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PubMed2004

Trends in overweight among adolescents living in the poorest and richest regions of Brazil.

OBJECTIVES: We assessed changes in body mass index (BMI) among Brazilian adolescents. METHODS: In 1975, 1989, and 1997, we conducted household surveys of the weights and statures of a probabilistic sample of about 50,000 Brazilian adolescents aged 10 to 19 years. Weighted prevalences were calculated and an analysis was performed with the sample design taken into account. RESULTS: Adolescents of rich (southeast) and poor (northeast) regions showed a substantial increase in BMI. In the southeast, the prevalence of overweight, defined by international age- and gender-specific BMI cutoffs, for both genders reached 17% in 1997, whereas in the northeast, the prevalence tripled, reaching 5% among boys and 12% among girls. Older girls living in urban areas in the southeast showed a decrease in prevalence from 16% to 13% in the latter 2 surveys. For all boys and for young girls, the BMI values for the 85th percentile in 1997 were much higher than the 95th percentile values in 1975. CONCLUSIONS: BMI increased dramatically in Brazilian adolescents, mainly among boys; among older girls from the richest region, the prevalence of overweight is decreasing.

Adolescent↗
PubMed2003

Social and dietary determinants of body mass index of adult Jamaicans of African origin.

OBJECTIVES: To determine the relationships between body mass index (BMI) and diet, social and behavioural factors among adult Jamaicans of African origin. DESIGN: Cross-sectional. SETTING: Urban communities in Jamaica, West Indies. SUBJECTS: Three-hundred and sixty-three males and 561 females of African origin, aged 25-74 y. RESULTS: Women had higher mean BMIs (27.5+/-6.4 kg/m(2)) than men (23.4+/-4.3 kg/m(2)); 30.7% of women compared with 6.7% of men were obese. There was a tendency for obese men to have higher percentage of intakes from fat and less from carbohydrate, and women reported diets in which the percentage contribution of protein increased significantly with increasing BMI. In multivariate analyses, BMI was not explained by energy but was associated with protein intakes in females only. Predictors of relative weight were inversely related. Social (marital status) and behavioural (cigarette smoking) factors predicted BMI in both genders; older age in men and increased fibre intakes in women were associated with lower BMI. CONCLUSIONS: Social and behavioural factors are important determinants of body weight. Further investigations are needed which consider factors such as physical activity, genetic and other environmental variables as predictors of relative weight.

Adult↗
PubMed2004

South African national household survey of HIV/AIDS prevalence, behavioural risks and mass media impact--detailed methodology and response rate results.

OBJECTIVES: To describe the methodology used in a recent survey of HIV/AIDS in South Africa and to present the response rates. METHODS: A cross-sectional, national household-based survey was conducted using second-generation surveillance procedures. A complex multistage sampling technique was used to create a master sample of 1,000 census enumerator areas out of a total of 86,000 nationally. Aerial photographs were taken and used to randomly select more than 10,197 households and ultimately 13,518 individuals from a sampling frame of 31,321 people. Phase 1 of the study involved notifying the household residents about the study and collecting key demographic information on respondents aged 2 years and older. This information was used to randomly select up to 3 respondents from each household: 1 adult (25 years and older), 1 youth (15-24 years), and 1 child (2-14 years). In phase 2 nurses interviewed respondents and collected oral fluid specimens for HIV testing. In the case of children aged 2-11 years, parents or guardians were interviewed, but HIV testing was performed on the selected children. Questionnaire data were anonymously linked with HIV test results. RESULTS: A total of 9,963 persons agreed to be interviewed and 8,840 were tested for HIV, yielding a response rate of 73.7% and 65.4% respectively. However, only 8,428 (62.3%) HIV test results were correctly matched with behavioural data. The results showed that those tested for HIV did not differ from those not tested in terms of key determinants. CONCLUSION: It is possible to use community-based surveys to study the prevalence of HIV in the general population.

