Assessing the Healthy People 2020 Objective to Expand Early Treatment Receipt Among a National Sample of Children with Autism Spectrum Disorder.

OBJECTIVE: To assess the progress of the Healthy People 2020 (HP2020) objective to increase the proportion of children with autism spectrum disorder (ASD) who receive treatment by 48 months old and to examine the relationship between predisposing, enabling, and need factors and age of initial treatment receipt. METHOD: We used data from the National Survey of Children's Health, 2016 to 2017, a nationally representative study of US children. Our sample included children aged 3 to 17 years old with ASD who received treatment (N = 1333). We conducted χ goodness of fit tests and logistic regression. RESULTS: The HP2020 objective to enroll 57.6% of 8-year-old children with ASD in treatment by 48 months old was not met (40.9%). Among 3- to 5-year-old children with ASD, the proportion who received treatment by 48 months old was more than double that of 8-year-old children (88.3%). We detected social inequities and significant differences by provider type and state mandate. CONCLUSION: Research with larger samples is needed to continue tracking progress. If the goal continues not to be met, work will be required to explain stagnation and to inform additional targeted efforts to reduce the age of initial treatment.

Healthy People 2020: Rural Areas Lag In Achieving Targets For Major Causes Of Death.

For the period 2007-17 rural death rates were higher than urban rates for the seven major causes of death analyzed, and disparities widened for five of the seven. In 2017 urban areas had met national targets for three of the seven causes, while rural areas had met none of the targets.

Hyperhomocysteinemia and folate levels in normal healthy Nigerians living in Zaria: Subanalysis of ABU homocysteine cross-sectional survey

Background: This study aimed to determine the prevalence of hyperhomocysteinemia and folate status in a sample of normal healthy Nigerians living in Zaria as well as assess the relationship between homocysteine, folate, and blood pressure (BP) levels. Methods: It was a cross-sectional analytical study carried out among 65 normal healthy volunteers aged 18­65 years. Participants were randomly selected from willing patient escorts, hospital employees, and willing staff presenting at the Ahmadu Bello University Medical Centre, Zaria and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. The percentage of participants who had high homocysteine levels as well as their plasma folate status was determined. Results: There were 9.2% with hyperhomocysteinemia >15 µmol/L and 51% with hyperhomocysteinemia >10 µmol/L. The mean plasma homocysteine level was 10.8 ± 2.7 µmol/L with male and female values of 10.7 ± 2.6 and 10.8 ± 2.8, respectively (P = 0.87). The mean plasma folate level was high (116.7 ± 44.0 ng/mL) with male value of (111.5 ± 44.9 ng/mL) which did not differ significantly (P = 0.37) from that of females (121.4 ± 43.3 ng/mL). Homocysteine showed a positive significant (P = 0.01) relationship with folate but not with BP's (P > 0.05). Conclusion: There is a high prevalence of hyperhomocysteinemia in normal healthy Northern-Nigerians which cannot be accounted for by suboptimal folate levels. Hyperhomocysteinemia may not be a risk factor for cardiovascular disease in normal healthy Nigerians despite its high levels as it showed no significant relationship with BP

Who is meeting the Healthy People 2020 objectives?: Comparisons between racially/ethnically diverse and immigrant children and adults.

INTRODUCTION: To determine the prevalence of reaching multiple Healthy People 2020 (HP 2020) objectives including nutrition and weight status, sleep health, physical activity, health-related quality of life, social determinants of health, and education among low-income, diverse children and adults. METHODS: Children ages 5- to 7-years-old (n = 150; 47% female) and their parents (mean age = 35; 91% mothers) from 6 racial/ethnic and immigrant/refugee groups (n = 25 from each; African American, Native American, Hispanic, Hmong, Somali, White) participated in this cross-sectional mixed-methods study. RESULTS: Overall, the majority of HP 2020 objectives were not being met across this low-income, racially/ethnically diverse, and immigrant/refugee sample of children and adults. In particular, African American children and parents consistently fell below the majority of the HP 2020 targets, with only 5 of the 24 HP 2020 objectives being met. Additionally, immigrant children and parents met less than 2/3 of the HP 2020 objectives. DISCUSSION: Concerted public health efforts are needed to address the disparities in reaching the HP 2020 objectives and informing the development of the future HP 2030 objectives among low-income, racially/ethnically diverse, and immigrant children and parents. In order to achieve and assess the current and future HP objectives in these diverse populations, changes may be needed in both interventions and assessment tools. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Striving to Meet Healthy People 2020 Objectives: Trend Analysis of Maternal Smoking.

