 2019. Suicide was more common in men (75%) than in women. In men, the highest mortality rate was observed among those 20-24 years old, whereas in women, the ages most affected were the 15-19-year-old age group. The most-used method for suicide was hanging. The most frequent place of suicide occurrence was at home (73%). The seasonality of suicide occurrence showed a slight increase in the spring-summer months compared with autumn-winter (53% vs. 47%). The rate of potential years of life lost statistically significantly increased from 2005 to 2019. Public health measures need to be implemented to investigate the underlying reasons and implement interventions in the population to decrease suicide mortality in Paraguay.

Public health surveillance and the data, information, knowledge, intelligence and wisdom paradigm.

This article points out deficiencies in present-day definitions of public health surveillance, which include data collection, analysis, interpretation and dissemination, but not public health action. Controlling a public health problem of concern requires a public health response that goes beyond information dissemination. It is undesirable to have public health divided into data generation processes (public health surveillance) and data use processes (public health response), managed by two separate groups (surveillance experts and policy-makers). It is time to rethink the need to modernize the definition of public health surveillance, inspired by the authors' enhanced Data, Information, Knowledge, Intelligence and Wisdom model. Our recommendations include expanding the scope of public health surveillance beyond information dissemination to comprise actionable knowledge (intelligence); mandating surveillance experts to assist policy-makers in making evidence-informed decisions; encouraging surveillance experts to become policy-makers; and incorporating public health literacy training - from data to knowledge to wisdom - into the curricula for all public health professionals. Work on modernizing the scope and definition of public health surveillance will be a good starting point.

En este artículo se señalan las deficiencias de las definiciones actuales de la vigilancia de salud pública, que incluyen la recopilación, el análisis, la interpretación y la difusión de los datos, pero no las medidas de salud pública. El control de un problema de salud pública de interés exige una respuesta de salud pública que vaya más allá de la difusión de información. No es deseable que la salud pública esté dividida por un lado en procesos de generación de datos (vigilancia de salud pública) y por otro en procesos de uso de datos (respuesta de salud pública), gestionados por dos grupos diferentes (expertos en vigilancia y responsables de la formulación de políticas). Ha llegado el momento de replantear la necesidad de modernizar la definición de la vigilancia de salud pública tomando como referencia el modelo mejorado de Datos, Información, Conocimiento, Inteligencia y Sabiduría de los autores. Entre las recomendaciones que se proponen se encuentran las de ampliar el alcance de la vigilancia de salud pública más allá de la difusión de información para que incluya también el conocimiento aplicable (inteligencia); instar a los expertos en vigilancia a que presten ayuda a los responsables de la formulación de políticas en la toma de decisiones basadas en la evidencia; alentar a los expertos en vigilancia a que se conviertan en responsables de la formulación de políticas; e incorporar la formación en conocimientos básicos de salud pública (desde los datos hasta los conocimientos y la sabiduría) en los planes de estudio de todos los profesionales de la salud pública. Un buen punto de partida será trabajar en la modernización del alcance y la definición de la vigilancia de salud pública.

Este artigo aponta deficiências nas definições atuais de vigilância em saúde pública, que incluem coleta, análise, interpretação e disseminação de dados, mas não ações de saúde pública. O controle de um problema preocupante de saúde pública exige uma resposta de saúde pública que vá além da disseminação de informações. A saúde pública não deve ser dividida em processos de geração de dados (vigilância em saúde pública) e processos de uso de dados (resposta de saúde pública) gerenciados por dois grupos distintos (especialistas em vigilância e formuladores de políticas). É hora de repensar a necessidade de modernizar a definição de vigilância em saúde pública, inspirada no modelo aprimorado de Dados, Informações, Conhecimento, Inteligência e Sabedoria dos autores. Nossas recomendações incluem: expansão do escopo da vigilância em saúde pública para além da disseminação de informações, de modo a abranger conhecimentos acionáveis (inteligência); obrigatoriedade de que os especialistas em vigilância auxiliem os formuladores de políticas na tomada de decisões baseadas em evidências; incentivo para que os especialistas em vigilância se tornem formuladores de políticas; e incorporação de capacitação em letramento em saúde pública (partindo dos dados para o conhecimento e em seguida para a sabedoria) nos currículos de todos os profissionais de saúde pública. O trabalho de modernizar o escopo e a definição de vigilância em saúde pública será um bom ponto de partida.

