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Schaumberg K, Bulik CM, Micali N. Patterns of maladaptive exercise behavior from ages 14-24 in a longitudinal cohort. J Child Psychol Psychiatry 2023; 64:1555-1568. [PMID: 37258173 PMCID: PMC10592554 DOI: 10.1111/jcpp.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior. METHOD Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of 'No Exercise for Weight Loss', 'Exercise for Weight Loss', and 'Maladaptive Exercise' over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors. RESULTS Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the 'Exercise for Weight Loss' category were more likely than those in the 'No Exercise for Weight Loss Category' to transition to 'Maladaptive Exercise' over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex. CONCLUSIONS Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals.
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Affiliation(s)
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, US
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nadia Micali
- Center for Eating and feeding disorders research, Mental Health Services in the Capital Region of Denmark, Psychiatric Centre Ballerup, Copenhagen, Denmark
- Institut for biologisk psykiatri, Psykiatrisk Center Sct. Hans, Boserupvej 2, 4000 Roskilde, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Lee DC, Orstad SL, Kanchi R, Adhikari S, Rummo PE, Titus AR, Aleman JO, Elbel B, Thorpe LE, Schwartz MD. Demographic, social and geographic factors associated with glycaemic control among US Veterans with new onset type 2 diabetes: a retrospective cohort study. BMJ Open 2023; 13:e075599. [PMID: 37832984 PMCID: PMC10582880 DOI: 10.1136/bmjopen-2023-075599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES This study evaluated whether a range of demographic, social and geographic factors had an influence on glycaemic control longitudinally after an initial diagnosis of diabetes. DESIGN, SETTING AND PARTICIPANTS We used the US Veterans Administration Diabetes Risk national cohort to track glycaemic control among patients 20-79-year old with a new diagnosis of type 2 diabetes. PRIMARY OUTCOME AND METHODS We modelled associations between glycaemic control at follow-up clinical assessments and geographic factors including neighbourhood race/ethnicity, socioeconomic, land use and food environment measures. We also adjusted for individual demographics, comorbidities, haemoglobin A1c (HbA1c) at diagnosis and duration of follow-up. These factors were analysed within strata of community type: high-density urban, low-density urban, suburban/small town and rural areas. RESULTS We analysed 246 079 Veterans who developed a new type 2 diabetes diagnosis in 2008-2018 and had at least 2 years of follow-up data available. Across all community types, we found that lower baseline HbA1c and female sex were strongly associated with a higher likelihood of within-range HbA1c at follow-up. Surprisingly, patients who were older or had more documented comorbidities were more likely to have within-range follow-up HbA1c results. While there was variation by community type, none of the geographic measures analysed consistently demonstrated significant associations with glycaemic control across all community types.
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Affiliation(s)
- David C Lee
- Emergency Medicine, NYU Grossman School of Medicine, New York City, New York, USA
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Stephanie L Orstad
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Medicine, NYU Grossman School of Medicine, New York City, New York, USA
| | - Rania Kanchi
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Samrachana Adhikari
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Pasquale E Rummo
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Andrea R Titus
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Jose O Aleman
- Medicine, NYU Grossman School of Medicine, New York City, New York, USA
- Veterans Affairs, VA New York Harbor Healthcare System, New York City, New York, USA
| | - Brian Elbel
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Wagner Graduate School of Public Service, NYU, New York City, New York, USA
| | - Lorna E Thorpe
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Mark D Schwartz
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Veterans Affairs, VA New York Harbor Healthcare System, New York City, New York, USA
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Alemu T, Tolossa D, Senbeta F, Zeleke T. Household determinants of continued adoption of sustainable land management measures in central Ethiopia. Heliyon 2023; 9:e13946. [PMID: 36895356 PMCID: PMC9988508 DOI: 10.1016/j.heliyon.2023.e13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
The government of Ethiopia has undertaken several projects to restore degraded farmlands using a variety of sustainable land management (SLM) techniques. One of the critical elements of the program was the rehabilitation of farmlands using physical soil and water conservation (SWC) strategies. This study examines household determinants of continued SWC adoption performances using areas representing a variety of contexts. The analysis was conducted using a binary logit model based on data collected from 525 sample households in two districts, namely Kewet and Sebeta-hawas. Of the study participants, 276 households were from the Kewet district in the Amhara region, and 249 households were from Sebeta-hawas in the Oromia region. The study findings revealed a significant difference between sampled households in the study areas regarding continued adoption performances, i.e. (25%) in the Sebeta-hawas and (41%) in the Kewet districts. Among others, productivity gains, consistent follow-up, sufficient farm labor, livestock holding, assistance-free efforts, the experience of soil erosion risks, and sloppy farm plots provided incentives for households to embrace the already introduced measures. Aside from that, there appeared to be differences in the relative contributions and significance of determinants influencing the likelihood of continued adoption. The important conclusion is that adoption effectiveness may differ under different circumstances and agro-ecosystems. Variables influencing continued adoption are also context-specific. Thus, decision-makers should consider contextual variations in designing policies and strategies that promote adoption continuities and utilizations.
