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1.
Nutrients ; 13(7)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34371931

RESUMO

The purpose of this study was to examine the independent and joint associations of acid-producing diets and depressive symptoms with physical health among breast cancer survivors. We studied a cohort of 2944 early stage breast cancer survivors who provided dietary, physical health, demographic, and lifestyle information at baseline, year 1, and year 4. We assessed the intakes of acid-producing diets via two commonly used dietary acid load scores: potential renal acid load (PRAL) and net endogenous acid production (NEAP). Physical health was measured using the Rand 36-Item Short Form Health Survey (SF-36), consisting of physical functioning, role limitation due to physical function, bodily pain, general health, and overall physical health subscales. Increased dietary acid load and depression were each independently and significantly associated with reduced physical health subscales and overall physical health. Further, dietary acid load and depression were jointly associated with worse physical health. For instance, depressed women with dietary acid load higher than median reported 2.75 times the risk (odds ratio = 2.75; 95% confidence interval: 2.18-3.47) of reduced physical function and 3.10 times the risk of poor physical health (odds ratio = 3.10; 95% confidence interval: 2.53-3.80) compared to non-depressed women with dietary acid load lower than median. Our results highlight the need of controlling acid-producing diets and the access of mental care for breast cancer survivors.


Assuntos
Ácidos/efeitos adversos , Afeto , Neoplasias da Mama/terapia , Sobreviventes de Câncer/psicologia , Depressão/complicações , Dieta/efeitos adversos , Saúde Mental , Ácidos/metabolismo , Adulto , Depressão/diagnóstico , Depressão/psicologia , Feminino , Nível de Saúde , Humanos , Concentração de Íons de Hidrogênio , Pessoa de Meia-Idade , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo
2.
J Acad Nutr Diet ; 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34389488

RESUMO

BACKGROUND: The evidence linking sugar-sweetened beverage (SSB) intake and mortality risk is conflicting, and associations between various SSB subtypes and mortality remain unclear. OBJECTIVE: To examine the association between baseline SSB intake, subtypes of SSB intake, and mortality risk in women. DESIGN: Prospective cohort study. PARTICIPANTS/SETTING: Participants of the California Teachers Study (n = 100,314; median age = 53 years) free of cardiovascular disease, cancer, and diabetes at baseline (1995-1996) were followed from 1995 to 2015. Baseline SSB intake was defined as caloric soft drinks (regular soft drinks, not diet soda), sweetened bottled waters or teas, and fruit drinks; and was derived from a self-administered food frequency questionnaire. MAIN OUTCOME MEASURE: Mortality was ascertained via annual linkage with state- and nationwide mortality records and the National Death Index over 20 years. STATISTICAL ANALYSIS: Multivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% CIs for assessing associations between SSB intake and mortality. Rare/never consumers were the comparator group. RESULTS: There were a total of 14,143 deaths over 20 years (30.5% from cardiovascular disease; 29.2% from cancer). In women who consumed ≥ 7 servings/week of SSBs at baseline (4% of participants), the multivariable-adjusted HRs were not significant for all-cause, cardiovascular disease-specific, or cancer-specific mortality. Consuming ≥ 7 servings/week of baseline caloric soft drink was associated with a higher risk of all-cause (HR = 1.26, 95% CI 1.10 to 1.46; P for trend = 0.02) and cancer-specific (HR = 1.33, 95% CI 1.08 to 1.63; P for trend = 0.08) mortality. In secondary analyses, consuming ≥ 1.5 c/day of baseline SSBs was associated with all-cause mortality (HR = 1.12, 95% CI 1.02 to 1.24; P for trend = 0.01). CONCLUSIONS: Although the baseline frequency of total SSB intake was not significantly associated with mortality, consuming ≥ 7 servings/week of caloric soft drinks was associated with higher risk of all-cause and cancer-specific mortality. Findings support public health efforts to reduce caloric soft drink consumption.

