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1.
Int J Behav Nutr Phys Act ; 19(1): 97, 2022 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-35907867

RESUMO

BACKGROUND: Latina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas. METHODS: The study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference. RESULTS: After adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference. CONCLUSIONS: Participants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits. TRIAL REGISTRATION: NCT01776632 , Registered March 18, 2011.


Assuntos
Exercício Físico , Promoção da Saúde , Acelerometria , Feminino , Hispânico ou Latino , Humanos , Atividades de Lazer
2.
Int J Behav Nutr Phys Act ; 15(1): 95, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285755

RESUMO

BACKGROUND: Few children consume sufficient servings of fruits and vegetables. Interventions aiming to improve children's dietary intake often target parent level factors, but limited research has examined the mediating role of parental factors on children's dietary intake. This study examined 10-month follow up data from the Entre Familia: Reflejos de Salud (Within the Family: Reflections of Health) trial to investigate (1) intervention effects on children's dietary intake, both sustained and new changes, and (2) whether changes in mothers' dietary intake, her parenting strategies, and behavioral strategies to promoting healthy eating in the home mediated changes in children's dietary intake. METHODS: Participants were 361 Mexican-origin families living in Imperial County, California. Families were randomly assigned to a 4-month dietary intervention or a delayed treatment control group. The intervention was delivered by promotoras (community health workers) via home visits and telephone calls. Assessments occurred at baseline, and 4- and 10-months post-baseline. RESULTS: At 10-months post-baseline, sustained intervention effects were observed on children's reported intake of varieties of vegetables, with differences getting larger over time. However, differential intervention effects on fast food were not sustained due to significant reductions in the control group compared with smaller changes in the intervention group. New intervention effects were observed on servings of sugar-sweetened beverages. However, the intervention continued to have no effect on children's reported fruit and vegetable servings, and varieties of fruits consumed. Mother-reported behavioral strategies to increase fiber and lower fat mediated the relationship between the intervention and children's intake of varieties of vegetables. Mothers' percent energy from fat and behavioral strategies to lower fat were mediators of children's daily servings of sugar-sweetened beverages. CONCLUSIONS: This study suggests that a promotora-led family based intervention can provide mothers with skills to promote modest changes in children's diet. Examining the parent related mechanisms of change will inform future interventions on important targets for improving children's diet. TRIAL REGISTRATION: https://clinicaltrials.gov/ . NCT02441049 . Retrospectively registered 05.06.2015.


Assuntos
Comportamento Infantil/psicologia , Dieta/métodos , Comportamento Alimentar/psicologia , Americanos Mexicanos/psicologia , Mães , Adulto , California , Criança , Dieta/psicologia , Feminino , Seguimentos , Frutas , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Estudos Retrospectivos , Verduras
3.
Health Educ Behav ; 45(4): 501-510, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29212358

RESUMO

AIMS: Examine intervention effects among mothers involved in a healthy eating randomized controlled trial. Furthermore, examine the mediating roles of individual and familial influences on observed outcomes. METHODS: Between 2009 and 2011, 361 families were recruited; half were assigned to an 11-session community health worker-delivered family-based intervention targeting Spanish-speaking Latino families in Imperial County, California. The intervention was delivered over a 4-month period. Home visits and telephone calls were delivered approximately weekly, with tapering near the end of the intervention to promote independence from the promotora. In this article, mothers' self-reported dietary intake was the primary outcome. Evaluation measures were taken at baseline, 4 months, and 10 months. RESULTS: Daily servings of fruits were higher among intervention versus control mothers (mean = 1.86 vs. mean = 1.47; effect size [ES] = 0.22) at 10 months post-baseline. Mothers in the intervention versus control condition also reported consuming a lower percent energy from fat (mean = 30.0% vs. 31.0%; ES = 0.30) and a higher diet quality (mean = 2.93 vs. mean = 2.67; ES = 0.29). Mediators of improvements were behavioral strategies to increase fiber and lower fat intake, family support for vegetable purchasing, and decreased unhealthy eating behaviors and perceived family barriers to healthy eating. DISCUSSION AND CONCLUSION: Family-based behavioral interventions are effective for changing the skills and family system needed to improve diet among Latina mothers. Health care providers and other practitioners are encouraged to target skill development and fostering a socially supportive environment.