Adolescent↗
PubMed2003

Mass media release of medical research results: an analysis of antihypertensive drug prescribing in the aftermath of the calcium channel blocker scare of March 1995.

BACKGROUND: Disclosure of medical research results to the public creates tension between lay medical reporters and the medical profession. OBJECTIVE: To explore the early effect of media attention on the risks associated with short-acting calcium channel blockers (CCBs) for treating hypertension after publication at a national meeting and following publication. DESIGN: Time-series analysis of prescription claims data. SETTING AND DATA SOURCE: National third-party pharmaceutical benefits manager. PATIENTS: Employed or retired persons and their families, 18 years of age or older, receiving prescription benefits from 1 of 4 national companies that contracted with the pharmaceutical benefits manager exclusively for prescription drug coverage. MEASUREMENTS: Prescription claims for antihypertensive drugs by fill date converted to a percentage of all cardiovascular drug claims. Data were grouped into weekly intervals before and immediately after the national release of negative information about CCBs on March 10, 1995 and following publication of the results on August 23, 1995. RESULTS: The most prevalent antihypertensive drugs were diuretics (21% of cardiovascular prescription claims) and calcium channel blockers (19%). A 10% decline in prescriptions filled for CCBs occurred 4 weeks following the intense media attention. Only prescriptions for long-acting calcium channel blockers declined. Alpha-1-blocker prescriptions increased by approximately the same amount that prescriptions for CCBs declined, suggesting substitution of one drug for the other. Changes in diuretic or beta-blocker prescriptions filled were not statistically significant. No immediate change in other cardiovascular drug classes occurred following journal publication. CONCLUSIONS: Intense media publicity regarding a controversial study measurably and unpredictably changed prescription claims.

Adolescent↗
PubMed2006

Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?

OBJECTIVE: To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later. DESIGN: Population-based 5-year longitudinal study. PARTICIPANTS: Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2). MAIN OUTCOME MEASURES: Weight status, binge eating, extreme weight control, and self-reported eating disorder. STATISTICAL ANALYSIS: Multiple linear and logistic regressions. RESULTS: Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors. CONCLUSIONS: Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

Adolescent↗
PubMed2006

Obesity intervention in persons with spinal cord injury.

STUDY DESIGN: A single group uncontrolled trial. OBJECTIVES: Despite widespread emphasis on the obesity-related health risks in persons with spinal cord injury (SCI), limited research has been carried out to intervene in this problem. This study was conducted to assess the initial effectiveness of a weight loss program on various health outcomes in persons with SCI. SETTING: A rehabilitation center in Birmingham, Alabama, United States. METHODS: A total of 16 individuals with chronic SCI who were overweight or obese participated in a weight management program that consisted of 12 weekly classes, covering nutrition, exercise, and behavior modification. Various outcomes were examined over a 6-month period (baseline, week 12, and week 24), including body composition measured by dual energy X-ray absorptiometry, physiologic measures, diet behavior, and psychosocial and physical functioning. Of these, 13 participants returned for the week 24 follow-up. RESULTS: Weight loss averaged 3.5+/-3.1 kg (3.8% of the initial weight) at week 12 and 2.9+/-3.7 kg (3.0% of the initial weight) at week 24. There was a significant reduction from baseline values at weeks 12 and 24 in body mass index, anthropometric measurements, and fat mass and improvement in diet behavior and psychosocial and physical functioning, while lean mass and blood albumin and hemoglobin levels were maintained. A correlation analysis showed that a greater weight loss was importantly (r>0.4) associated with a greater reduction in total cholesterol at weeks 12 and 24 and in systolic and diastolic blood pressure at week 24. Several factors were important (r>0.4 or r<-0.4) in determining the success in weight loss, including age, race, marital and employment status, family history of overweight/obesity, level and duration of injury, and cholesterol level at baseline. CONCLUSIONS: This is the first demonstration that a carefully planned program with time-calorie displacement diet is effective for overweight/obese individuals with SCI to lose weight without compromising total lean mass and overall health. It provides foundation for a future large clinical trial for weight loss of persons with SCI or other spinal cord dysfunction.