3.
J Am Heart Assoc ; 9(10): e014883, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32397792

RESUMO

Background Sugar-sweetened beverage (SSB) consumption has been associated with cardiometabolic risk. However, the association between total and type of SSB intake and incident cardiovascular disease (CVD) end points such as myocardial infarction, stroke, and revascularization is limited. Methods and Results We examined the prospective association of baseline SSB consumption with incident CVD in 106 178 women free from CVD and diabetes mellitus in the CTS (California Teachers Study), a cohort of female teachers and administrators, followed since 1995. SSBs were defined as caloric soft drinks, sweetened bottled waters or teas, and fruit drinks, and derived from a self-administered food frequency questionnaire. CVD end points were based on annual linkage with statewide inpatient hospitalization records. Cox proportional hazards models were used to assess the association between SSB consumption and incident CVD. A total of 8848 CVD incident cases were documented over 20 years of follow-up. After adjusting for potential confounders, we observed higher hazard ratios (HRs) for CVD (HR, 1.19; 95% CI, 1.06-1.34), revascularization (HR, 1.26; 95% CI, 1.04-1.54]), and stroke (HR, 1.21; 95% CI, 1.04-1.41) in women who consumed ≥1 serving per day of SSBs compared with rare/never consumers. We also observed a higher risk of CVD in women who consumed ≥1 serving per day of fruit drinks (HR, 1.42; 95% CI, 1.00-2.01 [P trend=0.021]) and caloric soft drinks (HR, 1.23; 95% CI, 1.05-1.44 [P trend=0.0002]), compared with rare/never consumers. Conclusions Consuming ≥1 serving per day of SSB was associated with CVD, revascularization, and stroke. SSB intake might be a modifiable dietary target to reduce risk of CVD among women.


Assuntos
Doenças Cardiovasculares/epidemiologia , Professores Escolares , Bebidas Adoçadas com Açúcar/efeitos adversos , California/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Feminino , Humanos , Incidência , Estudos Longitudinais , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Fatores de Tempo
4.
PLoS One ; 14(10): e0223638, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31596902

RESUMO

BACKGROUND: The association between sugar-sweetened beverage (SSB) consumption and colorectal cancer (CRC) risk remains unclear and published data are limited. METHODS: The analytic cohort included 99,798 women, free of cancer at baseline, from the California Teachers Study, a longitudinal cohort comprised of 133,477 female teachers and administrators who were active or recently retired members of the California State Teachers Retirement System in 1995. SSB consumption constituted caloric soft drinks, sweetened bottled waters and teas, and fruit drinks, derived from a self-administered food frequency questionnaire. Consumption was divided into four categories: Rare or never, >rare/never to <1 serving/week, ≥1 serving/week to <1 serving/day, and ≥1 serving/day. CRC endpoints were based on annual linkage with California Cancer Registry, defined as first diagnosis of CRC, and classified following the Surveillance, Epidemiology, and End Results Program coding system. Multivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HR) and 95% confidence intervals (CI) for assessing the association between SSB consumption and incident CRC. RESULTS: A total of 1,318 incident CRC cases were identified over 20 years of follow-up (54.5% proximal colon and 45.5% distal colorectum). Compared with rare/never consumers, the multivariable-adjusted HRs (95% CI) were 1.14 (0.86, 1.53) for total CRC; 1.11 (0.73, 1.68) for proximal colon; and 1.22 (0.80, 1.86) for distal colorectum cancers among women consuming ≥ 1 serving/day of SSBs. CONCLUSION: SSBs were not significantly associated with CRC risk. The biological effects of high SSB consumption make it important to continue to evaluate whether SSBs are associated with CRC. Additionally, future studies should further assess SSBs in large, racial/ethnically diverse cohorts of males and females, and, if feasible, address changes in SSB consumption over time.


Assuntos
Neoplasias Colorretais/epidemiologia , Bebidas Adoçadas com Açúcar/estatística & dados numéricos , Comportamento de Ingestão de Líquido , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade
5.
Nutrients ; 11(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31443226

RESUMO

Metabolic acidosis can lead to inflammation, tissue damage, and cancer metastasis. Dietary acid load contributes to metabolic acidosis if endogenous acid-base balance is not properly regulated. Breast cancer survivors have reduced capacities to adjust their acid-base balance; yet, the associations between dietary acid load and inflammation and hyperglycemia have not been examined among them. We analyzed data collected from 3042 breast cancer survivors enrolled in the Women's Healthy Eating and Living (WHEL) Study who had provided detailed dietary intakes and measurements of plasma C-reactive protein (CRP) and hemoglobin A1c (HbA1c). Using a cross-sectional design, we found positive associations between dietary acid load and plasma CRP and HbA1c. In the multivariable-adjusted models, compared to women with the lowest quartile, the intakes of dietary acid load among women with the highest quartile showed 30-33% increases of CRP and 6-9% increases of HbA1c. Our study is the first to demonstrate positive associations between dietary acid load and CRP and HbA1c in breast cancer survivors. Our study identifies a novel dietary factor that may lead to inflammation and hyperglycemia, both of which are strong risk factors for breast cancer recurrence and comorbidities.