Assuntos
Dieta , Saúde da Família/estatística & dados numéricos , Comportamento Alimentar , Hispânico ou Latino/estatística & dados numéricos , Mães/estatística & dados numéricos , Adulto , California , Agentes Comunitários de Saúde , Fibras na Dieta , Feminino , Frutas , Humanos , Verduras
4.
Am J Public Health ; 107(7): 1109-1115, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28520484

RESUMO

OBJECTIVES: To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. METHODS: We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. RESULTS: Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. CONCLUSIONS: A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls.


Assuntos
Exercício Físico , Promoção da Saúde/organização & administração , Hispânico ou Latino , Religião , Acelerometria , Adulto , California , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Pessoa de Meia-Idade , Apoio Social
5.
Contemp Clin Trials ; 45(Pt B): 404-415, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26358535

RESUMO

OBJECTIVES: To describe both conditions of a two-group randomized trial, one that promotes physical activity and one that promotes cancer screening, among churchgoing Latinas. The trial involves promotoras (community health workers) targeting multiple levels of the Ecological Model. This trial builds on formative and pilot research findings. DESIGN: Sixteen churches were randomly assigned to either the physical activity intervention or cancer screening comparison condition (approximately 27 women per church). In both conditions, promotoras from each church intervened at the individual- (e.g., beliefs), interpersonal- (e.g., social support), and environmental- (e.g., park features and access to health care) levels to affect change on target behaviors. MEASUREMENTS: The study's primary outcome is min/wk of moderate-to-vigorous physical activity (MVPA) at baseline and 12 and 24 months following implementation of intervention activities. We enrolled 436 Latinas (aged 18-65 years) who engaged in less than 250 min/wk of MVPA at baseline as assessed by accelerometer, attended church at least four times per month, lived near their church, and did not have a health condition that could prevent them from participating in physical activity. Participants were asked to complete measures assessing physical activity and cancer screening as well as their correlates at 12- and 24-months. SUMMARY: Findings from the current study will address gaps in research by showing the long term effectiveness of multi-level faith-based interventions promoting physical activity and cancer screening among Latino communities.


Assuntos
Detecção Precoce de Câncer , Exercício Físico , Promoção da Saúde/organização & administração , Hispânico ou Latino , Religião , Acelerometria , Adolescente , Adulto , Idoso , Pesos e Medidas Corporais , Agentes Comunitários de Saúde/organização & administração , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Pessoa de Meia-Idade , Projetos de Pesquisa , Apoio Social , Adulto Jovem
6.
J Health Commun ; 20(2): 165-76, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25375276

RESUMO

Entertainment education and the promotora model are 2 evidence-based health communication strategies. This study examined their combined effect on promoting healthy eating among mothers in a family-based intervention. Participants were 361 Mexican-origin families living in Imperial County, California, who were randomly assigned to an intervention or delayed treatment condition. The intervention involved promotoras (community health workers) who delivered 11 home visits and 4 telephone calls. Home visits included a 12-minute episode of a 9-part situation comedy depicting a family struggling with making healthy eating choices; an accompanying family workbook was reviewed to build skills and left with the family. Baseline and immediate postintervention data were collected from the mothers, including the primary outcome of daily servings of fruits and vegetables. Other dietary and psychosocial factors related to healthy eating were examined. At postintervention, mothers in the intervention reported increases in daily vegetable servings (p ≤ .05); however, no changes were observed in fruit consumption. Improvements were observed in behavioral strategies to increase fiber (p ≤ .001) and to decrease fat intake (p ≤ .001), unhealthy eating behaviors (p ≤ .001), and individual (p ≤ .05) and family-related (p ≤ .01) perceived barriers to healthy eating. Entertainment education and promotoras engaged families and improved mothers' diets. Further research should examine the dose needed for greater changes.