The association between race and age of diagnosis of retinoblastoma in United States children.

PURPOSE: To explore the associations between race and retinoblastoma diagnosis in United States children. METHODS: In this analytical nonconcurrent cohort study, we used 1988-2018 data from the Surveillance, Epidemiology, and End-Results (SEER) database. Children ages 0-17 with retinoblastoma were included (n = 758); those with missing data were excluded (n = 11; final cohort: n = 747). The exposure variable was race (White, Black, Asian/Pacific Islanders, American Indian/Alaska Native), and the outcome variable was diagnosis of retinoblastoma before versus after 2 years of age. Covariates included sex, rural-urban continuum, ethnicity, decade of diagnosis, and laterality of disease. Unadjusted and adjusted logistic regression analyses were performed to calculate odds ratios and 95% confidence intervals. RESULTS: No statistically significant association was found between racial/ethnic groups (OR = 0.61-0.99; P = 0.92) and age at diagnosis (OR = 0.86; P = 0.66). Females were more likely to be diagnosed earlier than males (OR = 0.62; 95% CI, 0.44-0.88; P = 0.042). No association was found between urban versus rural subjects (OR = 1.02; 95% CI, 0.60-1.75) or between decades (OR = 0.81; 95% CI, 0.54-1.22 and OR 0.96; 95% CI, 0.62-1.47). CONCLUSIONS: We found no statistically significant difference between racial/ethnic groups for diagnosis of children with retinoblastoma after 2 years of age. Future studies could explore why females are more likely than males to be diagnosed before 2 years of age.

The availability between recreational facilities and physical activity of US adolescents.

Determining the locations where adolescents tend to accumulate greater amounts of physical activity may assist policymakers to address the built environment design and promote PA. This study evaluated the association between the availability of recreational facilities and average minutes of moderate to vigorous physical activity (MVPA) per day of US adolescents in 2017 (n = 1,437). Data for this cross-sectional study were obtained from the 2017 Family Life, Activity, Sun, Health, and Eating study, an internet-based study collecting information on diet and PA of parent and adolescent dyads. Adolescents aged 12-17 from the US were included. Predicted daily minutes of MVPA were calculated. The exposure variables of interest were the availability of school recreational facilities, indoor recreational facilities, playing fields, bike/hiking/walking trails or paths or public parks. Participants were excluded if no information was provided for MVPA or availability of recreational facilities. Unadjusted and adjusted linear regression analysis was used to calculate mean daily minutes of MVPA and their corresponding 95 % confidence intervals. In fully adjusted models, we found statistically significant associations between the type of recreational facility and differences in daily minutes of MVPA for school (p-value < 0.001) and public parks p-value < 0.001), but not for the other recreational facilities. The average daily minutes of MVPA differed by 4.4 min (95 % CI 2.6, 6.2) if participants had school recreational facilities, respectively. School recreational facilities are important for engaging adolescents in PA objectives. Features within school recreational facilities should be studied to further investigate contributions to increased PA levels.

Public health surveillance and the data, information, knowledge, intelligence and wisdom paradigm / Vigilancia de salud pública y el paradigma de datos, información, conocimiento, inteligencia y sabiduría / Vigilância em saúde pública e o paradigma de dados, informações, conhecimento, inteligência e sabedoria

ABSTRACT This article points out deficiencies in present-day definitions of public health surveillance, which include data collection, analysis, interpretation and dissemination, but not public health action. Controlling a public health problem of concern requires a public health response that goes beyond information dissemination. It is undesirable to have public health divided into data generation processes (public health surveillance) and data use processes (public health response), managed by two separate groups (surveillance experts and policy-makers). It is time to rethink the need to modernize the definition of public health surveillance, inspired by the authors' enhanced Data, Information, Knowledge, Intelligence and Wisdom model. Our recommendations include expanding the scope of public health surveillance beyond information dissemination to comprise actionable knowledge (intelligence); mandating surveillance experts to assist policy-makers in making evidence-informed decisions; encouraging surveillance experts to become policy-makers; and incorporating public health literacy training - from data to knowledge to wisdom - into the curricula for all public health professionals. Work on modernizing the scope and definition of public health surveillance will be a good starting point.