OBJECTIVES: We examined trends in prevalence rates of smoking and smoking cessation during pregnancy among women in the United States to assess achievement of Healthy People 2020 prevention targets. METHODS: We assessed the smoking habits of 30 667 mothers whose children were born between 1985 and 2014 and who were sampled by the National Health and Nutrition Examination Survey, 1999-2014. Sampled participants were children aged 0-15 at the time of interview; however, an adult proxy-usually the biological mother-responded on the child's behalf and reported information about maternal tobacco use during pregnancy. We calculated prevalence rates, adjusted odds ratios (aORs), and predicted annual increase or decrease of smoking and quitting smoking during pregnancy, adjusting for mother's age at delivery and income level and child's race/ethnicity and sex. RESULTS: The average annual prevalence of smoking at any time during pregnancy decreased from 25.7% (95% confidence interval [CI], 15.3%-36.0%) in 1985 to 10.1% (95% CI, 7.1%-13.0%) in 2014 ( P < .001), and quitting smoking at any time during the index pregnancy increased from 36.6% (95% CI, 20.3%-52.9%) in 1985 to 54.9% (95% CI, 44.4%-65.4%) in 2008 ( P = .002). The adjusted annual risk of smoking during pregnancy decreased significantly by 3% (aOR = 0.97; 95% CI, 0.95-0.98; P < .001). The prevalence rate of smoking in the year 2020 extrapolated from the current trend would be 6.1%. CONCLUSIONS: Smoking during pregnancy in the United States is declining. However, renewed public health measures are needed to achieve the Healthy People 2020 objectives of preventing smoking among pregnant women in the United States.

Evaluación de la variedad y calidad en los menús escolares de Asturias. Curso 2015/2016 / Evaluation of variety and quality in the school menus of Asturias. 2015/2016

Fundamentos: Desde la primera evaluación en 2011 del "Programa de Alimentación Saludable y de Producción Ecológica en los Comedores Escolares de Asturias ", se ha venido analizando la mejora de los menús en cuanto a frecuencias en la oferta de grupos de alimentos. El objetivo de este estudio fue evaluar la calidad culinaria de los menús, de forma que complemente a dicho análisis. Métodos: Estudio descriptivo transversal con una muestra por conveniencia de los 243 centros de Educación Primaria de Asturias, es decir, 195 en el curso 2015-16. Se solicitó un menú mensual a todos los centros y en caso de no recibir respuesta se realizó una búsqueda en Internet. Se definieron unos criterios mínimos a cumplir en frecuencias, variedad y recetas diferentes para cada grupo de alimentos. Se analizaron todos los días de los menús y las diferencias entre los menús cocinados in situ vs catering, así como entre centros de titularidad pública vs privada/concertada. El análisis de datos se realizó con el programa SPSS y las diferencias entre porcentajes de cumplimiento con la prueba Chi cuadrado. Resultados: Se analizaron 195 menús (80,2%), obteniéndose altos porcentajes de cumplimiento en todos los criterios (superiores al 80%), excepto en la variedad de carbohidratos (27,7%), fruta (22,1%), carne procesada (13,9%), oferta de verdura como primer plato (6,1%) y proteína animal en el primer plato (2,6%). Conclusiones: El cumplimiento general de las recomendaciones respecto a variedad y recetas diferentes en los colegios es muy adecuado, especialmente en los de titularidad pública y de cocina propia

Background: Since the first evaluation in 2011 of the "Healthy Eating and Ecological Production Program in School Meals of Asturias ", the improvement of the menus has been analyzed in terms of frequencies in the food group offer. The objective of this study was to evaluate the culinary quality of the menus, in order to complement this analysis. Methods: Transversal descriptive study with a sample for convenience of the 243 Primary Education centers of Asturias, that is, 195 in the 2015-16 academic year.. A monthly menu was requested to all the centers and in case of not receiving a response, a search was made on the Internet. Minimum criteria were defined to comply with frequencies, variety and recipes for each food group. The menus were analyzed every day and the differences between the menus cooked on site vs catering, as well as between public versus private / concerted centers. The data analysis was performed with the SPSS program and the differences between percentages of compliance with the Chi square test. Results: 195 menus were analyzed (80.2%), obtaining high percentages of compliance in all the criteria (over 80%), except in the variety of carbohydrates (27.7%), fruit (22.1%). %), processed meat (13.9%), vegetable offer as first course (6.1%) and animal protein in the first course (2.6%). Conclusions: The general compliance of the recommendations with respect to variety and different recipes in the schools is very adequate, especially in those of public ownership and with own kitchen type

Incidence of gastrointestinal infections among U.S. active component service members stationed in the U.S. compared to U.S. civilians, 2012-2014.