Assuntos
Acidose/etiologia , Glicemia/metabolismo , Neoplasias da Mama/terapia , Proteína C-Reativa/análise , Sobreviventes de Câncer , Dieta/efeitos adversos , Hiperglicemia/etiologia , Mediadores da Inflamação/sangue , Inflamação/etiologia , Acidose/sangue , Acidose/diagnóstico , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Estudos Transversais , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Concentração de Íons de Hidrogênio , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Inflamação/sangue , Inflamação/diagnóstico , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
6.
Mil Med ; 184(11-12): e693-e700, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31004170

RESUMO

INTRODUCTION: Limited comprehensive data exist on risk behavior associated with sexually transmitted infections (STI) among ship-assigned US military personnel during the predeployment time period (PDT). This study examined whether sexual risk behaviors, alcohol use, involuntary drug consumption (IDC), posttraumatic stress disorder (PTSD), and depression during the 12 months prior to deployment were associated with provider-diagnosed STIs in this population. MATERIALS AND METHODS: Using cross-sectional data collected during 2012-2014 among sexually active personnel, multivariable regression assessed factors associated with STIs among all men (n = 1,831). Stratified analyses were conducted among men who have sex with women (MSW, n = 1,530), men who have sex with men or men and women (MSM, n = 83), and excluded those not reporting sexual partner gender (n = 218). RESULTS: Among MSW, transactional sex (AOR 3.8, 95% CI 1.5-9.4) meeting sexual partners at work (AOR 4.3, 95% CI 2.0-9.2), IDC (AOR 6.6, 95% CI 3.0-14.5), and incomplete mental health assessments (AOR 4.4, 95% CI 1.6-12.0) were significantly associated with STIs after adjustment. Among all men, those who identified as MSM (AOR 4.6, 95% CI 1.9-11.2) and drug screen positive (AOR 3.3, 95% CI 1.3-8.6) were significantly more likely to report an STI. CONCLUSIONS: Previously unreported factors significantly associated with STIs at the PDT among MSW in the adjusted analysis were meeting sexual partners at work and IDC. IDC during the PDT warrants further exploration. These results can inform tailored STI reduction interventions among shipboard personnel and similarly aged civilians undergoing similar transition/travel experiences.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Mentais/diagnóstico , Militares/estatística & dados numéricos , Comportamento Sexual/psicologia , Doenças Sexualmente Transmissíveis/diagnóstico , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Militares/psicologia , Fatores de Risco , Assunção de Riscos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/psicologia , Navios/estatística & dados numéricos , Estados Unidos/epidemiologia
7.
J Periodontol ; 89(2): 219-227, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29520828

RESUMO

BACKGROUND: Periodontal disease has been shown to be associated with cardiovascular disease (CVD). No known studies evaluate the relationship between periodontal disease status and biomarkers of CVD risk in the American Indian/Alaskan Native (AI/AN) population despite their disproportionately high rates of poor oral health and cardiovascular disease-related outcomes. This study compared levels of interleukin (IL)-6 and C-reactive protein (CRP) across increasing severity of periodontal disease status among younger adults between the ages of 21 and 43 years. METHODS: Plasma levels of IL-6 and CRP were measured in adult participants (ages 21 to 43 years) as part of a study of periodontal disease and CVD risk among an AI/AN population in southern California (n = 59). Periodontal evaluations were performed and disease status was classified into three categories based on highest probing depth (none/mild: < 3 mm; moderate: 4 to 5 mm; severe: ≥6 mm). Participants with known systemic disease or active infection were excluded. RESULTS: Severe periodontitis was significantly associated with increased levels of IL-6 compared with those with none or mild periodontitis before controlling for other variables (P = 0.02), but lacked significance after controlling for sex, BMI, smoking status, and high-density lipoprotein (P = 0.09). Moderate periodontal disease was positively associated with IL-6 levels after controlling for potential confounders (P = 0.01). Periodontal status was not associated with CRP, before or after adjusting for covariates. CONCLUSIONS: In this otherwise healthy AI/AN adult sample, moderate periodontal disease compared with none or mild periodontal disease was associated with increased levels of IL-6. High levels of CRP found in this population warrant further research.