Adult↗
PubMed1995

Metabolism of dynorphin A 1-13 in human blood and plasma.

PURPOSE: A detailed investigation of the metabolic routes and rates of Dyn A1-13 in human blood and plasma was performed. METHODS: Human plasma was incubated at 37 degrees C with dynorphin A 1-13 (Dyn A1-13, 15-20 microM). The generated dynorphin fragments were separated by a new ion-pair chromatographic method and identified by matrix assisted laser desorption mass spectroscopy. The kinetic behavior of parent compound and metabolites was evaluated in the absence and presence of enzyme inhibitors. RESULTS: The major plasma metabolites of Dyn A1-13 were Dyn A1-12, A2-12, A4-12 and A4-8. Further metabolites were Dyn A2-13, A3-13, A3-12, A5-12, A6-12, A7-12, A1-10, A2-10, A2-8 and A3-8. At 37 degrees C, Dyn A1-13 had a half-life of less than one minute in plasma and blood. Plasma half-lives of major metabolites ranged between 0.5 and 4 min. Inter- and intra-individual differences in healthy volunteers were 30% (c.v.). Dyn A1-13 is mainly metabolized by carboxypeptidases to Dyn A1-12 (80%) and by aminopeptidases to Dyn A2-13 (15%). Dyn A1-12 and Dyn A2-13 are predominantly converted into Dyn A2-12 (67% of Dyn A1-13). Subsequent metabolic steps yield Dyn A3-12 (16%), Dyn A4-12 (37%) and Dyn A4-8 (33%). Aminopeptidases generate Dyn A2-12, A3-12, A4-12, A5-12. ACE metabolizes Dyn A1-12 (19%), A2-12 (33%), A3-12 (34%) and A4-12 (46%). Bestatin-sensitive endopeptidases (possibly endopeptidase 24.11) metabolize 30% of Dyn A2-12. Dyn A4-8 is formed via Dyn A4-12 (23% of Dyn A4-12) and Dyn A2-10 (37% of Dyn A2-10). CONCLUSIONS: The combination of enzyme inhibition experiments and noncompartmental kinetic analysis proved to be a powerful tool for the detailed evaluation of the metabolic fate of Dyn A1-13 in human blood and plasma.

Adult↗
PubMed1997

Influence of interpersonal and mass-mediated interventions on injection drug and crack users: diffusion of innovations and HIV risk behaviors.

Evaluation research of public health media campaigns to influence behavior change often bemoans the lack of relevance to target audience and an absence of integrated interpersonal and mass-mediated communication channels. The assumption that illegal drug users are disconnected from mass-mediated communication may account for this absence of media interventions. The authors used cross-tabulation, chi-square, and regression analyses to demonstrate that many out-of-treatment drug users in an HIV-prevention research project are media consumers and that participants who recalled seeing or hearing media interventions reported greater levels of positive behavior change than participants who did not recall such messages. Results suggest coordination of human and mass-mediated public health messages relevant to this population to facilitate behavior changes.

Adolescent↗
PubMed2000

Correlates of physicians' prevention-related practices. Findings from the Women Physicians' Health Study.

BACKGROUND: Determinants of physicians' prevention-related counseling and screening practices are not well understood. Such determinants are worth knowing because we can then intervene on malleable variables and produce physicians with stronger prevention-related skills. Of the few such variables that have been examined, they have typically only been studied in univariate analyses or in small or otherwise limited populations and have been especially sparsely studied in women physicians. OBJECTIVE: To explore the effect of potential counseling- and screening-related variables in 4501 respondents to the Women Physicians' Health Study, a questionnaire-based study of a representative sample of US women MDs. RESULTS: Being a primary care practitioner and practicing a related health habit oneself were significantly correlated with reporting counseling and screening for all prevention-related variables examined. Current attempts to improve a related habit oneself, ethnicity, region, practice site, and amount of continuing medical education were sometimes significantly correlated with counseling and screening; most other variables studied (i.e., personal health status, a personal or family history of disease, control of work environment, and career satisfaction) were rarely significantly correlated. CONCLUSIONS: Being a primary care practitioner and having related healthy habits oneself were the most significant correlates of US women physicians' self-reported prevention-related counseling and screening practices. These findings suggest potential new directions for physician training.

