Etiology and prognosis of pregnancy-related pelvic girdle pain; design of a longitudinal study

The impact of individual and contextual socioeconomic factors on colorectal cancer screening adherence in Turin, Italy: a multilevel analysis

BACKGROUND

Screening participation can be influenced by both individual socioeconomic position and contextual factors. In Italy, disparities exist regarding screening adherence, but it is important to understand the specific factors driving these disparities in specific locations according to different screening protocols. The aim of this study is to identify the impact of individual and contextual socio-economic factors on adherence to the organized colorectal cancer screening in the city of Turin, Italy.

METHODS

Retrospective observational study on the population of assisted residents in Turin, eligible for colorectal screening from January 2010- June 2019. Colorectal screening in Piedmont involved inviting 58-year-old individuals to undergo a flexible sigmoidoscopy (FS) or, in case of non-adherence, a faecal immunochemical test (FIT). The program also included another protocol based directly on FIT as the first test. Adherence to the two screening protocols according to demographic/socioeconomic characteristics and contextual factors was evaluated with multilevel Poisson models.

RESULTS

90,227 eligible subjects (53% females) were analysed exploring adherence to FS/FIT. Lower likelihood of participation was found among males from High-Migratory-Pressure-Countries (HMPC), subjects with the lowest educational level, unemployed individuals, subjects living in rented houses, living alone/cohabiting and single parents. Among males, retirees and subjects living in more deprived areas participated more. 36,674 subjects (53% females) were analysed exploring adherence to the first FIT invitation. Adherence rate was higher among women (40% vs. 36%). Lower likelihood of participation was found among HMPC immigrants, males with the lowest educational level, people living in rented accommodation, living alone/cohabiting and single parents. Higher participation was found in retirees. In males, no differences were found between subjects living in more and less deprived areas, but a different likelihood of participation was observed across different areas of the city.

CONCLUSIONS

Socioeconomic and demographic characteristics influence access to organized colorectal screening in Turin. Immigrant status, low level of education, poor housing conditions and lack of social support, with some differences according to gender, emerged as the most significant barriers that should be tackled in order to increase screening participation and reduce inequalities. Contextual factors play a role only among male subjects.

The Frequency of Back Pain, Lumbar Pain, And Pelvic Girdle Pain During Pregnancy

BACKGROUND

Upper back pain, lower back pain, and pelvic girdle pain are common problems during pregnancy. There is limited research in Turkey on their prevalence and associated factors.

AIM

This study aims to determine the frequency of upper back, lower back, and pelvic girdle pain occurring in the second half of pregnancy and its associated factors.

METHODS

A descriptive, cross-sectional, and correlational study was conducted on 515 pregnant women between December 2019 and May 2020. Data were collected using a questionnaire. The questionnaire included sociodemographic characteristics and the pelvic girdle questionnaire.

FINDINGS

The study included 515 pregnant women. The mean age was 28.31 ± 3.86 years, and the mean gestational age was 32.78 ± 5.41 weeks. Of the participants, 2.7% reported upper back pain, 22.3% reported lower back pain, and 59% reported pelvic girdle pain. The mean pain score for those with upper back pain was 56.66 ± 30.11; for lower back pain, it was 48.19 ± 18.44; and for pelvic girdle pain was 10.60 ± 7.69. Maternal characteristics, including age, education level, employment status, smoking status, regular exercise, parity, gravidity, and gestational age, were significantly important determinants of pelvic girdle pain (PGP) during pregnancy.

CONCLUSION

More than half of pregnant women reported PGP. The prevalence of PGP was higher than that of upper and lower back pain. Specific maternal sociodemographic characteristics influenced PGP during pregnancy.

Socioeconomic mobility, metabolic health, and diet: mediation via subjective socioeconomic status

OBJECTIVE

Socioeconomic mobility, i.e., changing socioeconomic status (SES) between adolescence and adulthood, may impact health through changing resources, social status, and health-related behaviors. This analysis examined whether subjective SES contributes to associations of mobility with metabolic health (BMI and metabolic syndrome) and unhealthy diets (fast-food consumption and sugar-sweetened beverage [SSB] consumption).

METHODS

National Longitudinal Study of Adolescent to Adult Health data were used (n = 4132). Mobility was defined as the difference between adolescent (collected 1994-1995, ages 11-19 years) and adult (collected 2016-2018, ages 33-43 years) SES. Linear and logistic regressions examined associations of mobility with metabolic and dietary outcomes and mediation by subjective SES.

RESULTS

Substantial upward mobility was associated with lower risk of high SSB consumption compared with stable disadvantaged SES (risk difference: -0.10 [95% CI: -0.16 to -0.041]). Subjective SES mediated associations of upward, but not downward, mobility with risks of developing metabolic syndrome, high fast-food consumption, and high SSB consumption; upward mobility was associated with higher subjective SES and lower risks of poor metabolic and dietary outcomes.

CONCLUSIONS

The finding that subjective SES contributed to associations between upward mobility and better health may inform development of interventions designed to promote healthier diets and reduce socioeconomic disparities in metabolic health.

Associations of physical activity and weight gain during pregnancy with pregnancy-related pelvic girdle pain intensity - A retrospective cohort study

OBJECTIVE

The aims of this study were first, to explore pain trajectories of pelvic girdle pain, and second, to explore if weight gain during pregnancy and/or physical activity before and during pregnancy were associated with the severity of pelvic girdle pain.

METHODS

The study included data from a retrospective cohort study in 2009, with data collection performed via questionnaires. Group-based trajectory modelling was performed on the reported intensity of pelvic girdle pain in each pregnancy month, and associations between the latent classes and physical activity and/or weight gain were assessed.

RESULTS

A total of 569 women were included in the analyses. Five distinct trajectory classes for the course of pelvic girdle pain were identified. A higher body mass index (BMI) increase during pregnancy was negatively associated with the probability of being pain free, with -3.2 percentage points per unit increase in BMI (95 % CI -5.3 to -1.1; p = 0.003), and positively associated with the probability of experiencing early onset moderate to severe pain, +1.1 percentage points per unit increase in BMI (95 % CI 0.2 to 2.1; p = 0.022). Weight gain below recommendations was negatively associated with early onset moderate to severe pain; -10.6 percentage points per unit increase in BMI (95 % CI -18.8to-2.4;p = 0.011). Physical activity in pregnancy was not significantly associated with pain trajectory classes when adjusting for pre-pregnancy variables.

CONCLUSIONS

Our findings suggest that pelvic girdle pain intensity during pregnancy can take multiple courses and is associated with weight gain during pregnancy.

Perspectives of parents with lived experience of cytomegalovirus infection, on universal newborn screening for congenital cytomegalovirus (cCMV) in Canada: a patient-led qualitative study

OBJECTIVE

To understand parental perspectives regarding universal newborn screening (UNS) for congenital cytomegalovirus (cCMV) in Canada.

DESIGN

A qualitative, patient-led study using the Patient and Community Engagement Research approach consisting of online focus groups and in-depth individual interviews to understand parental preferences regarding UNS for cCMV. Data were analysed iteratively using inductive thematic analysis and narrative story analysis.

SETTING

Canada-wide study conducted via video conference from October to December 2023.

PATIENTS

12 participants from five Canadian provinces who self-identified as 18 years of age or older and as having parental lived experience with cytomegalovirus (CMV) or cCMV participated in the study.

RESULTS

We identified three themes: (1) attitudes about UNS for cCMV, including participants' unanimous support for UNS and confirmation that parental anxiety is not a deterrent for screening, (2) cCMV diagnosis, including the importance of coupling cCMV diagnosis with access to treatment and medical support and (3) awareness of cCMV, where participants shared their frustration about the lack of public and pregnant people's awareness of cCMV.

CONCLUSIONS

Parental anxiety is not a deterrent for UNS for cCMV. Children with cCMV and their families deserve every opportunity to attain their best possible outcomes. UNS offers children with cCMV access to early intervention if they need it, and also helps to raise awareness and education to prevent future CMV infections.

