The moderating role of depression in the association between hypertension during pregnancy and birth outcomes.

OBJECTIVE: Investigate how hypertension during pregnancy (HDP) and depression during pregnancy (DDP) independently and jointly affect infant birth outcomes. METHODS: This population-based, retrospective cohort study included a sample of 68,052 women who participated in PRAMS 2016-2018 survey. Poisson regression was used for adjusted relative risks (aRRs). RESULTS: Compared to women without HDP and DDP, aRRs for PTB and LBW among women with both HDP and DDP are 2.04 (95% CI 1.73, 2.42) and 2.84 (95% CI 2.27, 3.56), respectively, albeit lower than the expected joint effect of risk. CONCLUSION: DDP may modify the association between HDP and PTB, LBW.

Racial/Ethnic Differences in the Association Between Food Security and Depressive Symptoms Among Adult Foreign-Born Immigrants in the US: A Cross-Sectional Study.

Foreign-born immigrants are at greater risks of both food insecurity and depressive symptoms, while the association between the two has yet to be elucidated. Our sample includes 6,857 adults aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. Multivariable logistic regression was used to examine whether the association between food security and depressive symptoms varies across race/ethnicity among US foreign-born immigrants. The prevalence of depressive symptoms was 9.6% and 15.7% for low food security (LFS) and very low food security (VLFS). The adjust odds ratios (aORs) of depressive symptoms among Mexican American and Other Hispanic immigrants with VLFS were 2.66 (95% Confidence interval [CI]: 1.61, 4.38) and 2.05 (95% CI: 1.08, 3.86) as compared to those with full food security (FFS). Race/ethnicity may modify the association between food security and depressive symptoms among US foreign-born immigrants and a dose-response relationship was indicated among Hispanic and Other Race immigrants.

Sleep habits are associated with cognition decline in physically robust, but not in frail participants: a longitudinal observational study.

Frail older adults are vulnerable to stressors; thus, sleep related cognition impairment might more greatly affect frail than healthy older adults. In the present study, we investigated whether the association between sleep problems and cognition varies with physical frailty status (modified from Fried et al.). Participants 55 years and older who completed a baseline and follow-up questionnaire (median follow-up: 5.5 years), were included in the analysis. Sleep parameters were evaluated in an interview at the baseline. Cognitive decline was defined as a loss of 3 or more points on the Mini-Mental State Examination (MMSE) at follow-up. Associations between sleep problems and cognitive decline were examined using logistic regression and were stratified by baseline physical frailty status, adjusted for potential confounders. A short total sleep duration (< 5 vs. 7-9 h, odds ratio (OR) = 1.88, 95% confidence interval (CI) 1.18-3.00), excessive daytime sleepiness (OR = 1.49, 95% CI 1.04-2.13), low sleep efficiency (< 65% vs. ≥ 85%, OR = 1.62, 95% CI 1.07-2.46), and insomnia complaints (OR = 2.34, 95% CI 1.23-4.43) were associated with MMSE decline in physically robust. The association was stronger for the sleep summary score, which summarized abnormal sleep duration, excessive daytime sleepiness, and insomnia complaints ([Formula: see text] 2 vs. 0, OR = 3.79, 95% CI 2.10-6.85, p < 0.0001). Due to the low prevalence of frailty in this community-dwelling population, the statistical power to detect an association was low. More evidence is needed to clarify the role of sleep in the progression of cognitive decline in frail individuals.

Resilience buffers the effects of sleep problems on the trajectory of suicidal ideation from adolescence through young adulthood.