Gastrointestinal (GI) infections in the U.S. Armed Forces have consistently been among the most frequent disease and non-battle injury diagnoses. A retrospective analysis of surveillance data categorized as GI infections among active component service members during 2012-2014 was performed. During the study period, 99% of inpatient and outpatient GI encounters were reported as nonspecific GI infection (13,331 cases per 100,000 people), leaving only a small percentage of cases attributed to specific causes. The five most common organisms associated with GI infections were Campylobacter (10.30 per 100,000 people), nontyphoidal Salmonella (7.43), Giardia (3.15), Shigella (2.11), and norovirus (1.25). The civilian population incidence rates of foodborne diseases during the same time period are significantly greater than incidence rates within the U.S. active component for all select bacterial and parasitic pathogens, except Campylobacter. Nonspecific gastroenteritis incidence increased during winter months, which is similar to the seasonal pattern for viruses such as norovirus. The preponderance of nonspecific infections highlights the need for increased testing and a more in-depth review of the impact of GI infections on operational effectiveness within the U.S.

Interventions directed at eating habits and physical activity using the Transtheoretical Model: a systematic review / Intervenciones dirigidas a los hábitos alimenticios y la actividad física mediante el Modelo Transteórico: una revisión sistemática

Introduction: The multi-behavioral Transtheoretical Model (TTM) addresses multiple behaviors and it is a promising strategy to control multifactorial morbidities, such as chronic diseases. The results obtained using the TTM are positive, but are not consistently methodical. Objectives: The aim of this study was to systematically review the effectiveness of the Transtheoretical Model in multi-behavioral interventions for changing eating habits and levels of physical activity. Methods: A search on PubMed and SciELO databases was performed with inclusion criteria set for intervention studies before 2016 using the Transtheoretical Model for more than one behavior, including eating habits and/or engaging in physical activity. Results and conclusion: Eighteen studies were identified; there was a predominance of randomized clinical trials, studies conducted in the United States, and the use of the Internet and/or telephone. The selected studies were aimed at changing eating behaviors; five of the studies did not address physical activity. The main results were reduction of fat consumption, an increase in the consumption of fruit and vegetables, and increases in physical activity, which are progressions in the stages of change and weight loss identified by the Transtheoretical Model. However, the studies showed methodological weaknesses, including high participant loss and the omission of information about randomization and blinding (AU)

Introducción: el Modelo Tranteórico multiconductual aborda distintas conductas y es una estrategia prometedora para el abordaje de patologías multifactoriales, sobre todo en las enfermedades crónicas. Los resultados iniciales de su empleo han sido favorables, pero no han sido probados con rigor. Objetivos: el objetivo de este estudio fue realizar una revisión sistemática de la eficacia del Modelo Transteórico en el cambio de hábitos dietéticos y en el grado de actividad física con intervenciones en varias áreas de la conducta. Métodos: se realizó una búsqueda en PubMed y SCieLO utilizando como criterios de búsqueda estudios de intervención realizados antes de 2016 y que incluyeran más de un hábito, incluyendo hábitos alimentarios y/o actividad física. Resultados y conclusión: se identificaron 18 estudios, con un predominio de ensayos clínicos aleatorizados, estudios realizaos en Estados Unidos de Norteamérica, y uso de Internet y/o teléfono. Los estudios seleccionados tenían como meta el cambio en los hábitos dietéticos. En 5 de los estudios no se incluía la actividad física. El principal resultado de la intervención fue la disminución en el consumo de grasa y el aumento en la ingestión de frutas y verduras, así como un aumento en la actividad física. Estos cambios supusieron progresos en la pérdida de peso. Sin embargo, los trabajos eran metodológicamente débiles, incluyendo una alta tasa de abandonos, y falta de información sobre la aleatorización y cómo se realizó el estudio ciego (AU)

Social Determinants of Health and Adolescent Pregnancy: An Analysis From the National Longitudinal Study of Adolescent to Adult Health.