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Affiliation(s)
- Taye Alemu
- Department of Development Economics and Management, Ethiopian Civil Service University, Ethiopia
| | - Degefa Tolossa
- Center of Rural Development Studies, Addis Ababa University, Ethiopia
| | - Feyera Senbeta
- Center of Environment and Development Studies, Addis Ababa University, Ethiopia
| | - Tesfaye Zeleke
- Center of Environment and Development Studies, Addis Ababa University, Ethiopia
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Rajchert J, Zajenkowska A, Nowakowska I, Bodecka-Zych M, Abramiuk A. Hostility bias or sadness bias in excluded individuals: does anodal transcranial direct current stimulation of right VLPFC vs. left DLPFC have a mitigating effect? Cogn Affect Behav Neurosci 2022; 22:1063-1077. [PMID: 35474567 DOI: 10.3758/s13415-022-01008-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Exclusion has multiple adverse effects on individual's well-being. It induces anger and hostile cognitions leading to aggressive behavior. The purpose of this study was to test whether exclusion would affect recognition of anger on ambivalent faces of the excluders. We hypothesized that exclusion would elicit more anger encoding (hostility bias) than inclusion, but this effect would be mitigated by anodal tDCS of right VLPFC or left DLPFC-regions engaged in negative affect regulation. Participants (N = 96) were recognizing emotions (anger, sadness, happiness) on ambiguous faces of individuals who-as they were told-liked them or not. Results showed that exclusion induced more sadness bias. tDCS to VLPFC decreased anger and increased sadness recognition on excluders' faces compared with includers' faces, expressing a mixture of these two emotions. Additionally, stimulation to VLPFC and DLPFC decreased latencies for faces expressing sadness (sad-angry and happy-sad) but increased for happy-angry faces. Stimulation to VLPFC also increased reaction time to excluders faces while stimulation of DLPFC decreased reaction latency to includers faces. Results were discussed with the reference to the form of exclusion, motivational mechanism affected by disliking but also to lateralization (valence vs. arousal theory) and cortical regions engaged in encoding sadness after a threat to belonging.
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Bloome D, Ang S. Is the Effect Larger in Group A or B? It Depends: Understanding Results From Nonlinear Probability Models. Demography 2022; 59:1459-1488. [PMID: 35894791 DOI: 10.1215/00703370-10109444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Demographers and other social scientists often study effect heterogeneity (defined here as differences in outcome-predictor associations across groups defined by the values of a third variable) to understand how inequalities evolve between groups or how groups differentially benefit from treatments. Yet answering the question "Is the effect larger in group A or group B?" is surprisingly difficult. In fact, the answer sometimes reverses across scales. For example, researchers might conclude that the effect of education on mortality is larger among women than among men if they quantify education's effect on an odds-ratio scale, but their conclusion might flip (to indicate a larger effect among men) if they instead quantify education's effect on a percentage-point scale. We illuminate this flipped-signs phenomenon in the context of nonlinear probability models, which were used in about one third of articles published in Demography in 2018-2019. Although methodologists are aware that flipped signs can occur, applied researchers have not integrated this insight into their work. We provide formal inequalities that researchers can use to easily determine if flipped signs are a problem in their own applications. We also share practical tips to help researchers handle flipped signs and, thus, generate clear and substantively correct descriptions of effect heterogeneity. Our findings advance researchers' ability to accurately characterize population variation.
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Affiliation(s)
- Deirdre Bloome
- John F. Kennedy School of Government and Department of Sociology, Harvard University, Cambridge, MA, USA
| | - Shannon Ang
- School of Social Sciences, Nanyang Technological University, Singapore
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Bizuayehu HM, Harris ML, Chojenta C, Forder PM, Loxton D. Biopsychosocial factors influencing the occurrence and recurrence of preterm singleton births among Australian women: a prospective cohort study. Midwifery 2022; 110:103334. [DOI: 10.1016/j.midw.2022.103334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 03/23/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Haddon E. Class, partisanship and the great recession: the conflicting influences on attitudes towards inequality during economic crises. Can Rev Sociol 2021; 58:352-371. [PMID: 34324270 DOI: 10.1111/cars.12350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While some scholars suggest that critical attitudes towards inequality follow the class gradient during recessions, others find that classes are largely unresponsive. In this article, I consider how party affiliation interacts with class to shape perceptions of inequality during a recession. I argue that it is important to look at the interplay between class and partisanship to better understand individual views towards inequality during times of economic crises. Leveraging data from the International Social Survey Programme before and after The Great Recession, I find that the recession did not raise awareness of inequality across classes. This is because party affiliation moderates the relationship differently according to class. Specifically, party affiliation is more important in shaping the inequality views for the upper class and less so for the working class. Future research needs to consider the interplay between class and politics when exploring how inequality attitudes respond to economic crises.
