Change in lifestyle factors and their influence on health status and all-cause mortality

EDC mixtures during pregnancy and body fat at 7 years of age in a Swedish cohort, the SELMA study

BACKGROUND

Some endocrine disrupting chemicals (EDC), are "obesogens" and have been associated with overweight and obesity in children. Daily exposure to different classes of EDCs demands for research with mixtures approach.

OBJECTIVES

This study evaluates the association, considering sex-specific effects, between prenatal exposure to EDC mixture and children's body fat at seven years of age.

METHODS

A total of 26 EDCs were assessed in prenatal urine and serum samples from first trimester in pregnancy from 737 mother-child pairs participating in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. An indicator for children's "overall body fat" was calculated, using principal component analysis (PCA), based on BMI, percent body fat, waist, and skinfolds measured at seven years of age. Weighted quantile sum (WQS) regression was used to assess associations between EDC mixture and children's body fat.

RESULTS

Principal component (PC1) represented 83.6 % of the variance, suitable as indicator for children's "overall body fat", with positive loadings of 0.40-0.42 for each body fat measure. A significant interaction term, WQS*sex, confirmed associations in the opposite direction for boys and girls. Higher prenatal exposure to EDC mixture was borderline significant with more "overall body fat" for boys (Mean β = 0.20; 95 % CI: -0.13, 0.53) and less for girls (Mean β = -0.23; 95 % CI: -0.58, 0.13). Also, higher prenatal exposure to EDC mixture was borderline significant with more percent body fat (standardized score) for boys (Mean β = 0.09; 95 % CI: -0.04, 0.21) and less for girls (Mean β = -0.10 (-0.26, 0.05). The chemicals of concern included bisphenols, phthalates, PFAS, PAH, and pesticides with different patterns for boys and girls.

DISCUSSION

Borderline significant associations were found between prenatal exposure to a mixture of EDCs and children's body fat. The associations in opposite directions suggests that prenatal exposure to EDCs may present sex-specific effects on children's body fat.

Maternal nutrition during mid-pregnancy and children's body composition at 7 years of age in the SELMA study

Optimal nutrition during pregnancy is vital for both maternal and child health. Our objective was to explore if prenatal diet is associated with children's height and body fat. Nutrient intake was assessed through a FFQ from 808 pregnant women and summarised to a nutrition index, 'My Nutrition Index' (MNI). The association with children's height and body fat (bioimpedance) was assessed with linear regression models. Secondary analysis was performed with BMI, trunk fat and skinfolds. Overall, higher MNI score was associated with greater height (β = 0·47; (95 % CI 0·00, 0·94), among both sexes. Among boys, higher MNI was associated with 0·15 higher BMI z-scores, 0·12 body fat z-scores, 0·11 trunk fat z-scores, and larger triceps, and triceps + subscapular skinfolds (β = 0·05 and β = 0·06; on the log2 scale) (P-value < 0·05). Among girls, the opposite associations were found with 0·12 lower trunk fat z-scores, and smaller subscapular and suprailiac skinfolds (β = -0·07 and β = -0·10; on the log2 scale) (P-value < 0·05). For skinfold measures, this would represent a ± 1·0 millimetres difference. Unexpectedly, a prenatal diet in line with recommended nutrient intake was associated with higher measures of body fat for boys and opposite to girls at a pre-pubertal stage of development.

Prenatal exposures to mixtures of endocrine disrupting chemicals and sex-specific associations with children's BMI and overweight at 5.5 years of age in the SELMA study

BACKGROUND

Prenatal exposure to mixtures of endocrine disrupting chemicals (EDC) has the potential to disrupt human metabolism. Prenatal periods are especially sensitive as many developmental processes are regulated by hormones. Prenatal exposure to EDCs has inconsistently been associated with children's body mass index (BMI) and obesity. The objective of this study was to investigate if prenatal exposure to a mixture of EDCs was associated with children's BMI and overweight (ISO-BMI ≥ 25) at 5.5 years of age, and if there were sex-specific effects.

METHODS

A total of 1,105 mother-child pairs with complete data on prenatal EDCs concentrations (e.g., phthalates, non-phthalate plasticizers, phenols, PAH, pesticides, PFAS, organochlorine pesticides, and PCBs), children's measured height and weight, and selected covariates in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study were included in this analysis. The mixture effect of EDCs with children's BMI and overweight was assessed using WQS regression with 100 repeated holdouts. A positively associated WQS index with higher BMI and odds of overweight was derived. Models with interaction term and stratified weights by sex was applied in order to evaluate sex-specific associations.

RESULTS

A significant WQS*sex interaction term was identified and associations for boys and girls were in opposite directions. Higher prenatal exposure to a mixture of EDCs was associated with lower BMI (Mean β = -0.19, 95%CI: -0.40, 0.01) and lower odds of overweight (Mean OR = 0.72, 95%CI: 0.48, 1.04) among girls with borderline significance. However, the association among boys did not reach statistical significance. Among girls, the possible chemicals of concern were MEP, 2-OHPH, BPF, BPS, DPP and PFNA.

CONCLUSION

Prenatal exposure to a mixture of EDCs was associated with lower BMI and overweight among girls, and non-significant associations among boys. Chemicals of concern for girls included phthalates, non-phthalate plasticizers, bisphenols, PAHs, and PFAS.

Physical and social environmental factors related to co-occurrence of unhealthy lifestyle behaviors

Previous work identifying determinants of co-occurrence of behavioral risk factors have focused on their association with individuals' characteristics with scant attention paid to their relationship to contextual factors. Data came from 21,007 individuals ≥15 years of age who participated in the cross-sectional 2011-2012 Spanish National Health Survey. Two indicators were defined by tobacco consumption, alcohol intake, diet, physical activity, and body mass index. The first indicator, based on dichotomized measures, ranges from 0 to 5. The second one (unhealthy lifestyle index), ranges from 0 to 15, with 0 denoting the healthiest score. Among the determinants, we examined social support, five perceived characteristics of the neighborhood, and the socioeconomic deprivation index of the census tract of residence. Data were analyzed using multilevel linear and logistic regression models adjusted for the main sociodemographic characteristics. Using the dichotomized indicator, the probability of having 3-5 risk factors versus <3 factors was associated with low social support (Odds Ratio [OR] 1.50; 95% Confidence Interval [CI]: 1.25-1.80). Issues surrounding neighborhood cleanliness (OR = 1.18; 95%CI: 1.04-1.33), air pollution (OR = 1.38; 95%CI: 1.16-1.64), and street crime (OR = 1.21; 95%CI: 1.03-1.42) were associated with determinants of co-occurrence. Risk factors co-occurrence increased as deprivation level increased: the OR for the highest deprivation quintile versus the lowest was 1.30 (95%CI: 1.14-1.48). Similar results were observed when using the unhealthy lifestyle index. Poorer physical and social environments are related to greater co-occurrence of risk factors for chronic diseases. Health promotion interventions targeting the prevention of risk factors should consider the contextual characteristics of the neighborhood environment.