Assuntos
Agentes Comunitários de Saúde , Dieta/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Comunicação em Saúde/métodos , Educação em Saúde/métodos , Mães/educação , Mães/psicologia , Adulto , California , Prática Clínica Baseada em Evidências , Família/psicologia , Feminino , Seguimentos , Frutas , Humanos , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Verduras
7.
Subst Use Misuse ; 48(7): 523-31, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23581506

RESUMO

This study aimed to identify the prevalence and determinants of soft tissue infections and self-treatment among injection drug users (IDUs) in California. The study interviewed 864 IDUs in California using computer-assisted personal interview (CAPI) from 2003 to 2005. Multiple logistic regression analyses were performed to examine adjusted associations for recent abscess and abscess self-treatment. In these analyses, Latinos had higher odds than African Americans to self-treat, while IDUs reporting a usual place of health care had lower odds of self-treatment. Findings suggest an expansion of wound care facilities to mitigate the self-treatment of abscesses, with special consideration to Latinos.


Assuntos
Abscesso/epidemiologia , Usuários de Drogas/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Infecções dos Tecidos Moles/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Abscesso/etiologia , Abscesso/terapia , Adulto , California , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas de Troca de Agulhas , Prevalência , Fatores de Risco , Assunção de Riscos , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/terapia
8.
Salud Publica Mex ; 55 Suppl 3: 397-405, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24643488

RESUMO

OBJECTIVE: This intervention sought to promote healthy eating with the ultimate goal of reducing childhood obesity risk. MATERIALS AND METHODS: Three hundred and sixty-one Latino families living on the US-Mexico border with at least one child between 7-13 years of age were eligible to participate. Families randomly assigned to the four-month intervention received 14 contacts with a promotora (community health worker), consisting of 11 home visits and three telephone calls; the control condition was a delayed treatment intervention. Children reported on their dietary intake at baseline, immediately post-intervention and at the six month follow-up visit. RESULTS: The intervention reduced weekly consumption of fast food (p<0.05). A dose-response relationship was observed such that for every seven hours of promotora contact, monthly variety of fruits (p<0.01) and vegetables (p<0.01) increased by one. No other intervention effects were observed. CONCLUSIONS: Family-based interventions can improve children's eating habits, with the amount of contact with the promotora being key to success.


Assuntos
Comportamento Infantil , Dieta , Família , Comportamento Alimentar , Promoção da Saúde/organização & administração , Hispânico ou Latino/psicologia , Obesidade Infantil/prevenção & controle , California/epidemiologia , Criança , Agentes Comunitários de Saúde , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Fast Foods/estatística & dados numéricos , Feminino , Preferências Alimentares , Frutas , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , México/epidemiologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/etnologia , Pobreza , Fatores Socioeconômicos , Verduras
9.
J Womens Health (Larchmt) ; 22(1): 9-18, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23051068

RESUMO

BACKGROUND: Maternal depression is a common condition among new mothers that can be associated with poor maternal health and negative consequences on infant health. Little research has been conducted to examine maternal depression, especially among military mothers, where unique conditions often exist. Using data from a large military cohort, this study prospectively examined the relationship between deployment experience before and after childbirth and maternal depression among U.S. service women. METHODS: The study included 1,660 female Millennium Cohort participants who gave birth during active duty service and completed baseline and follow-up questionnaires between 2001 and 2008. Maternal depression was assessed at follow-up using Primary Care Evaluation of Mental Disorders Patient Health Questionnaire criteria. RESULTS: Deployment before childbirth, regardless of combat experience, and deployment without combat experience after childbirth did not increase the risk of maternal depression. Women who deployed and reported combat experience after childbirth were at increased risk for maternal depression compared with nondeployed women who gave birth (adjusted odds ratio [OR] 2.01, 95% confidence interval [CI] 1.17-3.43). Among the subgroup of female combat deployers, however, women who gave birth did not have a significantly increased risk for depression compared with those who did not give birth. CONCLUSIONS: Military women who deployed with combatlike experiences after childbirth were at increased risk for postdeployment maternal depression. The risk, however, appeared primarily related to combat rather than childbirth-related experiences.


