Breast reconstruction after mastectomy among Department of Defense beneficiaries by race.

BACKGROUND: Postmastectomy breast reconstruction increased approximately 20% between 1998 and 2008 in the United States and has been found to improve body image, self-esteem, and quality of life. These procedures, however, tend to be less common among minority women, which may be due to variations in health care access. The Department of Defense provides equal health care access, thereby affording an exceptional environment in which to assess whether racial variations persist when access to care is equal. METHODS: Linked Department of Defense cancer registry and medical claims data were used. The receipt of reconstruction was compared between white women (n = 2974) and black women (n = 708) who underwent mastectomies to treat incident histologically confirmed breast cancer diagnosed from 1998 through 2007. RESULTS: During the study period, postmastectomy reconstruction increased among both black (27.3% to 40.0%) and white (21.8% to 40.6%) female patients with breast cancer. Receipt of reconstruction did not vary significantly by race (odds ratio, 0.93; 95% confidence interval, 0.76-1.15). Reconstruction decreased significantly with increasing age, tumor stage, and receipt of radiotherapy and was significantly more common in more recent years and among active service women, TRICARE Prime (health maintenance organization) beneficiaries, and women whose sponsor was an officer. CONCLUSIONS: The receipt of breast reconstruction did not vary by race within this equal-access health system, indicating that the racial disparities reported in previous studies may have been due in part to variations in access to health care. Additional research to determine why a large percentage of patients with breast cancer do not undergo reconstruction might be beneficial, particularly because these procedures have been associated with noncosmetic benefits.

Past residence outside of the United States is associated with diet quality in adults currently residing in the United States.

OBJECTIVE: To evaluate healthy dietary factors in relation to prior residence outside the United States (US) among university-affiliated individuals currently residing in the US. METHODS: Current diet information was collected via a 4-day food record and residential history data were collected by in-person interview for 114 individuals. RESULTS: Residence outside of the US at any point during the interviewee's life was associated with higher diet quality (Healthy Eating Index-2005: 50.0 vs. 46.8) and lower added sugar intake (25.8 vs. 34.9 g/d). Concordance of residence as a child (≤12 years of age) and within the prior 5 years was more strongly associated with higher HEI-2005 score (52.7) than if childhood was outside of the US and recent within the US (47.1), compared with individuals who have only resided within the US (46.9). Results were similar when also accounting for self-reported current residence as permanent residence. Current diet quality, food groups, and nutrient intakes differed depending on where in the world region individuals resided as a child. Restricting the analyzes to a subgroup of individuals of younger age and similar education attenuated associations. CONCLUSIONS: Lower added sugar intake and higher overall diet quality were most consistently associated with residence outside of the US, and recent residence outside of the US may be more strongly associated than childhood residence. Some of these differences may be explained by demographic or socioeconomic factors. Future studies could evaluate explanatory factors for these observations, including detailed socioeconomic factors, exposure to diverse foods, and accessibility of processed foods.

Self-report of fruit and vegetable intake that meets the 5 a day recommendation is associated with reduced levels of oxidative stress biomarkers and increased levels of antioxidant defense in premenopausal women.

BACKGROUND: Oxidative stress has been associated with a variety of chronic diseases and reproductive disorders. Fruits and vegetables (F/V) may contribute to antioxidant vitamin and micronutrient levels and reduce oxidative stress. OBJECTIVE: To investigate the effect of meeting the 5 A Day For Better Health Program recommendation for F/V consumption on biomarkers of oxidative damage and antioxidant defense. DESIGN: In this longitudinal study, healthy premenopausal women (n=258) were followed for ≤2 menstrual cycles with ≤16 oxidative stress measures timed to cycle phase. MAIN OUTCOME MEASURES: Plasma concentrations of F2-isoprostane, 9-hydroxyoctadecadieneoic acid, 13-hydroxyoctadecadieneoic acid, erythrocyte activity of superoxide dismutase, glutathione reductase, and glutathione peroxidase, as well as blood micronutrient concentrations were measured. Dietary intake was assessed by food frequency questionnaires (FFQs) (1 per cycle), and 24-hour recalls (≤4 per cycle). STATISTICAL ANALYSES PERFORMED: Fruit and vegetable servings were dichotomized based on the recommendation to consume five servings of F/V each day. Linear mixed models with repeated measures were used to analyze lipid peroxidation markers, antioxidant vitamins, and antioxidant enzymes by cycle phase and in association with usual F/V intake. RESULTS: For both 24-hour recall (timed to cycle phase) and cycle-specific FFQ, meeting the recommendation to consume five servings of F/V each day was associated with decreased F2-isoprostanes (24-hour recall ß=-.10 [95% CI, -0.12 to -0.07]; FFQ ß= -.14 [95% CI, -0.18 to -0.11]). Glutathione reductase was lower in association with typical consumption of five or more servings of F/V by FFQ but not in the phase-specific analysis. Higher levels of ascorbic acid, lutein, beta carotene, and beta cryptoxanthin were observed with both intake measures. CONCLUSIONS: Meeting the 5 A Day For Better Health Program recommendation was associated with lower oxidative stress and improved antioxidant status in analyses of typical diet (via FFQ) and in menstrual cycle phase-specific analyses using 24-hour recalls. Green salads were commonly eaten and increasing intake of salads may be a useful strategy to influence oxidation in reproductive aged women.

Dietary intake measured from a self-administered, online 24-hour recall system compared with 4-day diet records in an adult US population.

The objective of this study was to compare nutrient intake of two 24-hour recalls collected using the Automated Self-Administered 24-Hour Dietary Recall to a 4-day food record. A convenience sample of university-affiliated adults was chosen because of the diverse population at this university. Ninety-three participants completed the 4-day record and were then prompted to complete two 24-hour recalls within 2 weeks after. Pearson correlation coefficients were calculated for nutrient intake and Healthy Eating Index 2005 (HEI-2005), a summary measure of diet quality. Nutrients and HEI-2005 were also divided into quartiles and percent agreement and κ values were calculated. Results indicated that mean nutrient intakes were similar across the recall and record. Pearson correlations comparing the record and recall ranged from 0.16 to 0.78; with most correlations being between 0.4 and 0.6. For quartiles of dietary intake, percent agreement was moderately high (62.6% to 79.8%), with low to moderate κ values (κ=0.11 to 0.52). The 24-hour recall provided a good overall ranking of intake compared to a 4-day food record. Overall correlations and percent agreement were moderate across the nutrients and HEI-2005, suggesting that the 24-recalls may have been capturing different information than the food record in our population. Individual researchers will need to weigh the benefits of a more automated system, such as efficiency, against the potential loss of food item detail and potential need for larger sample sizes, for their particular study populations.