PURPOSE: Although rates of adolescent pregnancy are at an all-time low in the United States, racial/ethnic and geographic disparities persist. This research used National Longitudinal Study of Adolescent to Adult Health (Add Health) data to analyze empirical relationships between social determinants of health (SDoH) and adolescent pregnancy. Examining relationships between the SDoH and adolescent pregnancy provides support for funding priorities and interventions that expand on the current focus on individual- and interpersonal-level factors. METHODS: On the basis of the Healthy People 2020 Social Determinants of Health Framework, the identification of proxy measures for SDoH within the Add Health study allowed for an analysis of relationships to adolescent pregnancy (N = 9,204). Logistic regression examined associations between adolescent pregnancy and each measure of SDoH. RESULTS: Results indicated that 6 of 17 measures of SDoH had an empirical relationship with adolescent pregnancy. Measures negatively associated with adolescent pregnancy included the following: feeling close to others at school, receipt of high school diploma, enrollment in higher education, participation in volunteering or community service, reporting litter or trash in the neighborhood environment as a big problem, and living in a two-parent home. CONCLUSIONS: Findings from this study support the need for increased research and intervention focus in SDoH related to areas of education and social and community context. Results of this study provide information for the allocation of resources to best address SDoH that show a link with adolescent pregnancy. Areas of future research can further explore the areas in which SDoH show a relationship with adolescent pregnancy.

Prevalence and prognosis of ECG abnormalities in normotensive and hypertensive individuals.

OBJECTIVE: To define the prevalence and prognosis of ECG abnormalities in hypertensive individuals. METHODS: ECG, blood pressure and other cardiovascular risk factors were recorded in a nationwide population sample of 5800 Finns. The presence of 15 ECG abnormalities was evaluated. Participants were divided into categories by blood pressure and followed for coronary heart (CHD) and cardiovascular disease (CVD) events. RESULTS: Mean follow-up was 10.4 ±â€Š2.2 years. The age- and sex-adjusted prevalence rates of ECG abnormalities were generally higher in the hypertensive participants than in normotensive individuals. In multivariable-adjusted Cox models, the following ECG abnormalities predicted CHD in hypertensive participants: left ventricular hypertrophy (LVH) by Sokolow-Lyon criteria [hazard ratio, 1.47; 95% confidence interval (CI), 1.07-2.01; P = 0.02], LVH with ST-depression and negative T wave (ST/T changes) (hazard ratio, 2.31; 95% CI, 1.20-4.43, P = 0.01), ST/T changes (hazard ratio, 2.12; 95% CI, 1.34-3.36; P = 0.001), positive T wave in lead aVR (AVRT+) (hazard ratio, 1.74; 95% CI, 1.15-2.64; P = 0.009) and poor R-wave progression (hazard ratio, 2.02; 95% CI, 1.27-3.22; P = 0.003). These ECG abnormalities were also significant predictors of CVD in hypertensive participants (P ≤ 0.03 for all). Nonspecific intraventricular conduction delay predicted CVD in the whole population (hazard ratio, 1.50; 95% CI, 1.06-2.13; P = 0.02). Prolonged QT interval, abnormal P-wave indices, left axis deviation and early repolarization pattern were not associated with CHD or CVD. CONCLUSION: ECG abnormalities are highly prevalent in hypertensive individuals. LVH is still the cornerstone of cardiovascular risk assessment in hypertensive patients. The additional assessment of ST/T changes, AVRT+ and poor R-wave progression in ECGs could improve risk prediction in hypertensive patients.

CANPLAY study: Secular trends in steps/day amongst 5-19year-old Canadians between 2005 and 2014.

