Longitudinal changes in glucose metabolism in women with gestational diabetes, from late pregnancy to the postpartum period.

AIMS/HYPOTHESIS: This study aimed to determine, in women with gestational diabetes (GDM), the changes in insulin sensitivity (Matsuda Insulin Sensitivity Index; ISOGTT), insulin response and disposition index (DI) from late pregnancy (34-37 weeks gestation, T1), to early postpartum (1-5 days, T2) and late postpartum (6-12 weeks, T3). A secondary aim was to correlate the longitudinal changes in maternal lipids, adipokines, cytokines and weight in relation to the changes in ISOGTT, insulin response and DI. METHODS: ISOGTT, insulin response and DI were calculated at the three time points (T1, T2 and T3) using the results of a 75 g OGTT. Adipokines, cytokines and lipids were measured prior to each OGTT. Linear mixed-effects models were used to compare changes across each time point. Changes in ISOGTT, insulin response and DI were correlated with changes in maternal adipokines, cytokines and lipids at each time point. RESULTS: A total of 27 women completed all assessments. Compared with T1, ISOGTT was 11.20 (95% CI 8.09, 14.31) units higher at 1-5 days postpartum (p < 0.001) and was 5.49 (95% CI 2.38, 8.60) units higher at 6-12 weeks postpartum (p < 0.001). Compared with T1, insulin response values were 699.6 (95% CI 957.5, 441.6) units lower at T2 (p < 0.001) and were 356.3 (95% CI 614.3, 98.3) units lower at T3 (p = 0.004). Compared with T1, the DI was 6434.1 (95% CI 2486.2, 10,381.0) units higher at T2 (p = 0.001) and was 4262.0 (95% CI 314.6, 8209.3) units higher at T3 (p = 0.03). There was a decrease in mean cholesterol, triacylglycerol, LDL-cholesterol and VLDL-cholesterol from T1 to T2 (all p < 0.001), and an increase in mean C-reactive protein, IL-6 and IL-8 from T1 to T2 (all p < 0.001). Mean leptin decreased from T1 to T2 (p = 0.001). There was no significant change in mean adiponectin (p = 0.99) or TNF-α (p = 0.81) from T1 to T2. The mean maternal BMI decreased from T1 to T2 (p = 0.001) and T3 (p < 0.001). There were no significant correlations between any measure of change in ISOGTT, insulin response and DI and change in maternal cytokines, adipokines, lipids or weight from T1 to T2. CONCLUSIONS/INTERPRETATION: In women with GDM, delivery was associated with improvement in both insulin sensitivity and insulin production within the first few days. Improvement in insulin production persisted for 6-12 weeks, but insulin sensitivity deteriorated slightly. These changes in glucose metabolism were not associated to changes in lipids, leptin, inflammation markers or body weight. TRIAL REGISTRATION: ClinicalTrials.gov NCT02082301.

Alcohol use/abuse and help-seeking among U.S. adults: The role of racial-ethnic origin and foreign-born status.

We used data from Wave 1 and Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions to examine racial-ethnic and nativity-based variations in alcohol use/abuse and treatment seeking while accounting for acculturation, stress, and social integration factors. The dependent variables included alcohol use, risky drinking, DSM-IV alcohol use disorder, and treatment seeking in the past 12 months. Racial-ethnic categories included African, European, Asian/Pacific Islander, Mexican, Puerto Rican, and other Hispanic/Latino. Acculturation, social stress, and social integration were assessed with previously validated, detailed measures. Bivariate probit models with sample selection were estimated for women and men. Immigrant status and origin associations with alcohol use/abuse and treatment seeking were strong and largely unaffected by other social factors. Europeans and men of Mexican origin had the highest while women of African, Asian/Pacific Islander, and Puerto Rican origins had the lowest rates of alcohol use/abuse. Years in the United States was associated with a higher risk of alcohol use/abuse for all immigrant groups. Foreign-born individuals were no less likely than U.S. natives to seek treatment if they were abusing or were dependent on alcohol. Further modeling of these relationships among specific immigrant groups is warranted. These findings inform alcohol rehabilitation and mental health services for racial-ethnic minorities and immigrants.