Assuntos
Depressão/epidemiologia , Militares/psicologia , Mães/psicologia , Transtornos de Estresse Traumático/epidemiologia , Estresse Psicológico/epidemiologia , Guerra , Adulto , Campanha Afegã de 2001- , Fatores Etários , Depressão/psicologia , Feminino , Seguimentos , Humanos , Lactente , Guerra do Iraque 2003-2011 , Modelos Logísticos , Militares/estatística & dados numéricos , Razão de Chances , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Estresse Psicológico/complicações , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
10.
Salud pública Méx ; 55(supl.3): 397-405, 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-704836

RESUMO

Objective. This intervention sought to promote healthy eating with the ultimate goal of reducing childhood obesity risk. Materials and methods. Three hundred and sixty-one Latino families living on the US-Mexico border with at least one child between 7-13 years of age were eligible to participate. Families randomly assigned to the four-month intervention received 14 contacts with a promotora (community health worker), consisting of 11 home visits and three telephone calls; the control condition was a delayed treatment intervention. Children reported on their dietary intake at baseline, immediately post-intervention and at the six month follow-up visit. Results. The intervention reduced weekly consumption of fast food (p<0.05). A dose-response relationship was observed such that for every seven hours of promotora contact, monthly variety of fruits (p<0.01) and vegetables (p<0.01) increased by one. No other intervention effects were observed. Conclusions. Family-based interventions can improve children's eating habits, with the amount of contact with the promotora being key to success.


Objetivo. Promover una alimentación saludable con el objetivo final de reducir el riesgo de obesidad infantil. Material y métodos. Trescientas sesenta y una familias latinas que viven en la frontera de EU y México, y que cuentan con por lo menos un hijo entre 7 y 13 años, fueron elegibles para participar. Las familias asignadas al azar a la intervención de cuatro meses tuvieron contacto 14 veces (11 visitas familiares y tres llamadas telefónicas) con una promotora; el grupo de control recibió el tratamiento de intervención al final del programa. Los niños reportaron su ingesta alimenticia al inicio, inmediatamente después de la intervención y en la visita de seguimiento a los seis meses. Resultados. La intervención redujo el consumo semanal de comida rápida (p<0.05). Se observó una relación dosis-respuesta tal que por cada siete horas de contacto con la promotora, la variedad mensual de frutas (p<0.01) y verduras (p<0.01) tuvo un incremento de uno. No se observaron otros efectos de intervención. Conclusiones. Las intervenciones basadas en la familia pueden mejorar los hábitos alimenticios de los niños, siendo la cantidad de contacto con la promotora clave para el éxito.


Assuntos
Criança , Feminino , Humanos , Masculino , Comportamento Infantil , Dieta , Família , Comportamento Alimentar , Promoção da Saúde/organização & administração , Hispânico ou Latino/psicologia , Obesidade Infantil/prevenção & controle , California/epidemiologia , Agentes Comunitários de Saúde , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Fast Foods , Comportamento Alimentar , Preferências Alimentares , Frutas , Hispânico ou Latino/estatística & dados numéricos , México/epidemiologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/etnologia , Pobreza , Fatores Socioeconômicos , Verduras
11.
Ann Behav Med ; 44(3): 365-74, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22899301

RESUMO

BACKGROUND: The principle of cross-level interactions of influence on behavior in ecological models is seldom studied. PURPOSE: To examine built environment × psychosocial interactive effects on physical activity. METHODS: Multi-level mixed regression analyses used data from the Neighborhood Quality of Life Study conducted in neighborhoods in two US regions (n = 2,199 adults). Outcomes were (1) objectively measured moderate-to-vigorous physical activity, (2) reported transport walking, and (3) leisure-walking. Conceptually matched built environment variables were analyzed for domain-specific outcomes. RESULTS: With leisure walking as the outcome, built environment × psychosocial interactions were significant in 7 of 20 models tested. Directions of interactions were consistent, indicating a stronger built environment-leisure walking association in adults with less favorable psychosocial status. Little evidence supported such interactions with objectively measured moderate-to-vigorous physical activity or transport walking as outcomes. CONCLUSION: The results imply that the built environment may exert stronger influence on adults who are not psychologically predisposed to be active.