OBJECTIVES: To examine both the between-person and within-person effects of sleep problems on the trajectory of suicidal ideation from ages 14 to 22 and investigate whether resilience moderates the effects. Age and sex differences were explored in the main and interaction effects of sleep problems and resilience on suicidal ideation. METHODS: The study sample included 2491 adolescents (1260 males and 1231 females) who participated in a prospective study spanning 2009 through 2016 in northern Taiwan. Sex-stratified multilevel models were used to examine the between-person and within-person effects of sleep problems and the moderating effects of resilience on the trajectory of suicidal ideation in males and females. RESULTS: Across adolescents, higher levels of sleep problems contributed to an elevated risk of suicidal ideation for both sexes. Within individuals, a higher risk of suicidal ideation was observed when an adolescent's sleep problems exceeded their typical levels. The within-person effects of sleep problems were further determined to vary by age in males, with the effects gradually decreasing throughout late adolescence but increasing again in young adulthood. The buffering effects of resilience were only observed in females. The relationships between the within-person effects of sleep problems and suicidal ideation were only significant in female adolescents with low levels of resilience. CONCLUSIONS: Our findings extend the research by demonstrating both the between-person and within-person association between sleep problems and suicidal ideation. We further revealed age and sex differences in the within-person effects of sleep problems and the buffering effects of resilience. Prevention and intervention programs that target sleep problems could be tailored based on individuals' age, sex, and levels of resilience to prevent suicidal ideation.

Pregnancy Outcomes after Preeclampsia: The Effects of Interpregnancy Weight Change.

OBJECTIVE: This study aimed to examine the effects of interpregnancy weight change on pregnancy outcomes, including recurrent preeclampsia, preterm birth, small-for-gestational age (SGA), large-for-gestational age (LGA), and cesarean delivery, among women with a history of preeclampsia. We also evaluated whether these associations were modified by prepregnancy body mass index (BMI) category in the first pregnancy (BMI < 25 vs. ≥25 kg/m2) and if associations were present among women who maintained a healthy BMI category in both pregnancies. STUDY DESIGN: We conducted a population-based retrospective cohort study including 15,108 women who delivered their first two nonanomalous singleton live births in Missouri (1989-2005) and experienced preeclampsia in the first pregnancy. We performed Poisson regression with robust error variance to estimate relative risks and 95% confidence intervals for outcomes of interest after controlling for potential confounders. RESULTS: Interpregnancy weight gain was associated with increased risk of recurrent preeclampsia, LGA, and cesarean delivery. These risks increased in a "dose-response" manner with increasing magnitude of interpregnancy weight gain and were generally more pronounced among women who were underweight or normal weight in the first pregnancy. Interpregnancy weight loss exceeding 1 BMI unit was associated with increased risk of SGA among underweight and normal weight women, while interpregnancy weight loss exceeding 2 BMI units was associated with reduced risk of recurrent preeclampsia among overweight and obese women. CONCLUSION: Even small changes in interpregnancy weight may significantly affect pregnancy outcomes among formerly preeclamptic women. Appropriate weight management between pregnancies has the potential to attenuate such risks. KEY POINTS: · Interpregnancy weight change among formerly preeclamptic women significantly affects pregnancy outcomes.. · Interpregnancy weight gain is associated with increased risk of recurrent preeclampsia, large-for-gestational-age and cesarean delivery.. · Interpregnancy weight loss is associated with increased risk of small-for-gestational age and recurrent preeclampsia..

Comparing the Performance of Charlson and Elixhauser Comorbidity Indices to Predict In-Hospital Mortality Among a Chinese Population.

OBJECTIVE: Earlier comorbidity measures have been developed or validated using the North American population. This study aims to compare five Charlson or Elixhauser comorbidity indices to predict in-hospital mortality using a large electronic medical record database from Shanxi, China. METHODS: Using the primary diagnosis code and surgery procedure codes, we identified four hospitalized patient cohorts, hospitalized between 2013 and 2017, in Shanxi, China, as follows: congestive heart failure (CHF, n=41,577), chronic renal failure (CRF, n=40,419), diabetes (n=171,355), and percutaneous coronary intervention (PCI, n=39,097). We used logistic regression models and c-statistics to evaluate the in-hospital mortality predictive performance of two multiple comorbidity indicator variables developed by Charlson in 1987 and Elixhauser in 1998 and three single numeric scores by Quan in 2011, van Walraven in 2009, and Moore 2017. RESULTS: Elixhauser comorbidity indicator variables had consistently higher c-statistics (0.824, 0.843, 0.904, 0.853) than all other four comorbidity measures, across all four disease cohorts. Moore's comorbidity score outperformed the other two score systems in CHF, CRF, and diabetes cohorts (c-statistics: 0.776, 0.832, 0.869), while van Walraven's score outperformed all others among PCI patients (c-statistics: 0.827). CONCLUSION: Elixhauser comorbidity indicator variables are recommended, when applied to large Chinese electronic medical record databases, while Moore's score system is appropriate for relatively small databases.