Type 2 diabetes and risk of diverticular disease: a Danish cohort study

OBJECTIVES

To investigate the association between type 2 diabetes and risk of diverticular disease. Unlike previous studies, which have found conflicting results, we aimed to distinguish between diabetes types and adjust for modifiable risk factors.

DESIGN

Observational cohort study.

SETTING

Population-based Danish medical databases, covering the period 2005-2018.

PARTICIPANTS

Respondents of the 2010 or the 2013 Danish National Health Survey, of which there were 15 047 patients with type 2 diabetes and 210 606 patients without diabetes.

PRIMARY AND SECONDARY OUTCOME MEASURES

Hazard ratios (HRs) for incident hospital diagnosis of diverticular disease adjusted for survey year, sex, age, body mass index (BMI), physical activity intensity, smoking behaviour, diet and education based on Cox regression analysis. As latency may affect the association between type 2 diabetes and diverticular disease, patients with type 2 diabetes were stratified into those with <2.5, 2.5-4.9 and ≥5 years duration of diabetes prior to cohort entry.

RESULTS

For patients with and without diabetes the incidence rates of diverticular disease were 0.76 and 0.54 events per 1000 person years, corresponding to a crude HR of 1.08 (95% CI 1.00 to 1.16) and an adjusted HR of 0.88 (95% CI 0.80 to 0.96). The HR was lower among patients with ≥5 years duration of diabetes (adjusted HR: 0.76, 95% CI 0.67 to 0.87) than among those with 2.5-4.9 years or <2.5 years duration.

CONCLUSION

We found that patients with type 2 diabetes had a higher incidence rate of diverticular disease compared with patients without diabetes. However, after adjustment for modifiable risk factors, driven by BMI, type 2 diabetes appeared to be associated with a slightly lower risk of diverticular disease. Lack of adjustment for BMI may partially explain the conflicting findings of previous studies.

Health and well-being of university students before and during COVID-19 pandemic: A gender comparison

Objective

COVID-19 has affected people’s health in various ways. University students are a particularly sensitive group for mental and physical health issues. The aim of this study was to assess and compare the mental and physical health of male and female first-year university students during and before COVID-19.

Method

Total of 115 first-year university students (54% male) answered questions about mental and physical health. The students were asked to estimate their physical activity, sedentary behavior, loneliness, stress, and sleep quality during COVID-19 opposed to before the pandemic.

Result

Males had fewer symptoms of anxiety and depression, and their self-esteem was higher than females (p<0.05). Over 50% of both genders estimated their mental health to be worse than before COVID-19. Larger proportion of males (69%) compared to females (38%) estimated that their physical health had worsened than before the pandemic. Larger proportion of females (38%) than males (14%) experience increased loneliness and stress (68% vs. 48%). Over 70% of both genders estimated increased sedentary behavior than before the pandemic, and larger proportion of males (76%), compared to females (56%), estimated that they were less physically active than before COVID-19. About 50% of participants estimated their sleep quality was worse than before COVID-19.

Conclusion

University students estimated their mental and physical health to have deteriorated during the pandemic. Therefore, it is important that the school and healthcare systems assist students in unwinding these negative health and lifestyle changes that have accompanied the pandemic.

Dietary Intake of Adult Residents in Luxembourg Taking Part in Two Cross-Sectional Studies-ORISCAV-LUX (2007-2008) and ORISCAV-LUX 2 (2016-2017)

Background: A balanced diet is an important lifestyle component and has been associated with a reduced risk of chronic diseases. Objectives: To assess dietary intake of adult residents in Luxembourg taking part in two population-based cross-sectional studies (ORISCAV-LUX, 2007–2008 and ORISCAV-LUX 2, 2016–2017). Methods: Dietary intake of the study participants (1242 in 2007/08 and 1326 in 2016/17), 25–69 years old, were evaluated using food-frequency questionnaires (134 items in 2007/2008 and 174 items in 2016/2017) according to the French ANSES-CIQUAL food composition database. Both food-group- and nutrient-based analyses were conducted. Results: Dietary patterns in ORISCAV-LUX 2, 2016–2017, were characterized by an increase in the estimated marginal means (EMM) of the intake of energy, total fat, saturated fatty acids, alcohol, and decreased EMM of total carbohydrates, magnesium, and calcium compared to 2007/08. We also observed an increased EMM of the intake of protein-rich food items and ready-to-eat foods/fast foods, together with a decreased intake of grains, dairy products, and vegetables (all p-values <0.05, linear mixed models). The intake of most micronutrients was stable or slightly increased in ORISCAV-LUX 2 vs. ORISCAV-LUX, except for the drop in magnesium and calcium, and generally met recommendations, in particular, EFSA population reference intakes (PRI), except for vitamin D. Conclusions: Though most micronutrient recommendations were met, nutrient consumption in terms of high energy, total fat, and sodium, as well as low carbohydrates, were not aligned with recommendations for balanced eating.

Physical activity and sedentary behaviour over adulthood in relation to all-cause and cause-specific mortality: a systematic review of analytic strategies and study findings

BACKGROUND

Questions remain about the effect on mortality of physical activity and sedentary behaviour over time. We summarized the evidence from studies that assessed exposure from multiple time points and critiqued the analytic approaches used.

METHODS

A search was performed on MEDLINE, Embase, Emcare, Scopus and Web of Science up to January 2021 for studies of repeatedly assessed physical activity or sedentary behaviour in relation to all-cause or cause-specific mortality. Relative risks from individual studies were extracted. Each study was assessed for risk of bias from multiple domains.

RESULTS

We identified 64 eligible studies (57 on physical activity, 6 on sedentary behaviour, 1 on both). Cox regression with a time-fixed exposure history (n = 45) or time-varying covariates (n = 13) were the most frequently used methods. Only four studies used g-methods, which are designed to adjust for time-varying confounding. Risk of bias arose primarily from inadequate adjustment for time-varying confounders, participant selection, exposure classification and changes from measured exposure. Despite heterogeneity in methods, most studies found that being consistently or increasingly active over adulthood was associated with lower all-cause and cardiovascular-disease mortality compared with being always inactive. Few studies examined physical-activity changes and cancer mortality or effects of sedentary-behaviour changes on mortality outcomes.

CONCLUSIONS

Accumulating more evidence using longitudinal data while addressing the methodological challenges would provide greater insight into the health effects of initiating or maintaining a more active and less sedentary lifestyle.

Breakfast Location Effect on Breakfast Quality and Obesity Risk in Saudi Female College Students

Background:

There is a lack of data regarding breakfast consumption and quality among college students in the Kingdom of Saudi Arabia.

Objective:

The objective of this study was to assess the prevalence of breakfast consumption and examine the effect of breakfast location on breakfast nutritional quality and obesity risk among female college students at Taibah University.