Assuntos
Planejamento Ambiental , Atividades de Lazer/psicologia , Atividade Motora , Qualidade de Vida/psicologia , Características de Residência , Caminhada/psicologia , Adulto , Estudos Transversais , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meio Social
12.
J Occup Environ Med ; 54(5): 615-20, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22547123

RESUMO

OBJECTIVE: To investigate the association between US Navy individual augmentee (IA) deployers, who may lack the protective effects of unit cohesion and social support, and newly reported mental health. METHODS: Responses from the Millennium Cohort Study questionnaires were examined for 2086 Navy deployers in this prospective exploratory study. Multivariable logistic regression was used to evaluate IA deployment and newly reported mental health symptoms. RESULTS: After adjusting for covariates, IA deployment was not significantly associated with newly reported posttraumatic stress disorder (odds ratio = 1.02; 95% confidence interval: 0.53-1.95) or mental health symptoms (odds ratio = 1.03; 95% confidence interval: 0.66-1.60) compared with non-IA deployment. CONCLUSION: IA deployment was not associated with increased risk for posttraumatic stress disorder or mental health symptoms following deployment. It is likely that social isolation was not highly influential among Navy IAs in this study.


Assuntos
Militares/psicologia , Identificação Social , Transtornos de Estresse Pós-Traumáticos/etiologia , Campanha Afegã de 2001- , Transtornos Relacionados ao Uso de Álcool/etiologia , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Guerra do Iraque 2003-2011 , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos , Guerra
13.
Ann Behav Med ; 43(1): 84-100, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22215470

RESUMO

BACKGROUND: Community-based interventions are needed to reduce the burden of childhood obesity. PURPOSE: To evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children. METHODS: Thirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2(nd) grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors. RESULTS: There were no significant intervention effects on children's BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring). CONCLUSION: A promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.


Assuntos
Serviços de Saúde Comunitária , Família/etnologia , Promoção da Saúde/métodos , Hispânico ou Latino , Obesidade/prevenção & controle , Pais/educação , Medicina do Comportamento , Índice de Massa Corporal , California , Criança , Comportamento Infantil/etnologia , Exercício Físico , Feminino , Humanos , Masculino , Obesidade/etnologia , Poder Familiar , Serviços de Saúde Escolar , Instituições Acadêmicas
14.
Alcohol Clin Exp Res ; 36(4): 670-6, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22250768

RESUMO

BACKGROUND: The physical features of fetal alcohol syndrome include smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and growth deficiencies on weight and height. However, little is known about the specific quantities of alcohol exposure, pattern of drinking, timing of exposure, and magnitude of risk for each of these features. METHODS: Using data on 992 subjects collected prospectively in California between 1978 and 2005, we examined the patterns and timing of alcohol exposure in relation to these features. Structural features were assessed by a dysmorphologist who performed a blinded physical examination of all infants. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0 to 6 weeks postconception, 6 to 12 weeks postconception, first trimester, second trimester, and third trimester. RESULTS: Higher prenatal alcohol exposure in every pattern was significantly associated with the incidence of smooth philtrum but not with short palpebral fissures. The strongest associations were with timing of exposure in the second half of the first trimester (RR 1.25, 95% CI 1.14 to 1.36 for average number of drinks per day; RR 1.17, 95% CI 1.09 to 1.26 for maximum number of drinks in 1 episode). Similarly, thin vermillion border was most strongly associated with exposure in the second half of the first trimester. Findings with respect to timing of exposure were similar for microcephaly and reduced birth weight. However, reduced birth length was increased with exposure in any trimester. These associations were linear, and there was no evidence of a threshold. CONCLUSIONS: Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose-related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.