Gestational Age of Delivery in Pregnancies Complicated by Diabetes.

Background: The recommended gestational age to deliver pregnancies complicated by diabetes ranges from 34 to 39 weeks of gestation. The objective of this study was to determine the optimal gestational age for delivery of patients with diabetes to minimize perinatal death. Methods: We extracted a population-based cohort of singleton, nonanomalous infants of diabetic pregnancies from the Missouri birth registry for the period January 1, 1989 to December 31, 2005 and compared perinatal outcomes of planned deliveries at 37, 38, 39, and 40 weeks to expectant management. Planned deliveries were identified by induction or cesarean delivery without documented medical or obstetric indications. The primary outcome was perinatal death, defined as stillbirth or neonatal death within 28 days of birth. Secondary outcomes were independent stillbirth, independent neonatal death, and a composite adverse neonatal event of assisted ventilation >30 minutes, birth injury, seizures, or 5-minute Apgar score ≤3. Groups were compared using t test and chi-square as appropriate. Results: In 4,905 diabetic pregnancies reaching 37 weeks, 1,012 (20.6%) patients were insulin dependent. Overall, the risk of perinatal death at any gestational age examined was low (3/1,000 births or lower), as was the risk of the adverse perinatal outcome (<2%). When only patients who were insulin dependent were included in the analysis, the risk of perinatal death at any gestational age remained low at 6 per 1,000 births or fewer. Conclusion: Delivery as early as 37 weeks is reasonable for women who have diabetes, although the absolute risk of perinatal death is low at 37 to 39 weeks.

Effect of interpregnancy interval after a first pregnancy complicated by placental abruption, on adverse maternal and fetal outcomes in a second pregnancy.

Background: For women who suffer from abruption in the first pregnancy, the extent to which birth spacing has an impact on maternal and fetal outcomes in a second pregnancy remains unclear.Objectives: To examine the effect of interpregnancy interval (IPI) after a first pregnancy complicated by placental abruption, on adverse maternal and fetal outcomes in a subsequent pregnancy.Study design: This was a population-based retrospective cohort study using maternally-linked Missouri birth registry from 1989 to 2005 (n = 2069). Exposure of interest was IPI and outcomes were placental abruption, preeclampsia, preterm birth, small for gestational age, cesarean delivery, and neonatal plus fetal deaths (neofetal death) in a second pregnancy. Logistic regressions were used to assess the association between IPI and the outcomes.Results: Compared with women with an IPI of 1-2 years, those with short IPI (<1 year) were more likely to experience preterm birth (aOR 3.01, 95% CI 1.71-5.28) and neonatal death (aOR 3.52, 95% CI 1.24-10.02) in their subsequent pregnancy. No significant associations between IPI and recurrent placental abruption or preeclampsia were detected.Conclusions: Women who become pregnant in less than a year's time of an initial placental abruption are at increased risk for preterm birth and neofetal death in a subsequent pregnancy. Other ischemic placental disease conditions are also shown to have serious health implications for a woman's next pregnancy.

Racial disparities in U.S. maternal influenza vaccine uptake: Results from analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2012-2015.

