Dietary diversity and nutritional status of adolescents in Lagos, Nigeria.

Background/Objectives: Adolescents in low- and middle-income countries, such as Nigeria, are at increased risk of malnutrition, especially obesity, but there is limited data describing the risk. We assessed this risk by examining the nutritional status and associated factors such as dietary habits, dietary diversity, nutritional knowledge and sociodemographic characteristics among adolescents in Lagos, Nigeria. Methods: A descriptive cross-sectional study in which 682 adolescents were selected from their communities using a multistage sampling technique. Dietary habits were assessed using a food frequency questionnaire, and dietary diversity was assessed through nonquantifiable 24-h diet recall. Anthropometric measurements were taken to determine nutritional status. Data were analyzed using Epi-Info software version 7.2.3.1. Nutritional status was evaluated using WHO AnthroPlus software. Chi-square was used to test for an association between categorical variables, and P values ≤0.05 were considered statistically significant. Results: The mean age of the adolescents was 13.6 ± 2.3 years, and only 47.4% of them had good nutritional knowledge. Dietary habits were poor and dietary diversity was low. The prevalence of overweight and obesity was 13.4% and 7.0%. Eating dinner, dieting to control weight and daily consumption of foods outside the home were associated with overweight and obesity (P < 0.05). Conclusions: Dietary habits and diversity of the adolescents were poor, while overweight and obesity were high. Eating dinner and daily consumption of foods outside the home were factors associated with being overweight and obesity. Our findings emphasize the critical need for adolescent nutrition programs that address weight control, especially among those who eat outside their homes.

Do geodemographic typologies explain variations in uptake in colorectal cancer screening? An assessment using routine screening data in the south of England.

BACKGROUND: Uptake of colorectal cancer (CRC) screening in UK is less than 60%. Geodemographic typologies are useful in describing patterns of individual preventive health behaviour but little is known of their value in assessing uptake of CRC screening, or how this compares to traditional measures of area deprivation. METHODS: We used data on CRC screening uptake in the South Central, South-East Coast and South-West England National Health Service regions in multilevel logistic regression to describe the effects of individual composition and contextual factors (area deprivation and geodemographic segments) on non-response to screening invitation. The relative impact of geodemographic segmentation and the index of multiple deprivation (IMD) 2007 was compared. The potential population impact of a targeted increase in uptake in specific geodemographic segments was examined. RESULTS: About 88 891 eligible adults were invited to be screened from 2006 to 2008. Uptake rate was 57.3% (CI: 57.0-57.7) and was lower amongst younger persons, men, residents of more deprived areas and people in specific geodemographic segments. Age and gender were significant determinants of uptake and contextual factors explained an additional 3% of the variation. Geodemographic segmentation reduced this residual contextual variation in uptake more than the IMD 2007 (72% vs. 53% reduction). The three geodemographic types that best predicted non-response were characterized by both ethnic mix and a higher than average proportion of single pensioner households renting council properties. Achieving average uptake in the 2.3% of the study population in these geodemographic segments would only increase the total population uptake rate by 0.5% (57.3-57.8%). CONCLUSION: Variation in the CRC screening uptake in Southern England is principally explained by characteristics of individuals but contextual factors also have a small but significant effect. This effect is captured in greater detail by geodemographic segmentation than by IMD 2007. This information could be used to inform the design of interventions aiming to improve uptake.

