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National Health (national + health)
Kinds of National Health Terms modified by National Health Selected AbstractsThe association between incisor trauma and occlusal characteristics in individuals 8,50 years of ageDENTAL TRAUMATOLOGY, Issue 2 2004Jay D. Shulman Abstract,,, To explore the association between incisal trauma and occlusal characteristics using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988,1994 (NHANES III). Incisal trauma examinations were performed on 15 364 individuals 6,50 years of age using an ordinal scale developed by the National Institute of Dental and Craniofacial Research. Occlusal examinations were performed on 13 057 individuals 8,50 years of age. We fitted separate multivariate logistic regression models for maxillary and mandibular incisor trauma adjusting for socio-demographic variables (age, gender, race-ethnicity) and occlusal characteristics (overbite, overjet, open bite). 23.45% of all individuals evidenced trauma on at least one incisor, with trauma more than four times more prevalent on maxillary (22.59%) than on mandibular incisors (4.78%). Males (OR = 1.67) had greater odds of trauma than females; Whites (OR = 1.37) and non-Hispanic Blacks (OR = 1.37) had greater odds of trauma than Mexican,Americans. The odds of trauma increased with age, peaked from age 21 to 30 (OR = 2.92), and declined. As overjet increased, so did the odds of trauma. Compared to individuals with ,0-mm overjet, odds of trauma increased from 1,3 mm (OR = 1.42) to 4,6 mm (OR = 2.42) to 7,8 mm (OR = 3.24) to >8 mm (OR = 12.47). Trauma to incisors is prevalent but mostly limited to enamel. Trauma to maxillary incisors is associated with overjet, gender, race-ethnicity, and age, while trauma to mandibular incisors is associated with gender, age, and overbite. [source] Impact of substance use on the physical health of patients with bipolar disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010M. P. Garcia-Portilla Garcia-Portilla MP, Saiz PA, Benabarre A, Florez G, Bascaran MT, Díaz EM, Bousoño M, Bobes J. Impact of substance use on the physical health of patients with bipolar disorder. Objective:, To describe the impact of tobacco, alcohol and cannabis on metabolic profile and cardiovascular risk in bipolar patients. Method:, Naturalistic, cross-sectional, multicenter Spanish study. Current use of tobacco, alcohol and cannabis was determined based on patient self-reports. Metabolic syndrome was defined using the National Health and Nutrition Examination Survey 1999,2000 and the American Heart Association/National Heart, Lung and Blood Institute criteria, and cardiovascular risk using the Framingham and the Systematic Coronary Risk Evaluation functions. Results:, Mean age was 46.6 years, 49% were male. Substance use: 51% tobacco, 13% alcohol and 12.5% cannabis. Patients who reported consuming any substance were significantly younger and a higher proportion was male. After controlling for confounding factors, tobacco was a risk factor for coronary heart disease (CHD) (unstandardized linear regression coefficient 3.47, 95% confidence interval 1.85,5.10). Conclusion:, Substance use, mainly tobacco, was common in bipolar patients. Tobacco use negatively impacted CHD risk. [source] Elevated C-reactive protein in Native Canadian children: an ominous early complication of childhood obesityDIABETES OBESITY & METABOLISM, Issue 5 2006R. Retnakaran Aim:, Subclinical inflammation has been proposed as a pathophysiologic mechanism linking obesity with vascular and metabolic disease. Native North American populations are experiencing high prevalence rates of both (i) childhood obesity and (ii) adult cardiovascular disease (CVD) and type 2 diabetes. Thus, we sought to determine whether subclinical inflammation is an early complication of obesity in Native children. Methods:, Serum concentrations of the inflammatory biomarker C-reactive protein (CRP) were assessed in a population-based, cross-sectional study of the Sandy Lake Oji-Cree community of Northern Ontario, Canada, involving 228 children aged 10,19 years (mean age 14.8). Results:, Median CRP in this population was 0.5 mg/l (interquartile range 0.18,1.79 mg/l). CRP levels were higher than age-matched reference data from the Third National Health and Nutrition Examination Survey (NHANES III). Importantly, fully 15.8% of the children of this community had CRP concentrations between 3 and 10 mg/l, a range that identifies adults at high risk of CVD. Moreover, increasing CRP concentration in this paediatric population was associated with an enhanced CV risk profile, consisting of increased adiposity, higher insulin resistance, worsening lipid profile (higher total cholesterol, triglycerides, low-density lipoprotein cholesterol, apolipoprotein B and total cholesterol : high-density-lipoprotein cholesterol ratio), increased leptin and decreased adiponectin. On multivariate analysis, waist circumference and interleukin-6 (IL-6) emerged as independent determinants of CRP concentration. Conclusion:, Subclinical inflammation is an early complication of childhood obesity in Native children and may foreshadow an increased burden of CVD and type 2 diabetes in the future. [source] Family health effects: complements or substitutesHEALTH ECONOMICS, Issue 8 2001Michael Lee Ganz Abstract Genetic endowments play a fundamental role in the production of health. At birth individuals have different capacities to be healthy, largely due to genetic dispositions. Whether or not individuals realize this health depends on their choice of health behaviours. Previous research has linked negative factors beyond the individual's control, which include genetic endowments, to both poor health and poor health behaviours. The health economics literature proposes that behaviours and genetic (or family health) endowments can be either substitutes or complements in the production of health. The goal of this paper is to investigate the behavioural consequences of changes in knowledge about one's genetic endowment. Using two waves of the National Health and Nutrition Examination Survey I Epidemiologic Followup Study, I find that for smokers, smoking intensity substitutes for newly diagnosed smoking-related family cancers, while smoking intensity is complementary to newly diagnosed non-smoking-related family cancers. I find no evidence for the hypothesized relationships with respect to alcohol consumption among drinkers. These results have implications for the growing field of genetic testing and test development. These results also reinforce current