Assuntos
Doenças Cardiovasculares , Índios Norte-Americanos , Doenças Periodontais , Periodontite , Adulto , Biomarcadores , Proteína C-Reativa , Humanos , Adulto Jovem
8.
J Racial Ethn Health Disparities ; 5(5): 1093-1106, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29327269

RESUMO

This study investigates how perceived unfair treatment, towards self and observed towards others due to ethnicity, is associated with periodontitis among diverse Hispanic/Latino adults, accounting for sociodemographic, health behavior, and acculturation factors. Baseline (2008-2011) dental and survey data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter epidemiologic study, were analyzed (N = 12,750). Crude and adjusted prevalence ratios and confidence limits were estimated. Half (49%) reported never being treated unfairly, while 41% reported they were sometimes, and 10% reported it often/always. One third (32%) never saw others treated unfairly, while 42% reported it sometimes, and 26% reported it often/always. In the final fully adjusted model, the prevalence of periodontitis was higher among adults who were as follows: non-Dominican, older, male, had a past year dental visit, current and former smokers, and among those who observed unfair treatment towards others. Lower prevalence was associated with higher income, higher educational attainment, less than full-time employment, reporting experiencing unfair treatment, higher acculturation scores, and having health insurance. Perceived unfair treatment towards self was negatively associated with periodontitis prevalence, while observed unfair treatment towards others was positively associated with the outcome among diverse Hispanics/Latinos. The associations between unfair treatment and periodontitis warrant further exploration.


Assuntos
Hispano-Americanos/estatística & dados numéricos , Periodontite/epidemiologia , Racismo/estatística & dados numéricos , Aculturação , Adolescente , Adulto , Idoso , Escolaridade , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Trauma Stress ; 30(5): 453-462, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-29077997

RESUMO

Undocumented immigration often presents with multiple stressors and contextual challenges, which may diminish mental health. This study is the first to provide population-based estimates for the prevalence of traumatic events and its association to clinically significant psychological distress among undocumented Mexican immigrants in the United States. This cross-sectional study used respondent-driven sampling to obtain and analyze data from clinical interviews with 248 undocumented Mexican immigrants residing in high-risk neighborhoods near the California-Mexico border. Overall, 82.7% of participants reported a history of traumatic events, with 47.0% of these meeting the criteria for clinically significant psychological distress. After controlling for relevant covariates, having experienced material deprivation, odds ratio (OR) = 2.26, 95% CI [1.18, 4.31], p = .013, and bodily injury, OR = 2.96, 95% CI [1.50, 5.83], p = .002, and not having a history of deportation, OR = 0.36, 95% CI [0.17, 0.79], p = .011, were associated with clinically significant psychological distress. These results support the need to revisit health and immigration policies and to devise solutions grounded in empirical evidence aimed at preventing the negative effects of trauma and psychological distress in this population.


Assuntos
Emigrantes e Imigrantes/psicologia , Americanos Mexicanos/psicologia , Transtornos de Estresse Pós-Traumáticos/etnologia , Estresse Psicológico/complicações , Imigrantes Indocumentados/psicologia , Adulto , California/epidemiologia , Estudos Transversais , Emigrantes e Imigrantes/legislação & jurisprudência , Feminino , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Imigrantes Indocumentados/legislação & jurisprudência , Adulto Jovem
10.
Public Health Nutr ; 20(15): 2786-2795, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28756784

RESUMO

OBJECTIVE: The Farmers' Market Fresh Fund Incentive Program is a policy, systems and environmental intervention to improve access to fresh produce for participants on governmental assistance in the USA. The current study examined factors associated with ongoing participation in this matched monetary incentive programme. DESIGN: Relationship of baseline factors with number of Fresh Fund visits was assessed using Poisson regression. Mixed-effects modelling was used to explore changes in consumption of fruits and vegetables and diet quality. SETTING: San Diego, California. SUBJECTS: Recipients of Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Security Income (SSI) who attended participating farmers' markets from 2010 to 2012 (n 7298). RESULTS: Among those with participation for ≤6 months, factors associated with increased visits included reporting more daily servings of fruits and vegetables (F&V) at baseline, being Vietnamese or Asian/Pacific Islander, and eligibility because of SNAP/CalFresh or SSI (v. WIC). Among those who came for 6-12 months, being Asian/Pacific Islander, eligibility because of SNAP/CalFresh and enrolling in the autumn, winter or spring were associated with a greater number of Fresh Fund visits. Among those who came for >12 months, being male and eligibility because of SSI were associated with a greater number of visits. Overall, the odds of increasing number of servings of F&V consumed increased by 2 % per month, and the odds of improved perception of diet quality increased by 10 % per month. CONCLUSIONS: Sustaining and increasing Fresh Fund-type programme operations should be a top priority for future policy decisions concerning farmers' market use in low-income neighbourhoods.