Transcutaneous electrical nerve stimulation (TENS) for chronic pain.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a popular pain treatment modality but its effectiveness in chronic pain management is unknown. This review is an update of the original Cochrane review published in Issue 3, 2001. OBJECTIVES: To evaluate the effectiveness of TENS in chronic pain. SEARCH STRATEGY: The Cochrane Library, EMBASE, MEDLINE and CINAHL were searched. Reference lists from retrieved reports and reviews were examined. Date of the most recent search: April 2008. SELECTION CRITERIA: RCTs were eligible if they compared active TENS versus sham TENS controls; active TENS versus 'no treatment' controls; or active TENS versus active TENS controls (e.g. High Frequency TENS (HFTENS) versus Low Frequency TENS (LFTENS)). Studies of chronic pain for three months or more which included subjective outcome measures for pain intensity or relief were eligible for evaluation. No restrictions were made to language or sample size. Abstracts, letters, or unpublished studies, and studies of TENS in angina, headache, migraine, dysmenorrhoea and cancer-related pain were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted and summarised on the following items: patients and details of pain condition, treatments, study duration, design, methods, subjective pain outcome measures, methodological quality, results for pain outcome measures and adverse effects, and conclusions by authors of the studies. Extracted data and methodological quality of studies were confirmed by the review authors. MAIN RESULTS: Of 124 studies identified from the searches, 99 did not fulfil pre-defined entry criteria. Twenty-five RCTs involving 1281 participants were evaluated. Included studies varied in design, analgesic outcomes, chronic pain conditions, TENS treatments and methodological quality. The reporting of methods and results for analgesic outcomes were inconsistent across studies and generally poor. Meta-analysis was not possible. Overall in 13 of 22 inactive control studies, there was a positive analgesic outcome in favour of active TENS treatments. For multiple dose treatment comparison studies, eight of fifteen were considered to be in favour of the active TENS treatments. Seven of the nine active controlled studies found no difference in analgesic efficacy between High Frequency (HF) TENS and Low Frequency (LF) TENS. AUTHORS' CONCLUSIONS: Since the last version of this review, new relevant studies have not provided additional information to change the conclusions. Published literature on the subject lacks the methodological rigour or robust reporting needed to make confident assessments of the role of TENS in chronic pain management. Large multi-centre RCTs of TENS in chronic pain are still needed.

Endometriosis and associated symptoms among Nigerian women.

OBJECTIVE: To determine the prevalence of endometriosis and identify associated symptoms among Nigerian women. METHODS: A cross-sectional study was conducted at a center in Ibadan, Nigeria, between October 2008 and December 2010. All women aged 18-45 years scheduled for their first diagnostic laparoscopy for gynecologic indications were enrolled. Participants completed a previously validated self-administered questionnaire. Endometriosis was diagnosed on the basis of visual evidence. RESULTS: Among 239 women analyzed, 115 (48.1%) had endometriotic lesions. Endometriosis was more common among women reporting dysmenorrhea and pelvic pain than among those not reporting these symptoms (20/28 [71.4%] vs 95/211 [45.0%]; P=0.009). Women who reported dysmenorrhea were significantly more likely to have endometriosis than were those without dysmenorrhea (90/171 [52.6%] vs 25/68 [36.8%]; P=0.027). The risk of endometriosis was not significantly increased in women with one pain symptom (odds ratio [OR]1.69; 95% confidence interval [CI] 0.67-4.27), but was significantly increased in women with two (OR 2.70; 95% CI 1.13-6.52) or three (OR 4.87; 95% CI 1.88-12.82) pain symptoms (χ(2)trend=15.5; P<0.001). In a multivariate logistic regression model, only pain other than dysmenorrhea or dyspareunia independently predicted endometriosis (P=0.017). CONCLUSION: Endometriosis is fairly common among Nigerian women. Efforts to increase the awareness of endometriosis among the public, researchers, and clinicians are needed.

Is early age at menarche a risk factor for endometriosis? A systematic review and meta-analysis of case-control studies.

OBJECTIVE: To review published studies evaluating early menarche and the risk of endometriosis. DESIGN: Systematic review and meta-analysis of case-control studies. SETTING: None. PATIENT(S): Eighteen case-control studies of age at menarche and risk of endometriosis including 3,805 women with endometriosis and 9,526 controls. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Medline and Embase databases were searched from 1980 to 2011 to locate relevant studies. Results of primary studies were expressed as effect sizes of the difference in mean age at menarche of women with and without endometriosis. Effect sizes were used in random effects meta-analysis. RESULT(S): Eighteen of 45 articles retrieved met the inclusion criteria. The pooled effect size in meta-analysis was 0.10 (95% confidence interval -0.01-0.21), and not significantly different from zero (no effect). Results were influenced by substantial heterogeneity between studies (I(2) = 72.5%), which was eliminated by restricting meta-analysis to studies with more rigorous control of confounders; this increased the pooled effect size to 0.15 (95% confidence interval 0.08-0.22), which was significantly different from zero. This represents a probability of 55% that a woman with endometriosis had earlier menarche than one without endometriosis if both were randomly chosen from a population. CONCLUSION(S): There is a small increased risk of endometriosis with early menarche. The potential for disease misclassification in primary studies suggests that this risk could be higher.

