Longitudinal changes in glucose metabolism in women with gestational diabetes, from late pregnancy to the postpartum period

AIMS/HYPOTHESIS

This study aimed to determine, in women with gestational diabetes (GDM), the changes in insulin sensitivity (Matsuda Insulin Sensitivity Index; IS_OGTT), insulin response and disposition index (DI) from late pregnancy (34-37 weeks gestation, T1), to early postpartum (1-5 days, T2) and late postpartum (6-12 weeks, T3). A secondary aim was to correlate the longitudinal changes in maternal lipids, adipokines, cytokines and weight in relation to the changes in IS_OGTT, insulin response and DI.

METHODS

IS_OGTT, insulin response and DI were calculated at the three time points (T1, T2 and T3) using the results of a 75 g OGTT. Adipokines, cytokines and lipids were measured prior to each OGTT. Linear mixed-effects models were used to compare changes across each time point. Changes in IS_OGTT, insulin response and DI were correlated with changes in maternal adipokines, cytokines and lipids at each time point.

RESULTS

A total of 27 women completed all assessments. Compared with T1, IS_OGTT was 11.20 (95% CI 8.09, 14.31) units higher at 1-5 days postpartum (p < 0.001) and was 5.49 (95% CI 2.38, 8.60) units higher at 6-12 weeks postpartum (p < 0.001). Compared with T1, insulin response values were 699.6 (95% CI 957.5, 441.6) units lower at T2 (p < 0.001) and were 356.3 (95% CI 614.3, 98.3) units lower at T3 (p = 0.004). Compared with T1, the DI was 6434.1 (95% CI 2486.2, 10,381.0) units higher at T2 (p = 0.001) and was 4262.0 (95% CI 314.6, 8209.3) units higher at T3 (p = 0.03). There was a decrease in mean cholesterol, triacylglycerol, LDL-cholesterol and VLDL-cholesterol from T1 to T2 (all p < 0.001), and an increase in mean C-reactive protein, IL-6 and IL-8 from T1 to T2 (all p < 0.001). Mean leptin decreased from T1 to T2 (p = 0.001). There was no significant change in mean adiponectin (p = 0.99) or TNF-α (p = 0.81) from T1 to T2. The mean maternal BMI decreased from T1 to T2 (p = 0.001) and T3 (p < 0.001). There were no significant correlations between any measure of change in IS_OGTT, insulin response and DI and change in maternal cytokines, adipokines, lipids or weight from T1 to T2.

CONCLUSIONS/INTERPRETATION

In women with GDM, delivery was associated with improvement in both insulin sensitivity and insulin production within the first few days. Improvement in insulin production persisted for 6-12 weeks, but insulin sensitivity deteriorated slightly. These changes in glucose metabolism were not associated to changes in lipids, leptin, inflammation markers or body weight.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02082301.

Alcohol use/abuse and help-seeking among U.S. adults: The role of racial-ethnic origin and foreign-born status

We used data from Wave 1 and Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions to examine racial-ethnic and nativity-based variations in alcohol use/abuse and treatment seeking while accounting for acculturation, stress, and social integration factors. The dependent variables included alcohol use, risky drinking, DSM-IV alcohol use disorder, and treatment seeking in the past 12 months. Racial-ethnic categories included African, European, Asian/Pacific Islander, Mexican, Puerto Rican, and other Hispanic/Latino. Acculturation, social stress, and social integration were assessed with previously validated, detailed measures. Bivariate probit models with sample selection were estimated for women and men. Immigrant status and origin associations with alcohol use/abuse and treatment seeking were strong and largely unaffected by other social factors. Europeans and men of Mexican origin had the highest while women of African, Asian/Pacific Islander, and Puerto Rican origins had the lowest rates of alcohol use/abuse. Years in the United States was associated with a higher risk of alcohol use/abuse for all immigrant groups. Foreign-born individuals were no less likely than U.S. natives to seek treatment if they were abusing or were dependent on alcohol. Further modeling of these relationships among specific immigrant groups is warranted. These findings inform alcohol rehabilitation and mental health services for racial-ethnic minorities and immigrants.