Perturbation-based balance training of older adults and effects on physiological, cognitive and sociopsychological factors: a secondary analysis from a randomised controlled trial with 12-month follow-up

BACKGROUND

Perturbation-based balance training (PBT) has shown promising, although diverging, fall-preventive effects; however, the effects on important physical, cognitive and sociopsychological factors are currently unknown. The study aimed to evaluate these effects on PBT at three different time points (post-training, 6-months and 12-months) in community-dwelling older adults compared with regular treadmill walking.

METHODS

This was a preplanned secondary analysis from a randomised, controlled trial performed in Aalborg, Denmark, between March 2021 and November 2022. Community-dwelling older adults aged ≥65 were randomly assigned to participate in four sessions (lasting 20 min each) of either PBT (intervention) or regular treadmill walking (control). All participants were assigned to four testing sessions: pretraining, post-training, 6-month follow-up and 12-month follow-up. At these sessions, physical, cognitive and sociopsychological measures were assessed.

RESULTS

In total, 140 participants were randomly allocated to either the PBT or control group. Short-term (pretraining to post-training) between-group differences were seen for choice stepping reaction time (-49 ms, 95% CI -80 to -18), dual-task gait speed (0.05 m/s, 95% CI 0.01 to 0.09) favouring the PBT group. However, these improvements were not sustained at the 6-month and 12-month follow-up. No significant between-group differences were found in other physical, cognitive or sociopsychological factors.

CONCLUSIONS

This study showed that PBT, in the short term, improved choice stepping reaction time and dual-task gait speed among community-dwelling older adults. Yet, these improvements were not retained for 6- or 12-months. The healthy state of the study's population may have imposed a ceiling effect limiting the ability to show any clinically relevant effects of PBT.

TRIAL REGISTRATION NUMBER

NCT04733222.

Women's and maternity care providers' perceptions of pain management during childbirth in hospitals in Southern Tanzania

BACKGROUND

The majority of women experience pain during childbirth. Offering and supporting women to use different methods for coping with pain is an essential competency for maternity care providers globally. Research suggests a gap between what women desire for pain management and what is available and provided in many low-and middle-income settings. The study aimed to understand how pain management is perceived by those involved: women experiencing childbirth and maternity care providers.

METHODS

Individual semi-structured interviews with women (n = 23), maternity care providers (n = 17) and focus group discussions (n = 4) with both providers and women were conducted in two hospitals in Southern Tanzania in 2021. Transcribed interviews were analysed using reflexive thematic analysis. Coding and analysis were supported by the software MAXQDA.

RESULTS

Three main themes were generated from the data. The first, 'pain management is multifaceted', describes how some providers and women perceived pain management as entailing various methods to manage pain. Providers perceived themselves as having a role in utilization of pain management to varying degree. The second theme 'pain management is primarily a woman's task' highlights a perception of pain management as unnecessary, which appeared to link with some providers' perceptions of pain as natural and necessary for successful childbirth. Few women explicitly shared this perception. The third theme 'practice of pain management can be improved' illustrates how women and maternity care providers perceived current practices of pain management as suboptimal. According to providers, this is primarily due to contextual factors such as shortage of staff and poor ward infrastructure.

CONCLUSION

Women's and maternity care providers' perceptions ranged from perceiving pain management as involving a combination of physiological, psychological and social aspects to perceive it as related with limited to no pain relief and/or support. While some women and providers had similar perceptions about pain management, other women also reported a dissonance between what they experienced and what they would have preferred. Efforts should be made to increase women's access to respectful pain management in Tanzania.

Strengthening the WHO Regional Office for Africa (WHO AFRO) COVID-19 vaccination information system

This manuscript describes the process and impact of strengthening the WHO Regional Office for Africa (WHO AFRO)'s COVID-19 vaccination information system. This system plays a critical role in tracking vaccination coverage, guiding resource allocation and supporting vaccination campaign roll-out for countries in the African region. Recognising existing data management issues, including complex reporting prone to human error, compromised data quality and underutilisation of collected data, WHO AFRO introduced significant system improvements during the COVID-19 pandemic. These improvements include shifting from an Excel-based to an online Azure-based data collection system, automating data processing and validation, and expansion of collected data. These changes have led to improvements in data quality and quantity including a decrease in data non-validity, missingness, and record duplication, and expansion of data collection forms to include a greater number of data fields, offering a more comprehensive understanding of vaccination efforts. Finally, the creation of accessible information products-including an interactive public dashboard, a weekly data pack and a public monthly bulletin-has improved data use and reach to relevant partners. These resources provide crucial insights into the region's vaccination progress at national and subnational levels, thereby enabling data-driven decision-making to improve programme performance. Overall, the strengthening of the WHO AFRO COVID-19 vaccination information system can serve as a model for similar efforts in other WHO regions and contexts. The impact of system strengthening on data quality demonstrated here underscores the vital role of robust data collection, capacity building and management systems in achieving high-quality data on vaccine distribution and coverage. Continued investment in information systems is essential for effective and equitable public health efforts.

The Acceptability of a Community-Based Perturbation-Based Balance Training to Older Adults and Healthcare Professionals

Background: Perturbation-based balance training (PBT) is a promising fall risk reduction method that involves inducing unexpected perturbations to balance to train participants reactive balance control. Due to the unpredictable nature of PBT, its acceptability to older adults could present a barrier to the implementation of PBT in the community. Aim/Purpose: The purpose of this study was to assess the perceived acceptability of a community-based PBT program to both older adults and healthcare professionals (HCPs). Methods: Nineteen older adults (aged 69.6 ± 6.6 years, 17 women, 2 men) and three HCPs participated in the qualitative study. Participants completed four PBT sessions facilitated in conjunction with HCPs. Interviews, based on the theoretical framework of acceptability, were conducted before and after PBT and analyzed using template analysis. Results: PBT was perceived as effective by older adults and HCPs. However, HCPs perceived the equipment cost as a substantial barrier to feasibility in the community.

"We are not there yet": perceptions, beliefs and experiences of healthcare professionals caring for women with pregnancy-related pelvic girdle pain in Australia

BACKGROUND

Pregnancy-related pelvic girdle pain (PPGP) is a common condition worldwide. Women report being unprepared about PPGP, and state they receive little recognition and support from healthcare professionals. Situated within the Common-Sense Model and Convergent Care Theory, this study sought to gain a conceptual understanding of the perceptions, beliefs and experiences of healthcare professionals who provide routine care for women with PPGP in Australia.

METHODS

A qualitative research design, using individual, semi-structured interviews with purposive sampling of healthcare professionals (N=27) consisting of doctors (N=9), midwives (N=9) and physiotherapists (N=9). Most participants were female (22/27) with a range of professional experience. An interview guide consisting of open-ended questions was used with a flexible and responsive approach. Thematic analysis was performed where interview data were transcribed, coded, grouped into meaningful categories and then constructed into broad themes.

RESULTS

Four themes were identified: 1. Identity and impact of PPGP; 2. What works well?; 3. What gets in the way?; and 4. Quality care: What is needed? Healthcare professionals recognised PPGP as a common and disabling condition, which created a large impact on a woman's life during pregnancy. Stepped-level care, including education and physiotherapy intervention, was seen to be helpful and led to a positive prognosis. Barriers at patient, clinician and organisation levels were identified and led to consequences for women with PPGP not receiving the care they need.

CONCLUSION

This study elucidates important implications for health care delivery. Acknowledging that PPGP is a common condition causing difficulty for many women, healthcare professionals identified strong teamwork and greater clinical experience as important factors in being able to deliver appropriate healthcare. Whilst healthcare professionals reported being committed to caring for women during pregnancy, busy workloads, attitudes towards curability, and a lack of formal education were identified as barriers to care. The findings suggest timely access, clear referral pathways and an integrated approach are required for best care practice for women with PPGP. A greater emphasis on the need for multidisciplinary models of care during pregnancy is evident.

Comparison of parent reported physician diagnosed asthma and general practitioner registration

OBJECTIVE

To compare parent reported physician diagnosed asthma from questionnaires for epidemiological purposes, to general practitioner (GP) recorded childhood asthma.