BACKGROUND: Pregnant women are at increased risk of hospitalization, serious complications, poor pregnancy outcomes, and mortality from influenza. Prior research suggests that there are racial/ethnic disparities in vaccination coverage and that a healthcare provider vaccination recommendation is associated with significantly higher vaccine uptake than without such a recommendation. The purpose of this study is to examine racial/ethnic disparities in healthcare providers' recommendations for pregnant women to receive the influenza vaccine and in vaccine uptake. METHODS: This cross-sectional population-based study analyzed data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) during 2012-2015 (n = 130161). Both healthcare provider recommendation and vaccine uptake were assessed dichotomously. Logistic regression was conducted to ascertain adjusted odds ratios and 95% confidence intervals, controlling for maternal age, marital status, education, prenatal care utilization, and smoking status. RESULTS: Influenza vaccine uptake during pregnancy ranged from 39.1% among non-Hispanic (NH) Black women to 55.4% among NH Asian women. In the adjusted analysis, NH Black and NH Asian women had 19% (95% CI 0.75-0.86) and 34% (95% CI 0.61-0.72) decreased odds of receiving a provider recommendation for influenza vaccine during pregnancy, respectively, compared to NH White women. For influenza vaccine uptake, NH Black women were 30% less likely (95% CI 0.65-0.74) to receive influenza vaccine during pregnancy compared to NH White women. CONCLUSIONS: Our findings indicate that there are racial/ethnic disparities in healthcare provider recommendation and influenza vaccine uptake among pregnant women in the United States. Targeted efforts toward providers and interventions focusing on pregnant women may be warranted to reduce the disparity.

The Difference in Sibling Birthweight and Neonatal Death: A Population-Based Cohort Study.

BACKGROUND: There has been a call for customized rather than population-based birthweight standards that would classify smallness based on an infant's own growth potential. Thus, this study aimed to examine the association between the difference in sibling birthweight and the likelihood of neonatal death among second births in a U.S. STUDY DESIGN: This was a population-based cohort study including 179,300 women who delivered their first two nonanomalous singleton live births in Missouri (1989-2005). We performed binary logistic regression to evaluate the association between being relatively smaller than the elder full- or half-sibling (i.e., smaller by at least 500 g) and neonatal death (i.e., deaths in the first 28 days of life) among second births after controlling for sociodemographic and pregnancy-related variables in the second pregnancy. RESULTS: The adjusted odds of neonatal death were 2.54-times higher among second births who were relatively smaller than their elder sibling. Among relatively small second births, every 100-g increase in the difference in sibling birthweight was associated with a 13% increase in the odds of neonatal death. CONCLUSION: The deviation from the elder sibling's birthweight predicts neonatal death. Taking into consideration the elder sibling's birthweight may be warranted in clinical and research settings.

Ambient air pollution the risk of stillbirth: A prospective birth cohort study in Wuhan, China.

BACKGROUND: Recent studies suggest that ambient air pollution exposure during pregnancy is associated with stillbirth occurrence. However, the results on the associations between ambient air pollutants and stillbirths are inconsistent and little is known about the gestational timing of sensitive periods for the effects of ambient air pollutants exposure on stillbirth. OBJECTIVE: This study aimed to examine whether exposure to high levels of ambient air pollutants in a Chinese population is associated with an increased risk of stillbirth, and determine the gestational period when the fetus is most susceptible. METHODS: We conducted a population-based cohort study in Wuhan, China, involving 95,354 births between June 10, 2011 and June 9, 2013. The exposure assessments were based on the daily mean concentrations of air pollutants obtained from the exposure monitor nearest to the pregnant women's residence. Logistic regression analyses were performed to determine the associations between stillbirths and exposure to each of the air pollutants at different pregnancy periods with adjustment for confounding factors. RESULTS: Stillbirth increased with a 10 µg/m3 increase in particulate matter 2.5 (PM2.5) in each stage of pregnancy, and a significant association between carbon monoxide (CO) exposure and stillbirth was found during the third trimester (adjusted odds ratio (aOR): 1.01, 95% confidence interval (CI): 1.00-1.01) and in the entire pregnancy (aOR: 1.18, 95% CI: 1.04-1.34). Furthermore, an increased risk of stillbirth in the third trimester was associated with a 10 µg/m3 increase in PM10 (aOR: 1.08, 95% CI: 1.04-1.11), nitrogen dioxide (NO2) (aOR: 1.13, 95% CI: 1.07-1.21) and sulfur dioxide (SO2) (aOR: 1.26, 95% CI: 1.16-1.35). However, no positive association was observed between ozone exposure and stillbirth. In the two-pollutant models, PM2.5 and CO exposures were found to be consistently associated with stillbirth. CONCLUSIONS: Our study revealed that exposure to high levels of PM2.5, PM10, SO2, NO2 and CO increases the risk of stillbirth and the most susceptible gestational period to ambient air pollution exposure was in the third trimester. Further toxicological and prospective cohort studies with improved exposure assessments are needed to confirm the causal link between air pollutants and stillbirth.