practices of ascertaining family health histories in the context of medical history taking. Copyright © 2001 John Wiley & Sons, Ltd. [source] Self-reported prevalence and awareness of metabolic syndrome: findings from SHIELDINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2008S. J. Lewis Summary Purpose:, This study assessed awareness of metabolic syndrome and evaluated health knowledge, attitudes and behaviours of respondents at risk. Methods:, Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD), a longitudinal US population-based survey initiated in 2004, included respondents, , 18 years of age, reporting a diagnosis of metabolic syndrome. Prevalence of metabolic syndrome was compared in SHIELD and National Health and Nutrition Examination Survey (NHANES) 1999,2002 survey. The proportion of SHIELD respondents who had heard of and/or understood metabolic syndrome was estimated. Respondents at high risk for metabolic syndrome were stratified into attitude-behaviour categories of ,Already Doing It', ,I Know I Should' and ,Don't Bother Me' and differences in attitudes and behaviours were evaluated with chi-square tests. Results:, Prevalence of reported metabolic syndrome was 0.6% in SHIELD screening questionnaire respondents (n = 211,097) vs. 25.9% in NHANES (n = 10,780). Less than 15% of SHIELD baseline questionnaire respondents (n = 22,001) had heard of or understood metabolic syndrome. Attitudes toward health status were more favourable in the ,Doing' group (27% reported fair/poor health) compared with those in the ,Should' (38%) and ,Don't' (54%) groups (p < 0.0001). The ,Don't' group was most likely to prefer medications to lifestyle change (13% vs. 2,4%) compared with ,Should' and ,Doing' groups (p < 0.0001). More ,Doing' respondents (79%) than ,Should' (59%) and ,Don't' (48%) respondents reported exercising regularly (p < 0.0001). Conclusions:, The lack of knowledge about metabolic syndrome reported in SHIELD indicates limited penetration of this concept into public awareness. With behaviour categories, respondents who report healthy attitudes are more likely to embrace lifestyle changes, while respondents who do not care may be more difficult to treat. [source] Could "Acculturation" Effects Be Explained by Latent Health Disadvantages Among Mexican Immigrants?INTERNATIONAL MIGRATION REVIEW, Issue 3 2009Brian K. Finch This paper tests portions of a new theory of immigrant health by focusing exclusively on latent biomarkers of future health risks. Using data from the National Health and Nutrition Examination Survey III, 1988,1994 , we uncover the typically observed immigrant health advantage among recent immigrants that diminishes among long-term immigrants. In addition, we observe worse health among U.S.-born Mexican Americans relative to non-Hispanic Whites. Finally, although our theory suggests that recent immigrants may have latent health risks due to disadvantaged childhood experiences, we do not find evidence in support of this theory. [source] Performance-Based Measures of Physical Function for High-Function PopulationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006J. David Curb MD OBJECTIVES: To improve and broaden the applicability of performance-based measures of function for use in clinical and research settings. DESIGN: Cross-sectional repeated-measures study. SETTING: Research clinic. PARTICIPANTS: Population-based sample of Japanese Americans without significant functional impairments aged 35 to 55 and 56 to 71 (N=203). MEASUREMENTS: Performance-based measures of physical function, including range of standard tests, newer automated measures of balance and strength and data on cognitive function, lifestyle, medical history, and physical activity. RESULTS: Of the nonplatform balance measures, only the one-leg stand was reliable (reliability coefficient (rc) =0.69) and able to discriminate between functional levels. Combining the Fourth National Health and Nutrition Examination Survey protocol of folded arm position while standing on a foam pad with the more-sophisticated balance platform test had the highest reliability and discrimination. With the strength chair, high rcs (0.88,0.96) were found for upper and lower extremity tests. Timed chair stands, a test of lower extremity and central strength were reliable. The 6-minute walk had a high rc (0.90). CONCLUSION: Many performance tests used today are not reliable. Only a few discriminate between the most highly functioning individuals and individuals with good function. Thus, a new recommended battery includes unassisted single-leg stand, balance platform "foam pad, eyes closed," elbow flexion and knee extension strength (strength chair), grip strength, timed chair stands, and the 6-minute walk. These simple performance-based tests have good reliability and discrimination across the range of function and can be used in most clinical and research settings to quickly assess global functional level. [source] Isokinetic Leg Muscle Strength in Older Americans and Its Relationship to a Standardized Walk Test: Data from the National Health and Nutrition Examination Survey 1999,2000JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004Yechiam Ostchega PhD Objectives: To describe isokinetic knee extensor muscle strength in older U.S. men and women by age and race/ethnicity and to ascertain its relationship to a standard, timed walking-speed test. Setting: The U.S. National Health and Nutrition Examination Survey (NHANES) 1999,2000. Design: A cross-sectional nationally representative health examination survey. Participants: All surveyed persons aged 50 and older (N=1,499) who performed muscle strength and timed walk examinations in the NHANES mobile examination center. Measurements: Concentric peak torque (strength) of the knee extensors at 1.05 rads/ s,1 velocity and a 6-m walk timed in seconds. Results: Knee extensor strength was inversely associated with age (P<.01), and women had less knee extensor muscle strength than men (P<.01). After adjustment for standing height, no significant difference in muscle strength was found across the three race/ethnicity groups (Mexican Americans, non-Hispanic blacks, and non-Hispanic whites) for men or women. After adjustment for age, race/ethnicity, weight, and height, increasing knee extensor strength was associated with significant increases in meters walked per second (P<.01). Conclusion: Knee extensor muscle strength is affected by age and sex but not by race/ethnicity and it is significantly associated with timed walk. [source] Prevalence and trends in low femur bone density among older US adults: NHANES 2005,2006 compared with NHANES IIIJOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2010Anne C Looker Abstract Hip fracture incidence appears to be declining in the United States, but changes in bone mineral density (BMD) of the population have not been evaluated. We used femur BMD data from the National Health and Nutrition Examination Survey (NHANES) 2005,2006 to estimate the prevalence of low femoral BMD in adults age 50 years and older and compared it with estimates from NHANES III (1988,1994). Dual-energy X-ray absorptiometry systems (pencil-beam geometry in NHANES III, fan-beam geometry in NHANES 2005,2006) were used to measure femur BMD, and World Health Organization (WHO) definitions of low BMD were used to categorize skeletal status. In 2005,2006, 49% of older US women had osteopenia and 10% had osteoporosis at the femur neck. In men, 30% had femur neck osteopenia and 2% had femur neck osteoporosis. An estimated 5.3 million older men and women had osteoporosis at the femur neck, and 34.5 million more had osteopenia in 2005,2006. When compared with NHANES III, the age-adjusted prevalence of femur neck osteoporosis in NHANES 2005,2006 was lower in men (by 3 percentage units) and women (by 7 percentage units) overall and among non-Hispanic whites. Changes in body mass index or osteoporosis medication use between surveys did not fully explain the decline in osteoporosis. Owing to the increase in the number of older adults in the US population, however, more older adults had low femur neck BMD (osteoporosis + osteopenia) in 2005,2006 than in 1988,1994. Thus, despite the decline in prevalence, the estimated number of affected older adults in 2005,2006 remained high. Copyright © 2010 American Society for Bone and Mineral Research [source] Age Trends in Femur Stresses From a Simulated Fall on the Hip Among Men and Women: Evidence of Homeostatic Adaptation Underlying the Decline in Hip BMDJOURNAL OF BONE AND MINERAL RESEARCH, Issue 9 2006Thomas J Beck ScD Abstract Age trends in proximal femur stresses were evaluated by simulating a fall on the greater trochanter using femur geometry from hip DXA scans of 5334 white men and women in the NHANES III survey. Expansion of femur outer diameter seems to counter net bone loss so that stresses remain similar across age groups, but stresses are higher in older women than in older men. Introduction: The age decline in hip BMD is caused by both bone loss and expansion of outer diameter that increases the region size over which mass is measured in a DXA scan. Because expansion has an opposing effect on structural strength, it may be a homeostatic adaptation to net bone loss to ensure that load stresses are kept within a narrow range. Materials and Methods: Age trends in femur stresses were evaluated with an engineering beam simulation of a fall on the greater trochanter. Hip geometry was extracted from hip DXA scans using the Hip Structure Analysis (HSA) software on 2613 non-Hispanic white men and 2721 women from the third National Health and Nutrition Examination Survey (NHANES III). Using body weight as load, stresses were computed on the inferior-medial and superior-lateral femur neck at its narrowest point and the medial and lateral shaft 2 cm distal to the midpoint of the lesser trochanter. Stresses and the underlying geometries in men and women >50 years oaf age were compared with those 20,49 years of age. Results: Compared with men <50 years of age, stresses in older men were 6% lower on both surfaces of the shaft, 4% lower on the inferior-medial neck, and not different on the superior-lateral neck. In women >50 years of age, stresses on the proximal shaft and inferior-medial neck remained within 3% of young values but were 13% greater on the superior-lateral neck. Neck stresses in young women were lower on the superior-lateral than the inferior-medial neck, but lateral stress increased to the level on the medial surface in older women. Stresses were higher in women than in men, with a greater gender difference in those >50 years of age. Conclusions: We conclude that femur expansion has a homeostatic effect in men and women that opposes bone loss so that stresses change little with age. Because expansion preserves stresses with progressively less bone mass, the process may reduce structural stability in the femoral neck under fall conditions, especially in the elderly female. [source] Structural Trends in the Aging Femoral Neck and Proximal Shaft: Analysis of the Third National Health and Nutrition Examination Survey Dual-Energy X-Ray Absorptiometry Data,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2000Thomas J. Beck Abstract Hip scans of U.S. adults aged 20,99 years acquired in the Third National Health and Nutrition Examination Survey (NHANES III) using dual-energy X-ray absorptiometry (DXA) were analyzed with a structural analysis program. The program analyzes narrow (3 mm wide) regions at specific locations across the proximal femur to measure bone mineral density (BMD) as well as cross-sectional areas (CSAs), cross-sectional moments of inertia (CSMI), section moduli, subperiosteal widths, and estimated mean cortical thickness. Measurements are reported here on a non-Hispanic white subgroup of 2719 men and 2904 women for a cortical region across the proximal shaft 2 cm distal to the lesser trochanter and a mixed cortical/trabecular region across the narrowest point of the femoral neck. Apparent age trends in BMD and section modulus were studied for both regions by sex after correction for body weight. The BMD decline with age in the narrow neck was similar to that seen in the Hologic neck region; BMD in the shaft also declined, although at a slower rate. A different pattern was seen for section modulus; furthermore, this pattern depended on sex. Specifically, the section modulus at both the narrow neck and the shaft regions remains nearly constant until the fifth decade in females and then declined at a slower rate than BMD. In males, the narrow neck section modulus declined modestly until the fifth decade and then remained nearly constant whereas the shaft section modulus was static until the fifth decade and then increased steadily. The apparent mechanism for the discord between BMD and section modulus is a linear expansion in subperiosteal diameter in both sexes and in both regions, which tends to mechanically offset net loss of medullary bone mass. These results suggest that aging loss of bone mass in the hip does not necessarily mean reduced mechanical strength. Femoral neck section moduli in the elderly are on the average within 14% of young