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Affiliation(s)
- Edward Haddon
- Department of Sociology, University of Victoria, Victoria, BC, Canada
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Vaughan EM, Hyman DJ, Naik AD, Samson SL, Razjouyan J, Foreyt JP. A Telehealth-supported, Integrated care with CHWs, and MEdication-access (TIME) Program for Diabetes Improves HbA1c: a Randomized Clinical Trial. J Gen Intern Med 2021; 36:455-463. [PMID: 32700217 PMCID: PMC7878600 DOI: 10.1007/s11606-020-06017-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many individuals with diabetes live in low- or middle-income settings. Glycemic control is challenging, particularly in resource-limited areas that face numerous healthcare barriers. OBJECTIVE To compare HbA1c outcomes for individuals randomized to TIME, a Telehealth-supported, Integrated care with CHWs (Community Health Workers), and MEdication-access program (intervention) versus usual care (wait-list control). DESIGN Randomized clinical trial. PARTICIPANTS Low-income Latino(a) adults with type 2 diabetes. INTERVENTIONS TIME consisted of (1) CHW-participant telehealth communication via mobile health (mHealth) for 12 months, (2) CHW-led monthly group visits for 6 months, and (3) weekly CHW-physician diabetes training and support via telehealth (video conferencing). MAIN MEASURES Investigators compared TIME versus control participant baseline to month 6 changes of HbA1c (primary outcome), blood pressure, body mass index (BMI), weight, and adherence to seven American Diabetes Association (ADA) standards of care. CHW assistance in identifying barriers to healthcare in the intervention group were measured at the end of mHealth communication (12 months). KEY RESULTS A total of 89 individuals participated. TIME individuals compared to control participants had significant HbA1c decreases (9.02 to 7.59% (- 1.43%) vs. 8.71 to 8.26% (- 0.45%), respectively, p = 0.002), blood pressure changes (systolic: - 6.89 mmHg vs. 0.03 mmHg, p = 0.023; diastolic: - 3.36 mmHg vs. 0.2 mmHg, respectively, p = 0.046), and ADA guideline adherence (p < 0.001) from baseline to month 6. At month 6, more TIME than control participants achieved > 0.50% HbA1c reductions (88.57% vs. 43.75%, p < 0.001). BMI and weight changes were not significant between groups. Many (54.6%) TIME participants experienced > 1 barrier to care, of whom 91.7% had medication issues. CHWs identified the majority (87.5%) of barriers. CONCLUSIONS TIME participants resulted in improved outcomes including HbA1c. CHWs are uniquely positioned to identify barriers to care particularly related to medications that may have gone unrecognized otherwise. Larger trials are needed to determine the scalability and sustainability of the intervention. CLINICAL TRIAL NCT03394456, accessed at https://clinicaltrials.gov/ct2/show/NCT03394456.
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Affiliation(s)
- Elizabeth M Vaughan
- Division of General Internal Medicine, Department of Medicine , Baylor College of Medicine, Houston, TX, USA.