Methods:

A total of 658 students participated in this cross-sectional study. Based on the Child and Adult Care Food Program (CACFP) recommendations, breakfast quality scores were computed by summing the individual food components and categorizing participants according to tertiles of the breakfast score distribution. Mixed-effects repeatedmeasures models were used to examine BMI categories with increasing tertiles of breakfast quality scores, stratified by breakfast location.

Results and Discussion:

Approximately 68% of the participants reported having breakfast regularly. The mean breakfast quality score was determined for students who had breakfast at home (12.5 ± 0.11), at college (10.41± 0.06), and in other places (8.19± 0.48). Obesity was associated with lower average breakfast quality scores based on breakfast location [mean quintile 3 compared with 1 difference: home 13.6 (P < 0.001), college 9.1 (P < 0.001), other 8.6 (P < 0.001)].

Conclusion:

The findings presented here indicated that a high percentage of students consume breakfast regularly. Students who had breakfast at home had high scores, which indicated good breakfast quality and a decreased risk of obesity. Further research on breakfast quality is needed in this area, as it affects the nutritional status and quality of life of the younger population.

Psychological factors and self-rated health: An observative study on cardiological patients

This study investigated the association of illness representations, awareness of bodily states and health complaints to self-rated health in N = 150 consecutive patients with heart disease (ischaemic disease, heart failure and heart valve disease) and explored differences between ‘health optimist’ and ‘health pessimist’ patients. After controlling for medical variables, health complaints accounted for 14.2 per cent of patients’ self-rated health, and illness representations contributed for another 16.2 per cent; body awareness was not associated with self-rated health. Also, ‘optimists’ tended to see less negative consequences from their illness and perceived greater control over illness treatment compared to ‘pessimists’. Targeting symptoms and illness representations may optimize rehabilitation outcomes.

Link between perceived oral and general health status among Yemeni adult dental patients

BACKGROUND

Self-perceived health is an essential measure of health status and even a paramount predictor of mortality. So long as it is said that oral health (OH) and general health (GH) are mirrors to each other. This study sought to determine how Yemeni adults rate their OH and GH, whether such a self-rating influenced by some potential risk factors, and whether both ratings (OH and GH) are correlated.

METHODS

A sample of 587 Yemeni dental patients aged 20 years and over were consecutively recruited. A structured interview form was used covering the following variables: age, gender, marital status, educational level, presence of dental prosthesis (DP), smoking and Qat chewing habits as independent variables, along with questions on "perceived oral health (POH)" and "perceived general health (PGH)" as dependent variables. The bivariate and multiple ordinal regression analyses were applied at P-value < 0.05.

RESULTS

Most of participants were women (73.6%), and married (71.4%), and more than half of them were young adults (58.2%), with high educational levels (53.3%), and not having DP. Only 310 participants responded to the questions on smoking and Qat chewing habits. Of these, 88.5% were non-smokers and 62.1% were Qat non-chewers. Up to 50% of the participants reported their POH as poor or fair, while lower proportions of participants (17%) reported their PGH as such. Younger age (compared to elders), high education levels (compared to primary education) and being single (compared to married) significantly revealed better levels of POH, while high education levels and being females significantly revealed better levels of PGH. Smoking and Qat chewing habits were found to have no effect on the perception of POH or PGH. POH and PGH were found to be significantly correlated (r = 0.486; P < 0.001).

CONCLUSION

Higher levels of oral health problems can be anticipated among patients who perceive poor general health, and vice versa. The age, marital status and education were independent determinants of POH, while the gender and education were independent determinants of PGH.

Measuring the efficiency of health systems in Asia: a data envelopment analysis

OBJECTIVE

This study aims to estimate the technical efficiency of health systems in Asia.

SETTINGS

The study was conducted in Asian countries.

METHODS

We applied an output-oriented data envelopment analysis (DEA) approach to estimate the technical efficiency of the health systems in Asian countries. The DEA model used per-capita health expenditure (all healthcare resources as a proxy) as input variable and cross-country comparable health outcome indicators (eg, healthy life expectancy at birth and infant mortality per 1000 live births) as output variables. Censored Tobit regression and smoothed bootstrap models were used to observe the associated factors with the efficiency scores. A sensitivity analysis was performed to assess the consistency of these efficiency scores.

RESULTS

The main findings of this paper demonstrate that about 91.3% (42 of 46 countries) of the studied Asian countries were inefficient with respect to using healthcare system resources. Most of the efficient countries belonged to the high-income group (Cyprus, Japan, and Singapore) and only one country belonged to the lower middle-income group (Bangladesh). Through improving health system efficiency, the studied high-income, upper middle-income, low-income and lower middle-income countries can improve health system outcomes by 6.6%, 8.6% and 8.7%, respectively, using the existing level of resources. Population density, bed density, and primary education completion rate significantly influenced the efficiency score.

CONCLUSION

The results of this analysis showed inefficiency of the health systems in most of the Asian countries and imply that many countries may improve their health system efficiency using the current level of resources. The identified inefficient countries could pay attention to benchmarking their health systems within their income group or other within similar types of health systems.

Would you like to add a weight after this blood pressure, doctor? Discovery of potentially actionable associations between the provision of multiple screens in primary care

RATIONALE, AIMS, AND OBJECTIVE

Guidelines recommend screening for risk factors associated with chronic diseases but current electronic prompts have limited effects. Our objective was to discover and rank associations between the presence of screens to plan more efficient prompts in primary care.

METHODS

Risk factors with the greatest impact on chronic diseases are associated with blood pressure, body mass index, waist circumference, glycaemic and lipid levels, smoking, alcohol use, diet, and exercise. We looked for associations between the presence of screens for these in electronic medical records. We used association rule mining to describe relationships among items, factor analysis to find latent categories, and Cronbach α to quantify consistency within latent categories.

RESULTS

Data from 92 140 patients in or around Toronto, Ontario, were included. We found positive correlations (lift >1) between the presence of all screens. The presence of any screen was associated with confidence greater than 80% that other data on items with high prevalence (blood pressure, glycaemic and lipid levels, or smoking) would also be present. A cluster of rules predicting the presence of blood pressure were ranked highest using measures of interestingness such as standardized lift. We found 3 latent categories using factor analysis; these were laboratory tests, vital signs, and lifestyle factors; Cronbach α ranged between .58 for lifestyle factors and .88 for laboratory tests.

CONCLUSIONS

Associations between the provision of important screens can be discovered and ranked. Rules with promising combinations of associated screens could be used to implement data driven alerts.