RESUMEN En este artículo se señalan las deficiencias de las definiciones actuales de la vigilancia de salud pública, que incluyen la recopilación, el análisis, la interpretación y la difusión de los datos, pero no las medidas de salud pública. El control de un problema de salud pública de interés exige una respuesta de salud pública que vaya más allá de la difusión de información. No es deseable que la salud pública esté dividida por un lado en procesos de generación de datos (vigilancia de salud pública) y por otro en procesos de uso de datos (respuesta de salud pública), gestionados por dos grupos diferentes (expertos en vigilancia y responsables de la formulación de políticas). Ha llegado el momento de replantear la necesidad de modernizar la definición de la vigilancia de salud pública tomando como referencia el modelo mejorado de Datos, Información, Conocimiento, Inteligencia y Sabiduría de los autores. Entre las recomendaciones que se proponen se encuentran las de ampliar el alcance de la vigilancia de salud pública más allá de la difusión de información para que incluya también el conocimiento aplicable (inteligencia); instar a los expertos en vigilancia a que presten ayuda a los responsables de la formulación de políticas en la toma de decisiones basadas en la evidencia; alentar a los expertos en vigilancia a que se conviertan en responsables de la formulación de políticas; e incorporar la formación en conocimientos básicos de salud pública (desde los datos hasta los conocimientos y la sabiduría) en los planes de estudio de todos los profesionales de la salud pública. Un buen punto de partida será trabajar en la modernización del alcance y la definición de la vigilancia de salud pública.

RESUMO Este artigo aponta deficiências nas definições atuais de vigilância em saúde pública, que incluem coleta, análise, interpretação e disseminação de dados, mas não ações de saúde pública. O controle de um problema preocupante de saúde pública exige uma resposta de saúde pública que vá além da disseminação de informações. A saúde pública não deve ser dividida em processos de geração de dados (vigilância em saúde pública) e processos de uso de dados (resposta de saúde pública) gerenciados por dois grupos distintos (especialistas em vigilância e formuladores de políticas). É hora de repensar a necessidade de modernizar a definição de vigilância em saúde pública, inspirada no modelo aprimorado de Dados, Informações, Conhecimento, Inteligência e Sabedoria dos autores. Nossas recomendações incluem: expansão do escopo da vigilância em saúde pública para além da disseminação de informações, de modo a abranger conhecimentos acionáveis (inteligência); obrigatoriedade de que os especialistas em vigilância auxiliem os formuladores de políticas na tomada de decisões baseadas em evidências; incentivo para que os especialistas em vigilância se tornem formuladores de políticas; e incorporação de capacitação em letramento em saúde pública (partindo dos dados para o conhecimento e em seguida para a sabedoria) nos currículos de todos os profissionais de saúde pública. O trabalho de modernizar o escopo e a definição de vigilância em saúde pública será um bom ponto de partida.

Diagnostic Performance of the Measurement of Skinfold Thickness for Abdominal and Overall Obesity in the Peruvian Population: A 5-Year Cohort Analysis.