Association between prenatal care utilization and risk of preterm birth among Chinese women.

It is recognized that prenatal care plays an important role in reducing adverse birth. Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits. This study was to estimate the association between prenatal care utilization (PCU) and preterm birth (PTB), and to investigate if medical conditions during pregnancy modified the association. This population-based case control study sampled women with PTB as cases; one control for each case was randomly selected from women with term births. The Electronic Perinatal Health Care Information System (EPHCIS) and a questionnaire were used for data collection. The PCU was measured by a renewed Prenatal Care Utilization (APNCU) index. Logistic regression models were used to estimate odds ratios (OR) and the 95% confidence interval (95% CI). Totally, 2393 women with PTBs and 4263 women with term births were collected. In this study, 695 (10.5%) women experienced inadequate prenatal care, and 5131 (77.1%) received adequate plus prenatal care. Inadequate PCU was associated with PTB (adjusted OR: 1.41, 95% CI: 1.32-1.84); the similar positive association was found between adequate plus PCU and PTB. Among women with medical conditions, these associations still existed; but among women without medical conditions, the association between inadequate PCU and PTB disappeared. Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB, but it does depend on whether the woman has a medical condition during pregnancy.

Diet quality and sleep quality among day and night shift nurses.

AIMS: To determine whether night shift workers have a poorer diet quality and sleep quality when compared with day shift nurses. BACKGROUND: There is a dearth of research investigating the association between diet quality and sleep quality of day and night shift nurses. METHODS: Data on nurses (n = 103) working either a day or night shift from two Midwestern hospitals were obtained from August 2015 to February 2016. The instruments used were the Diet History Questionnaire and the Pittsburg Sleep Quality Index. Independent samples t-tests were used to examine differences in diet and sleep quality by work shift schedule. RESULTS: There were no statistically significant differences between nurses working day or night shift and sleep quality (P = 0.0684), as well as diet quality (P = 0.6499). There was a significant difference between both body mass index (P = 0.0014) and exercise (P = 0.0020) with regard to diet quality. Body mass index and sleep quality were also significantly associated (P = 0.0032). CONCLUSION: Our study found no differences between day and night shift with regard to sleep and diet quality among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Deliberate health initiatives and wellness programmes specifically targeting nurses are needed to increase knowledge about maintaining a healthy lifestyle while working as a nurse, whether it is day or night shift.

Sex and age differences in the associations between sleep behaviors and all-cause mortality in older adults: results from the National Health and Nutrition Examination Surveys.

OBJECTIVE: Our aim was to examine sex- and age-specific relationships of sleep behaviors with all-cause mortality rates. METHODS: A retrospective cohort study was conducted among 5288 adults (≥50 years) from the 2005-2008 National Health and Nutrition Examination Surveys who were followed-up for 54.9 ± 1.2 months. Sleep duration was categorized as < 7 h, 7-8 h and >8 h. Two sleep quality indices were generated through factor analyses. 'Help-seeking behavior for sleep problems' and 'diagnosis with sleep disorders' were defined as yes/no questions. Sociodemographic covariates-adjusted Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: A positive relationship was observed between long sleep and all-cause mortality rate in the overall sample (HR = 1.90, 95% CI: 1.38, 2.60), among males (HR = 1.48, 95% CI: 1.05, 2.09), females (HR = 2.32, 95% CI: 1.48, 3.61) and elderly (≥65 years) people (HR = 1.80, 95% CI: 1.30, 2.50). 'Sleepiness/sleep disturbance' (Factor I) and all-cause mortality rate were positively associated among males (HR = 1.22, 95% CI: 1.03, 1.45), whereas 'poor sleep-related daytime dysfunction' (Factor II) and all-cause mortality (HR = 0.75, 95% CI: 0.62, 0.91) were negatively associated among elderly people. CONCLUSIONS: Sex- and age-specific relationships were observed between all-cause mortality rate and specific sleep behaviors among older adults.

Geographic variability in gestational weight gain: a multilevel population-based study of women having term births in Florida (2005-2012).