Assuntos
Dieta/economia , Motivação , Pobreza , Características de Residência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Criança , Feminino , Seguimentos , Assistência Alimentar , Abastecimento de Alimentos , Frutas/economia , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Verduras/economia , Adulto Jovem
11.
Am J Respir Crit Care Med ; 196(8): 993-1003, 2017 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-28613924

RESUMO

RATIONALE: Accurate reference values for spirometry are important because the results are used for diagnosing common chronic lung diseases such as asthma and chronic obstructive pulmonary disease, estimating physiologic impairment, and predicting all-cause mortality. Reference equations have been established for Mexican Americans but not for others with Hispanic/Latino backgrounds. OBJECTIVES: To develop spirometry reference equations for adult Hispanic/Latino background groups in the United States. METHODS: The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) recruited a population-based probability sample of 16,415 Hispanics/Latinos aged 18-74 years living in the Bronx, Chicago, Miami, and San Diego. Participants self-identified as being of Puerto Rican, Cuban, Dominican, Mexican, or Central or South American background. Spirometry was performed using standardized methods with central quality control monitoring. Spirometric measures from a subset of 6,425 never-smoking participants without respiratory symptoms or disease were modeled as a function of sex, age, height, and Hispanic/Latino background to produce background-specific reference equations for the predicted value and lower limit of normal. MEASUREMENTS AND MAIN RESULTS: Dominican and Puerto Rican Americans had substantially lower predicted and lower limit of normal values for FVC and FEV1 than those in other Hispanic/Latino background groups and also than Mexican American values from NHANES III (Third National Health and Nutrition Examination Survey). CONCLUSIONS: For patients of Dominican and Puerto Rican background who present with pulmonary symptoms in clinical practice, use of background-specific spirometry reference equations may provide more appropriate predicted and lower limit of normal values, enabling more accurate diagnoses of abnormality and physiologic impairment.


Assuntos
Emigrantes e Imigrantes , Pneumopatias/diagnóstico , Pneumopatias/etnologia , Padrões de Referência , Adolescente , Adulto , Idoso , América Central , Feminino , Hispano-Americanos , Humanos , Masculino , Americanos Mexicanos , México , Pessoa de Meia-Idade , América do Sul , Espirometria , Estados Unidos/etnologia , Adulto Jovem
12.
BMC Med Res Methodol ; 17(1): 69, 2017 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-28427350

RESUMO

BACKGROUND: Posttraumatic growth is the positive change resulting from traumatic experiences and is typically assessed with retrospective measures like the Posttraumatic Growth Inventory (PTGI). The PTGI was designed to include reference to a specific traumatic event, making it difficult to implement, without change, in prospective survey studies. Thus, a modified Posttraumatic Growth Inventory-Short Form (PTGI-SF) was included in a large prospective study of current and former U.S. military personnel. The current study provides preliminary psychometric data for this modified measure and its ability to assess psychological well-being at a single time point. METHODS: The study population (N = 135,843) was randomly and equally split into exploratory and confirmatory samples that were proportionately balanced on trauma criterion. Exploratory factor analysis and confirmatory factor analysis (CFA) were performed to assess the psychometric validity of the modified measure. The final model was also assessed in a subset of the confirmatory sample with a history of trauma using CFA. RESULTS: Results supported a single-factor model with two additional correlations between items assessing spirituality and items assessing compassion/appreciation for others. This model also fits among the subset with a history of trauma. The resulting measure was strongly associated with social support and personal mastery. CONCLUSIONS: The modified PTGI-SF in this study captures psychological well-being in cross-sectional assessments, in addition to being able to measure posttraumatic growth with multiple assessments. Results indicate that the modified measure is represented by a single factor, but that items assessing spirituality and compassion/appreciation for others may be used alone to better capture these constructs.