A Gender-based Comparison in Health Behaviors and State of Happiness among University Students

Objective The presence of good healthy behaviors among university students is imperative for their future life. This study aimed to compare positive health behaviors and state of happiness between the two genders of Bahria University (BU), Karachi, Pakistan. Subjects and methods This cross-sectional study was conducted at BU, Karachi, Pakistan. A total 813 students participated in this study. The health questionnaire, adapted from Health and Behavior Survey and the Subjective Happiness Scale, was used to assess self-reported happiness. The data were analyzed using IBM SPSS version 22. Results Overall self-reported health behaviors were found to be more prevalent in females as compared to males, but males reported a better self-reported general health (p = 0.012). Testicular and breast self-examination was not common in both genders. Smoking was found to be more common in males (p < 0.01). Males exhibited habit of regular breakfast (p = 0.013) whereas females showed a tendency to avoid food rich in cholesterol and fat (p < 0.01) and the practice of consuming food rich in fiber was found to be more prevalent among females (p < 0.01) and they showed urge to lose weight (p < 0.01). Sleep disturbance was found in both genders, more so in females (p = 0.012). Consciousness about dental hygiene was common in females (p < 0.01). As compared to the females, more males strongly believe that they are very happy in life (p < 0.01), and they make the most out of everything in life (p < 0.01). Conclusion There was a diverse response to positive health behaviors and state of happiness in both genders.

Informal care and health behaviors among elderly people with chronic diseases

BACKGROUND

The mechanism by which social relationships influence health can be interpreted as a social network regulating one's health behaviors. Based on the hypothesis that relatives, friends, or neighbors are sources of social support and may monitor one's health behaviors, researchers have gotten significant and consistent results that a social network can regulate health behaviors. However, few empirical studies have been conducted to examine the role of informal care in the regulation of health behaviors, especially for elderly individuals with chronic diseases that can be controlled by healthy behaviors. This paper researched the effects of informal care on health behaviors-smoking control, dietetic regulation, weight control, and maintenance of exercise-among elderly patients with chronic diseases in China who are facing the challenge of aging.

METHODS

We used the propensity score matching method to control the impacts of a very rich set of family and individual characteristics. The 2011-2012 national baseline data of the China Health and Retirement Longitudinal Study (CHARLS) was used.

RESULTS

Our findings showed that informal care could significantly help improve the health behaviors of elderly people. Informal care could improve the compliance of smoking control and dietetic regulation significantly. Elderly people with informal care smoked less and consumed more meals per day. For weight control, informal care helped decrease the possibility of weight gain of elderly people, but its impacts were not significant for BMI and weight loss. Last, for the elders, informal care could only help increase the probability of walking exercise; however, there was no significant result for moderate exercise.

CONCLUSIONS

Findings from this study highlight the importance of informal care among elderly people. Our results appeal to policy makers who aim to control chronic diseases that they should take informal care into account and provide appropriate policies to meet the demand of informal care for elderly people.

Evaluation of a web-based cognitive behavioral smoking cessation treatment for overweight/obese smokers

This pilot study tested the efficacy of an Internet-administered smoking cessation treatment for overweight/obese smokers. Participants were 54 community volunteers with overweight/obesity who were regular smokers. Treatment consisted of 12 weeks of nicotine replacement therapy and randomization to Internet-administered cognitive behavioral treatment or health education. In-person assessments of key outcomes occurred at baseline, post-treatment, and at 24-week follow-up. Cessation rates did not differ across the two treatments (25.9% vs 18.5%). Participants receiving cognitive behavioral treatment gained less weight when abstinent than those receiving the standard treatment. Larger studies are needed to replicate these findings.

Determinants of and socio-economic disparities in self-rated health in China

Background

Self-rated health (SRH) is not only used to measure health status and health inequalities, but also as a strong predictor of morbidity and mortality. The purpose of this study was to: 1) evaluate the factors that account for variations in self-rated health among Chinese citizens; and to 2) explore the process through which socio-economic status may impact self-rated health.

Methods

Data were derived from the Chinese General Social Survey (CGSS) (2013). Determinants of self-rated health were analyzed along four main dimensions: demographic characteristics, socio-economic status, lifestyle, and psychosocial factors. Multivariate odds ratios for good self-rated health were calculated for different variables in order to analyze the determinants. Binary logistic regression analysis was performed to assess the extent to which lifestyle and psychosocial factors explained the association between socio-economic status and self-rated health.

Results

About 65% of the survey respondents reported good self-rated health. Women, the elderly, married or single respondents and residents of Western China were less likely to report good self-rated health. Respondents who were engaged in work, had higher household income, reported high social class and higher socio-economic status compared with peers were more likely to report good self-rated health. Normal weight and physically active respondents along with those reporting a happy life, no depression, and good relationships with families and friends were related to good self-rated health. We also found the effect of socio-economic status on self-rated health was partly explained by lifestyle and psychosocial factors.

Conclusion

The present findings support the notion that both socio-economic status and lifestyle as well as psychosocial factors were related with good self-rated health. The interventions targeting these factors could improve the health status of the population. The depression was the most influential predictor of self-rated health, especially for the women and the elderly. Although lifestyle and psychosocial factors explained partly the the association between socio-economic status and health, the reason why socio-economic difference exists in health must be further explored. What’s more, it needs to be further studied why the same determinant has different influence strengths on the health of different groups of people.

Association of regular physical activity with total and cause-specific mortality among middle-aged and older Chinese: a prospective cohort study

Association between physical activity and mortality has rarely been investigated among the Chinese population. Furthermore, the most appropriate amount of physical activity for longevity benefits remains unclear. We used data from the Dongfeng-Tongji cohort, including 24,606 middle-aged and older retired adults in 2008 and followed to 2013, to quantify linear and non-linear dose-response relationships between regular physical activity and mortality risks by Cox proportional hazards model. Compared with participants who did not engage in regular physical activity, those performing regular physical activity had significantly 46%, 56%, and 49% decreased risks of mortality from all causes, circulatory, and respiratory diseases, respectively. Each one-SD increase in regular physical activity was associated with 32% decrease of respiratory disease mortality. There were significant nonlinear dose-response associations between regular physical activity and mortality from all causes and circulatory diseases. Mortality risks decreased monotonically with increased regular physical activity amount, and appeared to reach a threshold at around 100 MET-hours/week. More mortality benefits were found among non-smokers than that among current and former smokers. Our results suggest that middle-aged and older Chinese adults can achieve mortality benefits from regular physical activity at the WHO recommended minimum, and the benefit threshold appears at approximately 100 MET hours/week.

The associations between lifestyles and mental health using the General Health Questionnaire 12-items are different dependently on age and sex: a population-based cross-sectional study in Kanazawa, Japan

OBJECTIVES

The aim of this study was to examine potential differences of the associations between mental health and lifestyle factors across a wide range of age.

METHODS

In August/September 2011, data were collected from 4693 males (age 51.6 ± 19.5) and 5678 females (age 52.4 ± 19.4) living in Kanazawa, Japan. A cross-sectional community-based survey was conducted with self-administered questionnaire including the General Health Questionnaire (GHQ) 12-item version, sociodemographic, and lifestyle factors. Associations between the GHQ scores and other variables were examined using two-way analysis of variance (ANOVA) followed by multiple comparisons and logistic regression stratified by age and gender.