PURPOSE: We examined the extent of geographic variability in gestational weight gain (GWG), identified areas where women have suboptimal GWG, and evaluated whether individual- and area-level factors account for such variability. METHODS: We conducted a population-based cohort study including 1,385,574 women delivering term, singleton, and live births in Florida. We used a Bayesian, structured additive regression with a spatial function to analyze data from Florida's birth certificates (2005-2012) and ZIP code tabulation areas (ZCTAs; 2010 Census). RESULTS: The prevalence of insufficient (7.7%-42.9%) and excessive (17.1%-82.4%) GWG varied widely within Florida. Geographic variability was not explained by risk factors under study. Clusters in Orlando, Tampa, and Miami exhibited increased likelihood of insufficient GWG, whereas clusters in the Northwest of Florida exhibited increased likelihood of excessive GWG. CONCLUSIONS: We identified areas in Florida with high likelihood of suboptimal GWG that policy-makers should prioritize in the implementation of programs for optimizing GWG.

Gestational Weight Gain in the First Two Pregnancies and Perinatal Outcomes in the Second Pregnancy.

BACKGROUND: Gestational Weight Gain (GWG) below or above the Institute of Medicine (IOM) recommendations increases the risk of adverse pregnancy outcomes. However, it remains unknown whether the risk of adverse outcomes is affected by GWG in a previous pregnancy. We examined associations between GWG in the index (second) pregnancy and pregnancy outcomes, including preterm delivery and small for gestational age (SGA), while taking into consideration GWG in the first pregnancy. METHODS: In a population-based cohort study (n = 210 564), using the Missouri maternally-linked birth registry (1989-2005), we used multivariable Poisson regression with robust error variance stratified by prepregnancy body mass index (BMI) to evaluate associations between GWG in the index pregnancy and a composite indicator of GWG in the first and second pregnancies and our outcomes of interest, after controlling for sociodemographic and pregnancy-related confounders. RESULTS: Associations between GWG in the index pregnancy and pregnancy outcomes were moderated by GWG in the first pregnancy. Despite having GWG within recommendations in the index pregnancy, women had increased risk of preterm delivery and SGA if they had suboptimal GWG in their first pregnancy. Also, women having suboptimal GWG in the index pregnancy had increased risk of preterm delivery only if their GWG in the first pregnancy was also suboptimal. CONCLUSIONS: The observation that women who have GWG within recommendations in a current pregnancy may still have increased risk of adverse outcomes if they had suboptimal GWG in the first pregnancy has considerable clinical and public health implications.

The Effects of Race and Ethnicity on the Risk of Large-for-Gestational-Age Newborns in Women Without Gestational Diabetes by Prepregnancy Body Mass Index Categories.

Objectives Children born large for gestational age (LGA) are at risk of numerous adverse outcomes. While the racial/ethnic disparity in LGA risk has been studied among women with Gestational Diabetes Mellitus (GDM), the independent effect of race on LGA risk by maternal prepregnancy BMI is still unclear among women without GDM. Therefore, the objective of this study was to assess the association between maternal race/ethnicity and LGA among women without GDM. Methods This was a population-based cohort study of 2,842,278 singleton births using 2012 U.S. Natality data. We conducted bivariate and multivariate logistic regression analyses to assess the association between race and LGA. Due to effect modification by maternal prepregnancy BMI, we stratified our analysis by four BMI subgroups. Results The prevalence of LGA was similar across the different racial/ethnic groups at about 9%, but non-Hispanic Asian Americans had slightly higher prevalence of 11%. After controlling for potential confounders, minority women had higher odds of birthing LGA babies compared to non-Hispanic white women. Non-Hispanic Asian Americans had the highest odds of LGA babies across all BMI categories: underweight (aOR = 2.67; 95% CI: 2.24, 3.05); normal weight (aOR = 2.53; 2.43, 2.62); overweight (aOR = 2.45; 2.32, 2.60) and obese (aOR = 2.05; 1.91, 2.20). Conclusions for practice Racial/ethnic disparities exist in LGA odds, particularly among women with underweight or normal prepregnancy BMI. Most minorities had higher LGA odds than non-Hispanic white women regardless of prepregnancy BMI category. These racial/ethnic disparities should inform public health policies and interventions to address this problem.