METHODS

This study was embedded in the KOALA Birth Cohort Study with regular follow-up by ISAAC core questions on asthma in 2834 children in two different recruitment groups, with 'conventional' lifestyles or 'alternative' lifestyles. At age 11-13 years these data were linked to data extracted from GP records. We compared parent reported physician diagnosed asthma, asthma medication use, and current asthma with GP recorded asthma diagnosis and medication. Two different combinations of questions were used to define current asthma (i.e. ISAAC and MeDALL based definition).

RESULTS

Among 958 children with information provided both by the parents and GPs, 98 children (10.2%) had parent reported physician diagnosed asthma, 115 children (12.0%) had a GP recorded asthma diagnosis (Cohen's kappa 0.49; 95% CI 0.40 to 0.57). Discrepant cases showed that asthma symptoms at an early age led to different labeling between parents and GP. The agreement between ISAAC based definition and MeDALL based definition was excellent (Cohen's kappa 0.82; 95% CI 0.74 to 0.88).

CONCLUSION

Parent reported physician diagnosed asthma and GP recorded childhood asthma had only moderate agreement, and is possibly influenced by labeling early transient wheeze as asthma diagnosis. It is important that parent reported physician diagnosed asthma is combined with additional questions such as current asthma symptoms and asthma medication use, as used in ISAAC or MeDALL based current asthma, in order to obtain reliable information for epidemiological research.

Self-Reported Fall-Related Injury and Its Associated Factors among Adults with Visual Impairment Attending St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background

Falls account for vast majority of fractures and are a significant reason for trauma related hospital admissions. The main aim of this study is to determine the prevalence of self-reported fall, related injuries, and associated factors among adult patients with visual impairment.

Methods

Hospital-based cross-sectional study was conducted from July to August 2021. Systematic random sampling technique was used. The data were entered into Epi-data version 3.1 and exported to SPPS version 26 for analysis. Frequency, mean, and percentage, were used to summarize the descriptive data. The association between the outcome variable and explanatory variables was assessed using binary and multivariate logistic regressions. The adjusted odds ratio was calculated, and variables with a p-value below 0.05 at the 95% confidence interval (CI) were considered statistically significant.

Result

A total of 487 study participants were involved in this study with a response rate of 93.83%. The mean age of the study participants was 52 ± 16.26 years. The overall prevalence of self-reported fall was 36.1 %. Being female, being older than 64 years of age, rural residence, fear of falling, and blind stage of visual impairment were significantly associated with falling.

Conclusion

The prevalence of self-reported fall was high among visually impaired individuals. Female sex, age more than 64 years, rural residence, fear of falling, and blind stage of visual impairment were significantly associated with falling. Reducing patients' chances of suffering from falling-related injuries and consequences requires raising awareness about the burden, danger, and effects of falling on persons who are visually impaired.

The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis

A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations. There was a paucity of data for many countries with data from China representing 70% of the comparative studies. Within minority indigenous populations the pooled prevalence of HIV infection was 13.7% (95% CI 8.9, 19) and 8.4% (95% CI 6.3, 10.7) among other populations. The prevalence differential between populations was significant in the WPR (adjusted odds ratio 1.1, 95% CI 1.0, 1.2). Across both regions, in contrast to other populations, minority indigenous did not experience any significant reduction in HIV prevalence over the years of data collection. There was large heterogeneity in the prevalence of HIV across studies.

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

OBJECTIVE

The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.

METHODS

A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale.

RESULTS

Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included.

CONCLUSION

An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.

Aetiological research on the health of migrants living in Germany: a systematic literature review

BACKGROUND

Germany has become an important immigration country and health services need to adopt to meet the needs of an increasingly multicultural population. For public health planning, it is essential to understand the aetiology of health problems among migrant populations. The main objective was to systematically identify, evaluate and synthesise population-based studies that investigated exposure-outcome relationships among migrant groups in Germany.

METHODS

In November 2019, we searched PubMed and LIVIVO, and updated this search in November 2020, to identify peer-reviewed publications that fulfilled our eligibility criteria: English or German language; study on disease aetiology among major migrant groups in Germany, according to the latest microcensus; publication date from inception to 01 November 2020 and observational or experimental study designs. For quality appraisal, we used the Critical Appraisal Skills Programme checklists. Outcomes under investigation were categorised according to the WHO major disease groups, and their associations with risk factors were synthesised as a heat map.

RESULTS

Out of 2407 articles retrieved, we included 68 publications with a total number of 864 518 participants. These publications reported on cross-sectional data (n=56), cohort studies (n=11) and one intervention study. The population groups most frequently studied were from the Middle East (n=28), Turkey (n=24), sub-Saharan Africa (n=24), Eastern Europe (n=15) and the former Soviet Union (n=11). The outcomes under study were population group specific. There were consistent associations of demographic and socioeconomic factors with ill health among migrants in Germany.

DISCUSSION

In this systematic review, we observed low risk of bias in two-thirds of the studies. There is an increasing body of evidence for aetiological research on migrants' health in Germany. Still, the directions of associations between a wide range of risk factors and major disease groups seem only partially understood.

PROSPERO REGISTRATION NUMBER

CRD42018085074.

Socioeconomic and health-related inequalities in major depressive symptoms among older adults: a Wagstaff's decomposition analysis of data from the LASI baseline survey, 2017-2018

OBJECTIVES

To find out the association between socioeconomic and health status and depression among older adults and explore the contributing factors in the socioeconomic and health-related inequalities in late-life depression.

DESIGN

A cross-sectional study was conducted using large representative survey data.

SETTING AND PARTICIPANTS

Data for this study were derived from the baseline wave of the Longitudinal Ageing Study in India conducted during 2017-2018. The effective sample size was 30 888 older adults aged 60 years and above.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable in this study was depression among older adults. Descriptive statistics along with bivariate analysis was conducted to report the preliminary results. Multivariable binary logistic regression analysis and Wagstaff's decomposition were used to fulfil the objectives of the study.

RESULTS

There was a significant difference for the prevalence of depression (4.3%; p<0.05) among older adults from poor (11.2%) and non-poor categories (6.8%). The value of the Concentration Index was -0.179 which also confirms that the major depression was more concentrated among poor older adults. About 38.4% of the socioeconomic and health-related inequality was explained by the wealth quintile for major depression among older adults. Moreover, about 26.6% of the inequality in major depression was explained by psychological distress. Self-rated health (SRH), difficulty in activities of daily living (ADL) and instrumental ADL (IADL) contributed 8.7%, 3.3% and 4.8% to the inequality, respectively. Additionally, region explained about 23.1% of inequality followed by life satisfaction (11.2) and working status (9.8%) for major depression among older adults.

CONCLUSIONS

Findings revealed large socioeconomic and health-related inequalities in depression in older adults which were especially pronounced by poor household economy, widowhood, poor SRH, ADL and IADL difficulty, and psychological distress. In designing prevention programmes, detection and management of older adults with depression should be a high priority, especially for those who are more vulnerable.

Exploring solutions to improve antenatal care in resource-limited settings: an expert consultation

Background

Shortage or low-quality antenatal care is a complex and “wicked” problem relying heavily on contextual, socio-cultural, environmental and intersectional aspects. We report the outcome of an expert consultation discussing solutions to improve antenatal care quality, access and delivery in low- and middle-income countries, and providing recommendations for implementation.

Methods

The social ecological model was used as an analytical lens to map and interpret discussion points and proposed solutions. In addition, a conceptual framework for maternal and neonatal health innovation based on the building blocks of the World Health Organization health system and the Tanahashi Health Systems Performance Model provided a logical overview of discussed solutions.

Results

Many barriers and norms continue to hinder antenatal care access. From values, beliefs, traditions, customs and norms, to poor resource allocation, there is a need of reshaping health systems in order to provide high quality, respectful maternal and childcare. The burden of poor maternal health, morbidity and mortality is concentrated among populations who are vulnerable due to gender and other types of discrimination, have financial constraints and are affected by humanitarian crises.

Conclusions

In order to address maternal health issues, good quality and evidence-based services should be guaranteed. Investments in strengthening health systems, including data and surveillance systems and skilled health workforce, should be considered an essential step towards improving maternal health services.