values in females and within 6% in males. [source] Prevalence of Pelvic Paget's Disease of Bone in the United StatesJOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2000R. D. Altman M.D. Abstract The objective of this article was to estimate the prevalence of Paget's disease of bone in the United States from a statistically derived sample of the general population. Pelvic radiographs obtained in the First National Health and Nutrition Examination Survey (NHANES-I) were reviewed for the presence of Paget's disease. Age, sex, and geographic distribution of Paget's disease of the pelvic region were determined. The overall prevalence of Paget's disease in the United States was estimated. Pelvic Paget's disease is estimated to be present in 0.71 + 0.18% of the radiographs of the general population. The disease was higher in frequency in people who were in the older decades of life with the highest prevalence of 2.32 + 0.54% in the 65- to 74-year-old people. There is a slight male predominance in the 45- to 74-year age group. The regional distribution suggests the highest prevalence in the Northeast (1.48 + 0.52%) with the lowest prevalence in the South (0.26 + 0.25%). The prevalence was equal in white people and black people. An estimate of the overall prevalence of Paget's disease in the United States was at least 1% and perhaps as much as 2% of the general population with near equal sex distribution and the highest prevalence in the northeastern United States. [source] Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed-Dose Combination ApproachesJOURNAL OF CLINICAL HYPERTENSION, Issue 3 2003George L. Bakris MD Data from the Third National Health and Nutrition Examination Survey (NHANES III) demonstrate that only 11% of people with diabetes who are treated for high blood pressure achieve the blood pressure goal of <130/85 mm Hg recommended in the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The current study tests the hypothesis that initial therapy with a fixed-dose combination will achieve the recommended blood pressure goal in patients with type 2 diabetes faster than conventional monotherapy. This randomized, double-blind, placebo-controlled study had as a primary end point achievement of blood pressure <130/85 mm Hg. Participants (N=214) with hypertension and type 2 diabetes received either amlodipine/benazepril 5/10 mg (combination) or enalapril 10 mg (conventional) once daily for 4 weeks, titrated to 5/20 mg/day or 20 mg/day, respectively at this time, if target blood pressure was not achieved. Hydrochlorothiazide (HCTZ) 12.5 mg/day was added for the final 4 weeks, if target blood pressure was still not reached. Time from baseline to achieve blood pressure <130/85 mm Hg was shorter in the combination group (5.3±3.1 weeks combination vs. 6.4±3.8 weeks conventional; p=0.001). At 3 months, more participants in the combination group achieved treatment goal (63% combination vs. 37% conventional; p=0.002). Data analysis at 3 months comparing blood pressure control rates between the fixed-dose combination group (with out HCTZ) to the conventional group (receiving HCTZ) showed an even greater disparity in blood pressure goal achievement (87% combination without HCTZ vs. 37% conventional group with HCTZ; p=0.0001). We conclude that initial therapy with a fixed-dose combination may be more efficacious than conventional monotherapy approaches for achieving blood pressure goals in the diabetic patient. A fixed-dose combination approach appears as safe as the current conventional approaches. [source] A systematic review and meta-synthesis: evaluating the effectiveness of nurse, midwife/allied health professional consultantsJOURNAL OF CLINICAL NURSING, Issue 10 2007Ann Humphreys PhD, Cert Ed Aim., This paper presents the findings of a systematic review and meta-synthesis, which was undertaken to identify and assess studies that evaluated the nurse/midwife/allied health professional consultant role. Background., As part of the modernization agenda in the National Health Service the United Kingdom government proposed ,Consultant' posts for nurses/midwives and allied health professionals as an opportunity for experienced practitioners to extend their roles. Four key functions were identified as being significant to this role development: expert practice, leadership, education and research. Explicit within the proposal was a requirement of these new roles to be evaluated. Method., Inclusion criteria focussed on studies where an aspect of the role had been evaluated or where the consultant carried out the research. A total of 1931 citations was filtered to reveal 107 studies that possibly met the inclusion criteria. Of these 107, 14 studies were critically appraised and subjected to thematic analysis. Study methodology varied but of the 14 studies, 10 involved some form of measurement. The others adopted a literature review or descriptive approach. Conclusions., The extent to which consultants were involved in all aspects of the ,four pillars' was assessed in only a small number of studies. However, a number of studies implicitly implied active engagement in expert practice and leadership by focussing on specific service developments. Relevance to clinical practice., To date, a number of studies evaluating service developments, education, expert practice and leadership have been carried out. However although a number of studies have assessed perceived impact of the consultant role, no measure of actual benefit has been published to date. Studies that evaluate the cost benefit/outcomes of these roles in relation to both activity and quality of service are required. [source] Alcohol consumption and periodontal diseaseJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2004Nutrition Examination Survey, The Third National Health Abstract Objective: This study was carried out to evaluate the effect of alcohol consumption on the severity of periodontal disease. Material and Methods: This cross-sectional study employed 13,198 subjects of the Third National Health and Nutrition Examination Survey (NHANES III) aged 20 and older who have at least six natural teeth. Alcohol intake was represented both as a continuous variable and dichotomized using 5, 10, 15, and 20 drinks/week as cut-points. Periodontal disease was represented by clinical attachment loss (CAL) and was assessed both as a continuous variable and dichotomized as <1.5 mm and 1.5 mm. Independent effect of alcohol on CAL was assessed by weighted multiple linear and logistic regression analyses adjusting simultaneously for the effects of