Nativity, Race-Ethnicity, and Dual Diagnosis among US Adults.

Purpose: This study investigated disparities in dual diagnosis (comorbid substance-use and depressive/anxiety disorders) among US adults by nativity and racial-ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities. Design/methodology: The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial-ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance-use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance-use or psychiatric disorder; substance-use disorder only; depressive/anxiety disorder only; and, dual diagnosis. The data were analyzed using multinomial logistic regression. Findings: The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto-Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial-ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments. Research limitations: The limitations included measures of immigrant status, race-ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities. Practical and Social Implications: This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps. Originality/value: This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial-ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).

Anxiety Disorders among US Immigrants: The Role of Immigrant Background and Social-Psychological Factors.

This study used the National Epidemiological Survey on Alcohol and Related Conditions, a longitudinal adult sample, to estimate the rates of prevalent, acquired, and persisting anxiety disorders by nativity and racial-ethnic origin while adjusting for acculturation, stress, social ties, and sociodemographics. Prevalent and acquired anxiety disorders were less likely among foreign-born than US-born, except Puerto-Rican- and Mexican-born who had higher risks. Persisting cases were similar between foreign-born and US-born, except Asian/Pacific Islanders who had lower risk. Stress and preference for socializing outside one's racial-ethnic group were associated with higher while close ties were associated with lower rates of acquired/persisting anxiety disorders.

Major Depressive Disorder and Dysthymia at the Intersection of Nativity and Racial-Ethnic Origins.

Immigrants often have lower rates of depression than US-natives, but longitudinal assessments across multiple racial-ethnic groups are limited. This study examined the rates of prevalent, acquired, and persisting major depression and dysthymia by nativity and racial-ethnic origin while considering levels of acculturation, stress, and social ties. Data from the National Epidemiologic Survey on Alcohol and Related Conditions were used to model prevalence and 3-year incidence/persistence of major depression and dysthymia (DSM-IV diagnoses) using logistic regression. Substantive factors were assessed using standardized measures. The rates of major depression were lower for most immigrants, but differences were noted by race-ethnicity and outcome. Furthermore, immigrants had higher prevalence but not incidence of dysthymia. The associations between substantive factors and outcomes were mixed. This study describes and begins to explain immigrant trajectories of major depression and dysthymia over a 3-year period. The continuing research challenges and future directions are discussed.

Tanzanian men's gender attitudes, HIV knowledge, and risk behaviours.

This study uses data from the 2004-05 Tanzanian Demographic and Health Survey to examine whether men's traditional gender role attitudes contribute to their sexual risk behaviours for HIV. Logistic regression with random effects were used to analyze effects on risk behaviours at last sex (partners being drunk and condom use) with the three most recent sexual relationships. Men's traditional gender attitudes increased risky sexual behaviours (e.g., not using a condom) even when they had accurate knowledge regarding HIV risks. The impact of men's gender attitudes and HIV knowledge on risky sexual behaviours did not vary by relationship type. Unexpectedly, condom use was more likely when either partner was drunk compared to neither being drunk, though the protective impact of HIV knowledge remained. Overall, these findings suggest that traditional gender attitudes present barriers to preventing HIV/AIDS that even increased knowledge about HIV risks may not overcome.

Tanzanian Men's Gender Attitudes; HIV Knowledge; and Risk Behaviours

This study uses data from the 2004-05 Tanzanian Demographic and Health Survey to examine whether men's traditional gender role attitudes contribute to their sexual risk behaviours for HIV. Logistic regression with random effects were used to analyze effects on risk behaviours at last sex (partners being drunk and condom use) with the three most recent sexual relationships. Men's traditional gender attitudes increased risky sexual behaviours (e.g.; not using a condom) even when they had accurate knowledge regarding HIV risks. The impact of men's gender attitudes and HIV knowledge on risky sexual behaviours did not vary by relationship type. Unexpectedly; condom use was more likely when either partner was drunk compared to neither being drunk; though the protective impact of HIV knowledge remained. Overall; these findings suggest that traditional gender attitudes present barriers to preventing HIV/AIDS that even increased knowledge about HIV risks may not overcome

Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention.