Assuntos
Transtornos do Espectro Alcoólico Fetal/patologia , Transtornos do Crescimento/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal , Anormalidades Induzidas por Medicamentos/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/complicações , Peso ao Nascer , Estatura , California/epidemiologia , Coleta de Dados , Face/anormalidades , Feminino , Idade Gestacional , Cabeça/anatomia & histologia , Humanos , Recém-Nascido , Lábio/anormalidades , Modelos Logísticos , Microcefalia/induzido quimicamente , Microcefalia/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores Socioeconômicos
15.
Med Sci Sports Exerc ; 44(4): 637-46, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21946156

RESUMO

BACKGROUND: There is growing interest in identifying neighborhood environment factors related to physical activity. PURPOSE: This study aimed to examine whether objective built (e.g., residential density) and perceived (e.g., aesthetics) environment factors around adults' residence are correlates of their physical activity and reported walking behavior after accounting for known psychosocial (e.g., self-efficacy, barriers to physical activity) and demographic correlates of physical activity. METHODS: Objective built environment characteristics were created through network buffers around individual participants (n = 2199) selected from neighborhoods differing on walkability characteristics and household income. Participants wore accelerometers to obtain a more objective measure of overall physical activity and self-reported on leisure and transportation-related walking, perceptions of neighborhood environment, psychosocial factors related to physical activity, and demographic factors. Census-level demographic factors were also considered. RESULTS: Retail floor area ratio, a metric combining land use mix and pedestrian design factors, was the environmental factor most related to accelerometry-measured physical activity and self-reported transportation-related walking after accounting for psychosocial and demographic factors. Street connectivity was also related to transportation-related walking, whereas perceived aesthetics was positively related to leisure walking. CONCLUSIONS: Environmental factors, particularly the availability of proximal nonresidential destinations designed for pedestrian access, were related to adults' physical activity and walking after accounting for psychosocial and demographic correlates, including reasons for residential selection.


Assuntos
Atividade Motora/fisiologia , Características de Residência/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Caminhada/fisiologia , Caminhada/psicologia , Caminhada/estatística & dados numéricos
16.
J Phys Act Health ; 9(7): 985-95, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21953281

RESUMO

BACKGROUND: The study aim was to assess the relation of parent status to physical activity (PA) and the impact of parental roles, age and number of children on PA. METHODS: Data for 909 women and 965 men, aged 20-57, were analyzed. Mixed Models were used to assess differences in PA between parents and adults without children, with analyses stratified by sex. The primary outcome was accelerometer-measured total daily minutes of moderate-to-vigorous PA (MVPA). RESULTS: Parenthood was not related to MVPA, but mothers reported more total PA than nonmothers. For mothers and fathers, self-reported household activity was higher and sitting time lower, compared with nonparents. Both men and women with children aged 0-5 reported the highest household activity and the lowest sitting time, with household PA higher and sitting time lower with more children. There was no evidence that leisure, transport, or occupational activity varied by parenthood. CONCLUSIONS: Considering the potential impact of child-rearing on parent time demands, there was little difference in parents' objectively measured MVPA compared with nonparents. Educational interventions or extracurricular programs for students and parents could target families with school-aged children. Development of tools to obtain parent reports of child care-specific PA behaviors would be useful.


Assuntos
Características da Família , Comportamentos Relacionados com a Saúde , Atividade Motora , Acelerometria , Adulto , Índice de Massa Corporal , Pré-Escolar , Exercício Físico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Autorrelato , Fatores Socioeconômicos
17.
Autoimmune Dis ; 2011: 741267, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22162801

RESUMO

The objective of this study was to prospectively assess the association between deployment in support of the operations in Iraq and Afghanistan and newly reported lupus and rheumatoid arthritis while also considering the effects of demographic, behavioral, and occupational characteristics. A total of 77,047 (2001-2003) and 31,110 (2004-2006) participants completed the baseline Millennium Cohort questionnaire and were resurveyed approximately every 3 years. Longitudinal analyses were used to assess the adjusted association between deployment to Iraq and Afghanistan with and without combat exposures and newly reported disease. After adjusting, deployment was not significantly associated with newly reported lupus compared with nondeployers. However, compared with nondeployers, deployers with and without combat exposures were significantly less likely to newly report rheumatoid arthritis. Women, non-Hispanic black, and Hispanic participants had a significantly elevated risk for both diseases. Overall, deployment was not associated with an increased risk of newly reported lupus or rheumatoid arthritis.