INTRODUCTION: The Canadian Physical Activity Levels Among Youth (CANPLAY) study collected pedometer data from eight surveys between 2005 and 2014, making it a unique database of objective population physical activity surveillance. The purpose of this study was to describe secular physical activity trends for 5-19year olds. METHODS: Canadian children from nationally representative samples (10,000 recruited, n≅5500 per survey) were mailed a pedometer kit, asked to wear the pedometer for 7 consecutive days, log steps daily, then return the log by mail. Weighted medians and prevalence estimates were calculated. Trends were tested by χ(2) test of independence. RESULTS: An overall median of 10,935 steps/day was taken by Canadian children 5-19years of age (n=43,806) across the eight surveys. Steps/day increased between 2005-06 and 2007-08, then decreased in 2012-14. The prevalence of taking sufficient steps/day (defined as ≥10,000 steps/day for 5year olds, ≥13,000 steps/day for 6-11year-old boys; ≥11,000 steps/day for 6-11year-old girls; and ≥10,000 steps/day for 12-19year olds;) also increased then decreased over time, whereas the prevalence of accumulating <7000 steps/day generally increased over time. Trends were significant for boys, girls and each age group. DISCUSSION: The CANPLAY surveillance system provided comparable data at multiple time points over 9years. An overall shift in the distribution of steps/day towards a less active lifestyle occurred between 2005-06 and 2012-14 for boys, girls and each age group. This provides evidence that the national policy goal to increase children's steps/day by 2015 has not been met.

Under-5 mortality in 2851 Chinese counties, 1996-2012: a subnational assessment of achieving MDG 4 goals in China.

BACKGROUND: In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. METHODS: We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. FINDINGS: In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4.4%. INTERPRETATION: The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8.8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates. FUNDING: National "Twelfth Five-Year" Plan for Science and Technology Support, National Health and Family Planning Commission of The People's Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation.

Effects of an intervention program (HHP) on the promotion of healthy habits in early adolescence / Efectos de un programa de intervención (PHS) para la mejora de los hábitos saludables en la primera adolescencia

Background: it is vital to monitor and promote healthy lifestyle habits in early adolescence, as it is a time of changes when future lifestyle habits are formed. Methods: a study was conducted to find out the effects of a Healthy Habits Program (HHP) in children between the ages of 10 and 12 years (N=158). The study included an intervention group (IG) (n=90), which participated in the HHP for 8 months, and a control group (CG) (n=100). In order to assess healthy habits in these children we used the Inventory of Healthy Habits (IHH), the reliability of which was previously evaluated (N=134). Results: the IHH obtained good reliability, Interclass Correlation Coefficient (range .506-884; p<.001) and Spearman Correlation Coefficient (range r=529-884; p<.001). As regards the HHP, there were no differences in eating habits initially (p=.564), but by the end of the study (p=.001) the IG showed better habits. As for the other healthy habits indicators, the CG had better habits initially (p=.047), but the score of the IG improved and there were no differences between the groups at the end of the study. Conclusions: it was shown that the IHH is a suitable and reliable questionnaire for studying habits in adolescents. The HHP brought about changes in the IG, which achieved better scores for eating habits and sum of health habits (AU)

Introducción: la vigilancia y promoción de los hábitos de vida saludables en la primera adolescencia resulta vital, por ser una etapa de cambios y configuración de futuros hábitos de vida. Metodologia: se realizaron dos estudios en niños entre 10-12 años de edad. El primero sobre la fiabilidad del Inventario de Hábitos Saludables (IHS) (N=134), y el segundo de diseño cuasi-experimental (N=158), para el estudio pre-post de los efectos del Programa de Hábitos Saludables (PHS). Los hábitos se midieron con el IHS; el grupo de intervención (GI) (n=90) participó en el PHS durante 8 meses, y el (GC) (n=100). Resultados: el IHS obtuvo una buena fiabilidad, siendo el índice de correlación interclase (rango .506-884; p<0,001) y el coeficiente de correlación de Spearman (rango r=529- 884; p<.001). Respecto al PHS, no existieron diferencias de alimentación previas (p=0,564), pero sí al final del mismo (p=0,001), a favor del GI. Del resto de indicadores de hábitos saludables, el GC tenía mejores hábitos iniciales (p=0,047), pero el GI mejoró su puntuación, no existiendo diferencias finales entre grupos. Conclusiones: el IHS resultó ser un cuestionario adaptado y fiable para el estudio de los hábitos en adolescentes. El PHS provocó cambios en el GI, consiguiendo mejores puntuaciones en alimentación y sumatorio de hábitos saludables (AU)

Relevancia de un programa de equilibrio en la calidad de vida relacionada con la salud de mujeres adultas mayores obesas / Relevance of a program balance in health-related quality of life of obese elderly women