RESULTS

Multiple comparisons indicated that people aged 20-39 or 40-64 had higher GHQ scores than older aged. The two-way ANOVA revealed significant interaction between body mass index and age group, and between exercise and age group. Overweight or underweight males aged 40-64 had poorer mental health than those at normal weight. In the elderly, being underweight was significantly associated with poor mental health. There were no significant effects of exercise on mental health for young adults. The logistic regression showed significant negative effects of short-time sleep in adults.

CONCLUSIONS

The associations between mental health and lifestyles differ across age groups. Further study is needed to reveal effects of aging on lifestyle and mental health with a longitudinal design.

Going beyond life expectancy in assessments of health systems' performance: life expectancy adjusted by perceived health status

International comparisons of health systems data have been used to guide health policy. Health systems performance is generally evaluated on how different factors contribute to mortality and longevity. Fewer studies scrutinize the factors that determine morbidity in different countries, partly because indicators that assess morbidity on a country level are not as widely available as mortality and longevity data. We introduce a new health status indicator able to combine mortality and morbidity in a single composite measure for each country and gender at a point in time (LEAPHS), yielding the average number of years that men (women) can expect to live in "good" (or better) health. Using the Sullivan method we combine the mortality risk, calculated for specific age and gender groups, with perceived health status for the same age and gender groups, and we estimate how medical care and various socio-economic, environmental and structural, lifestyle, and technological factors affect LEAPHS and life expectancy at birth for a large panel of thirty OECD countries. We find that some variables (alcohol consumption, urbanization) have a significant effect on both LEAPHS and life expectancy, while one variable (the number of hospitals) has a significant effect for both genders on life expectancy only. However, the effects of many other variables (health expenditure per capita, health expenditure per capita squared, GDP growth, and technology) were only significant predictors for LEAPHS. This leads us to conclude that LEAPHS is able to capture the impact of some health determinants not captured by life expectancy at birth. While we believe this new measure may be useful for health economists and statisticians doing cross-country analyses, further comparisons with other measures may be useful.

Biological costs of economic transition: Stress levels during the transition from communism to capitalism in Poland

At the end of the 1980s, Poland began the transformation from an essentially one-party communist system to a politically pluralistic democratic system. These political and economic changes had major social consequences, among others unemployment and a sharp decrease in real personal income. The aim of the study was to investigate the possible relationship between stress in adult men, measured by the Allostatic Load, and the socio-economic deterioration during the first part of the economic transition. The Allostatic Load included eleven markers assessing adverse nutritional intake, cardiovascular activity, inflammatory processes, and lung, hepatic and renal functions. The results indicate a significantly higher risk of metabolic dysregulation in men examined after 1990, compared to men from previous years. After adjustment for socioeconomic variables and lifestyle variables, men examined in 1991 had a 31% greater risk of higher Allostatic Load compared with men examined in 1985 (OR=1.31; p=0.0541), in 1992, this risk was 50% greater (OR=1.50; p<0.01), and in 1993, the risk was 66% greater (OR=1.66; p<0.05). The conclusion is drawn that significantly more stressogenic factors for men were those directly connected with the financial situation of their families, than a sudden but short increase of prices for goods and services.

Long-term healthy lifestyle patterns and tooth loss studied in a Swedish cohort of middle-aged and older people

The promotion of a healthy lifestyle has become an issue of public health importance in the context of ageing populations and increasing prevalence of chronic diseases.

OBJECTIVE

(i) To estimate changes in use of fluoridated tooth paste, use of tooth picks, smoking and alcohol consumption and (ii) to examine whether experience with incident or prevalent tooth loss predict healthy lifestyle transitions from age 50 to 70.

METHOD

In 1992, 6346 individuals born in 1942 agreed to participate in a prospective cohort study and 3585 completed follow-up questionnaires in 1997, 2002, 2007 and 2012. Statistical analyses were conducted by chi-square statistics, Cochran's Q and logistic regression.

RESULTS

In total, 15.7% and 74.0% reported incident (tooth loss only in 2012) and prevalent tooth loss (tooth loss in 1992 and 2012). Significant differences occurred between the 1992 and 2012 prevalence of using toothpicks (from 48.3% to 69.1%), smoking (from 26.9% to 10.1%) and alcohol consumption (from 41.5% to 50.5%), 29% and 15.6% increased use of toothpicks and alcohol consumption, whereas 15.5% stopped daily smoking. Increased use of fluoridated tooth paste, smoking cessation and failure to increase use of toothpicks was associated with prevalent tooth loss between age 50 and 70.

CONCLUSION

This study revealed positive and negative trends in oral health behaviours over a 20-year period in persons aged 50 at baseline. Mixed support was obtained for the assumption that oral health promoting lifestyle transitions follow experience with tooth loss. Older people with tooth loss experience could benefit from targeted counselling aimed at coping with oral diseases.

Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis--an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks

BACKGROUND

There are several guidelines addressing the issues around the use of NSAIDs. However, none has specifically addressed the upper versus lower gastrointestinal (GI) risk of COX-2 selective and non-selective compounds nor the interaction at both the GI and cardiovascular (CV) level of either class of drugs with low-dose aspirin. This Consensus paper aims to develop statements and guidance devoted to these specific issues through a review of current evidence by a multidisciplinary group of experts.

METHODS

A modified Delphi consensus process was adopted to determine the level of agreement with each statement and to determine the level of agreement with the strength of evidence to be assigned to the statement.

RESULTS

For patients with both low GI and CV risks, any non-selective NSAID (ns-NSAID) alone may be acceptable. For those with low GI and high CV risk, naproxen may be preferred because of its potential lower CV risk compared with other ns-NSAIDs or COX-2 selective inhibitors, but celecoxib at the lowest approved dose (200 mg once daily) may be acceptable. In patients with high GI risk, if CV risk is low, a COX-2 selective inhibitor alone or ns-NSAID with a proton pump inhibitor appears to offer similar protection from upper GI events. However, only celecoxib will reduce mucosal harm throughout the entire GI tract. When both GI and CV risks are high, the optimal strategy is to avoid NSAID therapy, if at all possible.

CONCLUSIONS

Time is now ripe for offering patients with osteoarthritis the safest and most cost-effective therapeutic option, thus preventing serious adverse events which could have important quality of life and resource use implications. Please see related article: http://dx.doi.org/10.1186/s12916-015-0291-x.

Prevalence of leisure-time sedentary behaviour and sociodemographic correlates: a cross-sectional study in Spanish adults

Background

Being physically inactive has been linked to a higher mortality and poorer quality of life. This cross-sectional study examines the prevalence of leisure-time sedentary behaviour in a population of Spanish adults and its correlates with several sociodemographic variables.

Methods

Data were collected from 1,330 subjects living in Madrid (age: 18-65 years, 51.6% women) by telephone interview. The sampling error was ±2.7% for a 95.5% confidence level. Leisure-time sedentary behaviour was assessed using the Global Physical Activity Questionnaire (version 2). Further factors examined were: country of birth, sex, age, civil state, education level, employment and economic status and physical activity of parents.