Adult↗
PubMed1998

Health-related behaviors of women physicians vs other women in the United States.

OBJECTIVE: To examine the health-related behaviors of women physicians compared with those of other women of high and not high socioeconomic status and with national goals. METHODS: We examined the results of a questionnaire-based survey of a stratified random sample, the Women Physicians' Health Study, and a US telephone survey (Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention, Atlanta, Ga). We analyzed 3 samples of women aged 30 to 70 years: (1) respondents from the Women Physicians' Health Study (n = 4501); (2) respondents from the Behavioral Risk Factor Surveillance System (n = 1316) of the highest socioeconomic status; and (3) all other respondents from the Behavioral Risk Factor Surveillance System (n = 35,361). RESULTS: Women physicians were more likely than other women of high socioeconomic status and even more likely than other women not to smoke. The few physicians (3.7%) who smoked reported consuming fewer cigarettes per day, and physicians who had stopped smoking reported quitting at a younger age than women in the general population. Women physicians were less likely to report abstaining from alcohol, but those who drank reported consuming less alcohol per episode than other women and were less likely to report binging on alcohol than women in the general population. Unlike women in the general population and even other women of high socioeconomic status, women physicians' reported behaviors exceeded national goals for the year 2000 in all examined behaviors and screening habits. CONCLUSIONS: Women physicians report having generally good health habits even when compared with other socioeconomically advantaged women and report exceeding all examined national goals for personal screening practices and other personal health behaviors. Women physicians' behaviors may provide useful standards for other women in the United States.

Adult↗
PubMed2005

Personal fulfillment motivates adolescents to be physically active.

OBJECTIVES: To identify factors that motivate adolescents to be physically active; to assess differences in motivators for groups at risk for physical inactivity, including girls vs boys, overweight vs nonoverweight youth, and youth with low vs high perceived sport competence; and to assess links between activity motivation and physical activity. DESIGN: Cross-sectional study. SETTING: A middle school in rural central Pennsylvania. PARTICIPANTS: Two hundred two girls (n = 92) and boys (n = 110). MAIN EXPOSURE: Motivations to be physically active were assessed using the Activity Motivation Scale. Perceived sport competence was measured by the Physical Self Description Questionnaire. Participants' height and weight were measured and used to classify their overweight status. MAIN OUTCOME MEASURE: Three self-reported measures were used to assess adolescents' physical activity. RESULTS: Adolescents were most likely to report personal fulfillment as the strongest motivating factor for physical activity (mean [SD], 3.49 [0.56]), followed by weight-based motivation (mean [SD], 2.39 [0.93]), peer motivation (mean [SD], 2.09 [0.67]), and parent motivation (mean [SD], 1.72 [0.73]; F = 680.74; P<.001). Overweight adolescents reported significantly higher weight-based motivation (mean [SD], 2.84 [0.79]) compared with nonoverweight adolescents (mean [SD], 2.06 [0.89]; F = 40.52; P<.001), and adolescents with low perceived sport competence reported significantly lower personal fulfillment motivation (mean [SD], 3.20 [0.68]) compared with adolescents with higher perceived sport competence (mean [SD], 3.69 [0.32]; F = 52.31; P<.001). Personal fulfillment was the only motivating factor that showed a consistent moderate to strong association with physical activity across all regression models. CONCLUSION: Personal fulfillment motivation should be considered when designing physical activity promotion programs for adolescents.