Assuntos
Militares/psicologia , Psicometria/métodos , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos
13.
Womens Health Issues ; 27(3): 356-365, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28160994

RESUMO

BACKGROUND: Research on the reproductive health of U.S. servicewomen deployed in support of the recent operations in Iraq and Afghanistan is sparse. The objective of this study was to evaluate whether military experiences, including combat deployment, deployment length, and life stressors during the recent conflicts, were associated with increased odds for miscarriage or impaired fecundity among U.S. servicewomen. METHODS: We used data from the Millennium Cohort Study, a large longitudinal military study that began in 2001 and includes military personnel from all service branches, including active duty and Reserve/National Guard personnel. Participants for this study included women aged 18 to 45 years who had completed two questionnaires (2004-2006 and 2007-2008). Separate multivariable logistic regression models were performed to estimate the odds of reporting miscarriage and impaired fecundity by military experiences that adjusted for covariates. Subanalyses were conducted using International Classification of Diseases, Ninth Revision, Clinical Modification codes found in the Military Health System Data Repository for both outcomes among servicewomen on active duty. RESULTS: Overall, 31% and 11% of military servicewomen reported miscarriage and impaired fecundity, respectively, during the approximate 3-year follow-up period. After adjusting for demographic, behavioral, and military characteristics, deployment experiences and life stressors were not associated with miscarriage or perceived impaired fecundity. Subanalyses using medical record data confirmed these results. CONCLUSIONS: Overall, these results suggest that military deployments do not increase risk for miscarriage and impaired fecundity among U.S. servicewomen. However, because the point estimates for many of the exposures were elevated, more research is needed to better understand the potential risks associated with environmental exposures and specific types of combat exposures.


Assuntos
Aborto Espontâneo/epidemiologia , Campanha Afegã de 2001- , Fertilidade , Guerra do Iraque 2003-2011 , Militares/psicologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Afeganistão , Estudos de Coortes , Feminino , Humanos , Iraque , Estudos Longitudinais , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Gravidez , Fatores de Risco , Estresse Psicológico/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
14.
J Community Health ; 42(3): 558-564, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27837356

RESUMO

This study examines the demographic representativeness of the County of San Diego Body Mass Index (BMI) Surveillance System to determine if the BMI estimates being obtained from this convenience sample of individuals who visited their healthcare provider for outpatient services can be generalized to the general population of San Diego. Height and weight were transmitted from electronic health records systems to the San Diego Immunization Registry (SDIR). Age, gender, and race/ethnicity of this sample are compared to general population estimates by sub-regional area (SRA) (n = 41) to account for regional demographic differences. A < 10% difference (calculated as the ratio of the differences between the frequencies of a sub-group in this sample and general population estimates obtained from the U.S. Census Bureau) was used to determine representativeness. In 2011, the sample consisted of 352,924 residents aged 2-100 years. The younger age groups (2-11, 12-17 years) and the oldest age group (≥65 years) were representative in 90, 75, and 85% of SRAs, respectively. Furthermore, at least one of the five racial/ethnic groups was represented in 71% of SRAs. This BMI Surveillance System was found to demographically represent some SRAs well, suggesting that this registry-based surveillance system may be useful in estimating and monitoring neighborhood-level BMI data.


Assuntos
Índice de Massa Corporal , Registros Eletrônicos de Saúde/estatística & dados numéricos , Sobrepeso/epidemiologia , Vigilância em Saúde Pública/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sistema de Registros , Vacinação , Adulto Jovem
15.
Biol Res Nurs ; 18(2): 230-6, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26316514

RESUMO

BACKGROUND: Analyzing telemetry electrocardiogram (ECG) data over an extended period is often time-consuming because digital records are not widely available at hospitals. Investigating trends and patterns in the ECG data could lead to establishing predictors that would shorten response time to in-hospital cardiac arrest (I-HCA). This study was conducted to validate a novel method of digitizing paper ECG tracings from telemetry systems in order to facilitate the use of heart rate as a diagnostic feature prior to I-HCA. METHODS: This multicenter study used telemetry to investigate full-disclosure ECG papers of 44 cardiovascular patients obtained within 1 hr of I-HCA with initial rhythms of pulseless electrical activity and asystole. Digital ECGs were available for seven of these patients. An algorithm to digitize the full-disclosure ECG papers was developed using the shortest path method. The heart rate was measured manually (averaging R-R intervals) for ECG papers and automatically for digitized and digital ECGs. RESULTS: Significant correlations were found between manual and automated measurements of digitized ECGs (p < .001) and between digitized and digital ECGs (p < .001). Bland-Altman methods showed bias = .001 s, SD = .0276 s, lower and upper 95% limits of agreement for digitized and digital ECGs = .055 and -.053 s, and percentage error = 0.22%. Root mean square (rms), percentage rms difference, and signal to noise ratio values were in acceptable ranges. CONCLUSION: The digitization method was validated. Digitized ECG provides an efficient and accurate way of measuring heart rate over an extended period of time.