Results

76.3% of the subjects interviewed reported a mostly sedentary leisure-time lifestyle. The remaining subjects (23.7%) reported a moderate to high level of physical activity, meeting minimum recommendations. Logistic regression adjusted for all variables identified the following population subsets as showing a greater risk of sedentary behaviour: women (odds ratio (OR) = 2.14; 95% confidence interval (CI): 1.64, 2.79), participants aged 41-50 years (OR = 1.64; 95%CI:1.05, 2.51), those with a middle economic status (OR = 1.48; 95% CI: 1.04, 2.10) or not providing information about their income (OR = 1.97; 95% CI: 1.05, 3.67), and those whose father (OR = 1.53; 95% CI: 1.13, 2.07) and/or mother (OR = 1.41; 95% CI: 1.01, 1.97) were never physically active during leisure-time.

Conclusions

The high prevalence of self-reported sedentary behaviour recorded suggests the need for public health policies targeted at increasing leisure-time physical activity levels. Our data identified several population subsets as priority candidates for possible interventions pursuing this goal.

An association rule mining-based framework for understanding lifestyle risk behaviors

Objectives

This study investigated the prevalence and patterns of lifestyle risk behaviors in Korean adults.

Methods

We utilized data from the Fourth Korea National Health and Nutrition Examination Survey for 14,833 adults (>20 years of age). We used association rule mining to analyze patterns of lifestyle risk behaviors by characterizing non-adherence to public health recommendations related to the Alameda 7 health behaviors. The study variables were current smoking, heavy drinking, physical inactivity, obesity, inadequate sleep, breakfast skipping, and frequent snacking.

Results

Approximately 72% of Korean adults exhibited two or more lifestyle risk behaviors. Among women, current smoking, obesity, and breakfast skipping were associated with inadequate sleep. Among men, breakfast skipping with additional risk behaviors such as physical inactivity, obesity, and inadequate sleep was associated with current smoking. Current smoking with additional risk behaviors such as inadequate sleep or breakfast skipping was associated with physical inactivity.

Conclusion

Lifestyle risk behaviors are intercorrelated in Korea. Information on patterns of lifestyle risk behaviors could assist in planning interventions targeted at multiple behaviors simultaneously.

Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: A 39-year prospective study

This study estimated the long-term mortality hazards and disability risks associated with various combinations of smoking and physical inactivity measured over time in a sample of middle-aged adults. Data came from a national sample of Swedish adults, originally interviewed in 1968 and followed until 2007 (N=1,682). Smoking and physical activity status were measured at baseline and 13 years later (1981). Different patterns of change and stability in smoking and physical inactivity over this 13 year period were used as predictors of mortality through 2007. Also, associations between different patterns of these health behaviors and the odds of disability (measured in 2004) were estimated among survivors (n=925). Results suggest that mortality rates were elevated among persistent (HR=1.7; 95% CI=1.5, 2.0) and new smokers (HR=2.5; 95% CI=1.6, 4.1), but not among discontinued smokers. However, mortality rates remained elevated among discontinued smokers who were also persistently inactive (HR=1.9; 95% CI=1.3, 2.6). Additional findings suggest that persistent physical inactivity during midlife was associated with increased odds of late-life disability (OR=1.8; 95% CI=1.1, 2.7), but that smoking had no clear additive or multiplicative effects on disability. As such, these findings indicate that while persistent smoking during midlife primarily impacts subsequent mortality, persistent physical inactivity during midlife appears to counteract the survival benefits of smoking cessation, while also imposing a long-term risk on late life disability among those who do survive to old age.

Clusters of AMI risk factors and their association with left ventricular hypertrophy: a population-based study within the Skaraborg Project, Sweden

OBJECTIVES

Risk factors for acute myocardial infarction (AMI) are known to cluster and to be differently distributed in men and women. The aim of this study was to sex-specifically explore clusters of acknowledged AMI risk factors by factor analysis, and to study whether such clusters are associated with left ventricular hypertrophy (LVH), used as a subclinical measure of CHD.

METHODS

In 2001-2005, 2328 subjects (30-74 years) were randomly selected from two municipalities in Sweden (participation-rate 76%) and were assessed with regard to cardiovascular risk factors; 852 participants also had an echocardiographic examination performed.

RESULTS

Factor analysis identified three identical factors in men and women. WHR, HOMA-ir, systolic blood pressure, and ApoB/ApoA1 loaded significantly on the principal "metabolic factor", leisure-time physical activity and self-rated health loaded significantly on the "vitality factor", and smoking and alcohol consumption loaded significantly on the "addiction factor". The metabolic factor was associated with LVH in both men (P<0.001) and women (P<0.001), whereas the addiction factor was associated with LVH solely in men (P=0.002).

CONCLUSIONS

The consistent pattern in the clustering of acknowledged AMI risk factors suggests common underlying mechanisms in both men and women. However, whereas the metabolic factor was paramount in both men and women in the association with LVH, the addiction factor had an impact solely in men. As LVH often precedes AMI, a deeper understanding of risk factors for LVH, including consideration of the supposed sex differences, can be useful in order to explore prevention strategies for AMI.

Health shocks in the family: gender differences in smoking changes

OBJECTIVE

This study estimates the likelihood of starting and stopping smoking when respondents and their partners report new chronic illnesses.

METHOD

Analysis of longitudinal data from the Health and Retirement Study tests whether starting or stopping smoking is more likely when (a) the respondent, (b) their partner, (c) or both report a new chronic condition, and whether these patterns differ by gender.

RESULTS

Both men and women are more likely to quit smoking when reporting a new chronic condition, relative to when reporting none. However only women are more likely to quit smoking when their partners fall ill. Women are also more likely than men to start smoking at this time.

DISCUSSION

Among older couples, women's smoking changes are more sensitive to health shocks in the partnership. Interventions aimed at preventing unhealthy behaviors should pay attention to how each partner deals with the stress of health shocks.

Exercise habits and tobacco use among male Latino farmworkers

Migrant farmworkers risk occupational injury and are at risk for developing chronic health conditions. Exercise may enhance health and help to reduce the risk of occupational injury and/or reduce the risk of developing a chronic health condition. Little is known, however, about the exercise habits of Latino migrant farmworkers. Male Latino migrant farmworkers completed an exercise and health habits questionnaire at health screening clinics. One hundred fifty-three (58.2%) subjects reported exercising during the week. There was no difference in age between those who reported exercising and those who did not (p = .78). Only 42 (16%) of all workers reported exercising for 3 or more hours a week. Seventeen percent of the subjects reported smoking and almost 10% reported chewing tobacco. A majority of subjects do not meet the Centers for Disease Control and Prevention (CDC) exercise guidelines. Tobacco use is highest among individuals who do not exercise. These findings suggest the need for health education interventions for this population. Additional studies are warranted to understand exercise and health habits of this population.