Anxiety Disorders among US Immigrants: The Role of Immigrant Background and Social-Psychological Factors

This study used the National Epidemiological Survey on Alcohol and Related Conditions, a longitudinal adult sample, to estimate the rates of prevalent, acquired, and persisting anxiety disorders by nativity and racial-ethnic origin while adjusting for acculturation, stress, social ties, and sociodemographics. Prevalent and acquired anxiety disorders were less likely among foreign-born than US-born, except Puerto-Rican- and Mexican-born who had higher risks. Persisting cases were similar between foreign-born and US-born, except Asian/Pacific Islanders who had lower risk. Stress and preference for socializing outside one's racial-ethnic group were associated with higher while close ties were associated with lower rates of acquired/persisting anxiety disorders.

Nativity, Race-Ethnicity, and Dual Diagnosis among US Adults

PURPOSE

This study investigated disparities in dual diagnosis (comorbid substance-use and depressive/anxiety disorders) among US adults by nativity and racial-ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.

DESIGN/METHODOLOGY

The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial-ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance-use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance-use or psychiatric disorder; substance-use disorder only; depressive/anxiety disorder only; and, dual diagnosis. The data were analyzed using multinomial logistic regression.

FINDINGS

The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto-Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial-ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.

RESEARCH LIMITATIONS

The limitations included measures of immigrant status, race-ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.

PRACTICAL AND SOCIAL IMPLICATIONS

This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.

ORIGINALITY/VALUE

This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial-ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).

Dating, Drinking, and Rape: Effects of Victim's and Assailant's Alcohol Consumption on Judgments of Their Behavior and Traits

Effects of an acquaintance rape victim's and her assailant's alcohol consumption on judgments of their behavior and traits were examined in a 2 × 2 × 2 between-subjects factorial experiment. Sixty-eight women and 64 men, 21 or older, read one of four stories in which only the victim, only the assailant, both victim and assailant, or neither victim nor assailant consumed alcohol. One individual difference trait, rape attitudes, was also measured. The interaction of victim and assailant drinking diminished the view that a rape had occurred and that the victim responded negatively, whereas it enhanced judgments of the assailant's likability and sexuality. The portrayal of only the victim drinking resulted in a more negative view of the assailant's behavior and traits. Evaluations of the victim depended on the assailant's drinking behavior rather than on her own. Implications for treatment of rape victims and establishing assailant accountability are discussed.

Major Depressive Disorder and Dysthymia at the Intersection of Nativity and Racial-Ethnic Origins

Immigrants often have lower rates of depression than US-natives, but longitudinal assessments across multiple racial-ethnic groups are limited. This study examined the rates of prevalent, acquired, and persisting major depression and dysthymia by nativity and racial-ethnic origin while considering levels of acculturation, stress, and social ties. Data from the National Epidemiologic Survey on Alcohol and Related Conditions were used to model prevalence and 3-year incidence/persistence of major depression and dysthymia (DSM-IV diagnoses) using logistic regression. Substantive factors were assessed using standardized measures. The rates of major depression were lower for most immigrants, but differences were noted by race-ethnicity and outcome. Furthermore, immigrants had higher prevalence but not incidence of dysthymia. The associations between substantive factors and outcomes were mixed. This study describes and begins to explain immigrant trajectories of major depression and dysthymia over a 3-year period. The continuing research challenges and future directions are discussed.

Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention

BACKGROUND

Understanding what factors contribute to alcohol abuse in resource-poor countries is important given its adverse health consequences. Past research shows that social peers influence substance abuse, suggesting that the social environment may be an effective target for reducing alcohol abuse across a population. This study investigates the determinants of alcohol use and abuse in rural Zimbabwe and tests a community popular opinion leader (CPOL) community-based intervention partly directed at reducing alcohol abuse.

METHODS

Tests were conducted on the impact of the CPOL intervention on alcohol use patterns across communities in rural Zimbabwe over three waves from 2003 to 2007, including community- and individual-level tests using data based on in-person interviews of adult men and women (ages 18-30; N=5543). Data were analyzed using paired-sample t-tests, as well as logistic and ordinary least-squares regression with random effects.

RESULTS

Higher drinking (any use, more frequent use, greater quantity, and/or frequent drunkenness) was generally associated with being male, older, not married, more highly educated, of Shona ethnicity, away from home frequently, employed, having no religious affiliation, or living in areas with a higher crude death rate or lower population density. Over the study period, significant declines in alcohol use and abuse were found in intervention and control sites at relatively equal levels.

CONCLUSIONS

Although no support was found for the effectiveness of the CPOL study in reducing alcohol abuse, Zimbabwe is similar to other countries in the impact of socio-demographic and cultural factors on alcohol use and abuse.