Changes in Body Mass Index and the Trajectory of Depressive Symptoms Among Rural Men and Women.

PURPOSE: This study examined the association between body mass index (BMI) changes over time and the risk of elevated depressive symptoms in a cohort of Midwestern rural adults. METHODS: The longitudinal study used data from a telephone survey in 2005 including 1,475 men and women enrolled in the Walk the Ozarks to Wellness Project from 12 rural communities in Missouri, Arkansas, and Tennessee. Multilevel random intercept mixed models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between BMI calculated from self-reported height and body weight and elevated depressive symptoms, adjusting for sociodemographic, behavioral, and medical variables. FINDINGS: Elevated depressive symptoms were common in this rural population (17%-19%) and the mean BMI was 28 kg/m2 . For each unit increase in BMI over time, representing an average increase of about 5.8 pounds from baseline weight, there was a 6% increased odds of elevated depressive symptoms (aOR: 1.06, 95% CI: 1.02-1.12). CONCLUSIONS: Our findings hold important public health implications given the increasing rates of overweight and obesity over the past couple of decades, particularly among rural adults.

Neighborhood Conditions and Psychosocial Outcomes Among Middle-Aged African Americans.

OBJECTIVE: We examined associations between observed neighborhood conditions (good/adverse) and psychosocial outcomes (stress, depressive symptoms, resilience, and sense of control) among middle-aged and older African Americans. METHODS: The sample included 455 middle-aged and older African Americans examined in Wave 10 of the African American Health (AAH) study. Linear regression was adjusted for attrition, self-selection into neighborhoods, and potential confounders, and stratified by the duration at current address (<5 vs ≥5 years) because of its hypothesized role as an effect modifier. RESULTS: Among individuals who lived at their current address for ≥5 years, residing in neighborhoods with adverse versus good conditions was associated with significantly less stress (standardized ß = -0.18; P = .002) and depressive symptoms (standardized ß = -0.12; P = .048). Among those who lived at their current address for <5 years, residing in neighborhoods with adverse versus good conditions was not significantly associated with stress (standardized ß = 0.18; P = .305) or depressive symptoms (standardized ß = 0.36; P = .080). CONCLUSION: Neighborhood conditions appear to have significant, complex associations with psychosocial factors among middle-aged and older African Americans. This holds important policy implications, especially since adverse neighborhood conditions may still result in adverse physical health outcomes in individuals with >5 years at current residence despite being associated with better psychosocial outcomes.

Hourly peak PM2.5 concentration associated with increased cardiovascular mortality in Guangzhou, China.

Hourly peak concentration may capture health effects of ambient fine particulate matter pollution (PM2.5) better than daily averages. We examined the associations of hourly peak concentration of PM2.5 with cardiovascular mortality in Guangzhou, China. We obtained daily data on cardiovascular mortality and hourly PM2.5 concentrations in Guangzhou from 19 January 2013 through 30 June 2015. Generalized additive models were applied to evaluate the associations with adjustment for potential confounding factors. Significant associations were found between hourly peak concentrations of PM2.5 and cardiovascular mortality, particularly from ischemic heart diseases (IHD) and cerebrovascular diseases (CBD). Every 10 µg/m3 increment of hourly peak PM2.5 at lag 03 day was associated with a 1.15% (95% CI: 0.67%, 1.63%); 1.02% (95% CI: 0.30%, 1.74%) and 1.09% (95% CI: 0.27%, 1.91%) increase in mortalities from total cardiovascular diseases, IHD and CBD, respectively. The effects remained after adjustment for daily mean PM2.5 and gaseous air pollutants, though there was a high correlation between PM2.5 peak and PM2.5 mean (correlation coefficient=0.95). No significant association was observed for acute myocardial infarction (AMI). In addition to daily mean concentration of PM2.5, hourly peak concentration of PM2.5 might be one important risk factor of cardiovascular mortality and should be considered as an important air pollution indicator when assessing the possible cardiovascular effects of PM2.5.