Is anyone truly healthy? Trends in health risk factors prevalence and changes in their associations with all-cause mortality.

OBJECTIVE: The purpose of the study was to determine trends in the prevalence of individual health risk factors across time and to examine if their associations with mortality have changed over time. METHODS: Data from the National Health and Nutrition Examination Surveys (NHANES III- 1988-1994 and NHANES 1999-2014; age ≥20 years) was used to examine differences in the odds ratio (OR) of 5-year mortality risk associated with various common health risk factors over the two survey periods using weighted logistic regression analysis adjusting for age, sex, obesity category and white ethnicity (n = 28,279). RESULTS: Over 97% of individuals had at least one of the 19 risk factors examined with no difference in the prevalence over time (P>0.34). The prevalence of lifestyle, social/mental and physical risk factors (2.2 to 19.1%) increased over time (P<0.0002), while the prevalence of having physiological risk factors decreased by ~6.5% (P<0.0001). Having any lifestyle or social/mental risk factor was significantly associated with a higher 5-year OR for mortality risk in 1999-2014, than 1988-94. In particular, having low education or use of mental health medication were not associated with mortality risk in 1988-94 (P>0.1), but were significantly associated with a higher 5-year OR for mortality in 1999-2014 (P<0.0001). Conversely, physiological risk factors were more weakly related with mortality risk in 1988-1994, than 1999-2014. Having any physical risk factor, and poor self-rated health were similarly related with 5-year mortality risk at both timepoints. CONCLUSION: Health risk factors have both increased and decreased in prevalence over time, along with changes in the association between many of the risk factors and mortality risk. Taken together, these changes complicate interpretation of temporal trends and warrant cautious interpretation of population health patterns based on surveillance data.

Effects of Exercise on Resting Metabolic Rate in Adolescents with Overweight and Obesity.

Background: We examined the effects of exercise training on resting metabolic rate (RMR), and whether changes in body composition are associated with changes in RMR in adolescents with overweight and obesity. Methods: One hundred forty adolescents (12-18 years, BMI ≥85th percentile) participated in randomized exercise trials (3-6 months) at UPMC Children's Hospital of Pittsburgh (18 control, 51 aerobic, 50 resistance, and 21 combined aerobic and resistance exercise). All participants had RMR assessments by indirect calorimetry after a 10-12 hour overnight fast, and body composition by magnetic resonance imaging and dual-energy X-ray absorptiometry. Results: There were no significant changes in RMR (kcal/day) between exercise groups vs. controls (p > 0.05). All exercise groups decreased visceral fat (-0.2 ± 0.02 kg; p < 0.05) compared to control. Increases in fat-free mass (FFM) were only seen in the combined group (2.3 ± 0.4 kg; p < 0.05), whereas increases in skeletal muscle mass were observed in both resistance (1.2 ± 0.2 kg; p < 0.05) and combined (1.5 ± 0.3 kg; p < 0.05) groups vs. control. Change in FFM, but not fat mass (FM), visceral fat, or skeletal muscle mass (p > 0.05), was a significant determinant of changes in RMR, independent of exercise modality (p = 0.04). Conclusion: Although exercise modality was not associated with changes in RMR, change in FFM, but not skeletal muscle or FM, was a significant correlate of changes in RMR in adolescents with overweight and obesity. Clinicaltrials.gov registration numbers: NCT00739180, NCT01323088, NCT01938950.

Age- and sex- specific all-cause mortality risk greatest in metabolic syndrome combinations with elevated blood pressure from 7 U.S. cohorts.