Controlling risky behavior associated with AIDS: the role of social support, family functioning, self-efficacy and AIDS risk perception

OBJECTIVES

We believe that major steps can be taken towards Acquired Immunodeficiency Syndrome (AIDS) prevention through identifying the relevant factors that are apt to predict risky behavior. The main purpose of the present study was to analyze and evaluate the relationship of social support, family functioning, self-efficacy and AIDS risk perception to controlling risky behavior associated with AIDS.

METHODS

To conduct this cross-sectional study, 765 subjects (59% female) were selected from the youth inhabiting the western provinces of Iran through cluster sampling. Five questionnaires were used: AIDS risk perception, self-efficacy in controlling risky behavior associated with AIDS, controlling risky behavior associated with AIDS, the multidimensional scale of perceived social support, and the family assessment device.

RESULTS

The results demonstrated that all two models enjoyed acceptable fitness, and the mediating roles of self-efficacy and AIDS risk perception were confirmed. Moreover, family functioning and perceived social support together could predict 20% of the variance of controlling risky behavior associated with AIDS. The results also indicated that family functioning with a standardized coefficient of - 0.24 and self-efficacy in controlling risky behavior associated with AIDS with a standardized coefficient of 0.58 could predict the controlling risky behavior associated with AIDS (p < 0.01).

CONCLUSIONS

Our findings suggest that self-efficacy and AIDS risk perception play major roles in controlling risky behavior associated with AIDS. Therefore, it is recommended that families and psychologists promote self-efficacy in order to prevent the occurrence of high-risk behaviors.

Mental distress and associated factors among women who experienced gender based violence and attending court in South Ethiopia: a cross-sectional study

BACKGROUND

Gender-based violence is an act that has physical, psychological, and sexual consequences for women. It is a widespread issue, particularly in developing countries, and it causes women mental distress. Despite the fact that gender-based violence has a significant impact on mental distress, there have no study in Ethiopia. As a result, the purpose of this study was to determine the prevalence and associated factors of mental distress among mothers who had experienced gender-based violence and were in court.

METHODS

A cross-sectional study was conducted on 423 samples. The data was entered into Epi-data version 3.01 and analyzed with SPSS version 21. Binary logistic regression was used, and variables with p-values less than 0.05 were considered statistically significant with regard to mental distress at the respective 95% CI.

RESULT

The prevalence of mental distress was found to be 59.6% in this study. Mental distress was associated with factors such as a lack of social support, a lack of formal education, a husband's substance use, rural residence, age greater than 33 years, and a low family income.

CONCLUSION

The prevalence of mental distress is high when compared to the majority of previous findings from other countries. Screening and managing psychological distress in women with a history of violence is preferable, and integrating psychosocial care into court services is recommended.

Acute stress disorder and the associated factors among traumatized patients admitted at Felege-Hiwot and the University of Gondar comprehensive specialized hospitals in Northwest Ethiopia

BACKGROUND

Acute stress disorder is the main factor of impairment in multiple areas of functioning that affects almost all age groups and which also influences mental and physical health. However, it negatively impacts the quality of life and social activities. The empirical evidence about probable acute stress disorder (ASD) and its associated factors is not available in Ethiopia to date. Therefore, the present study was aimed at identifying the magnitude and associated factors of probable ASD among traumatized patients in order to plan and render informed intervention for these vulnerable people.

METHODS

An institutional-based cross-sectional study was conducted at Felege-Hiwot and the University of Gondar comprehensive specialized hospitals from March 11/2020 to April 20/2020, by using a structured and semi-structured questionnaire. Systematic random sampling was used to recruit a total of 422 patients. The standard acute stress disorder scale was used to identify the prevalence of acute stress disorder by employing a face-to-face interview. Bivariate and multivariate logistic regression analysis was used to identify associated factors with probable acute stress disorder. Statistical significance was declared on 95% of confidence intervals (CI) at P < 0.05.

RESULTS

The prevalence of probable acute stress disorder was found to be 45% (95% CI: 40.2 to 49.6). In the multivariate logistic analysis; exposure to past history of trauma (AOR = 3.46, 95%, CI: 1.01-11.80), past psychiatry illness (AOR = 3.02, 95% CI: 1.15-7.92), anxiety (AOR = 2.38, 95% CI: 1.30-4.38), poor social support (AOR = 4.07, 95% CI: 2.20-7.52) and moderate (AOR = 4.56, 95% CI:2.44-8.52), and sever perceived threat to life (AOR = 2.75, 95% CI: 1.64, 4.60) were factors significantly associated with probable acute stress disorder.

CONCLUSION

Findings of this study indicated that the prevalence of probable acute stress disorder among study participants exposed to multiple forms of traumatic events was considerably high. History of trauma and past psychiatric illness, poor and moderate social support, and moderate perceived stress were factors significantly associated with probable acute stress disorder. The ministry of health and other concerned health organizations may find the current finding useful for early detection, prevention, and intervention strategies to minimize the factor of acute stress disorder in trauma survivors.

"This is hard to cope with": the lived experience and coping strategies adopted amongst Australian women with pelvic girdle pain in pregnancy

Background

Women with pregnancy-related pelvic girdle pain (PPGP) report diminished ability to perform physical activities and experience higher rates of mood disorders, such as anxiety and depression, than pregnant women without PPGP. Despite these physical and psychological impacts, little is known about the lived experiences of PPGP amongst Australian women and the ways in which they cope. Situated within biographical disruption and social support theories, this study sought to gain a conceptual understanding of the experience and impact of PPGP on daily life, and how women cope with this condition during pregnancy.

Methods

A qualitative research design, situated within a phenomenological framework, using individual, semi-structured interviews consisting of open-ended questions was used with a flexible and responsive approach. Purposive sampling of pregnant women attending a single hospital included 20 participants between 14 and 38 weeks gestation, classified with PPGP as per recommended guidelines, with a mean (SD) age of 31.37 (4.16) years. Thematic analysis was performed where interview data was transcribed, coded, grouped into meaningful categories and then constructed into broad themes.

Results

Three themes were identified: 1. a transformed biography; 2. coping strategies; and 3. what women want. The pain experienced created a dramatic change in women’s lives, making the pregnancy difficult to endure. Women utilised social support, such as family, to help them cope with pain, and a self-care approach to maintain a positive mindset and reduce stress. Although a few women received support from healthcare professionals, many reported a lack information on PPGP and limited societal recognition of the condition. Women wanted early education, personalised information and prompt referral to help them cope with PPGP.

Conclusions

Findings from this study highlighted the complexity of living with PPGP as women attempted to deal with the unexpected impact on daily life by seeking support from partners and families, while also struggling with societal expectations. Although women with PPGP used a number of coping strategies, they sought greater support from healthcare professionals to effectively manage PPGP. These findings have important implications for the provision of health care to women living with PPGP.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12618001423202.

Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design

Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.

Health conditions and the risk of home injury in French adults: results from a prospective study of the MAVIE cohort

BACKGROUND

Home injury (HI) is a significant cause of mortality and morbidity in adults of all ages. Health conditions significantly impact HI among old adults, but little is known for other adults.

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

We assessed the associations between health-related factors and HI's risk in a French study, the MAVIE (Mutualistes pour la recherche contre les Accidents de la VIE courante) cohort.

METHODS

Poisson mixed models were fitted using health-related data information (diseases, treatments and disabilities) at baseline and the number of injuries prospectively recorded during the follow-up, adjusting for significant sociodemographics and exposure to a range of home activities. Attributable fractions were estimated based on risk ratio (RR) estimations measured in the fully adjusted models.

RESULTS

A total of 6146 dwelling adults aged 15 or older were followed up for 5.1 years on average. Vertigo or dizziness (RR=2.36, 95% CI 1.06 to 5.01) and sciatica or back pain (RR=1.49, 95% CI 1.08 to 2.05) were independently associated with an increased risk of HI. These two groups of conditions showed the most significant associations among people aged 15-49, whereas musculoskeletal diseases other than rachialgias and arthropathies were the most significant health-related risk factor in people aged 50 and older. Sciatica or back pain represented the highest burden of HIs in overall adults (8%) and among people aged 15-49 (12%).