age, gender, race, education, income, smoking, diet, diabetes, gingival bleeding, number of remaining teeth. Results: There was a significant linear relationship between number of drinks per week and log CAL (p=0.0001). Odds ratios for the risk of attachment loss using 5, 10, 15, and 20 drinks/week as cut-points were 1.22 [1.02,1.47], 1.39 [1.13,1.71], 1.54 [1.22,1.93], and 1.67 [1.25,2.23], respectively. Conclusion: Alcohol consumption may be associated with increased severity of CAL in a dose-dependent fashion. Prospective studies and studies of mechanism are needed to confirm the role of alcohol as a risk factor for periodontal disease. [source] ORIGINAL ARTICLE: Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US,JOURNAL OF DIABETES, Issue 3 2010Earl S. FORD Abstract Background:, Recently, a Joint Scientific Statement bridged differences between previous definitions of metabolic syndrome. Our objective was to estimate the prevalence of metabolic syndrome in a representative sample of US adults and to examine its correlates. Methods:, We analyzed data for up to 3461 participants aged ,20 years of the 2003,2006 National Health and Nutrition Examination Survey. Results:, Using waist circumference thresholds of ,102 cm for men and ,88 cm for women, the age-adjusted prevalence of metabolic syndrome was 34.3% among all adults, 36.1% among men, and 32.4% among women. Using racial- or ethnic-specific International Diabetes Federation criteria for waist circumference, the age-adjusted prevalence of metabolic syndrome was 38.5% for all participants, 41.9% for men, and 35.0% for women. Prevalence increased with age, peaking among those aged 60,69 years. Prevalence was lower among African American men than White or Mexican American men, and lower among White women than among African American or Mexican American women. In a multivariate regression model, significant independent associations were noted for age (positive), gender (men higher than women), race or ethnicity (African Americans and participants of another race lower than Whites), educational status (inverse), hypercholesterolemia (positive), concentrations of C-reactive protein (positive), leisure time physical activity (inverse), microalbuminuria (positive), and hyperinsulinemia (positive). Additional adjustment for body mass index weakened many of the associations, with educational status and microalbuminuria no longer significant contributors to the model. Conclusion:, Metabolic syndrome continues to be highly prevalent among adults in the US. [source] Serum concentrations of vitamin D and parathyroid hormone and prevalent metabolic syndrome among adults in the United StatesJOURNAL OF DIABETES, Issue 4 2009Earl S. FORD Abstract Background:, Some reports suggest that concentrations of vitamin D are inversely, whereas concentrations of parathyroid hormone (PTH) are directly, associated with prevalent metabolic syndrome. Because of lingering uncertainty about these associations, we examined the cross-sectional associations between serum concentrations of 25-hydroxyvitamin D3 and PTH with metabolic syndrome in a representative sample of adults in the US. Methods:, We used data from 1705 participants in the 2005,2006 National Health and Nutrition Examination Survey. Vitamin D was measured by radioimmunoassay, whereas PTH was measured using an electrochemiluminescent process. Results:, The mean concentration of vitamin D for participants with and without metabolic syndrome was 20.3 and 22.9 ng/mL, respectively (P = 0.001). The mean concentration of PTH for participants with and without metabolic syndrome was 44.5 and 41.0 pg/mL, respectively (P = 0.002). The age-adjusted mean concentrations of vitamin D (P for linear trend <0.001) decreased linearly, whereas PTH (P for linear trend = 0.002) increased linearly, as the number of components of metabolic syndrome increased. After adjusting for age, gender, physical activity, urinary albumin creatinine ratio, and concentrations of C-reactive protein and calcium, concentrations in the highest quintile of vitamin D [prevalence ratio (PR) = 0.59; 95% confidence interval (CI) 0.44,0.79], but not PTH (PR = 1.18; 95% CI 0.97,1.43), was significantly associated with prevalent metabolic syndrome. Conclusion:, Concentrations of vitamin D, but not PTH, were significantly associated with prevalent metabolic syndrome among US adults. [source] Health characteristics and health services utilization in older adults with intellectual disability living in community residencesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 4 2002M. P. Janicki Abstract Background The health status and health needs of adults with intellectual disability (ID) change with advancing age, and are often accompanied by difficulties with vision, hearing, mobility, stamina and some mental processes. Aim The present study collected health status information on a large cohort of adults with ID aged , 40 years living in small group, community-based residences in two representative areas of New York State, USA. Method Adult group home residents with ID aged between 40 and 79 years (n = 1371) were surveyed to determine their health status and patterns of morbidity. Results Most subjects were characterized as being in good health. The frequency of cardiovascular, musculoskeletal and respiratory conditions, and sensory impairments increased with age, while neurological, endocrine and dermatological diseases did not. Psychiatric and behavioural disorders declined with increasing age, at least through 70 years of age. Although most conditions increased with age, their frequency varied by sex and level of ID. Frequencies of age-related organ system morbidity were compared to data from the National Health and Nutrition Evaluation Survey III. It was found that adults with ID had a lower overall reported frequency of cardiovascular risk factors, including hypertension and hyperlipidaemia, and adult-onset diabetes. Inconsistencies with mortality data among older adults with ID were observed (which showed equal if not greater prevalence of deaths as a result of cardiovascular disease and cancer). Conclusion These results suggest that either a cohort effect is operating (i.e. contemporary populations are healthier than previous populations), or that there may be under-recognition of select risk factors and diseases. [source] Treatment planning for replacing missing teeth in UK general dental practice: current trendsJOURNAL OF ORAL REHABILITATION, Issue 7 2010P. M. PATEL Summary, The aim of this study was to examine the confidence, barriers and attitudes towards the replacement of missing teeth by