| | - David J Hyman
- Division of General Internal Medicine, Department of Medicine , Baylor College of Medicine, Houston, TX, USA
| | - Aanand D Naik
- Division of General Internal Medicine, Department of Medicine , Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E DeBakey VA Medical Center, Houston, TX, USA
- Division of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Susan L Samson
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Javad Razjouyan
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E DeBakey VA Medical Center, Houston, TX, USA
- Division of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John P Foreyt
- Division of General Internal Medicine, Department of Medicine , Baylor College of Medicine, Houston, TX, USA
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Bertoli W, Conceição KS, Andrade MG, Louzada F. A new mixed-effects regression model for the analysis of zero-modified hierarchical count data. Biom J 2020; 63:81-104. [PMID: 33073871 DOI: 10.1002/bimj.202000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 11/07/2022]
Abstract
Count data sets are traditionally analyzed using the ordinary Poisson distribution. However, such a model has its applicability limited as it can be somewhat restrictive to handle specific data structures. In this case, it arises the need for obtaining alternative models that accommodate, for example, (a) zero-modification (inflation or deflation at the frequency of zeros), (b) overdispersion, and (c) individual heterogeneity arising from clustering or repeated (correlated) measurements made on the same subject. Cases (a)-(b) and (b)-(c) are often treated together in the statistical literature with several practical applications, but models supporting all at once are less common. Hence, this paper's primary goal was to jointly address these issues by deriving a mixed-effects regression model based on the hurdle version of the Poisson-Lindley distribution. In this framework, the zero-modification is incorporated by assuming that a binary probability model determines which outcomes are zero-valued, and a zero-truncated process is responsible for generating positive observations. Approximate posterior inferences for the model parameters were obtained from a fully Bayesian approach based on the Adaptive Metropolis algorithm. Intensive Monte Carlo simulation studies were performed to assess the empirical properties of the Bayesian estimators. The proposed model was considered for the analysis of a real data set, and its competitiveness regarding some well-established mixed-effects models for count data was evaluated. A sensitivity analysis to detect observations that may impact parameter estimates was performed based on standard divergence measures. The Bayesian p -value and the randomized quantile residuals were considered for model diagnostics.
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Affiliation(s)
- Wesley Bertoli
- Department of Statistics, Federal University of Technology - Paraná, Curitiba, Brazil
| | - Katiane S Conceição
- Department of Applied Mathematics and Statistics, Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
| | - Marinho G Andrade
- Department of Applied Mathematics and Statistics, Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
| | - Francisco Louzada
- Department of Applied Mathematics and Statistics, Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
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Simons HR, Leon-Atkins J, Kohn JE, Spector H, Hillery JF, Fager G, Kantor LM. Contraceptive counseling practices and patient experience: Results from a cluster randomized controlled trial at Planned Parenthood. Contraception 2019; 101:14-20. [PMID: 31655073 DOI: 10.1016/j.contraception.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/05/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Systematic reviews of contraceptive counseling interventions have shown inconsistent impact on patient outcomes. The current study assessed the effects of an evidence-informed contraceptive counseling staff training intervention on patient experience, contraceptive selection, and behavior over three months of follow-up. STUDY DESIGN We randomly assigned 10 Planned Parenthood health centers in the Southeastern US to intervention (staff received contraceptive counseling training) and control (usual counseling) groups. From December 2016-June 2017, patients completed surveys immediately post visit (n = 756) and one and three months after. We compared differences in patients' counseling experience (e.g., number of evidence-informed practices experienced, satisfaction with counseling), contraceptive selection, and behavior (e.g., method discontinuation, accurate pill use, condom use) between study groups using mixed effect models with health center specified as a random effect. RESULTS Seven hundred and fifty-six participants completed the baseline survey; 579 (77%) completed one or both follow-up surveys. The intervention group was more likely to report experiencing all evidence-informed counseling practices (adj. Prevalence Ratio [aPR] = 2.27, 95% CI 1.27, 4.04) with less variation in the number of practices and higher satisfaction with their counseling than the control group (p < 0.01). We found no sustained differences in contraceptive behaviors at both one- and three-month follow-up. CONCLUSIONS We found immediate positive effects of the intervention on patients' perceptions of their counseling experience and no differences in changes in contraceptive behavior over time between the study groups. IMPLICATIONS Evidence-based strategies to improve the quality of contraceptive care and subsequent outcomes, while centering patients' needs and preferences, are needed. The contraceptive counseling intervention offers a tool for increasing consistency in contraceptive counseling practices across health centers and improving patient satisfaction.
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Affiliation(s)
- Hannah R Simons
- Planned Parenthood Federation of America, New York, NY, USA.