What works for whom? Determining the efficacy and harm of treatments for pain

There has been a tension between the needs of regulators and industry to demonstrate that interventions are effective and safe, and the needs of professionals to understand how well interventions will work for their patients, and patients to understand what might work for them as individuals. The custom has been to focus on statistical outcomes based on average results, but in-depth analysis based on outcomes obtained by individual patients demonstrates that few are average. Rather, a minority of patients achieve very large reductions in pain (responders), while the majority achieve little (nonresponders). Those who benefit in terms of pain also benefit in other areas, with improved sleep, fatigue, mood, function, quality of life, and ability to work. This changes how benefit and risk are seen; nonresponders should stop treatments that don't work and not, therefore, be exposed to risks, while responders have very large benefits to offset against rare but potentially serious harm. This alternative view, patient-centred and practice-orientated, has major implications for clinical practice, how and why we do clinical trials and how they are designed, how health economic evaluations are done, for decisions made by regulatory and other bodies, and for the theory and practice of evidence-based medicine.

The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain

BACKGROUND

Chronic pain is distressing for patients and a burden on healthcare systems and society. Recent research demonstrates different aspects of the negative impact of chronic pain and the positive impact of successful treatment, making an overview of the costs and consequences of chronic pain appropriate.

OBJECTIVE

To examine recent literature on chronic noncancer and neuropathic pain prevalence, impact on quality and quantity of life, societal and healthcare costs, and impact of successful therapy.

METHODS

Systematic reviews (1999 to February 2012) following PRISMA guidelines were conducted to identify studies reporting appropriate outcomes.

RESULTS

Chronic pain has a weighted average prevalence in adults of 20%; 7% have neuropathic pain, and 7% have severe pain. Chronic pain impeded activities of daily living, work and work efficiency, and reduced quality and quantity of life. Effective pain therapy (pain intensity reduction of at least 50%) resulted in consistent improvements in fatigue, sleep, depression, quality of life, and work.

CONCLUSION

Strenuous efforts should be put into obtaining good levels of pain relief for people in chronic pain, including the opportunity for multiple drug switching, using reliable, validated, and relatively easily applied patient-centered outcomes. Detailed, thoughtful and informed decision analytic policy modeling would help understand the key elements in organizational change or service reengineering to plan the optimum pain management strategy to maximize pain relief and its stream of benefits against budgetary and other constraints. This paper contains the information on which such models can be based.

Results of a 2-week inpatient stay at the department for internal and integrative medicine: an observational study

Introduction. The Department for Internal and Integrative Medicine in Essen utilizes mind/body medical elements in order to empower patients with chronic diseases to better cope with their symptoms and to adopt a healthy lifestyle. This study explored the influence and predictors of a 2-week integrative treatment program on patients' quality of life. Methods. This observational study was conducted with inpatients as part of the quality assurance program. Patients' quality of life, psychological symptoms, and health locus of control were measured on admission and discharge and again 3, 6, and 12 months after discharge. Regression analyses were conducted to determine the factors predicting improved quality of life. Results. Data from 2486 inpatients treated in 2001–2004 were included (80% female, mean age 53.9 ± 14.3 years). Response rates decreased to 50% at 12 months. Small-to-moderate effects were found on patients' quality of life, anxiety, and depression. Patients' internal locus of control significantly increased. Improved quality of life was mainly predicted by lower baseline scores. Conclusion. Results of this study suggest that a 2-week inpatient treatment might sustainably reduce patients' symptoms and increase their quality of life; however, conclusions are only preliminary. More research is needed to enable the effectiveness to be judged conclusively.

Co-occurrence of obesogenic risk factors among adolescents

PURPOSE

The purpose of this study was to determine the prevalence, sociodemographic distribution, and co-occurrence of five potentially obesogenic behavioral risk factors (low physical activity, high screen time, low fruit and vegetable intake, high soft drink consumption, and high snack intake) among adolescents.

METHODS

Cross-sectional representative population survey (n = 1,568) of grade 6, 8, and 10 students (49% male) randomly selected from 70 primary and secondary schools in New South Wales, Australia, between February and May 2007. Co-occurrence was assessed using an observed-to-expected ratio (O/E) method.

RESULTS

Only 5% of boys and 9% of girls had none of the five obesogenic behavioral risk factors studied. Overall, 51.4% of boys and 42.9% of girls had three or more risk factors. Prevalence of multiple risk factors (3+) was higher among boys and girls from lower income households and among girls whose mothers had less than grade 12 education. For both boys and girls, the occurrence of all five risk factors was 160% greater than expected (O/E ratio: 2.6).

CONCLUSIONS

There was clear evidence of a co-occurrence of obesogenic risk factors among adolescents, especially among those from lower socioeconomic backgrounds, indicating this group would benefit from targeted prevention strategies.

Health behavior change following chronic illness in middle and later life

OBJECTIVES

Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life.

METHODS

Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease.

RESULTS

Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors.

DISCUSSION

Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

The evaluation of lifestyle interventions in the Netherlands

Current investments in preventive lifestyle interventions are relatively low, despite the significant impact of unhealthy behaviour on population health. This raises the question of whether the criteria used in reimbursement decisions about healthcare interventions put preventive interventions at a disadvantage. In this paper, we highlight the decision-making framework used in the Netherlands to delineate the basic benefits package. Important criteria in that framework are ‘necessity’ and ‘cost-effectiveness’. Several normative choices need to be made, and these choices can have an important impact on the evaluation of lifestyle interventions, especially when making these criteria operational and quantifiable. Moreover, the implementation of the decision-making framework may prove to be difficult for lifestyle interventions. Improvements of the decision-making framework in the Netherlands are required to guarantee sound evaluations of lifestyle interventions aimed at improving health.

Effects of walking speed and results of timed get-up-and-go tests on quality of life and social participation in elderly individuals with a history of osteoporosis-related fractures

OBJECTIVE

To investigate the relationships between physical performance, quality of life (QoL), and social participation among elderly men and women with a history of osteoporosis-related fractures.

METHOD

The study was a population-based cross-sectional study including 155 participants aged 60 to 93 years from the Swedish longitudinal investigation, "Good Aging in Skåne." The participants had suffered fracture of the vertebrae, hip, pelvis, or ankle. Physical performance was expressed as walking speed (WS) and timed get-up-and-go (TUG). QoL was measured as using the Health Related Quality of Life (HRQoL) and Life Satisfaction (LS) scales. Social participation was defined as taking part in social, cultural, and leisure activities.

RESULTS

Lower WS and/or TUG were associated with lower HRQoL, lower LS, and a reduction in social participation, after adjustment for confounding factors.

DISCUSSION

Measurements of WS and TUG could be used to determine QoL and social participation in elderly people having sustained fractures.

Self-rated health status and cardiorespiratory fitness as predictors of mortality in men

Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for all-cause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18 488 men who completed a health survey, clinical examination and a maximal exercise treadmill test during 1987-2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (p(trend) <0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, hypercholesterolaemia, cardiovascular disease, diabetes and cancer. Adjustment for fitness attenuated the association (p value =0.09). The authors also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (p(trend) = 0.006). The combined analysis of SRH and fitness showed that fit men with good or excellent SRH had a 58% lower risk of mortality than their counterparts. SRH and fitness were both associated with all-cause mortality in men. Fit men with good or excellent SRH live longer than unfit men with poor or fair SRH.