BACKGROUND: The association between metabolic syndrome (MetS) and all-cause mortality is well established but it is unclear if there are differences in mortality risk among the 32 possible MetS combinations. Hence, the purpose of this study is to evaluate the associations between different MetS combinations and its individual components with all-cause mortality, and to examine differences in the association by age and sex. METHODS: A merged sample of 82,717 adults from 7 U.S. cohorts was used. RESULTS: In our sample, MetS was present in 32% of men, 34% of women, 28% of younger adults (18-65 years) and 62% of older adults (>65 years) with 14,989 deaths over 14.6 ± 7.4 years of follow-up. Risk of all-cause mortality was higher in younger individuals with a greater number of MetS factors present, but in older adults having all 5 MetS factors was the only combination significantly associated with mortality. Regardless of age or sex, elevated blood pressure was the MetS factor most consistently present in MetS combinations that were significantly and most strongly associated with mortality. In fact, elevated blood pressure in the absence of other risk factors was significantly associated with mortality in men (HR, 95% CI = 1.56, 1.33-1.84), women (HR = 1.62, 1.44-1.81) and younger adults (HR = 1.61, 1.45-1.79). Conversely, waist circumference, glucose and triglycerides in isolation were not associated with mortality (p>0.05). CONCLUSION: In a large U.S. population, different combinations of MetS components vary substantially in their associations with all-cause mortality. Men, women and younger individuals with MetS combinations including elevated blood pressure had stronger associations with greater mortality risk, with minimal associations between MetS and mortality risk in older adults. Thus, we suggest that future algorithms may wish to consider differential weighting of these common metabolic risk factors, particularly in younger populations.

Effects of heel height and high-heel experience on foot stability during quiet standing.

BACKGROUND: The use of high-heeled shoes (HHS) introduces instability into the wearer's balance system but how high-heel experience might influence standing balance is less examined in literature. RESEARCH QUESTION: (1) Does foot stability decrease in both the antero-posterior (AP) and medial-lateral (ML) directions with increasing heel height during quiet standing? (2) Does high-heel experience improve the wearer's foot stability during quiet standing in high-heeled conditions? METHODS: Twenty-four young females (12 regular and 12 non-regular HHS wearers) were recruited to perform quiet standing while wearing shoes with heel heights of 1 cm, 5 cm, 8 cm and 10 cm. The effects of heel height on the mean center of pressure (COP), their variability (standard deviations) and mean COP velocities in both the AP and ML directions were analysed by one-way repeated measures ANOVA and Bonferroni post-hoc test. The effects of high-heel experience were analysed through independent samples t-tests. RESULTS: The variability of the COP in both directions increased with heel height, although significance was found only in the ML direction. The COP velocities in both directions were highest for the 1 cm heel, decreased as the heel increased to 8 cm and increased again for the 10 cm heel. Experienced HHS wearers exhibited significantly smaller COP variances (AP) for the 8 cm and 10 cm heels, smaller COP velocities (AP) for all heels, and smaller COP variances (ML) and COP velocities (ML) for the 10 cm heel. SIGNIFICANCE: The use of HHS results in greater stability distortions in both AP and ML directions but high-heel experience improves balance control under high-heeled conditions. Our findings enhance the understanding of how high-heel experience might influence standing balance in different heel height, and highlights the importance of the ML components of the in-foot COP measures in the examination of standing balance in HHS.

Garment needs of pregnant women based on content analysis of in-depth interviews.

AIMS: This study aims to identify the needs, concerns and problems of pregnant women when using maternity support garments. BACKGROUND: Maternity support belt is regarded as helpful in reducing low back pain during pregnancy. However, several garment-related problems exist which might lead to poor adherence behaviour undermining the benefit of garment therapy. DESIGN: A qualitative exploratory study. METHODS. Semi-structured interviews were conducted with 10 pregnant Chinese women who experienced low back pain during pregnancy. All the interviews followed an interview guide and different maternity support garments were shown to the participants as a method of tangible objects to stimulate responses. Content analysis was used to analyse the data. RESULTS: The results showed that 60% of pregnant women discontinued using maternity support garments due to excessive heat, perceived ineffectiveness, itchiness, excessive pressure around the abdomen and inconvenience of adjustment. The content analysis generated five main themes of needs including effective function, safety, skin comfort, ease to put on and take off and aesthetics of maternity support garments. DISCUSSION: The findings of the five main themes of needs were largely consistent with previous studies examining medical garments for overall satisfaction and compliance. The results revealed that women's physiological and psychological changes during pregnancy influenced their clothing preferences on both functional and aesthetical values. CONCLUSIONS: Maternity support garments are convenient and easily-accessible therapy to manage LBP during pregnancy and are frequently recommended and worn by pregnant women. However, inappropriate choice of garment therapy not only led to ineffectiveness but also undesirable effects. The key findings of the five main themes of garment needs in pregnant women will facilitate healthcare professionals in providing evidence-based advice to assist patients in the selection of an appropriate and optimal maternity support garment. RELEVANCE TO CLINICAL PRACTICE: These recommendations in the clinical practice will assist patients in making well informed treatment decisions and ultimately improve the quality of care.

Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review.

AIMS: This article aims to review the literature published to date on the types, current use, the biomechanical effects and adverse effects of maternity support belts for low back pain during pregnancy, to identify future research directions. BACKGROUND: Lumbar/pelvic support belts are frequently recommended for the prevention and treatment of low back pain during pregnancy. DESIGN: Systematic review. METHODS: MEDLINE, CINAHL, the Cochrane Library and patents databases were electronically searched. RESULTS: Maternity support belts belong to one of the four main types of maternity support garments, which are widely commercially-available. Current research showed limited evidence in support of the commercial maternity products regarding the effectiveness in the prevention and/or treatment of low back pain during pregnancy, other than that from the manufacturers. However, potential stabilisation effect of maternity support belt was demonstrated in some studies. Adverse effects reported include increased pain, fetal heart rate changes, skin irritation and discomfort. CONCLUSIONS: There is insufficient scientific evidence to conclude that wearing maternity support belts reduces pregnancy-related low back pain and/or pelvic girdle pain. Future research directions in the area of biomechanics and physiology are recommended. RELEVANCE TO CLINICAL PRACTICE: This review provides comprehensive understanding of the effectiveness of maternity support belts for the relief of low back pain during pregnancy which will facilitate healthcare professionals in providing evidence-based advice to their patients.

Evaluation of the performance of using mean absolute amplitude analysis of thoracic and abdominal signals for immediate indication of sleep apnoea events.

AIM: To evaluate the sensitivity of mean absolute amplitudes of the thoracic and the abdominal signals as a prompt indicator of the occurrence of sleep apnoea events. BACKGROUND: To provide symptomatic management of sleep apnoea, a reliable method of detecting sleep apnoea is essential to ensure that the intervention can be applied only when needed. It is also crucial to identify the threshold for the trigger of an intervention using a deployed sensor. DESIGN: Twenty-six subjects aged between 18-65 years who were diagnosed with obstructive or central sleep apnoea underwent an overnight sleep study. METHOD: Signals of nasal and oral airflow, thoracic and abdominal efforts and pulse oximetry level were recorded using a polysomnography device. RESULTS: With a 95% CI, the overall area under the receiver operating characteristic of the thoracic signal, the abdominal signal and the combination of the thoracic and the abdominal signals were 84.56, 87.48 and 90.91%, respectively. Using -20, -25 and -30% as a cut-off point, the sensitivity values of thoracic signal, abdominal signal and combination of the thoracic and the abdominal signals ranged from 70.29-86.25% and the specificity values ranged from 74.82 to 90.09%. CONCLUSIONS: Using mean absolute amplitude analysis, the results of this study showed that combination of the thoracic and the abdominal signals achieved the best overall and individual performances compared with thoracic signal and abdominal signal. Overall, thoracic signal, abdominal signal and combination of the thoracic and the abdominal signals have a good performance with an receiver operating characteristic value higher than 80%. The thoracic and the abdominal signals were good parameters for the identification of the occurrence of sleep apnoea, being as quick as the nasal airflow signal. RELEVANCE TO CLINICAL PRACTICE: These results suggested that sleep apnoea events could be identified through constant monitoring of the patient's thoracic and abdominal signals. Knowledge of these signals could help nurses to manage sleep apnoea in patients.

Using pulse oximetry level to indicate the occurrence of sleep apnoea events.

The aim of this research study was to identify an alternative to nasal airflow as a prompt and unobtrusive indicator of sleep apnoea events. This study attempted to select pulse oximetry (SpO2) level as an alternative parameter to indicate the occurrence of sleep apnoea. Ten subjects diagnosed with sleep apnoea underwent an overnight polysomnography (PSG) study. Signals of nasal flow and SpO2 level were recorded. Time differences were compared between the "onset of nasal airflow cessation" (ONAC) and the "onset of three percent oxygen desaturation from the baseline" (OOD) during sleep apnoea events. The results of this study showed that measuring SpO2 level was more comfortable for patients, but that there was around a twenty second delay after the onset of the cessation of nasal airflow. It was concluded that the measurement of SpO2 level was useful for screening suspected sleep apnoea patients, but it might not be able to provide "online detection" of the occurrence of sleep apnoea events.