Objetivo: el objetivo de este estudio ha sido analizar los efectos de un programa de intervención específico de fuerza y equilibrio en la calidad de vida en mujeres obesas mayores. Material y método: participaron 56 mujeres obesas mayores (media 67,2 +/- 2,1 años) que se distribuyeron aleatoriamente en grupo control (28) y experimental (28). El grupo experimental llevó a cabo un programa de ejercicio basado en el equilibrio y la fuerza del tren inferior, durante 24 semanas. Se midió la fuerza y el equilibrio antes y después de la intervención. Del mismo modo, se determinó la percepción de la calidad de vida relacionada con la salud (CVRS) a través del cuestionario SF-36. Resultados: el grupo experimental mostró una mejora significativa en todas las pruebas. En el test de la silla se observó un incremento del 28,3 % después del programa (P<0.05). La prueba de salto con contramovimiento (CMJ) reflejó una mejora del 20,8 % (P< 0,001). Igualmente se detectaron cambios positivos en el test de equilibrio con los ojos cerrados (P< 0,001). No obstante, el nivel de significación con los ojos abiertos fue menor que con los ojos cerrados (P<0,05). Asimismo se apreció una mejora significativa del grupo experimental sobre el grupo control en todas las dimensiones del SF-36. Conclusión: un programa específico de equilibrio produce cambios positivos en la estabilidad de una muestra de mujeres mayores adultas obesas, mejorando significativamente la CVRS en todas sus dimensiones, destacando la salud física y los componentes mentales función social y salud mental. Se abren nuevos caminos para un mayor bienestar de las mujeres obesas (AU)

Objective: the objective of this study was to analyze the effects of a specific intervention program of strength and balance in the quality of life in obese women elderly. Material and methods: a total of 56 obese women elderly (average 67.2 +/- 2.1 age) were randomized into control group (28) and experimental (28). The experimental group carried out an exercise program based on balance and lower body strength, for 24 weeks. Balance and strength was measured before and after the intervention. Similarly, the perception health-related quality of life (HRQOL) was determined using SF-36. Results: the experimental group showed a significant improvement in all tests. In the test of the chair was observed an increase of 28.3% after the program (P <0.05). The test countermovement jump (CMJ) reflected an improvement of 20.8% (P <0.001). Equally positive changes were detected in the test of balance with closed eyes (P <0.001). However, the significance level with open eyes was lower than with closed eyes (P <0.05). Also, was observed a significant improvement in the experimental group on monitoring in all dimensions of SF-36. Conclusion: a specific program of balance produces positive changes in the stability of a sample of obese women elderly, significantly improving HRQOL in all dimensions, emphasizing physical health and social function and mental health mental components. Are opened new avenues for greater welfare of obese women elderly (AU)

Evaluation of the effects of a programme promoting adequate and healthy eating on adolescent health markers: an interventional study / Evaluación de los efectos de un programa de promoción de una alimentación adecuada y saludable en los marcadores de salud para adolescentes: un estudio de intervención

Aim: to evaluate the effects of a protocol promoting adequate and healthy eating on adolescent health parameters. Methods: this controlled intervention study was conducted for 9 months, with the participation of adolescents enrolled in two schools (intervention/control) located in a poor neighbourhood in the city of Salvador (Bahia), Brazil. For the intervention school, activities promoting adequate and healthy eating were designed based on the Food Guide for the Brazilian Population (Guia Alimentar para a População Brasileira). Students underwent biochemical, sexual maturation and anthropometric tests at baseline and at the end of the 9-month period. In addition, students answered a questionnaire on food consumption, physical activity and sedentary behaviour. Information on the socioeconomic status of their family was also obtained. Generalized Estimating Equation (GEE) analysis was chosen to evaluate the associations of interest. Results: students under intervention presented decreases of 7.64 mg/dL in mean total cholesterol (TC) (p = 0.009) and 7.77 mg/dL in mean low-density lipoprotein cholesterol (LDLc) (p = 0.003) and increases of 18% in legume consumption (odds ratio [OR] = 1.18; 95% confidence interval [CI] 1.03-1.37) and 17% in vegetable consumption (OR = 1.17; 95%CI 1.01-1.35) compared with students who did not undergo intervention. No differences were observed in the anthropometric parameters analysed. Conclusion: the results showed a positive effect of activities promoting adequate and healthy eating on reducing TC and LDLc and on increasing the consumption of vegetables and legumes, evidencing that the intervention model was able to prevent and/or treat cardiovascular risk factors in adolescents (AU)