Assuntos
Eletrocardiografia/métodos , Registros Eletrônicos de Saúde , Parada Cardíaca/diagnóstico , Frequência Cardíaca/fisiologia , Processamento de Sinais Assistido por Computador , Telemetria/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
17.
J Rheumatol ; 42(8): 1376-82, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25877497

RESUMO

OBJECTIVE: To determine the effect of rheumatoid arthritis (RA) disease severity on pregnancy outcomes in pregnant women with and without autoimmune diseases. METHODS: A prospective cohort study was conducted using the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. Pregnant women with RA enrolled between 2005 and 2013 were selected if they (1) delivered a live-born singleton infant; and (2) completed 3 telephone-based measures of RA disease severity prior to 20 weeks' gestation, including the Health Assessment Questionnaire Disability Index (HAQ-DI), pain score, and patient's global scale. Associations between RA disease severity and preterm delivery, small for gestational age (SGA), or cesarean delivery were tested in unadjusted and multivariate analyses using modified Poisson regression models. RESULTS: The sample consisted of 440 women with RA. Several unadjusted comparisons yielded significant associations. After adjustment for covariates, increasing disease severity was associated with risk for preterm delivery and SGA. For each unit increase in HAQ-DI (0-1), the adjusted relative risk (aRR) for preterm delivery increased by 58% (aRR 1.58, 95% CI 1.17-2.15). Among those with HAQ-DI > 0.5, the aRR for SGA was 1.81 (95% CI 1.01-3.33). CONCLUSION: RA disease severity in early pregnancy, as measured in this study, was predictive of preterm delivery and SGA. These findings suggest that the risk of preterm delivery and SGA in women with RA might be lowered if RA is well controlled early in pregnancy.


Assuntos
Artrite Reumatoide/diagnóstico , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Índice de Gravidade de Doença
18.
Community Ment Health J ; 51(4): 385-92, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25107309

RESUMO

The present study investigated whether a culturally-tailored problem-solving intervention delivered by a trained depression care specialist (DCS) would improve depressive symptoms over a 6 month period among Hispanic/Latino patients in a federally-qualified community health center by the California-Mexico border. Participants included 189 low income Hispanic/Latino patients of Mexican heritage. Based on the improving mood-promoting access to collaborative treatment (IMPACT) evidence-based treatment, patients received evidence-based problem-solving therapy. The Patient Health Questionnaire-9 (PHQ-9) was administered to assess changes in self-reported depressive symptoms between baseline and monthly for a 6-month follow up period. The majority of participants were female (72.5%) with a mean age of 52.5 (SD = 11.7). The mean PHQ-9 at baseline was 16.9 (SD = 4.0) and at the 6-month follow-up, the average PHQ-9 decreased to 9.9 (SD = 5.7). A linear mixed model analysis showed significant improvement in PHQ-9 scores over a 6 month period (F = 124.1; p < 0.001) after controlling for age, gender, smoking and diabetes. There was a significant three way interaction between time, gender and smoking (p = 0.01) showing that the depressive symptoms among male smokers did not improve as much as non-smoking males and females. Results suggest that a culturally-tailored problem solving approach can significantly reduce depressive symptoms among Hispanic/Latino low-income patients.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Assistência à Saúde Culturalmente Competente/métodos , Depressão/terapia , Hispano-Americanos/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Depressão/diagnóstico , Depressão/etnologia , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
19.
J Clin Monit Comput ; 29(3): 385-92, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25236259