CONCLUSION

Our results suggest that adults with musculoskeletal disorders and vertigo or dizziness symptoms have a higher risk of HI, regardless of age.

Prevalence and Factors Associated with Pelvic Girdle Pain During Pregnancy in Australian Women: A Cross-Sectional Study

STUDY DESIGN

Cross-sectional study conducted between December 2017 and October 2019.

OBJECTIVE

To determine the prevalence and risk factors associated with pregnancy-related pelvic girdle pain (PPGP) in Australia.

SUMMARY OF BACKGROUND DATA

PPGP is a common condition worldwide yet the prevalence and associated risk factors are not known in Australia.

METHODS

A random sample of pregnant women (N = 780) of (mean [SD]) 31 (5) years of age between 14 and 38 weeks gestation attending ante-natal care in a tertiary referral hospital in Sydney, Australia was conducted. The main outcome measure was point-prevalence of PPGP as classified by recommended guidelines including a physical examination. A number of potential risk factors, including socio-demographic characteristics, country of birth, ethnicity, history of low back pain (LBP) and PPGP, family history of PPGP, occupational factors, and physical activity were investigated with logistic regression.

RESULTS

The point-prevalence of PPGP in a random sample of 780 Australian women was 44% with the odds of having PPGP increasing with each additional week of gestation (odds ratio [OR]) (OR 1.02). Increasing parity (P = 0.03, OR 1.15), country of birth (P = 0.03), and greater duration of time spent standing (P = 0.009, OR 1.06) were associated with PPGP. The strongest predictors of PPGP were previous LBP and/or PPGP both pregnancy (P < 0.001, OR 4.35) and not pregnancy related (P < 0.001, OR 2.24), and a family history of PPGP (P < 0.001, OR 3.76).

CONCLUSION

The prevalence of PPGP in Australian women was high with almost half the sample classified with PPGP, matching data reported worldwide. The identified risk factors associated with PPGP can be included in routine ante-natal care to screen women and identify those at risk of this common and disabling condition.Level of Evidence: 1.

Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries

BACKGROUND

Maternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in Africa. We examined the spatial distribution of maternal mortality in Africa and explored the influence of SDoH on the spatial distribution.

METHODS

We used country-level secondary data of 54 African countries collected between 2006 and 2018 from three databases namely, World Development Indicator, WHO's Global Health Observatory Data and Human Development Report. We performed descriptive analyses, presented in tables and maps. The spatial analysis involved local indicator of spatial autocorrelation maps and spatial regression. Finally, we built Bayesian networks to determine and show the strength of social determinants associated with maternal mortality.

RESULTS

We found that the average prevalence of maternal mortality ratio (MMR) in Africa was 415 per 100 000 live births. Findings from the spatial analyses showed clusters (hotspots) of MMR with seven countries (Guinea-Bissau, Guinea, Sierra Leone, Cote d'Ivoire, Chad and Cameroon, Mauritania), all within the Middle and West Africa. On the other hand, the cold spot clusters were formed by two countries; South Africa and Namibia; eight countries (Algeria, Tunisia, Libya, Ghana, Gabon and Congo, Equatorial Guinea and Cape Verde) formed low-high clusters; thus, indicating that these countries have significantly low MMR but within the neighbourhood of countries with significantly high MMR. The findings from the regression and Bayesian network analysis showed that gender inequities and the proportion of skilled birth attendant are strongest social determinants that drive the variations in maternal mortality across Africa.

CONCLUSION

Maternal mortality is very high in Africa especially in countries in the middle and western African subregions. To achieve the target 3.1 of the sustainable development goal on maternal health, there is a need to design effective strategies that will address gender inequalities and the shortage of health professionals.

Organic food use, meat intake, and prevalence of gestational diabetes: KOALA birth cohort study

Purpose

To evaluate whether consumption of organic food and reduced intake of meat products in pregnancy are associated with lower prevalence of gestational diabetes (GD).

Methods

Women participating in the KOALA Birth Cohort Study with valid informed consent, a singleton pregnancy and information on their food intake were considered in this cross-sectional analysis. Participants with and without GD were compared with each other in terms of dietary characteristics (n = 37 and n = 2766, respectively). Multivariable logistic regression (LR) was used to adjust for relevant covariates.

Results

Organic food consumption tended to be lower, although not significantly, in women with GD compared to women without GD, whereas consumption of meat was positively associated with GD prevalence. LR modelling showed that GD was significantly associated with higher consumption of meat and, in addition, also of cheese, after adjustment for other relevant covariates. GD was associated with some indicators of animal product intake, namely dietary animal to plant protein ratio and maternal plasma arachidonic acid (for the latter, data available for n = 16 and n = 1304, respectively). Food patterns of participants with GD were characterised by more meat products and less vegetarian products.

Conclusions

Due to the low number of participants with GD, results have to be interpreted cautiously. Consumption of organic food during pregnancy does not seem to be markedly associated with a lower GD prevalence; lower intake of meat and cheese, irrespective of its origin (organic or conventional), does. The latter supports previous studies suggesting a causal association between consumption of animal products and GD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02601-4.

Lived experiences of people living with HIV: a descriptive qualitative analysis of their perceptions of themselves, their social spheres, healthcare professionals and the challenges they face daily

BACKGROUND

Human immunodeficiency virus (HIV) infection rates have been gradually increasing in Istanbul, Turkey. Many people living with HIV (PLWH) here encounter difficulties, for example, in adapting to the chronic disease and obtaining continuous access to healthcare services. In this study, we aimed to explore the challenges PLWH face in their daily lives and understand their perceptions of themselves, healthcare professionals and services, and their social spheres via their expressed lived experiences in the healthcare setting.

METHOD

Individual semi-structured in-depth interviews were conducted face-to-face with 20 PLWH in Istanbul. All the interviews were voice-recorded and transcribed verbatim except one, upon participant request, for which the interviewer took notes. These logs and the interviewer's notes were analyzed thematically using the inductive content analysis method.

RESULTS

The themes concerned experiences in three distinct contexts: 1) Interactions with healthcare providers; 2) Participants' responses to their HIV diagnosis; and 3) Interactions with their social networks. Firstly, the results highlighted that the participants perceived that healthcare professionals did not inform them about the diagnosis properly, failed to protect patients' confidentiality and exhibited discriminative behaviors towards them. Secondly, after the diagnosis the participants had difficulty in coping with their unsettled emotional state. While many ceased sexual activities and isolated themselves, some sought support. Lastly, living with HIV affected their relationships with their families and friends either positively or negatively. Moreover, they had to face the difficulties concerning spouse/partner notification issues about which many needed professional support.

CONCLUSION

Healthcare professionals' discriminative or inappropriate attitudes and customs in healthcare institutions are perceived to impair PLWH's utilization of healthcare services. Structural factors such as social pressure, societal ignorance about HIV, limited access to HIV prevention, and regulatory barriers might contribute to these challenges. The results suggest that it is necessary to raise healthcare professionals' and society's awareness about HIV and develop national policies to establish a well-functioning referral system and appropriate spouse/partner notification services.

Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Pregnant Ontario Population

OBJECTIVE

The purpose of the current pilot study is to determine the point and period prevalence of site-specific back pain, low back pain (LBP), pelvic girdle pain (PGP), and combined pain (Combo Pain) in pregnant women at a large urban centre in Ontario.

METHODS

Point and period prevalence for LBP, PGP, and Combo Pain were determined using a questionnaire and accompanying pain diagram. Women were included in the study if they were healthy, of child-bearing age (18-45 years), currently experiencing a singleton pregnancy (any trimester), and proficient in the English language.

RESULTS

Data collected from 287 women were included in the analysis. Three-quarters of women suffered from some sort of pregnancy-related back pain. The point and period prevalences for women who were experiencing LBP, PGP, and Combo Pain were 15.7%, 17.8%, and 15.3% and 33.4%, 27.9%, and 30.7%, respectively. Secondary analyses demonstrated that increasing GA and suffering from both pains at some point prior to pregnancy (Prior Both) increased the risk of experiencing PGP and Combo Pain during pregnancy, respectively.