A longitudinal study of the relative importance of factors related to use of dental services among young adults

BACKGROUND

The decline in the appropriate use of dental services from childhood to adulthood is of concern. The relative importance of factors influencing use of dental services in young adulthood should inform strategies to address this issue.

AIM

To develop models predictive of inadequate utilisation of dental care in young adults and to determine the relative importance of health behaviours, need for dental care, and socio-demographic factors. Inadequate utilisation of dental care was determined as lack of visit for dental care during the study period and as problem-based care-seeking behavior.

METHODS

A random sample of Adelaide young adults was selected from the electoral roll. Participants were interviewed and offered a dental examination at baseline. Two and a half years later participants were contacted again and interviewed on the use of dental services and usual reason for visiting and a number of explanatory factors. The population attributable fractions for the explanatory variables which were significant in the model for this cohort of young adults were calculated using the log-binomial method.

RESULTS

There were 819 participants at follow-up a response rate of 65% of baseline participants. In the two and a half year period between baseline and follow-up about one quarter of young adults did not make a dental visit and over one third reported that they usually made a dental visit for a problem. The attributable fraction calculation indicated that 30% of infrequent visiting was attributed to reporting no need for dental care, 17% to difficulty paying a $100 dental bill, 17% to being male and 10% to smoking. The attributable fraction calculation indicated that 27% of usually visiting for a problem was attributed to having no tertiary education, 23% to not having dental insurance, 14% to being male, 12% to smoking, 10% to avoiding dental care due to cost and 5% to use of the public sector.

CONCLUSION

Need and affordability factors were more important than general health behavior factors in influencing use of dental care by a cohort of young adults.

Lifestyle risk factors of students: a cluster analytical approach

OBJECTIVE

Unhealthy lifestyle behaviours have been identified as a problem amongst students. This present study investigated the prevalence and clustering of five lifestyle risk factors within a UK Higher Education (HE) institution during the period of April-May in 2008.

METHOD

In a cross-sectional design, 410 students completed a 'health and lifestyle' survey. Data was collected on psychological stress, physical activity (PA), fruit and vegetable intake, binge drinking, smoking, and demographic factors.

RESULTS

Three subgroups emerged from the cluster analysis: 'unhealthy/high risk', 'moderately healthy/moderate risk' and 'healthy/low risk' group. The groups were cross-tabulated by demographics and the resulting clusters provided an insightful indication of how behaviours interact. Data on the whole sample revealed that the prevalence of three lifestyle risk factors were high; 70% did not meet the recommended guidelines of PA, 66% ate less than the recommended servings of fruit and vegetables per day, and 56% reported binge drinking at least once in a seven-day period. Psychological stress was also high amongst the sample, with females experiencing greater psychological stress than males.

CONCLUSION

Students' health lifestyles are of concern. The tendency for specific health lifestyle factors to aggregate in clusters has important implications for health promotion within this environment.

A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults

This systematic review examines critically the scientific basis for Canada's Physical Activity Guide for Healthy Active Living for adults. Particular reference is given to the dose-response relationship between physical activity and premature all-cause mortality and seven chronic diseases (cardiovascular disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes (diabetes mellitus) and osteoporosis). The strength of the relationship between physical activity and specific health outcomes is evaluated critically. Literature was obtained through searching electronic databases (e.g., MEDLINE, EMBASE), cross-referencing, and through the authors' knowledge of the area. For inclusion in our systematic review articles must have at least 3 levels of physical activity and the concomitant risk for each chronic disease. The quality of included studies was appraised using a modified Downs and Black tool. Through this search we identified a total of 254 articles that met the eligibility criteria related to premature all-cause mortality (N = 70), cardiovascular disease (N = 49), stroke (N = 25), hypertension (N = 12), colon cancer (N = 33), breast cancer (N = 43), type 2 diabetes (N = 20), and osteoporosis (N = 2). Overall, the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified. Moreover, higher levels of physical activity reduce the risk for premature all-cause mortality. The current Canadian guidelines appear to be appropriate to reduce the risk for the seven chronic conditions identified above and all-cause mortality.

Lifestyle changes of Japanese people on overseas assignment in Michigan, USA

BACKGROUND

Temporary work assignments in the United States (US) are widely considered to have negative health outcomes on Asians mostly due to adverse changes in diet and exercise, though there is little research on this phenomenon. This study investigated the impact of lifestyle changes on the biological and psychological health and health behaviours of Japanese people on temporary assignments in the US.

METHODS

In this cross sectional survey, we distributed a 38 item self-administered questionnaire addressing health habits, mental health function, lifestyle changes and dietary habits to adult Japanese patients presenting for general physicals at a family medicine clinic serving Japanese patients. We conducted simple statistics and regression analysis between length of stay and other health outcomes to determine whether length of residence in the US was predictive of negative lifestyle changes.

RESULTS

Most participants reported increased caloric intake, weight gain, and less exercise. They also reported increased time with family. More women than men reported physical symptoms and anxiety related to stress. Smoking and alcohol intake were essentially unchanged. No associations were identified between length of residence in the US and health lifestyle habits or other health outcomes.

CONCLUSION

Negative lifestyle changes occur in diet and exercise for overseas Japanese people, but a positive change in increased family time was found. Women appear to be at a greater risk for somatic disorders than men. As duration of stay does not appear predictive of adverse changes, clinicians should advise patients going abroad of these risks regardless of the term of the work assignment.

[Evidence-based guidelines for physical activity of adult Canadians]

This review of the literature provides an update on the scientific biological and psychosocial bases for Canada's Physical Activity Guide for Health Active Living, with particular reference to the effect of physical activity on the health of adults aged 20-55 years. Existing physical activity guidelines for adults from around the world are summarized briefly and compared to the Canadian guidelines. The descriptive epidemiology of physical activity and inactivity in Canada is presented, and the strength of the relationship between physical activity and specific health outcomes is evaluated, with particular emphasis on minimal and optimal physical activity requirements. Finally, areas requiring further investigation are highlighted. Summarizing the findings, Canadian and most international physical activity guidelines advocate moderate-intensity physical activity on most days of the week. Physical activity appears to reduce the risk for over 25 chronic conditions, in particular coronary heart disease, stroke, hypertension, breast cancer, colon cancer, type 2 diabetes, and osteoporosis. Current literature suggests that if the entire Canadian population followed current physical activity guidelines, approximately one-third of deaths related to coronary heart disease, one quarter of deaths related to stroke and osteoporosis, 20% of deaths related to colon cancer, hypertension, and type 2 diabetes, and 14% of deaths related to breast cancer could be prevented. It also appears that the prevention of weight gain and the maintenance of weight loss require greater physical activity levels than current recommendations.