Adolescent↗
PubMed1997

Body figure perceptions and eating attitudes among Australian schoolchildren aged 8 to 12 years.

OBJECTIVE: How widespread is the desire for thinness among preadolescent Australian children and are there gender differences? METHOD: Two hundred forty-four children from Grades 3 to 6 completed the children's version of the Eating Attitudes Test (ChEAT), reported whether they had ever wanted to be thinner or tried to lose weight, and selected pictures ranging from thin to fat to depict their current and ideal body images. RESULTS: Fifty percent of girls and 33% of boys have wanted to be thinner, and 40% and 24%, respectively, have attempted to lose weight. Percentages of girls and boys scoring above the ChEAT screening threshold for anorexia risk were 14% and 8%, respectively. ChEAT scores, attitudes and behaviors, and current and ideal figure perceptions were significantly related to body mass index (BMI). DISCUSSION: Attitudes and behaviors were consistent with recent U.S. and Israeli findings that concerns about being overweight are prevalent among 8- to 12-year-olds. High ChEAT scores among Grade 3 children raised the question of whether very young children adequately understand this questionnaire.

Attitude↗
PubMed1990

Changes in breast self-examination behavior achieved by 89,835 participants in the Canadian National Breast Screening Study.

Breast self-examination (BSE) behavior was analyzed in 89,835 participants in the National Breast Screening Study (NBSS) of whom 64,619 were eligible for annual rescreening and 25,216 were followed by mail after a single screen exam. Among those eligible for rescreening, BSE competence scores based on seven BSE criteria significantly improved over time and correlated directly with reported BSE frequencies. Among all participants, the proportion reporting BSE frequencies of greater than or equal to 12/year increased over time from approximately 20% on entry to 50% to 64% at final screen. Similarly, reports of zero frequency diminished from 50% to 10% to 15%. Variables such as educational status, age (fifth versus sixth decades), eligibility for mammography, smoking history, and ethnic origin had negligible or no influence on BSE competence. However, women with first-degree relatives with breast cancer had significantly higher BSE scores. NBSS experience suggests that most women who enter screening programs will upgrade their BSE skills if subjected to brief episodes of repeated BSE instruction.

Adult↗
PubMed2001

Effect of added NaHCO3 on the basic properties of apatite cement.

Alternation of a composition of set apatite cement (AC) from carbonate-free apatite (CO3-free AP) to carbonate apatite (CO3-AP) may accelerate replacement of the set AC with bone because CO3-AP can be dissolved much faster than CO3-free AP in the weak acidic solution produced by osteoclasts. In this investigation, NaHCO3 was added to the AC component and the effects of added NaHCO3 on cement-setting behavior and on set mass were studied as an initial step for the fabrication of AC, which can be replaced with bone faster than current AC. When NaHCO3 was added to AC, the resultant set mass contained CO3. Although not all CO3 was incorporated in the set AC, the amount of CO3 incorporated into the set AC increased with the amount of added NaHCO3. Powder X-ray diffraction analysis and Fourier transform infrared spectrometer measurements revealed the formation of B-type CO3-AP. The setting time measured in an incubator at 37 degrees C and 100% relative humidity slowed from 30 to 45 min, indicating that NaHCO3 has an inhibitory effect on AP formation. The diametral tensile strength of the set AC decreased significantly with the addition of NaHCO3. Scanning electron microscopic observation revealed that fine crystals were formed in the set AC when NaHCO3 was added to AC. As a result, the crystallinity indices of the set AC measured using X-ray diffraction and Fourier transform infrared spectroscopy decreased with an increase in the amount of added NaHCO3. The dissolution rate of set AC in weak acid, pH 5.5, increased with the amount of added NaHCO3. We concluded that the formation of B-type CO3-AP and the resulting faster dissolution of set AC in weak acidic solution is preferable for the faster replacement of set AC with bone even though the decreased diametral tensile strength value is a shortcoming.

Apatites↗