BACKGROUND: Understanding what factors contribute to alcohol abuse in resource-poor countries is important given its adverse health consequences. Past research shows that social peers influence substance abuse, suggesting that the social environment may be an effective target for reducing alcohol abuse across a population. This study investigates the determinants of alcohol use and abuse in rural Zimbabwe and tests a community popular opinion leader (CPOL) community-based intervention partly directed at reducing alcohol abuse. METHODS: Tests were conducted on the impact of the CPOL intervention on alcohol use patterns across communities in rural Zimbabwe over three waves from 2003 to 2007, including community- and individual-level tests using data based on in-person interviews of adult men and women (ages 18-30; N=5543). Data were analyzed using paired-sample t-tests, as well as logistic and ordinary least-squares regression with random effects. RESULTS: Higher drinking (any use, more frequent use, greater quantity, and/or frequent drunkenness) was generally associated with being male, older, not married, more highly educated, of Shona ethnicity, away from home frequently, employed, having no religious affiliation, or living in areas with a higher crude death rate or lower population density. Over the study period, significant declines in alcohol use and abuse were found in intervention and control sites at relatively equal levels. CONCLUSIONS: Although no support was found for the effectiveness of the CPOL study in reducing alcohol abuse, Zimbabwe is similar to other countries in the impact of socio-demographic and cultural factors on alcohol use and abuse.

Epidemiology of alcohol abuse among US immigrant populations.

The knowledge of racial and ethnic variations in alcohol abuse among US immigrants is limited. We compared the prevalence and correlates of alcohol abuse among US foreign-born versus US-natives by race-ethnicity using data from the National Epidemiological Survey on Alcohol and Related Conditions. Alcohol abuse outcomes included clinical diagnosis, excessive drinking, and intoxication. The foreign-born respondents had lower rates of alcohol abuse than the US-born, but some variations were noted by race-ethnicity. The risk of clinical diagnosis due to traumatic events was higher for the foreign-born population. Future research should continue to investigate the role of stress, the specific traumatic events most problematic for immigrant groups, and the interplay of the original and host culture in shaping the patterns of alcohol abuse in the immigrant population.

The role of relationship power in couple decisions about contraception in the US.

Most analyses of the contraceptive decision-making in which couples engage are based on the reports of only one partner, usually the female partner. This study uses information from the 2006 National Couples Survey conducted in the US, which was obtained from both partners in intimate heterosexual relationships to investigate the relative impact of the male and female partner's method preferences on the type of method they use together. It also investigates the extent to which differences in power between the partners, measured on multiple dimensions, may weigh the decision-making process toward one partner or the other. The results suggest that men's and women's method preferences are both significantly related to the couples' method choice. Further, there is no evidence of a significant gender difference in the magnitude of these relationships, although women in married and cohabiting relationships appear to have greater power over method choice than women in dating relationships. The analysis also finds that structural power as measured by relative education and income affects partner differences in the relationship between preferences and method choice, but is more important for married and cohabiting couples than for dating couples. In contrast, relationship-based power sources, including relative commitment and relative relationship alternatives, have significant effects only for dating couples.

Self-reported health in Poland and the United States: a comparative analysis of demographic, family and socioeconomic influences.

This study compares the social determinants of individual health between the United States, a capitalist society, and Poland, a 'post-communist' society. The effects of demographic factors, family characteristics and socioeconomic status on self-reported health are estimated with OLS regression using data from the 1994 American and Polish General Social Surveys. The results show lower self-reported health and more rapid declines in health for people over 60 in Poland than in the United States. Also, in Poland, women report worse health than do men while the opposite is found for the United States. The relationships between education, income and health were stronger in the United States than in Poland. Age, gender and SES may operate differently in the two countries because of a gap in social development (e.g. varying living standards and styles, health care systems and cultural attitudes) between the West and the former Eastern Europe.