general dental practitioners (GDPs). The perceived impact of the recently introduced National Health Service (NHS) contract on the provision of prosthodontic treatments was also considered. Pre-piloted postal questionnaires were mailed to 500 GDPs in Wales. Open- and closed-ended questions were utilised to establish confidence, adequacy of training and attitudes towards treatments for replacing missing teeth. Two hundred and seventeen completed questionnaires were received (response rate = 43·4%). Many respondents described themselves as ,confident' or ,very confident' in the provision of removable partial dentures (RPDs) (acrylic = 100%, metal based = 99·5%), cantilever resin-bonded bridges (94·4%) and conventional bridgework (98·6%). GDPs were ,not confident' providing fixed-fixed resin-bonded bridges (21·1%) or implants (81·4%). Financial barriers were identified to the provision of prosthodontic treatments, including comments such as "the new [National Health Service] contract does limit the treatments available". Privately funded patients were more likely to be offered a fixed bridge or implant replacement of a missing upper first molar, whereas non-privately funded patients were more likely to be offered no treatment (P < 0·01). Most respondents reported confidence at providing more routine forms of prosthodontic care such as RPDs and bridges. It appears that funding arrangements may have an impact on treatments offered to replace missing teeth, particularly under the current NHS contract. [source] The Effect of Functional Dentition on Healthy Eating Index Scores and Nutrient Intakes in a Nationally Representative Sample of Older AdultsJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2009R. Bethene Ervin PhD Abstract Objective: The objectives of this study were to examine the associations between functional dentition and the Healthy Eating Index (HEI) scores and nutrient intakes among older adults in the United States. Methods: The sample consisted of 2,560 adults, 60 years and over from the National Health and Nutrition Examination Survey 1999-2002. We used multivariate linear regression to examine associations between functional dentition and HEI scores or nutrient intakes controlling for the potential confounding effects of age, race/ethnicity, education, smoking status, body mass index (BMI), self-reported health, and caloric intake. Dentate status was classified as: edentulous (no natural permanent teeth or implants), 1-20 teeth, or,21 teeth. A functional dentition was defined as having 21 or more teeth present. HEI scores and nutrient intakes were based on one 24-hour dietary recall. Results: Males with a functional dentition consumed slightly more fruit and had higher alpha- and beta-carotene intakes than edentulous males. Females with any natural teeth had higher vitamin C intakes than edentulous females. There were no significant associations between dentate status and any of the remaining HEI scores or nutrient intakes for either sex. Conclusions: Having a functional dentition did not contribute substantially to higher HEI scores or nutrient intakes in this nationally representative sample of older adults. However, older men and women with no teeth or those who wear dentures consumed fewer servings of fruits and vegetables, especially those rich in carotenes and vitamin C, than those with teeth. [source] The cost-effectiveness of macrogol 3350 compared to lactulose in the treatment of adults suffering from chronic constipation in the UKALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010R. R. TAYLOR Background, It is unknown whether macrogol 3350 (Movicol) affords the UK's National Health Service (NHS) a cost-effective addition to the current range of laxatives. Aim, To estimate the cost-effectiveness of macrogol 3350 compared with lactulose in the treatment of chronic constipation, from the perspective of the UK's NHS. Methods, A decision model depicting the management of chronic constipation was constructed using clinical outcomes and resource use values derived from patients suffering from chronic constipation in The Health Independent Network (THIN) database. The model was used to estimate the cost-effectiveness of a GP prescribing macrogol 3350 instead of lactulose to treat adults ,18 years of age suffering from chronic constipation. Results, Sixty-eight percent of patients given macrogol 3350 were successfully treated within 6 months after starting treatment compared to 60% of patients given lactulose.Patients' health status at 6 months was estimated to be 0.458 and 0.454 quality-adjusted life years (QALYs) in the macrogol 3350 and lactulose groups respectively. The total 6-monthly NHS cost of initially treating patients with macrogol 3350 or lactulose was estimated to be £420 (US $688) and £419 (US $686) respectively. Hence, the cost per QALY gained with macrogol 3350 was estimated to be £250 (US $410). Conclusion, Macrogol 3350 affords the NHS a cost-effective addition to the range of laxatives available for this potentially resource-intensive condition. Aliment Pharmacol Ther,31, 302,312 [source] Can Nutritional Label Use Influence Body Weight Outcomes?KYKLOS INTERNATIONAL REVIEW OF SOCIAL SCIENCES, Issue 4 2009Andreas C. Drichoutis SUMMARY Many countries around the world have already mandated, or plan to mandate, the presence of nutrition related information on most pre-packaged food products. Health advocates and lobbyists would like to see similar laws mandating nutrition information in the restaurant and fast-food market as well. In fact, New York City has already taken a step forward and now requires all chain restaurants with 15 or more establishments anywhere in US to show calorie information on their menus and menu board. The benefits were estimated to be as much as 150,000 fewer obese New Yorkers over the next five years. The implied benefits of the presence of nutrition information are that consumers will be able to observe such information and then make informed (and hopefully healthier) food choices. In this study, we use the latest available dataset from the US National Health and Nutrition Examination Survey (2005,2006) to explore whether reading such nutrition information really has an effect on body weight outcomes. In order to deal with the inherent problem of cross-sectional datasets, namely self-selection, and the possible occurrence of reverse causality we use a propensity score matching approach to estimate causal treatment effects. We conducted a series of tests related to variable choice of the propensity score specification, quality of matching indicators, robustness