| | | | - Julia E Kohn
- Planned Parenthood Federation of America, New York, NY, USA
| | | | - Jade F Hillery
- Planned Parenthood Federation of America, New York, NY, USA
| | - Gulielma Fager
- Planned Parenthood Federation of America, New York, NY, USA
| | - Leslie M Kantor
- Planned Parenthood Federation of America, New York, NY, USA; Rutgers School of Public Health, Newark, NJ, USA
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Moita B, Marques AP, Camacho AM, Leão Neves P, Santana R. One-year rehospitalisations for congestive heart failure in Portuguese NHS hospitals: a multilevel approach on patterns of use and contributing factors. BMJ Open 2019; 9:e031346. [PMID: 31481570 PMCID: PMC6731885 DOI: 10.1136/bmjopen-2019-031346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Identification of rehospitalisations for heart failure and contributing factors flags health policy intervention opportunities designed to deliver care at a most effective and efficient level. Recognising that heart failure is a condition for which timely and appropriate outpatient care can potentially prevent the use of inpatient services, we aimed to determine to what extent comorbidities and material deprivation were predictive of 1 year heart failure specific rehospitalisation. SETTING All Portuguese mainland National Health Service (NHS) hospitals. PARTICIPANTS A total of 68 565 hospitalisations for heart failure principal cause of admission, from 2011 to 2015, associated to 45 882 distinct patients aged 18 years old or over. OUTCOME MEASURES We defined 1 year specific heart failure rehospitalisation and time to rehospitalisation as outcome measures. RESULTS Heart failure principal diagnosis admissions accounted for 1.6% of total hospital NHS budget, and over 40% of this burden is associated to patients rehospitalised at least once in the 365-day follow-up period. 22.1% of the patients hospitalised for a principal diagnosis of heart failure were rehospitalised for the same cause at least once within 365 days after previous discharge. Nearly 55% of rehospitalised patients were readmitted within 3 months. Results suggest a mediation effect between material deprivation and the chance of 1 year rehospitalisation through the effect that material deprivation has on the prevalence of comorbidities. Heart failure combined with chronic kidney disease or chronic obstructive pulmonary disease increases by 2.8 and 2.2 times, respectively, the chance of the patient becoming a frequent user of inpatient services for heart failure principal cause of admission. CONCLUSIONS One-fifth of patients admitted for heart failure are rehospitalised due to heart failure exacerbation. While the role of material deprivation remained unclear, comorbidities considered increased the chance of 1 year heart failure specific rehospitalisation, in particular, chronic kidney disease and chronic obstructive pulmonary disease.
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Affiliation(s)
- Bruno Moita
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana Patricia Marques
- Departamento de Políticas e Gestão dos Sistemas de Saúde, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Pedro Leão Neves
- Centro Hospitalar Universitário do Algarve, Faro, Portugal
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal
| | - Rui Santana
- Departamento de Políticas e Gestão dos Sistemas de Saúde, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
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Lee S, Kim S, Kim Y, Oh B, Hwang H, Park T. Pathway analysis of rare variants for the clustered phenotypes by using hierarchical structured components analysis. BMC Med Genomics 2019; 12:100. [PMID: 31296220 PMCID: PMC6624181 DOI: 10.1186/s12920-019-0517-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Backgrounds Recent large-scale genetic studies often involve clustered phenotypes such as repeated measurements. Compared to a series of univariate analyses of single phenotypes, an analysis of clustered phenotypes can be useful for substantially increasing statistical power to detect more genetic associations. Moreover, for the analysis of rare variants, incorporation of biological information can boost weak effects of the rare variants. Results Through simulation studies, we showed that the proposed method outperforms other method currently available for pathway-level analysis of clustered phenotypes. Moreover, a real data analysis using a large-scale whole exome sequencing dataset of 995 samples with metabolic syndrome-related phenotypes successfully identified the glyoxylate and dicarboxylate metabolism pathway that could not be identified by the univariate analyses of single phenotypes and other existing method. Conclusion In this paper, we introduced a novel pathway-level association test by combining hierarchical structured components analysis and penalized generalized estimating equations. The proposed method analyzes all pathways in a single unified model while considering their correlations. C/C++ implementation of PHARAOH-GEE is publicly available at http://statgen.snu.ac.kr/software/pharaoh-gee/.
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Affiliation(s)
- Sungyoung Lee
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sunmee Kim
- Department of Psychology, McGill University, Montreal, Canada
| | - Yongkang Kim
- Department of Statistics, Seoul National University, Seoul, Korea
| | - Bermseok Oh
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Heungsun Hwang
- Department of Psychology, McGill University, Montreal, Canada
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, Korea. .,Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea.
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Abstract
To optimize designs for longitudinal studies analyzed by mixed-effect models with binary outcomes, the Fisher information matrix can be used. Optimal design approaches, however, require a priori knowledge of the model. We aim to propose, for the first time, a robust design approach accounting for model uncertainty in longitudinal trials with two treatment groups, assuming mixed-effect logistic models. To optimize designs given one model, we compute several optimality criteria based on Fisher information matrix evaluated by the new approach based on Monte-Carlo/Hamiltonian Monte-Carlo. We propose to use the DDS-optimality criterion, as it ensures a compromise between the precision of estimation of the parameters, and hence the Wald test power, and the overall precision of parameter estimation. To account for model uncertainty, we assume candidate models with their respective weights. We compute robust design across these models using compound DDS-optimality. Using the Fisher information matrix, we propose to predict the average power over these models. Evaluating this approach by clinical trial simulations, we show that the robust design is efficient across all models, allowing one to achieve good power of test. The proposed design strategy is a new and relevant approach to design longitudinal studies with binary outcomes, accounting for model uncertainty.