The escalating prevalence of overall and abdominal obesity, particularly affecting Latin America, underscores the urgent need for accessible and cost-effective predictive methods to address the growing disease burden. This study assessed skinfold thicknesses' predictive capacity for overall and abdominal obesity in Peruvian adults aged 30 or older over 5 years. Data from the PERU MIGRANT 5-year cohort study were analyzed, defining obesity using BMI and waist circumference. Receiver operating characteristic curves and area under the curve (AUC) with 95% confidence intervals (CI) were calculated. Adults aged ≥ 30 (n = 988) completed the study at baseline, with 47% male. A total of 682 participants were included for overall and abdominal obesity analysis. The 5-year prevalence values for overall and abdominal obesity were 26.7% and 26.6%, respectively. Subscapular skinfold (SS) best predicted overall obesity in men (AUC = 0.81, 95% CI: 0.75-0.88) and women (AUC = 0.77, 95% CI: 0.67-0.88). Regarding abdominal obesity, SS exhibited the highest AUC in men (AUC = 0.83, 95% CI: 0.77-0.89), while SS and the sum of trunk skinfolds showed the highest AUC in women. In secondary analysis excluding participants with type-2 diabetes mellitus (DM2) at baseline, SS significantly predicted DM2 development in men (AUC = 0.70, 95% CI: 0.58-0.83) and bicipital skinfold (BS) did in women (AUC = 0.73, 95% CI: 0.62-0.84). The findings highlight SS significance as an indicator of overall and abdominal obesity in both sexes among Peruvian adults. Additionally, SS, and BS offer robust predictive indicators for DM2.

Racial Disparities in Cardiovascular Health Among the Acute Coronary Syndrome Population.

The relative distribution of proportions of cardiovascular health (CVH) categories within racial groups has been examined. However, little scientific evidence exists on the gap trend in racial/ethnic disparities in mean CVH score among non-Hispanic (NH) Whites and Blacks. This study examined the trend(s) in the gap(s) in predicted CVH scores between NH Whites and Blacks over 10 years. In a cross-sectional analytical study, 10 years of Medical Expenditure Panel Survey data from 2008 to 2018 were pooled, utilizing multivariate Poisson's regression of CVH metrics on race, while controlling for relevant covariates. The interactions of acute coronary syndrome (ACS) with CVH metrics, and other key variables such as trends and grouped Charlson Comorbidity Index allowed for variations in the effect of these variables on the subgroups. The mean gap in CVH scores was on average 0.15 [95% confidence interval (CI) 0.137 to 0.170], with Blacks consistently having reduced odds of having ideal CVH until 2014. The overall impact of having an ACS decreased acquired CVH scores by 24.1% [95% CI -0.275 to 0.207], and was equal for both racial subgroups (P < 0.05). The Affordable Care Act (ACA)-trend was positive, increasing the likelihood of improved CVH in the sample (P < 0.05), deflecting a downward trend in acquired CVH scores for both races, as the gap narrowed into more recent years. The CVH gap was stabilized by the ACA, but never really converged, suggesting that efforts to reduce existing disparities between Blacks and NH Whites in the United States would require government policies to look beyond mere "access" and/or "affordability" to health care.

Time Period of Treatment's Effect on the Association Between Race and Survival in Patients With Malignant Colorectal Adenocarcinoma.

BACKGROUND: Colorectal cancer is one of the most common malignancies diagnosed in the United States, with 126,240 new cases diagnosed in 2020. Past studies have shown that disparities may exist between certain patient populations, but it is unknown how they are affected over time as treatments evolve. The purpose of this study was to determine whether the decade of treatment modifies the association between race and five-year survival in adults diagnosed and treated for malignant colorectal adenocarcinomas since the 1970s. METHODS: This was a non-concurrent retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The inclusion criteria involved patients with primary malignant colorectal adenocarcinoma between the years 1975 and 2018. Exclusion criteria included previous malignancies or missing information on any of the variables. The exposure variable was the patient's race, and the main outcome variable was average five-year survival rates. The effect modifier was the time period in which the patient received treatment. The covariates of the study included age, sex, Hispanic status, surgical intervention recommendation, and disease stage. Unadjusted and adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using Cox regression models. RESULTS: As the interaction term between race/ethnicity and year of diagnosis was statistically significant, the data were stratified according to year of diagnosis. Black patients in both time periods had a higher mortality rate from malignant colorectal carcinoma after adjustment for the covariates (1975-1990: HR 1.10, 95% CI 1.06-1.15; 1991-2018: HR 1.19, 95% CI 1.16-1.23) when compared with White patients. American Indian, Alaskan Native, and Asian patients were found to have lower mortality in both time periods when compared with White patients (1975-1990: HR 0.90, 95% CI 0.85-0.95; 1991-2018: HR 0.93, 95% CI 0.89-0.96). CONCLUSION: Our data found that despite the evolution in the standard of care treatment for malignant colorectal adenocarcinoma since the year 1975, Black patients had lower five-year survival rates when compared with their White counterparts as well as increased rates of being diagnosed with this disease. Overall, addressing these disparities in colorectal cancer outcomes is critical for improving public health and reducing healthcare costs.