CONCLUSION

The current study demonstrates that 76% of sampled women experienced pregnancy-related back pain and the prevalence of site-specific pain (LBP, PGP, and Combo Pain) increases with increased gestation. Risk factors include advanced GA and experiencing both types of pain prior to pregnancy (Prior Both). Furthermore, it is suggested that a standard definition of pain by location should be developed and employed so that future studies can elucidate appropriate prevention strategies and treatment options for each.

Altered musculoskeletal mechanics as risk factors for postpartum pelvic girdle pain: a literature review

[Purpose] The aim of this literature review was to detect the factors associated with pelvic girdle pain persisting for over 3 months in the postpartum period. [Methods] We performed a broad literature search for eligible studies published before May 1, 2018 using electronic databases and processed the data using a review process. [Results] In the initial online search, we identified 12,174 potential studies. Finally, 22 studies met the specified criteria and were included for examination of risk factors for persistent pelvic girdle pain after delivery. Pain intensity and disability during pregnancy were risk factors for pelvic girdle pain persisting for over 6 months after delivery. The active straight leg raising test predicted the risk of persistent pelvic girdle pain after delivery. Dysfunction of the pelvic floor muscles was also a risk factor for persistent pelvic girdle pain. [Conclusion] Pain intensity and disability during pregnancy, positive provocation tests, active straight leg raising test, and musculoskeletal mechanics were positively associated with pelvic girdle pain persisting for over 3 months after delivery.

Medical Spending for the 2001 Anthrax Letter Attacks

ABSTRACTIntroductionThis paper assesses the total medical costs associated with the US anthrax letter attacks of 2001. This information can be used to inform policies, which may help mitigate the potential economic impacts of similar bioterrorist attacks.

METHODS

Journal publications and news reports were reviewed to establish the number of people who were exposed, were potentially exposed, received prophylactics, and became ill. Where available, cost data from the anthrax letter attacks were used. Where data were unavailable, high, low, and best cost estimates were developed from the broader literature to create a cost model and establish economic impacts.

RESULTS

Medical spending totaled approximately $177 million.

CONCLUSIONS

The largest expenditures stemmed from self-initiated prophylaxis (worried well): people who sought prophylactic treatment without any indication that they had been exposed to anthrax letters. This highlights an area of focus for mitigating the economic impacts of future disasters. (Disaster Med Public Health Preparedness. 2019;13:539-546).

Gut Microbiota and Body Weight in School-Aged Children: The KOALA Birth Cohort Study

OBJECTIVE

This study aimed to examine the intestinal microbiota composition of school-aged children in association with (over)weight.

METHODS

The fecal microbiota composition of 295 children was analyzed using the Human Intestinal Tract Chip. Anthropometric outcomes (overweight [BMI  ≥  85th percentile], age- and sex-standardized BMI and weight z scores) were measured at 6 to 7 years of age, and elastic net was used to select genus-like bacterial groups related to all anthropometric outcomes. Subsequently, multiple linear and logistic regression models were used to model associations between selected bacterial groups and anthropometric measures while controlling for confounders.

RESULTS

Prevotella melaninogenica, Prevotella oralis, Dialister, and uncultured Clostridiales II (UCII) accounted for 26.1% of the variation in microbiota composition. Several bacterial groups were inversely associated with the anthropometric outcomes: Sutterella wadsworthensis, Marvinbryantia formatexigens, Prevotella melanogenica, P oralis, Burkholderia, uncultured Clostridiales II, and Akkermansia, while Streptococcus bovis was positively associated with overweight. Microbial diversity and richness, and Bacteroidetes to Firmicutes ratio, were not significantly associated with any of the outcomes.

CONCLUSIONS

In the largest population-based study on childhood gut microbiota and body weight so far, both new and previously identified bacterial groups were found to be associated with overweight. Further research should elucidate their role in energy metabolism.

How do Australian women cope with pelvic girdle pain during pregnancy? A qualitative study protocol

INTRODUCTION

Pelvic girdle pain is commonly experienced during pregnancy and results in significant physical, psychosocial and work-related challenges. Few studies have investigated the lived experiences of pregnant women with pelvic girdle pain and their coping strategies. There is a need to develop a greater understanding of this prevalent condition among Australian women. Thus, this study seeks to gain information about the impact of pelvic girdle pain on daily life and how women cope with this condition during pregnancy.

METHODS AND ANALYSIS

A qualitative research design, situated within a phenomenological framework, is adopted. The participants will be invited to describe their lived experiences of pregnancy-related pelvic girdle pain, the impact on their daily life and the strategies they use to cope with the condition. A stratified purposive sample will be undertaken to ensure the sample provides information-rich cases representative of women with pregnancy-related pelvic girdle pain. Face-to-face, individual, semistructured interviews will be conducted with participants at Westmead Hospital, Sydney, Australia. A solicited diary will be offered to any participants who may find attending the interview difficult. All participants will also be invited to attend a focus group session. The different methods of data collection used in this study will allow for triangulation, thereby increasing the trustworthiness of findings.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Human Research Ethics Committees of Westmead Hospital, Sydney, and Western Sydney University, Sydney. Dissemination of results will be via journal articles and conference presentations.

Prevalence of pregnancy-related pelvic girdle pain and associated factors in Australia: a cross-sectional study protocol

INTRODUCTION

Pregnancy-related pelvic girdle pain (PPGP) is a common musculoskeletal disorder. Women with PPGP report difficulty performing everyday functional activities, such as standing and walking. However, the magnitude of the problem remains unknown in Australia. It is important to determine how many women are affected by this condition and the factors associated with PPGP as this will direct healthcare services to being able to better manage women during pregnancy. Thus, this study aims to determine the prevalence of PPGP and associated factors in a Western Sydney population.

METHODS AND ANALYSIS

This study is a cross-sectional study to be conducted at a single hospital in Australia. Participants will be over 18 years of age, between 14 and 38 weeks gestation and recruited randomly from all pregnant women attending antenatal care. Participants will have anthropomorphic measures recorded, such as height and body weight, and be asked to complete questionnaires about their current pregnancy, sociodemographic information, ethnoculture, occupational factors and participation in functional activities. The classification of PPGP will be made as per the published guidelines and will include a physical examination.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Human Research Ethics Committees of Westmead Hospital, Sydney, and Western Sydney University, Sydney. Dissemination of results will be via journal articles and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12617000904370.

Organic food consumption during pregnancy and its association with health-related characteristics: the KOALA Birth Cohort Study

OBJECTIVE

To investigate the associations of organic food consumption with maternal pre-pregnancy BMI, hypertension and diabetes in pregnancy, and several blood biomarkers of pregnant women.

DESIGN

Prospective cohort study.

SETTING

Pregnant women were recruited at midwives' practices and through channels related to consumption of food from organic origin.

SUBJECTS

Pregnant women who filled in FFQ and donated a blood sample (n 1339). Participant groups were defined based on the share of consumed organic products; to discriminate between effects of food origin and food patterns, healthy diet indicators were considered in some statistical models.

RESULTS

Consumption of organic food was associated with a more favourable pre-pregnancy BMI and lower prevalence of gestational diabetes. Compared with participants consuming no organic food (reference group), a marker of dairy products intake (pentadecanoic acid) and trans-fatty acids from natural origin (vaccenic and rumenic acids) were higher among participants consuming organic food (organic groups), whereas elaidic acid, a marker of the intake of trans-fatty acids found in industrially hydrogenated fats, was lower. Plasma levels of homocysteine and 25-hydroxyvitamin D were lower in the organic groups than in the reference group. Differences in pentadecanoic acid, vaccenic acid and vitamin D retained statistical significance when correcting for indicators of the healthy diet pattern associated with the consumption of organic food.

CONCLUSIONS

Consumption of organic food during pregnancy is associated with several health-related characteristics and blood biomarkers. Part of the observed associations is explained by food patterns accompanying the consumption of organic food.

Organic food consumption during pregnancy is associated with different consumer profiles, food patterns and intake: the KOALA Birth Cohort Study

OBJECTIVE

To find out how the consumption of organic food during pregnancy is associated with consumer characteristics, dietary patterns and macro- and micronutrient intakes.