checks, and sensitivity to unobserved heterogeneity, using Rosenbaum bounds to validate our propensity score exercise. Our results generally suggest that reading nutrition information does not affect body mass index. The implications of our findings are also discussed. [source] Serum bilirubin and colorectal cancer risk: a population-based cohort studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2006G. N. IOANNOU Summary Background Bilirubin has antioxidant properties and has been postulated to protect against the development of malignancies. Aim To investigate whether baseline serum bilirubin concentration predicts the incidence of colorectal cancer in a nationally representative sample of the US population. Methods Participants of the first National Health and Nutrition Examination Survey were divided into four groups based on quartiles of baseline serum bilirubin concentration in mg/dL: <0.38 (n = 1410), 0.38 to <0.5 (n = 1287), 0.5 to <0.6 (n = 1048) and ,0.6 (n = 1742). The incidence of colorectal cancer during the following 20 years was determined from hospitalization records and death certificates. Results 110 cases of colorectal cancer-related death or hospitalization were identified among 5487 participants during 88 339 person-years of follow-up (12 per 10 000 person-years). There was no association between baseline serum bilirubin concentration and the incidence of colorectal cancer either in unadjusted analyses or after adjusting for age, gender, ethnicity, smoking, body mass index, alcohol consumption and educational attainment. Conclusions Baseline serum bilirubin concentration did not predict the subsequent incidence of colorectal cancer in this population-based cohort study. [source] Relationship of serum cholesterol levels to atopy in the US populationALLERGY, Issue 7 2010M. B. Fessler To cite this article: Fessler MB, Jaramillo R, Crockett PW, Zeldin DC. Relationship of serum cholesterol levels to atopy in the US population. Allergy 2010; 65: 859,864. Abstract Background:, Cholesterol promotes Th2 immunity and allergic inflammation in rodents; whether this occurs in humans is unclear. Reports of both direct and inverse associations between serum cholesterol and atopy in different populations suggest that race and/or other demographic variables may modify these relationships. Aims of the study:, To determine the relationships between levels of three serum cholesterol measures [total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), and non-HDL-C] and atopy in a sample representative of the US population. Methods:, Cross-sectional study of 6854 participants aged ,6 years from the 2005,2006 National Health and Nutrition Examination Survey. Results:, In the overall population, adjusted odds ratios (AORs) per two-standard deviation increase in TC and non-HDL-C for biochemical atopy (defined as ,1 allergen-specific IgE to 19 allergens) were 1.17 [95% confidence interval (CI), 1.00,1.38] and 1.19 (95% CI, 1.03,1.39), respectively. Interactions by race were noted for the two relationships (interaction P = 0.004 and P = 0.009, respectively) with non-Hispanic Whites (NHWs) having direct relationships [TC: AOR 1.27 (95% CI, 1.03,1.57); non-HDL-C: AOR 1.27 (95% CI, 1.03,1.56)] and non-Hispanic Blacks (NHBs) inverse relationships [TC: AOR 0.77 (95% CI, 0.62,0.95); non-HDL-C: AOR 0.86 (95% CI, 0.69,1.08)]. The adjusted HDL-C,atopy relationship was nonsignificant for NHWs and inverse for NHBs [AOR 0.77 (95% CI, 0.61,0.96)]. Relationships were independent of body mass index and serum C-reactive protein and unmodified by corticosteroid or statin usage. Results were similar using current hay fever/allergy as the atopy outcome. Conclusions:, There are marked inter-racial differences in the relationship between serum cholesterol and atopy in the US population. [source] Prevalence and Trends in Overweight in Mexican-American Adults and ChildrenNUTRITION REVIEWS, Issue 2004Katherine M. Flegal Ph.D. Overweight and obesity have been increasing in many countries. Our objective is to describe the trends in overweight and obesity occurring in the Mexican-American population in the United States. Data on measured height and weight for Mexican Americans come from the following surveys: the Hispanic Health and Nutrition Examination Survey (HHANES, 1982,84), the Third National Health and Nutrition Examination Survey (NHANES III, 1988,94), and NHANES 1999,2002. In 1999,2002, 73% of Mexican-American adults were overweight and 33% were obese. Obesity increased between NHANES III and NHANES 1999,2002, from 24% to 27% for men and from 35% to 38% for women. Increases were also seen for children and adolescents. The Mexican-American population in the United States, both children and adults, is showing trends in overweight and obesity over time that are similar to those seen in other segments of the U.S. population and indeed in many countries [source] Trends in overweight and obese adults in Malaysia (1996,2009): a systematic reviewOBESITY REVIEWS, Issue 6 2010A. Z. Khambalia Summary Like other nations experiencing rapid industrialization, urbanization and a nutrition transition, there is concern in Malaysia of a possible escalation in the prevalence of overweight and obesity. In 1996, the National Health and Morbidity Survey reported a 16.6% and 4.4% prevalence of overweight and obesity, respectively. In the following decade, there have been several national and community surveys on overweight and obesity in Malaysia. The objective of this systematic review is to describe the trend from 1996 to 2009 in the prevalence of overweight and obesity in adults in Malaysia nationally and by gender, age and race. Results indicate that there has been a small rise in overweight adults in the years 1996, 2003 and 2006 (20.7%, 26.7% and 29.1%) and a much more dramatic increase in obesity in 1996, 2003, 2004 and 2006 (5.5%, 12.2%, 12.3% and 14.0%). Evidence showed a greater risk for overweight and obesity among women compared with men. Based on the highest-quality studies, overweight and obesity levels were highest among adults 40,59 years old. Overweight levels were highest among Indians, followed by Malays, Chinese and Aboriginals, with less consistency across studies on the order of risk or obesity by ethnicity. [source] The burden of overweight and obesity-related ill health in the UKOBESITY REVIEWS, Issue 5 2007S. Allender Summary This paper reviews previous cost studies of overweight and obesity in the UK. It proposes a method for estimating the economic and health costs of overweight and obesity in the UK which could also be