Regional Variation in Health Care Utilization Among Adults With Inadequate Cardiovascular Health in the USA.

Background Prior evidence of region-level differences in health outcomes and specialized healthcare services in the US poses questions of whether there are differences in utilization of healthcare that may account for regional differences in healthcare outcomes. This study aimed to examine regional differences in healthcare utilization for individuals with poor cardiovascular health (CVH) compared to those with ideal/intermediate CVH.  Methods In this cross-sectional analytical study, two 3-year periods (2008-2010 and 2018-2020) were pooled and analyzed using multivariate Poisson's regression of region on counts of healthcare utilization, while controlling for relevant covariates. The interaction of the non-southern regions with recent years was to reveal how the regional dispersion in healthcare usage was changing over time for the non-southern regions compared to the south. Results The results showed significant regional variation in healthcare usage for individuals with poor CVH, with lower health utilization rates observed primarily in southern states, consistent with higher rates of coronary heart disease in those regions. The impact of a unit improvement on CVH score was to reduce the level of healthcare utilization by 15.7% ([95% CI, 15 - 17%; p < 0.001]) for individuals with poor CVH and 19.1% ([95% CI, 19 - 20%; p < 0.001]) for the intermediate and ideal subgroups, with the Northeast exhibiting the highest level of healthcare usage. Conclusion Our results suggest that there is a need for public health interventions to reduce regional disparities in access to healthcare for the people at greatest risk of cardiovascular events by considering individual factors as well as the broader regional and policy contexts where these people live.

Effect Modification of Race on the Associated Tumor Size at Diagnosis and 10-Year Cancer Survival Rates in Women with Cervical Squamous Cell Carcinoma in the United States.

BACKGROUND: While there may be an association between race, tumor size, and survival in patients with cervical squamous cell carcinoma (SCC), evidence on the effect of race on the association between tumor size at diagnosis and survival is limited. Our study evaluated whether race modifies the association between tumor size and 10-year survival in cervical SCC. METHODS: This non-concurrent cohort study with the Surveillance, Epidemiology, and End Results (SEER) database included women diagnosed with cervical SCC between 2004-2018. The independent variable was diagnosis tumor size, where 2-4 cm was classified as high risk, and <2 cm was considered low risk. The dependent variable was 10-year cancer-specific survival rates, and race was our effect modifier. Unadjusted and adjusted Cox regression analysis were conducted to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: While a higher proportion of Black/Asian/Pacific Islander patients presented with tumor sizes of 2-4 cm compared to <2 cm (32.8% vs. 22.3%; p = 0.007) and having a tumor size of 2-4 cm had a significantly decreased 10-year survival (HR: 2.7; 95% CI: 1.3-5.8), the interaction between race and 10-year cancer-specific survival was not significant. CONCLUSION: Although race did not modify the interaction between tumor size and 10-year survival, emphasis needs to be placed on screening and proper data collection, especially for minority races, and studies with larger sample sizes should be conducted in order to better implement future recommendations to improve health and survival.

Large scale application of the Finnish diabetes risk score in Latin American and Caribbean populations: a descriptive study.