RESUMO

Survival after in-hospital cardiac arrest (I-HCA) remains < 30 %. There is very limited literature exploring the electrocardiogram changes prior to I-HCA. The purpose of the study was to determine demographics and electrocardiographic predictors prior to I-HCA. A retrospective study was conducted among 39 cardiovascular subjects who had cardiopulmonary resuscitation from I-HCA with initial rhythms of pulseless electrical activity (PEA) and asystole. Demographics including medical history, ejection fraction, laboratory values, and medications were examined. Electrocardiogram (ECG) parameters from telemetry were studied to identify changes in heart rate, QRS duration and morphology, and time of occurrence and location of ST segment changes prior to I-HCA. Increased age was significantly associated with failure to survive to discharge (p < 0.05). Significant change was observed in heart rate including a downtrend of heart rate within 15 min prior to I-HCA (p < 0.05). There was a significant difference in heart rate and QRS duration during the last hour prior to I-HCA compared to the previous hours (p < 0.05). Inferior ECG leads showed the most significant changes in QRS morphology and ST segments prior to I-HCA (p < 0.05). Subjects with an initial rhythm of asystole demonstrated significantly greater ECG changes including QRS morphology and ST segment changes compared to the subjects with initial rhythms of PEA (p < 0.05). Diagnostic ECG trends can be identified prior to I-HCA due to PEA and asystole and can be further utilized for training a predictive machine learning model for I-HCA.


Assuntos
Eletrocardiografia , Parada Cardíaca/fisiopatologia , Monitorização Fisiológica , Idoso , Arritmias Cardíacas , Síndrome de Brugada , Doença do Sistema de Condução Cardíaco , Reanimação Cardiopulmonar , Feminino , Sistema de Condução Cardíaco/anormalidades , Frequência Cardíaca , Humanos , Unidades de Terapia Intensiva , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Fatores de Risco , Telemetria , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico
20.
BMC Infect Dis ; 14: 576, 2014 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-25475044

RESUMO

BACKGROUND: Basic trainees in the US military have historically been vulnerable to respiratory infections. Adenovirus and influenza are the most common etiological agents responsible for febrile respiratory illness (FRI) among trainees and present with similar clinical signs and symptoms. Identifying demographic and clinical factors associated with the primary viral pathogens causing FRI epidemics among trainees will help improve differential diagnosis and allow for appropriate distribution of antiviral medications. The objective of this study was to determine what demographic and clinical factors are associated with influenza and adenovirus among military trainees. METHODS: Specimens were systematically collected from military trainees meeting FRI case definition (fever ≥38.0°C with either cough or sore throat; or provider-diagnosed pneumonia) at eight basic training centers in the USA. PCR and/or cell culture testing for respiratory pathogens were performed on specimens. Interviewer-administered questionnaires collected information on patient demographic and clinical factors. Polychotomous logistic regression was employed to assess the association between these factors and FRI outcome categories: laboratory-confirmed adenovirus, influenza, or other FRI. Sensitivity, specificity, positive and negative predictive value were calculated for individual predictors and clinical combinations of predictors. RESULTS: Among 21,570 FRI cases sampled between 2004 and 2009, 63.6% were laboratory-confirmed adenovirus cases and 6.6% were laboratory-confirmed influenza cases. Subjects were predominantly young men (86.8% men; mean age 20.8 ± 3.8 years) from Fort Jackson (18.8%), Great Lakes (17.1%), Fort Leonard Wood (16.3%), Marine Corps Recruit Depot (MCRD) San Diego (19.0%), Fort Benning (13.3%), Lackland (7.5%), MCRD Parris Island (8.7%), and Cape May (3.2%). The best multivariate predictors of adenovirus were the combination of sore throat (odds ratio [OR], 2.94; 95% confidence interval [CI], 2.66-3.25), cough (OR, 2.33; 95% CI, 2.11-2.57), and fever (OR, 2.07; 95% CI, 1.90-2.26) with a PPV of 77% (p ≤ .05). A combination of cough, fever, training week 0-2 and acute onset were most predictive of influenza (PPV =38%; p ≤ .05). CONCLUSIONS: Specific demographic and clinical factors were associated with laboratory-confirmed influenza and adenovirus among military trainees. Findings from this study can guide clinicians in the diagnosis and treatment of military trainees presenting with FRI.


Assuntos
Infecções por Adenoviridae/epidemiologia , Influenza Humana/epidemiologia , Militares , Infecções Respiratórias/epidemiologia , Infecções por Adenoviridae/complicações , Tosse/etiologia , Demografia , Feminino , Febre/etiologia , Humanos , Influenza Humana/complicações , Masculino , Medicina Militar , Infecções Respiratórias/complicações , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
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