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Affiliation(s)
- Jérémy Seurat
- IAME, UMR 1137, INSERM, Université Paris Diderot, Paris, France
| | - Thu Thuy Nguyen
- IAME, UMR 1137, INSERM, Université Paris Diderot, Paris, France
| | - France Mentré
- IAME, UMR 1137, INSERM, Université Paris Diderot, Paris, France
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Ting CY, Ting RSK, Lim CJ, King TL, Ting H, Gerofi J. Pilot study on functional performance and acceptability of two new synthetic adhesive male condoms (Wondaleaf): a randomized cross-over trial. Contraception 2019; 100:65-71. [PMID: 30871936 DOI: 10.1016/j.contraception.2019.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study compared the condom failure rate, safety and acceptability of two new synthetic adhesive male condoms, Wondaleaf-Cap® (WLC) and Wondaleaf-On-Man® (WLM), with a marketed latex external condom Durex®-Together (DT). STUDY DESIGN We enrolled healthy married, monogamous, heterosexual condom users in a randomized controlled, cross-over, pilot trial in Malaysia. We randomized participants to six groups with different condom use-orders of the experimental WLC and WLM and control latex condom for four episodes for vaginal sex over 1 month for each condom type. We summarized the clinical and non-clinical failure rate, safety and acceptability of each condom type using descriptive statistics. We tested differences in condom failure and acceptability using generalized estimating equations and repeated measure ANOVA respectively. RESULTS We screened 75 couples and randomized 50 eligible couples. Two couples withdrew before receiving any condom. The remaining used 576 condoms with 192 uses for each condom variant. Clinical failure rates of WLC, WLM and DT were 1.04%, 0% and 0.52%, respectively. Non-clinical failure rates of WLC, WLM and DT were 2.08%, 3.12% and 1.04%, respectively. Removal was found more painful with Wondaleaf products than the DT. Preferences of participants for WLC, WLM and DT were 33.3%, 29.2% and 25%, respectively. Overall, WLC and DT had greater acceptances among male participants than WLM. CONCLUSION Results of this pilot study support that use of synthetic adhesive male condoms is associated with failure rates similar to those seen with existing latex, and with greater acceptability. A larger study to ascertain non-inferiority is underway. IMPLICATIONS The availability of synthetic adhesive male condoms may increase the acceptability of condom use. However, removal pain and clinical performance requires further study.
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Affiliation(s)
- Chuo Yew Ting
- Sarawak Research Society, Lot 56, Phase 5, Lorong Greenwood 21, Greenwood Park Batu 9 ½ Jalan Kuching-Serian, 94200 Kuching, Sarawak, Malaysia; Institute of Borneo Studies, Universiti Malaysia Sarawak, Jalan Datuk Mohammad Musa, 94300 Kota Samarahan, Sarawak, Malaysia.
| | - Rachel Sing-Kiat Ting
- Monash University Malaysia, Jeffrey Cheah School of Medicine and Health Sciences, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia.
| | - Chien Joo Lim
- Clinical Research Center, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia.
| | - Teck Long King
- Clinical Research Center, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia; Pharmacy Department, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia.
| | - Hiram Ting
- Sarawak Research Society, Lot 56, Phase 5, Lorong Greenwood 21, Greenwood Park Batu 9 ½ Jalan Kuching-Serian, 94200 Kuching, Sarawak, Malaysia; Faculty of Hospitality and Tourism Management, UCSI University, Muara Tebas Land District, Sejingkat, 93450 Kuching, Sarawak, Malaysia.
| | - John Gerofi
- Enersol Pty Ltd, 235 Nelson St, Annandale, NSW, 2038, Australia.