DESIGN

Cross-sectional description of consumer characteristics, dietary patterns and macro- and micronutrient intakes associated with consumption of organic food during pregnancy.

SETTING

Healthy, pregnant women recruited to a prospective cohort study at midwives' practices in the southern part of the Netherlands; to enrich the study with participants adhering to alternative lifestyles, pregnant women were recruited through various specific channels.

SUBJECTS

Participants who filled in questionnaires on food frequency in gestational week 34 (n 2786). Participant groups were defined based on the share of organic products within various food types.

RESULTS

Consumers of organic food more often adhere to specific lifestyle rules, such as vegetarianism or anthroposophy, than do participants who consume conventional food only (reference group). Consumption of organic food is associated with food patterns comprising more products of vegetable origin (soya/vegetarian products, vegetables, cereal products, bread, fruits, and legumes) and fewer animal products (milk and meat), sugar and potatoes than consumed in conventional diets. These differences translate into distinct intakes of macro- and micronutrients, including higher retinol, carotene, tocopherol and folate intakes, lower intakes of vitamin D and B12 and specific types of trans-fatty acids in the organic groups. These differences are seen even in groups with low consumption of organic food.

CONCLUSIONS

Various consumer characteristics, specific dietary patterns and types of food intake are associated with the consumption of organic food during pregnancy.

Alcohol Consumption and Binge Drinking in Young Men as Predictors of Body Composition Changes During Military Service

AIMS

To evaluate the influences of alcohol consumption frequency and binge drinking on changes in the body composition, lifestyle habits and physical fitness of healthy young men during military service.

METHODS

A population-based study of men performing their military service in the Sodankylä Jaeger Brigade, Finland in 2005. Body composition, fitness and lifestyle habits were evaluated at baseline and 6-12 months follow-up. Alcohol consumption frequency and binge drinking were categorized as: 'not at all', 'at least once a month' and 'at least once a week'.

RESULTS

Data were available for 983 participants. Mean (SD) age was 19.2 (1.0) years. At baseline, participants who reported binge drinking at least once a week (29.8%) had the most unfavourable body composition, lifestyle habits and physical fitness compared with the group with no binge drinking. Significant (P < 0.05) mean reductions in % body fat (-2.3%) and weight (-1.8 kg), as well as improvements in lifestyle habits and physical fitness were observed in the weekly binge drinking group during the military service. The reductions in relative weight (%) and % body fat were associated with binge drinking at least once a week (regression coefficient for relative weight -1.39, 95% CI [-2.32; -0.45], P = 0.004, and for % body fat -0.68, 95% CI [-1.35; -0.01], P = 0.049).

CONCLUSION

Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. Frequent binge drinkers may obtain the greatest benefit of military-service-based exercise intervention, as reflected in the improvements in body composition, lifestyle habits and physical fitness.

SHORT SUMMARY

Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. The greatest benefit of military service comprehending exercise intervention was observed among those with binge drinking once a week at the baseline, with favourable changes in lifestyle factors, body composition and fitness.

Protecting the fabric of society? Heterosexual views on the usefulness of the anti-gay laws in Barbados, Guyana and Trinidad and Tobago

This study evaluated the extent to which people living in Barbados, Guyana and Trinidad and Tobago believe that the anti-gay laws currently in place: (1) reflect moral standards; (2) stop the spread of homosexuality; (3) are important from a public health perspective; and (4) protect young people from abuse. Analysis reveals that demographics, religion, interpersonal contact and beliefs about the origin of homosexuality all influenced an individual's views on the usefulness of the anti-gay laws in these states, but the significance of their impacts varied substantially across the arguments.

Early Life Antibiotic Exposure and Weight Development in Children

OBJECTIVE

To examine the timing, frequency, and type of antibiotic exposure during the first 10 years of life in association with (over)weight across this period in a cohort of 979 children.

STUDY DESIGN

Within the Child, Parents and Health: Lifestyle and Genetic Constitution Birth Cohort Study, antibiotic exposure record was obtained from general practitioners. Anthropometric outcomes (age- and sex-standardized body mass index, weight and height z-scores, and overweight) were measured repeatedly at 7 time points during the first 10 years of life. Generalized estimating equations method was used for statistical analysis.

RESULTS

After adjusting for confounding factors, children exposed to one course of antibiotics compared with none in the first 6 months of life had increased weight- (adjusted generalized estimating equations estimates [adjβ] 0.24; 95% CI 0.03-0.44) and height (adjβ 0.23; 95% CI 0.0002-0.46) z-scores; exposure to ≥2 courses during the second year of life was associated with both increased weight (adjβ 0.34; 95% CI 0.07-0.60), and height z-scores (adjβ 0.29; 95% CI -0.003 to 0.59). Exposure later in life was not associated with anthropometric outcomes. Associations with weight z-scores were mainly driven by exposure to broad- (≥2 courses: adjβ 0.11; 95% CI 0.003-0.22) and narrow-spectrum β-lactams (1 course: adjβ 0.18; 95% CI 0.005-0.35) during the follow-up period. Specific antibiotic used was not associated with body mass index z-scores and overweight.

CONCLUSIONS

Repeated exposure to antibiotics early in life, especially β-lactam agents, is associated with increased weight and height. If causality of obesity can be established in future studies, this further highlights the need for restrictive antibiotic use and avoidance of prescriptions when there is minimal clinical benefit.

Age-period-cohort analysis of suicide mortality by gender among white and black Americans, 1983-2012

Background

Previous studies suggested that the racial differences in U.S. suicide rates are decreasing, particularly for African Americans, but the cause behind the temporal variations has yet to be determined. This study aims to investigate the long-term trends in suicide mortality in the U.S. between 1983 and 2012 and to examine age-, period-, and cohort-specific effects by gender and race.

Method

Suicide mortality data were collected from the Web-based Injury Statistics Query and Reporting System (WISQARS) and analyzed with the Joinpoint regression and age-period-cohort (APC) analysis.

Results

We found that although age-standardized rate of suicide in white males, white females, black males, and black females all changed at different degrees, the overall situation almost has not changed since these changes offset each other. By APC analysis, while the age effect on suicide demonstrate an obvious difference between white males and females (with the peak at 75 to 79 for white males and 45 to 54 for white females), young black people are predominantly susceptible to suicide (risk peaks in early 20s for black males and late 20s for black females). Cohort effects all showed a descending trend, except that in white males and females which showed an obvious increase peaked in around cohort 1960. There was a similar period effect trend between different genders in the same race group, but between the races, differences were found in the period before 1990 and after 2000.

Conclusion

We confirmed that the distinction in age-specific suicide rate patterns does exist by gender and by race after controlling for period and cohort effects, which suggested that minorities’ age patterns of suicide may have been masked up by the white people in the whole population. The differences of period effects and cohort effects between white and black Americans were likely to be mainly explained by the difference in race susceptibility to economic depression.

Alcohol consumption patterns in Thailand and their relationship with non-communicable disease

BACKGROUND

Heavy alcohol consumption is an established risk factor for non-communicable diseases (NCDs) but few studies have investigated drinking and disease risk in middle income, non-western countries. We report on the relationship between alcohol consumption and NCDs in Thailand.

METHODS

A nationwide cross sectional survey was conducted of 87,151 Thai adult open university students aged 15 to 87 years (mean age 30.5 years) who were recruited into the Thai Cohort Study. Participants were categorized as never having drunk alcohol (n = 22,527), as being occasional drinkers who drank infrequently but heavily (4+ glasses/occasion - occasional heavy drinkers, n = 24,152) or drank infrequently and less heavily (<4 glasses/occasion - occasional light drinkers, n = 26,861). Current regular drinkers were subdivided into those who either drank heavily (4 + glasses per occasion - regular heavy drinkers, n = 3,675) or those who drank less (<4 glasses/occasion -regular light drinkers, n = 490). There were 7,548 ex-drinkers in the study. Outcomes were lifetime diagnoses of self-reported NCDs and obesity (body mass index ≥ 25).