Developing symptom-based predictive models of endometriosis as a clinical screening tool: results from a multicenter study.

OBJECTIVE: To generate and validate symptom-based models to predict endometriosis among symptomatic women prior to undergoing their first laparoscopy. DESIGN: Prospective, observational, two-phase study, in which women completed a 25-item questionnaire prior to surgery. SETTING: Nineteen hospitals in 13 countries. PATIENT(S): Symptomatic women (n = 1,396) scheduled for laparoscopy without a previous surgical diagnosis of endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sensitivity and specificity of endometriosis diagnosis predicted by symptoms and patient characteristics from optimal models developed using multiple logistic regression analyses in one data set (phase I), and independently validated in a second data set (phase II) by receiver operating characteristic (ROC) curve analysis. RESULT(S): Three hundred sixty (46.7%) women in phase I and 364 (58.2%) in phase II were diagnosed with endometriosis at laparoscopy. Menstrual dyschezia (pain on opening bowels) and a history of benign ovarian cysts most strongly predicted both any and stage III and IV endometriosis in both phases. Prediction of any-stage endometriosis, although improved by ultrasound scan evidence of cyst/nodules, was relatively poor (area under the curve [AUC] = 68.3). Stage III and IV disease was predicted with good accuracy (AUC = 84.9, sensitivity of 82.3% and specificity 75.8% at an optimal cut-off of 0.24). CONCLUSION(S): Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy. Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis. We invite other researchers to validate the key models in additional populations.

Modelling the impact of a healthy diet on cardiovascular disease and cancer mortality.

BACKGROUND: Quantifying the potential health benefits of improvements in the nutritional quality of the average diet of a population would provide evidence for resource allocation between population-level interventions aimed at reducing chronic disease. METHODS: A model was built linking consumption of food components with biological risk factors (blood pressure, serum cholesterol and obesity) and subsequent mortality from coronary heart disease, stroke and cancer. Meta-analyses of individual-level studies that quantified the RR of increased consumption/increased risk factor level on disease outcomes were used to build the model. The sensitivity of the model to the results from the meta-analyses was assessed with Monte Carlo simulations. Country-specific estimates of current nutrient intake compared against dietary recommendations for the UK were used to demonstrate the model. RESULTS: Approximately 33 000 deaths per year would be avoided if UK dietary recommendations were met. The modelled reduction in deaths for coronary heart disease was 20 800 (95% credible interval 17 845-24 069), for stroke 5876 (3856-7364) and for cancer 6481 (4487-8353). Over 15 000 of the avoided deaths would be due to increased consumption of fruit and vegetables. CONCLUSIONS: The developed model estimates the impact of population-level dietary changes and is robust. Achieving UK dietary recommendations for fruit and vegetable consumption (five portions a day) would result in substantial health benefits-equivalent benefits would be achieved if salt intakes were lowered to 3.5 g per day or saturated fat intakes were lowered to 3% of total energy.

Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.

OBJECTIVE: To assess the impact of endometriosis on health-related quality of life (HRQoL) and work productivity. DESIGN: Multicenter cross-sectional study with prospective recruitment. SETTING: Sixteen clinical centers in ten countries. PATIENT(S): A total of 1,418 premenopausal women, aged 18-45 years, without a previous surgical diagnosis of endometriosis, having laparoscopy to investigate symptoms or to be sterilized. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Diagnostic delay, HRQoL, and work productivity. RESULT(S): There was a delay of 6.7 years, principally in primary care, between onset of symptoms and a surgical diagnosis of endometriosis, which was longer in centers where women received predominantly state-funded health care (8.3 vs. 5.5 years). Delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia, and heavy periods) and a higher body mass index. Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis. Each affected woman lost on average 10.8 hours (SD 12.2) of work weekly, mainly owing to reduced effectiveness while working. Loss of work productivity translated into significant costs per woman/week, from US$4 in Nigeria to US$456 in Italy. CONCLUSION(S): Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.

Modelling income group differences in the health and economic impacts of targeted food taxes and subsidies.