Background: The prevalence of type 2 diabetes (T2D) continues to increase in the Americas. Identifying people at risk for T2D is critical to the prevention of T2D complications, especially cardiovascular disease. This study gauges the ability to implement large population-based organized screening campaigns in 19 Latin American and Caribbean countries to detect people at risk for T2D using the Finnish Diabetes Risk Score (FINDRISC). Methods: This cross-sectional descriptive analysis uses data collected in a sample of men and women 18 years of age or older who completed FINDRISC via eHealth during a Guinness World Record attempt campaign between October 25 and November 1, 2021. FINDRISC is a non-invasive screening tool based on age, body mass index, waist circumference, physical activity, daily intake of fruits and vegetables, history of hyperglycemia, history of antihypertensive drug treatment, and family history of T2D, assigning a score ranging from 0 to 26 points. A cut-off point of ≥ 12 points was considered as high risk for T2D. Results: The final sample size consisted of 29,662 women (63%) and 17,605 men (27%). In total, 35% of subjects were at risk of T2D. The highest frequency rates (FINDRISC ≥ 12) were observed in Chile (39%), Central America (36.4%), and Peru (36.1%). Chile also had the highest proportion of people having a FINDRISC ≥15 points (25%), whereas the lowest was observed in Colombia (11.3%). Conclusions: FINDRISC can be easily implemented via eHealth technology over social networks in Latin American and Caribbean populations to detect people with high risk for T2D. Primary healthcare strategies are needed to perform T2D organized screening to deliver early, accessible, culturally sensitive, and sustainable interventions to prevent sequelae of T2D, and reduce the clinical and economic burden of cardiometabolic-based chronic disease.

Factors Associated with Normal-Weight Abdominal Obesity Phenotype in a Representative Sample of the Peruvian Population: A 4-Year Pooled Cross-Sectional Study.

To examine factors associated with abdominal obesity among normal-weight individuals from the Demographic and Health Survey of Peru (2018-2021). Cross-sectional analytical study. The outcome variable was abdominal obesity defined according to JIS criteria. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables and abdominal obesity using the GLM Poisson distribution with robust variance estimates. A total of 32,109 subjects were included. The prevalence of abdominal obesity was 26.7%. The multivariate analysis showed a statistically significant association between abdominal obesity and female sex (aPR: 11.16; 95% CI 10.43-11.94); categorized age 35 to 59 (aPR: 1.71; 95% CI 1.65-1.78); 60 to 69 (aPR: 1.91; 95% CI 1.81-2.02); and 70 or older(aPR: 1.99; 95% CI 1.87-2.10); survey year 2019 (aPR: 1.22; 95% CI 1.15-1.28); 2020 (aPR: 1.17; 95% CI 1.11-1.24); and 2021 (aPR: 1.12; 95% CI 1.06-1.18); living in Andean region (aPR: 0.91; 95% CI 0.86-0.95); wealth index poor (aPR: 1.26; 95% CI 1.18-1.35); middle (aPR: 1.17; 95% CI 1.08-1.26); rich (aPR: 1.26; 95% CI 1.17-1.36); and richest (aPR: 1.25; 95% CI 1.16-1.36); depressive symptoms (aPR: 0.95; 95% CI 0.92-0.98); history of hypertension (aPR: 1.08; 95% CI 1.03-1.13), type 2 diabetes (aPR: 1.13; 95% CI 1.07-1.20); and fruit intake 3 or more servings/day (aPR: 0.92; 95% CI 0.89-0.96). Female sex, older ages, and low and high income levels increased the prevalence ratio for abdominal obesity, while depressive symptoms, living in the Andean region, and fruit intake of 3 or more servings/day decreased it.

Comparative Analysis of Clinical Practice Guidelines for the Pharmacological Treatment of Type 2 Diabetes Mellitus in Latin America.

PURPOSE OF REVIEW: Type 2 diabetes mellitus (T2DM) is one of the leading causes of death and disability in the world. The majority of diabetes deaths (> 80%) occur in low- and middle-income countries, which are predominant in Latin America. Therefore, the purpose of this article is to compare the clinical practice guideline (CPG) for the pharmacological management of T2DM in Latin America (LA) with international reference guidelines. RECENT FINDINGS: Several LA countries have recently developed CPGs. However, the quality of these guidelines is unknown according to the AGREE II tool and taking as reference three CPGs of international impact: American Diabetes Association (ADA), European Diabetes Association (EASD), and Latin American Diabetes Association (ALAD). Ten CPGs were selected for analysis. The ADA scored > 80% on the AGREE II domains and was selected as the main comparator. Eighty percent of LA CPGs were developed before 2018. Only one was not recommended (all domains < 60%). The CPGs in LA have good quality but are outdated. They have significant gaps compared to the reference. There is a need for improvement, as proposing updates every three years to maintain the best available clinical evidence in all guidelines.