RESULTS

Most women were never drinkers (40 % among females) or occasional light drinkers (39 %), in contrast to men (11 % and 22 %, respectively). Alcohol consumption was associated with urban in-migration and other recognized risks for NCDs (sedentary lifestyle and poor diet). After adjustment for these factors the odds ratios (ORs) for several NCDs outcomes - high cholesterol, hypertension, and liver disease - were significantly elevated among both occasional heavy drinkers (1.2 to 1.5) and regular heavy drinkers (1.5 to 2.0) relative to never drinkers.

CONCLUSIONS

Heavy alcohol consumption of 4 or more glasses per occasion, even if the occasions were infrequent, was associated with elevated risk of NCDs in Thailand. These results highlight the need for strategies in Thailand to reduce the quantity of alcohol consumed to prevent alcohol-related disease. Thailand is fortunate that most of the female population is culturally protected from drinking and this national public good should be endorsed and supported.

Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms

BACKGROUND

In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women's decision-making autonomy and their perceptions about social support for institutional delivery in their community.

METHODS

This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers-women's decision-making autonomy and community perceptions of institutional delivery-we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software.

RESULTS

The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive.

CONCLUSIONS

This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women's decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors.

The intestinal microbiota composition and weight development in children: the KOALA Birth Cohort Study

OBJECTIVE

To investigate whether the intestinal microbiota composition in early infancy is associated with subsequent weight development in children.

METHODS

Analyses were conducted within the KOALA Birth Cohort Study (n = 2834). This cohort originates from two recruitments groups: pregnant women with a conventional lifestyle (no selection based on lifestyle) and pregnant women recruited through alternative channels (organic shops, anthroposophic clinicians/midwives, Steiner schools and relevant magazines). From 909 one-month-old infants, fecal samples were collected and analyzed by quantitative PCR targeting bifidobacteria, Bacteroides fragilis group, Clostridium difficile, Escherichia coli, Lactobacilli and total bacteria counts. Between the ages of 1 and 10 years, parent-reported weight and height was collected at 7 time points. Age- and gender-standardized body mass index (BMI) z-scores were calculated. Data were analyzed using generalized estimating equation.

RESULTS

Colonization with B. fragilis group was borderline significantly associated with a higher BMI z-score of 0.15 (95% confidence interval (CI): -0.02 to 0.31), in the conventional subcohort. After stratification for fiber intake (P(forinteraction) = 0.003), colonization with B. fragilis group was associated with a 0.34 higher BMI z-score among children with a low-fiber intake in this subcohort (95% CI: 0.17-0.53). Higher counts among colonized children were positively associated with BMI z-score only in children within the conventional subcohort and a high-fiber diet (BMI z-score 0.08; 95% CI: 0.01-0.14), but inversely associated in children with a low-fiber diet (BMI z-score -0.05; 95% CI: -0.10 to 0.00), and in children recruited through alternative channels (BMI z-score -0.10; 95% CI: -0.17 to -0.03). The other bacteria were not associated with BMI z-scores, regardless of subcohort.

CONCLUSION

Using a targeted approach, we conclude that the intestinal microbiota, particularly the B. fragilis group, is associated with childhood weight development. To identify the potential impact of additional bacterial taxa, further prospective studies applying an unconstrained in-depth characterization of the microbiota are needed.

Maternal but not fetal FADS gene variants modify the association between maternal long-chain PUFA intake in pregnancy and birth weight

Several studies have shown a positive association between maternal fish intake in pregnancy and pregnancy duration and child birth weight (BW), probably due to fish n-3 (ω-3) long-chain polyunsaturated fatty acids (LC-PUFAs). n-3 LC-PUFAs can also be synthesized endogenously, and their synthesis depends on single nucleotide polymorphisms (SNPs) in the fatty acid desaturase (FADS) gene encoding for FADS. We assessed the associations of maternal docosahexaenoic acid (DHA) intake in pregnancy with pregnancy duration and BW and investigated whether these associations are modified by maternal or fetal FADS SNP genotypes. We hypothesized that we would find stronger associations in minor allele homozygous mothers or fetuses due to their lower n-3 LC-PUFA endogenous synthesis and hence higher dependence on dietary supply. Data on maternal diet, pregnancy duration, and BW were available for 2622 mother-child pairs from the KOALA (Kind, Ouders en gezondheid: Aandacht voor Leefstijl en Aanleg) Birth Cohort Study. The rs174556 FADS SNP was genotyped in 1516 mothers and 1515 children. Associations and gene-diet interactions were tested with linear regression adjusting for potential confounders, including intake of other PUFAs. Women at the 75th percentile of DHA intake had 0.7-d longer pregnancies (P = 0.016) and 28-g heavier infants (P = 0.039) than did women at the 25th percentile of intake. Associations with arachidonic acid intake were of the same order but in the opposite direction. Mothers who were homozygous for the minor allele had 2-d shorter pregnancies (P = 0.035) and infants who were nearly 140 g lighter (P = 0.006) than did mothers who were major allele homozygotes. Post hoc analyses revealed that they had higher prepregnancy BMI (P = 0.020). Among the women homozygous for the minor allele, those at the 75th percentile of DHA intake had 226-g heavier infants than those at the 25th percentile of intake (P = 0.030), whereas DHA intake was not significantly associated with BW in major allele carriers. These findings suggest that maternal and fetal fatty acid requirements during pregnancy depend on maternal genetic variation in LC-PUFA synthesis.

Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy: a systematic review

STUDY DESIGN

Systematic review of the literature.

OBJECTIVES

To review and assess the peer-reviewed literature on the effectiveness of physical therapy interventions in treating lumbopelvic pain during pregnancy.

BACKGROUND

Current guidelines on interventions for lumbopelvic pain during pregnancy differ in their recommendations for assessment and intervention. Recent publications may allow revising current recommendations for the treatment of this complex problem.

METHODS

An electronic search strategy was conducted in PubMed, PEDro, Scopus, and CINAHL of literature published from January 1992 to November 2013. Two authors independently assessed all abstracts for eligibility. Articles were independently rated for quality by 2 authors, using the Cochrane Back Review Group criteria for methodological quality. Where possible, effect sizes were calculated for the different interventions.

RESULTS

A total of 22 articles (all randomized controlled trials) reporting on 22 independent studies were included. Overall, the methodological quality of the studies was moderate. Data for 4 types of interventions were considered: a combination of interventions (7 studies, n = 1202), exercise therapy (9 studies, n = 2149), manual therapy (5 studies, n = 360), and material support (1 study, n = 115).

CONCLUSION

All included studies on exercise therapy, and most of the studies on interventions combined with patient education, reported a positive effect on pain, disability, and/or sick leave. Evidence-based recommendations can be made for the use of exercise therapy for the treatment of lumbopelvic pain during pregnancy.

LEVEL OF EVIDENCE

Therapy, level 1a-. J Orthop Sports Phys Ther 2014;44(7):464-473. Epub 10 May 2014. doi:10.2519/jospt.2014.5098.

Perturbation training can reduce community-dwelling older adults' annual fall risk: a randomized controlled trial

BACKGROUND

Previous studies indicated that a single session of repeated-slip exposure can reduce over 40% of laboratory-induced falls among older adults. The purpose of this study was to determine to what degree such perturbation training translated to the reduction of older adults' annual falls risk in their everyday living.

METHODS

Two hundred and twelve community-dwelling older adults (≥65 years old) were randomly assigned to either the training group (N = 109), who then were exposed to 24 unannounced repeated slips, or the control group (N = 103), who merely experienced one slip during the same walking in the same protective laboratory environment. We recorded their falls in the preceding year (through self-reported history) and during the next 12 months (through falls diary and monitored with phone calls).

RESULTS

With this single session of repeated-slip exposure, training cut older adults' annual risk of falls by 50% (from 34% to 15%, p < .05). Those who experienced merely a single slip were 2.3 times more likely to fall during the same 12-month follow-up period (p < .05) than those who experienced the 24 repeated slips. Such training effect was especially prominent among those who had history of falls.

CONCLUSION

A single session of repeated-slip exposure could improve community-dwelling older adults' resilience to postural disturbances and, hence, significantly reduce their annual risk of falls.