used in other countries. Costs of obesity studies were identified via a systematic search of electronic databases. Information from the WHO Burden of Disease Project was used to calculate the mortality and morbidity cost of overweight and obesity. Population attributable fractions for diseases attributable to overweight and obesity were applied to National Health Service (NHS) cost data to estimate direct financial costs. We estimate the direct cost of overweight and obesity to the NHS at £3.2 billion. Other estimates of the cost of obesity range between £480 million in 1998 and £1.1 billion in 2004 [Correction added after online publication 11 June 2007: ,of the cost of obesity' added after ,Other estimates']. There is wide variation in methods and estimates for the cost of overweight and obesity to the health systems of developed countries. The method presented here could be used to calculate the costs of overweight and obesity in other countries. Public health initiatives are required to address the increasing prevalence of overweight and obesity and reduce associated healthcare costs. [source] Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and IndiansOBESITY REVIEWS, Issue 3 2002M. Deurenberg-Yap Summary The aim of this study was to investigate the relationship between body mass index (BMI) and body fat percentage (BF%) in Singaporean Chinese, Malays and Indians, and to determine the risk for selected comorbidities at various BMI categories and abdominal fat distributions, as assessed by waist circumference (WC). The study was a cross-sectional (population) design. In total, 4723 subjects participated in the National Health Survey of 1998 in which the risks were investigated. A selected subsample of 291 subjects participated in a detailed body composition study, where weight, height and WC were measured, as were blood pressure, total and high-density lipoprotein (HDL) cholesterol, serum triglycerides and fasting glucose. In the subsample, BF% was determined by means of a chemical four-compartment model. At any given BF% the BMI of Singaporeans was about 3 kg m,2 lower than that of Caucasians. There were slight differences in the BF%/BMI relationship between the three ethnic groups. For all the ethnic groups, it was found that at low categories of BMI (between 22 and 24 kg m,2) and WC (between 75 and 80 cm for women and between 80 and 85 cm for men), the absolute risks for having at least one of the aforementioned risk factors were high, ranging from 41 to 81%. At these same categories the relative risks were significantly higher compared to the reference category, odds ratios ranging from 1.97,4.38. These categories of BMI and WC were all far below the cut-off values of BMI and WC as currently recommended by the World Health Organization (WHO). The data from the current study, which includes evidence that not only risk factors, but also BF% are elevated at low BMI values, presents a strong case for lowering the BMI cut-off value for overweight and obesity among Singaporeans, from 25 kg m,2 and 30 kg m,2 to 23 kg m,2 and 27 kg m,2, respectively. [source] Prescription and non-prescription analgesic use among the US adult population: results from the third National Health and Nutrition Examination Survey (NHANES III),PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2003Ryne Paulose-Ram PhD Abstract Purpose To estimate prescription and non-prescription analgesic use in a nationally representative sample of US adults. Methods Data collected during the third National Health and Nutrition Examination Survey (1988,1994), for persons 17 years and older were analyzed (n,=,20,050). During the household interview, respondents reported use, in the last month, of prescription and non-prescription analgesics. Results An estimated 147 million adults reported monthly analgesic use, Prescription analgesic use was 9% while non-prescription use was 76%. Females were more likely than males to use prescription (11 vs. 7%, p,<,0.001) and non-prescription (81 vs. 71%, p,<,0.001) analgesics. Across race,ethnicity groups, males (,8%) and females (11,13%) had similar age-adjusted prescription analgesic use. Non-prescription analgesic use was higher among non-Hispanic whites than non-Hispanic blacks and Mexican,Americans for males (76 vs. 53% (p,<,0.001) and 59% (p,<,0.001), respectively) and females (85 vs. 68% (p,<,0.001) and 71% (p,<,0.001), respectively). With increasing age, prescription analgesic use increased whereas non-prescription use decreased. Approximately 30% of adults used multiple analgesics during a 1-month period. This was more common among females (35%) than males (25%, p,<,0.001) and among younger (17,44 years, 33%) rather than older age groups (45+ years, 26%, p,<,0.001). Conclusions Analgesic use among US adults is extremely high, specifically of non-prescription analgesics. Given this, health care providers and consumers should be aware of potential adverse effects and monitor use closely. Published in 2002 by John Wiley & Sons, Ltd. [source] The trend of mean BMI values of US adults, birth cohorts 1882,1986 indicates that the obesity epidemic began earlier than hitherto thoughtAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 5 2010John Komlos Background: The trend in the body mass index (BMI) values of the US population has not been estimated accurately because the time series data are unavailable and the focus has been on calculating period effects. Objectives: To estimate the trend and rate of change of BMI values by birth cohorts stratified by gender and ethnicity born 1882,1986. Methods: We use loess additive regression models to estimate age and trend effects of BMI values of US-born black and white adults measured between 1959 and 2006. We use all the National Health Examination Survey and National Health and Nutrition Examination Survey data. Results: The increase in BMI was already underway among the birth cohorts of the early 20th century. The rate of increase was fastest among black females; for the three other groups under consideration, the rates of increase were similar. The generally persistent upward trend was punctuated by upsurges, particularly after each of the two world wars. The estimated rate of change of BMI values increased by 71% among black females between the birth cohorts 1955 and those of 1965 is indicative of the rapid increases in their weight. Conclusions: We infer that transition to postindustrial weights was a gradual process and began considerably earlier than hitherto supposed. Am. J. Hum. Biol. 22:631,638, 2010. © 2010 Wiley-Liss, Inc. [source] | |||||||||||||||||||