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Hödl M, Halfens RJG, Lohrmann C. Effectiveness of conservative urinary incontinence management among female nursing home residents-A cluster RCT. Arch Gerontol Geriatr 2019; 81:245-251. [PMID: 30684769 DOI: 10.1016/j.archger.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/03/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Guideline-compliant conservative management of urinary incontinence (UI) is the first step of the initial management for UI and is recommended for long-term care in older persons. Recent studies have focused on the effects of guideline-compliant UI management. However, most of these studies were tested in another setting than nursing homes and were not focused on conservative management. AIMS To measure the effectiveness of 29 evidence-based nursing recommendations regarding the conservative management of UI in Austrian nursing homes. METHODS The study is a cluster randomized intervention trial with institution as the unit of randomization. Twelve nursing homes in two Austrian provinces (Styria, Carinthia) were randomly allocated to the intervention group (IG) and control group (CG). Data were collected from participating residents over a three-month period. The intervention consisted of the implementation of recommendations for the conservative management of UI among female nursing home residents. The primary outcome variable was the daily UI experienced by the participating residents. RESULTS Residents in the (IG n = 216) had a lower risk (OR = 0.14, p = 0.02) of experiencing daily UI and were less likely to receive absorbent products (OR = 0.01, p = 0.01) than residents in the CG (n = 165). Residents in the IG (OR = 5.16, p = 0.00) were five times more likely to receive recommended interventions (e.g., bladder training) than residents in the CG. CONCLUSION Introducing guideline-compliant management into nursing practice can increase the likelihood of evidence-based interventions for the conservative management of UI. The intervention in this study targeted on nurses/nurse managers and can be recommended for the nursing home setting.
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Affiliation(s)
- Manuela Hödl
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4/3, 8010 Graz, Austria.
| | - Ruud J G Halfens
- Maastricht University, Department of Health Services Research, CAPHRI, Care and Public Health Research Institute, Duboisdomein 30, 6229 GT Maastricht, the Netherlands.
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4/3, 8010 Graz, Austria.
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Potharajaroen S, Tangwongchai S, Tayjasanant T, Thawitsri T, Anderson G, Maes M. Bright light and oxygen therapies decrease delirium risk in critically ill surgical patients by targeting sleep and acid-base disturbances. Psychiatry Res 2018; 261:21-7. [PMID: 29276990 DOI: 10.1016/j.psychres.2017.12.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 11/07/2017] [Accepted: 12/16/2017] [Indexed: 12/20/2022]
Abstract
This study examined the effects of bright light therapy (BLT) on the incidence of delirium in post-operative patients admitted to a surgical intensive care unit (SICU) and delineates risk and protective factors. We included 62 patients in a single-blind, randomized controlled study. The intervention group was treated with care as usual plus BLT for three consecutive days. Delirium was diagnosed by DSM-5 criteria with the Confusion Assessment Method-Intensive Care Unit (CAM-ICU). Risk factors for delirium were measured, including the APACHE II score, Insomnia Severity Index (ISI), as well as hematocrit and bicarbonate levels. Results were adjusted for treatment with nasal cannula oxygen and medications. Thirteen patients developed delirium within the three days following surgery. Generalized estimating equations analysis showed a significant preventive effect of BLT on delirium, which was independent of risk or treatment factors. Higher APACHE-II and ISI scores, lower hematocrit and lower bicarbonate levels increased the risk of developing delirium. BLT plus nasal cannula oxygen significantly reduced the likelihood of delirium. BLT significantly lowered ISI scores, while nasal cannula oxygen significantly enhanced bicarbonate levels. The results indicate that BLT and supplementary oxygen therapy may protect against delirium by targeting sleep-wake and deficits in the bicarbonate buffer system.
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Abstract
During economic reform, Chinese economic labor markets became segmented by state sector associated with a planned redistributive economy and private sector associated with the market economy. By considering an economic sector as a concrete institutional setting in post-reform China, this paper compares the extent to which socioeconomic status, measured by education and income, is associated with self-rated health between state sector and private sector. The sample is limited to urban Chinese employees between the ages of 18 and 55 who were active in the labor force. By analyzing pooled data from the 1991-2006 Chinese Health and Nutrition Survey, I find that there is a stronger association between income and self-rated health in the private sector than in the state sector. This study suggests that sectoral differences between market and redistributive economies are an important key to understanding health inequalities in post-reform urban China.
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Affiliation(s)
- Soyoung Kwon
- Department of Psychology & Sociology, Texas A & M University, Kingsville, TX, USA
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18
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Raval AD, Madhavan S, Mattes MD, Salkini M, Sambamoorthi U. Impact of Prostate Cancer Diagnosis on Noncancer Hospitalizations Among Elderly Medicare Beneficiaries With Incident Prostate Cancer. J Natl Compr Canc Netw 2016; 14:186-94. [PMID: 26850489 DOI: 10.6004/jnccn.2016.0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/05/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze the impact of cancer diagnosis on noncancer hospitalizations (NCHs) by comparing these hospitalizations between the precancer and postcancer periods in a cohort of fee-for-service Medicare beneficiaries with incident prostate cancer. METHODS A population-based retrospective cohort study was conducted using the SEER-Medicare linked database for 2000 through 2010. The study cohort consisted of 57,489 elderly men (aged ≥ 67 years) with incident prostate cancer. NCHs were identified in 6 periods (t1-t6) before and after the incidence of prostate cancer. Each period consisted of 120 days. For each period, NCHs were defined as inpatient admissions with primary diagnosis codes not related to prostate cancer, prostate cancer-related procedures, or bowel, sexual, and urinary dysfunction. Bivariate and multivariate comparisons on rates of NCHs between the precancer and postcancer periods accounted for the repeated measures design. RESULTS The rate of NCHs was higher during the postcancer period (5.1%) compared with the precancer period (3.2%). In both unadjusted and adjusted models, elderly men were 37% (odds ratio [OR], 1.37; 95% CI, 1.32, 1.41) and 38% (adjusted OR, 1.38; 95% CI, 1.33, 1.46) more likely to have any NCHs during the postcancer period compared with the precancer period. CONCLUSIONS Elderly men with prostate cancer had a significant increase in the risk of NCHs after the diagnosis of prostate cancer. This study highlights the need to design interventions for reducing the excess NCHs after prostate cancer diagnosis among elderly men.