18.
Clin Infect Dis ; 53(12): 1173-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21976459

RESUMO

BACKGROUND: Clostridium difficile infection (CDI) has increased in frequency and severity over the past decade. An understanding of the modifiable risk factors for disease severity has considerable clinical applicability. METHODS: We performed a retrospective case review of 485 cases in patients aged 1-99 years at the Naval Medical Center San Diego from November 2004 through December 2008. We compared potential risk factors for association with complications (megacolon, surgery, intensive care unit stay, and death) or mortality alone with use of univariable and multivariable logistic regression modeling. RESULTS: Forty-seven patients (9.8%) developed ≥1 complication, and 23 (4.7%) died. We found independent associations between complications and acid suppression (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.79), admission for CDI (OR, 4.14; 95% CI, 2.17-7.92), older age (≥80 years; OR, 3.14; 95% CI, 1.46-6.73), and corticosteroid use (OR, 2.09; 95% CI, 1.01-4.35). Age ≥80 years (OR, 5.51; 95% CI, 2.25-13.49) and acid suppression (OR, 4.74; 95% CI, 1.57-14.37) were associated with increased odds of death. CONCLUSIONS: Data published elsewhere have suggested that acid suppression therapy is a risk factor for CDI acquisition and relapse. These findings suggest an additional role in increased severity of disease, including mortality, and merit further study.


Assuntos
Clostridioides difficile/isolamento & purificação , Clostridioides difficile/patogenicidade , Infecções por Clostridium/mortalidade , Infecções por Clostridium/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções por Clostridium/complicações , Humanos , Lactente , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
19.
Am J Med Genet A ; 155A(12): 2949-55, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22002918

RESUMO

The characteristic facial features of the more severe end of Fetal Alcohol Spectrum Disorders (FASD) include smooth philtrum, thin vermillion of the upper lip, and short palpebral fissures. A systematic evaluation of a comprehensive list of minor structural defects in association with varying patterns of prenatal exposure to alcohol has not been performed. We examined the patterns and timing of prenatal alcohol exposure to minor structural malformations occurring in at least 5% of the sample. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0-6 weeks post-conception, 6-12 weeks post-conception, first trimester, second trimester, and third trimester. Naevus flammeus neonatorum is significantly associated with various patterns of drinking during the second half of the first trimester (RR 1.14, 95% CI 1.04, 1.24 for average number of drinks per day; RR 1.04, 95% CI 1.02, 1.07 for number of binge episodes; RR 1.08, 95% CI 1.01, 1.15 for maximum number of drinks in one episode) and similar for number of binge episodes in all categories of timing of exposure and in the second trimester for average number of drinks per day. Other minor malformations occurring in at least 5% of the sample were not found to be significantly associated with prenatal alcohol exposure. Expected minor malformations were not found to be significantly associated with prenatal alcohol exposure. Naevus flammeus neonatorum appears to be part of the spectrum of features associated with prenatal alcohol exposure.


Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos do Espectro Alcoólico Fetal/etiologia , Exposição Materna/efeitos adversos , Adulto , Criança , Pré-Escolar , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Prospectivos
20.
J Child Health Care ; 15(4): 358-69, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21996682

RESUMO

Childhood asthma is particularly prevalent among disadvantaged children and is associated with greater functional consequences. This study described factors associated with childhood asthma in a sample of Latino and non-Latino children. Data were from baseline measures of 791 parent and child dyads involved in a childhood obesity prevention study. Parents completed a self-administered survey assessing childhood factors, demographics, acculturation and child asthma diagnosis. Multivariate mixed effects logistic regression analyses tested for correlates of child asthma and ethnicity interactions. Children were 4-10 years old, half were female, 86.0 percent were US-born and 45.7 percent were overweight or obese. The prevalence of childhood asthma was 11.5 percent. In multivariate analyses, the odds of childhood asthma were greater among children of non-Latino descent (OR = 4.1, CI: 1.8, 9.2), who had health insurance (OR = 11.1, CI: 2.7, 46.4), were male (OR = 1.8; CI: 1.1, 3.1) and born pre-term (OR = 3.0, CI: 1.4, 6.3). This study supports socio-demographic disparities in childhood asthma and evidence of their independent effects.


Assuntos
Asma/etnologia , Disparidades nos Níveis de Saúde , Classe Social , Aculturação , Adulto , California , Criança , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino
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