Objetivo: evaluar las repercusiones de un protocolo de promoción de una alimentación adecuada y saludable en los parámetros de salud de adolescentes. Métodos: se trata de un estudio de intervención, controlado, con una duración de nueve meses, en el cual participaron estudiantes, con una edad entre 10 y 17 años, matriculados en dos escuelas (intervención/ control) situadas en un barrio pobre del municipio de Salvador (Bahia), Brasil. Fueron previstas para la escuela bajo intervención acciones de promoción de una alimentación adecuada y saludable, con base en el Guia Alimentar para a População Brasileira (Guía Alimentaria para la Población Brasileña). Con el propósito de evaluar el efecto de tales acciones, todos los alumnos fueron sometidos a los exámenes bioquímicos, de maduración y antropométricos al principio y al final de los nueve meses. Además, contestaron a un cuestionario sobre consumo alimentario, actividad física y comportamiento sedentario. También se consiguió información sobre las condiciones socioeconómicas de la familia. La opción fue el análisis de Ecuaciones de Estimaciones Generalizadas (GEE) para evaluar las asociaciones de interés. Resultados: se verificó que los estudiantes bajo intervención presentaron una disminución de 7,64 mg/dL en la media del colesterol total (p = 0,009), de 7,77 mg/dL en la media del LDLc (p = 0,003), un incremento del 18% en el consumo de legumbres (OR = 1,18; 95%IC 1,03-1,37) y del 17% en el consumo de verduras (OR = 1,17; 95%IC 1,01-1,35), comparados con aquellos que no fueron sometidos a la intervención. No hubo diferencias en los pará- metros antropométricos estudiados. Conclusión: los resultados apuntaron un efecto positivo de las acciones de promoción de la alimentación adecuada y saludable en la reducción del colesterol total, LDL-c, en el aumento del consumo de vegetales y legumbres, evidenciando una vez más que el modelo de intervención fue capaz de prever y/o tratar factores de riesgo cardiovascular en los adolescentes (AU)

The increase of dairy intake is the main dietary factor associated with reduction of body weight in overweight adults after lifestyle change program / El aumento de la ingesta de lácteos es el principal factor dietético asociado con la reducción del peso corporal en adultos con sobrepeso después de un programa de cambio de estilo de vida

This study evaluated which was the main nutritional change associated with weight reduction of overweight adult participants of a lifestyle change program. It was hypothesized that increases in dairy intake could be an important nutrition intervention in a lifestyle change program. 117 individuals, male (19.5%) and female (80.5%), with a minimum age of 36 years (54.2±10.4). All study participants were enrolled in a lifestyle change program consisting of nutritional counseling and physical activity during 20 weeks. All participants were grouped in three groups according to Body Mass Index (BMI) delta median (-0.87 kg/m2 ) of individuals that showed weight loss: G1 - lost more than 0.87 kg/m2 of BMI (n=38); G2 - lost 0 to 0.87 kg/m2 of BMI (n=36); and G3 - increased BMI (n=43). G1 increased dairy, fruit and vegetables intake and after forward stepwise multiple regression analysis, it was noted that an increase in dairy product intake of 0.40 servings per day had an impact of 9.6% on the loss of one kg/m2 of BMI. In conclusion, an increase in dairy product intake was the main dietary factor associated with reductions in body weight in overweight adults after 20 weeks of lifestyle change program (AU)

Este estudio evaluó cuál era el cambio nutricional principal asociado con la reducción de peso de los participantes adultos con sobrepeso de un programa de cambio de estilo de vida. La hipótesis era que el aumento de la ingesta de lácteos podría ser una importante intervención nutricional en un programa de cambio de estilo de vida. 117 personas, de sexo masculino (19,5%) y mujeres (80,5%), con una edad mínima de 36 años (54,2±10,4). Todos los participantes en el estudio fueron incluidos en un programa de cambio de estilo de vida que consiste en el asesoramiento nutricional y la actividad física durante 20 semanas. Todos los participantes fueron agrupados en tres grupos de acuerdo con el Índice de Masa Corporal (IMC) medio delta (-0,87 kg/m2 ): G1 - perdieron más de 0,87 kg/m2 (n=38); G2 - perdió 0-0,87 kg/m2 (n=36); y G3 - aumentó el IMC (n=43). El G1 aumentó lácteos, frutas y verduras y después de un análisis de regresión múltiple por pasos hacia adelante se observó un aumento en la ingesta de productos lácteos de 0,40 porciones por día que tuvo un impacto del 9,6% en la pérdida de un kg/ m2 de IMC. En conclusión, el aumento en la ingesta de productos lácteos fue el principal factor dietético asociado con reducciones en el peso corporal en adultos con sobrepeso después de 20 semanas de programa de cambio de estilo de vida (AU)