OBJECTIVE: To examine the effects, by income group, of targeted food taxes and subsidies on nutrition, health and expenditure in the UK. METHODS: A model based on consumption data and demand elasticity was constructed to predict the effects of four food taxation-subsidy regimens. Resulting changes in demand, expenditure, nutrition, cardiovascular disease (CVD) and cancer mortality were estimated. Data Expenditure data were taken from the Expenditure and Food Survey; estimates of price elasticities of demand for food were taken from a report based on the National Food Survey 1988-2000. Estimates of effect on CVD and cancer mortality of changing fat, salt, fruit and vegetable intake were taken from previous meta-analyses. RESULTS: (i) Taxing principal sources of dietary saturated fat is unlikely to reduce cardiovascular disease (CVD) or cancer mortality. (ii) Taxing 'less healthy' foods (defined by the WXYfm nutrient profiling model) could increase CVD and cancer deaths by 35-1300 yearly. (iii) Taxing 'less healthy' foods and subsidising fruits and vegetables by 17.5% could avert up to 2900 CVD and cancer deaths yearly. (iv) Taxing 'less healthy' foods and using all tax revenue to subsidize fruits and vegetables could avert up to 6400 CVD and cancer deaths yearly. Few obesity-related CVD deaths are averted by any of the regimens. All four regimens would be economically regressive and positive health effects will not necessarily be greater in lower-income groups where the need for dietary improvement is higher. CONCLUSIONS: A targeted food tax combined with the appropriate subsidy on fruits and vegetables could reduce deaths from CVD and cancer.

MULTI-CENTRE STUDIES OF THE GLOBAL IMPACT OF ENDOMETRIOSIS AND THE PREDICTIVE VALUE OF ASSOCIATED SYMPTOMS.

INTRODUCTION: Endometriosis can be difficult to diagnose clinically and models that use symptoms to predict whether the disease is present or not are based on limited patient populations. Endometriosis also influences health-related quality of life, but little is known about its impact across the world. We therefore initiated two integrated multicentre studies to collect prospective, standardised, epidemiological data, to 1) examine the global impact of endometriosis and relative effect of risk-factors, and 2) develop a symptom-based diagnostic tool. METHODS: The Global Study of Women's Health (GSWH) and the Women's Health Symptom Survey (WHSS) prospectively recruit 18-45 year old women having a laparoscopy across 23 and 19 centres, respectively, worldwide. Women with a previous surgical diagnosis of endometriosis are excluded. Multi-lingual patient questionnaires and a surgical questionnaire, incorporating validated instruments, are used to collect the data. The GSWH aims to recruit >2,000 women by December 2009; the WHSS to recruit 1,000 women in each of the two model-generating and validation stages. RESULTS: A six-week pilot study in Oxford, UK, established the feasibility of the study protocols. Of 32 eligible women, 27 participated (response rate - 84.4%); 26% completed the questionnaire online. Endometriosis was found in 47.4%. Extrapolating the recruitment rates from the pilot study, the target sample sizes for the GWSH and WHSS were deemed feasible. CONCLUSIONS: Using standardised data collection, the GSWH and WHSS will provide insight into the global impact of endometriosis and develop a validated, symptom-based, diagnostic tool. They have the potential to provide the basis for future, longitudinal, follow-up studies and a collaborative Endometriosis Biobank implementing standardised collection of DNA and tissue samples.

Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis.

OBJECTIVE: To explore the association between low serum vitamin D and risk of active tuberculosis in humans. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Observational studies published between 1980 and July 2006 (identified through Medline) that examined the association between low serum vitamin D and risk of active tuberculosis. RESULTS: For the review, seven papers were eligible from 151 identified in the search. The pooled effect size in random effects meta-analysis was 0.68 with 95% CI 0.43-0.93. This 'medium to large' effect represents a probability of 70% that a healthy individual would have higher serum vitamin D level than an individual with tuberculosis if both were chosen at random from a population. There was little heterogeneity between the studies. CONCLUSIONS: Low serum vitamin D levels are associated with higher risk of active tuberculosis. Although more prospectively designed studies are needed to firmly establish the direction of this association, it is more likely that low body vitamin D levels increase the risk of active tuberculosis. In view of this, the potential role of vitamin D supplementation in people with tuberculosis and hypovitaminosis D-associated conditions like chronic kidney disease should be evaluated.