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Affiliation(s)
- Amit D Raval
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Suresh Madhavan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Malcolm D Mattes
- Department of Radiation Oncology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Mohamad Salkini
- Department of Urology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, School of Medicine, West Virginia University, Morgantown, West Virginia
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Leung Yinko SSL, Maheswaran J, Pelletier R, Bacon SL, Daskalopoulou SS, Khan NA, Eisenberg MJ, Karp I, Lavoie KL, Behlouli H, Pilote L. Sex differences in health behavior change after premature acute coronary syndrome. Am Heart J 2015; 170:242-8. [PMID: 26299220 DOI: 10.1016/j.ahj.2015.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited information is available on the health behavior profile of patients with premature acute coronary syndrome (ACS). The purpose of this study is to desribe the health bahvior of young patients with ACS at the baseline and 1 year post-ACS and examine sex differences. METHODS GENESIS-PRAXY is a prospective cohort study of adults (18-55 years old) hospitalized with ACS from 26 centers located in Canada, United States, and Switzerland. Data on diet, physical activity, smoking, alcohol consumption, and recreational drug use were collected through self-administered questionnaires at baseline and 1 year post-ACS. RESULTS Our analysis included 740 patients with complete data. At baseline, the health behavior profile of young patients with ACS was worse than that of the general population. Men had a lower fruit and vegetable intake, consumed alcohol more, and used recreational drugs more than women. Conversely, fewer men than women were smokers (34% vs 42%). At 1 year post-ACS, the proportion of those consuming ≥5 daily servings of fruits and vegetables increased modestly (+5% vs +1%, for men vs women) but remained lower than the general population. Among women, the prevalence of smoking remained about twice as high as the general population. Recreational drug use also remained higher than in the general population. CONCLUSIONS Despite small improvements at 1 year post-ACS, the health behavior profile of young patients remained worse than that of the general population. Greater efforts to improve health behaviors post-ACS among young patients are needed, and a sex-based approach may be required to ensure successful behavioral changes.
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Affiliation(s)
- Sylvie S L Leung Yinko
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Roxanne Pelletier
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Igor Karp
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Department of Psychology, University of Quebec at Montreal, Montreal, Quebec, Canada; Research Centre, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Pilote
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Han WJ, Shibusawa T. Trajectory of physical health, cognitive status, and psychological well-being among Chinese elderly. Arch Gerontol Geriatr 2015; 60:168-77. [DOI: 10.1016/j.archger.2014.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/21/2014] [Accepted: 09/05/2014] [Indexed: 11/27/2022]
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Abstract
OBJECTIVES We estimated national trends of the prevalence of edentulism (complete tooth loss) for Asian American subgroups in the United States and investigated factors that could contribute to improvements in edentulism across populations over time. METHODS We used 10 waves of the National Health Interview Survey data collected from 1999 to 2008. Eligible respondents were those aged 50 years and older who completed the question on tooth loss. We contrasted the odds and probabilities of edentulism over time in Chinese, Filipinos, Asian Indians, and other Asians with those in Whites, Blacks, and Hispanics. RESULTS The rates of edentulism differed substantially across Asian subgroups. Compared with Whites, Chinese and other Asians had a lower risk of being edentulous, whereas being Filipino increased the odds. The rate for Asian Indians was similar to that for Whites. Nonetheless, rates of decline were similar across the Asian population groups. CONCLUSIONS Asian Americans are heterogeneous in edentulism. Innovative and sustainable public health programs and services are essential to prevent oral health diseases and conditions.
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Affiliation(s)
- Bei Wu
- School of Nursing, Duke University, 307 Trent Dr, DUMC 3322, Durham, NC 27710, USA.
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