Compliance of physical activity guidelines by Chilean low-income children: difference between school and weekend days and nutritional status / Grado de cumplimiento de niños chilenos de bajos recursos con la recomendación diaria de actividad física: diferencia entre semana y fin de semana según estado nutricional

The main objectives of this study were to compare in 6-9 y Chilean low-income children, daily minutes of moderate/vigorous physical activity (MVPA) and compliance of the guideline of 60 min of daily MVPA on weekdays versus weekends, by sex and nutritional status (NS). The sample included 250 children (139 boys). Weight and height were measured; MVPA was assessed with NL1000 pedometers during 7 days. The sample was categorized into normal-weight (N) and overweight (OW) according to BMI z score (WHO reference 2007). Comparisons between weekdays and weekends included: a) MVPA by sex, using t-test b) MVPA of N and OW by sex, using ANOVA c) Compliance of guideline by sex and NS, using test of proportions. 66% of the children were OW, accumulating significantly more MVPA on weekdays, 50.5 min versus 40.3; boys more than girls; this result was similar by NS, except for N girls who spent similarly on weekdays as on weekends. Only 33 % boys and 15% girls (p= 0.03) and 17 and 9% (p=0.058) met the guideline on weekdays and weekends respectively, similarly by NS. A very small proportion of children met the MVPA guideline; adopting an active lifestyle is key, considering their high overweight prevalence (AU)

Los principales objetivos de este estudio fueron comparar en escolares chilenos de bajos ingresos (6-9 años), minutos diarios de actividad física moderada / vigorosa (AFMV) y el cumplimiento de la recomendación de 60 minutos diarios de AFMV durante la semana y fin de semana, por sexo y estado nutricional (EN). La muestra incluyó a 250 niños (139 varones). Se midieron peso, talla y AFMV que se evaluó con podómetros (NL1000) durante 7 días. La muestra se clasificó en peso normal (N) y sobrepeso (SP) según puntaje z de IMC (OMS 2007). Las comparaciones entre días de semana y fines de semana incluyeron : a) AFMV por sexo, utilizando la prueba t b) AFMV de N y SP según sexo, usando ANOVA y c) grado de cumplimiento de la recomendación por sexo y EN, utilizando la prueba de proporciones. 66% de los niños eran SP, acumulando significativamente más AFMV los días de semana, 50.5 min versus 40,3; los niños más que las niñas. Este resultado fue similar según EN, excepto para las niñas N. Sólo 33% de los niños y 15% de las niñas (p = 0,03) y el 17% y el 9% (p = 0,058) cumplieron con la recomendación durante la semana y fin de semana, respectivamente con resultados similares según EN. Un bajísimo % de niños chilenos cumple con la recomendación diaria de AFMV. La adopción de un estilo de vida activo desde temprana edad es clave, teniendo en cuenta además la alta prevalencia de sobrepeso (AU)

Malaria in the Americas: trends from 1959 to 2011.

Malaria has declined in recent years in countries of the American continents. In 2011, 12 of 21 endemic countries had already met their 2015 Millennium Development Goal. However, this declining trend has not been adequately evaluated. An analysis of the number of cases per 100,000 people (annual parasite index [API]) and the percentage of positive blood slides (slide positivity rate [SPR]) during the period of 1959-2011 in 21 endemic countries was done using the joinpoint regression methodology. During 1960-1979, API and SPR increased significantly and peaked in the 1980s. Since the 1990s, there have been significant declining trends in both API and SPR. Additionally, both Plasmodium vivax and P. falciparum species-specific incidence have declined. With the exception of two countries, such a collectively declining malaria trend was not observed in previous decades. This presents a unique opportunity for the Americas to seriously consider malaria elimination as a final goal.