Self-reported health in Poland and the United States: a comparative analysis of demographic, family and socioeconomic influences

This study compares the social determinants of individual health between the United States, a capitalist society, and Poland, a 'post-communist' society. The effects of demographic factors, family characteristics and socioeconomic status on self-reported health are estimated with OLS regression using data from the 1994 American and Polish General Social Surveys. The results show lower self-reported health and more rapid declines in health for people over 60 in Poland than in the United States. Also, in Poland, women report worse health than do men while the opposite is found for the United States. The relationships between education, income and health were stronger in the United States than in Poland. Age, gender and SES may operate differently in the two countries because of a gap in social development (e.g. varying living standards and styles, health care systems and cultural attitudes) between the West and the former Eastern Europe.

Family effects on self-reported health among Russian wives and husbands

Alcohol abuse and a transition to the market economy are often blamed for high mortality and low life expectancy in Russia, but little is known about proximate influences on individual health. This study estimates family influences on the self-reported health of Russian wives and husbands. Predicting gender differences in the determinants of health status, hypotheses are presented for the effects on spouses' self-reported health of five family characteristics: economic status, household division of labor, family decision-making, presence of young children, and housing conditions. Controls are included for age, education, sensitivity, alcohol use, job-related time, and urban-rural location. Data from a 1996 sample of couples (n = 925) from Moscow and two rural regions of Russia are analyzed using logistic regression. The findings provide mixed support for the hypotheses, though they do show the important role of family characteristics on spouses' health. Family economic standing is important to both spouses' self-reported health, though young children in the home is not. Family decision-making does influence spouses' health: when Russian wives are the primary decision makers in the family, their own health suffers, though their husbands' health is better. And support is found for the combined effects of job-related time and household labor but only for wives' health. When wife's household labor is low, the probability of her having poor health increases, the more time she devotes to her job. However, when she does substantially more domestic labor than her husband, her job-related time has the opposite effect, reducing the chances of poor health, the more time she spends on job activities. This study is important both in helping to account for poor health of Russians during the current economic and social transition and in identifying aspects of family life that affect men's and women's health cross-nationally.

Economic change and health benefits: structural trends in employer-based health insurance

Drawing on structural theories of economic outcomes, we investigated how economic change affects the distribution of health benefits, the main source of health insurance for American workers. Through an aggregate level analysis, we show how the effects of industry level characteristics on the level of health benefits change between 1988 and 1997. Due to the increased reliance on women, nonwhite workers, and part-time labor, we expect declines in the effect sizes of gender and race composition and proportion full-time. In contrast, we predict increases in the effects of proportion small firm employment, proportion union, and industry sector due to rising health care costs, the competitive economic environment, and greater union effectiveness. We analyze data from the March Current Population Surveys for 1987 to 1997 using generalized least-squares regression. The positive effect of proportion white increases over time, while the positive effect of level of full-time work declines. The negative effects of small firm employment and being a retail or nonprofessional service industry increase in magnitude. Both union activity and gender composition have stable effects over the period. The results challenge views of a declining significance of race and gender in the labor market.

The influence of gender on sex: a study of men's and women's self-reported high-risk sex behavior

An investigation is presented of the relationship between gender and five self-reported high-risk sex behaviors: ever having had casual sex, the lifetime number of vaginal sex partners, the lifetime number of anal sex partners, having had multiple vaginal sex partners over the short term, and having had multiple anal sex partners over the short term. The analysis was guided by a conceptual model that emphasized the constraints and opportunities for high-risk sex behavior that arise from an individual's structural position and cultural context. Gender differences in high-risk sex behaviors were predicted to be due to differences in men's and women's family roles, work roles, religious behaviors, and past sex experience. In addition, the effects of certain sociocultural factors on the high-risk sex behaviors were expected to be dependent on an individual's gender. The hypotheses were evaluated using national data from the United States on self-reported sex behaviors for men ages 20 to 39 years old and women ages 20 to 37 years old. Data analyses were conducted using ordinary least-squares regression and logistic regression. Findings provided mixed support for the predictions. Gender was not significantly related to short-term, self-reported high-risk sex behaviors once social and cultural factors were included in the statistical models. But it continued to predict lifetime behaviors. Several variables, including race, age, age at first sex, and marital status, had gender-specific effects on the self-reported high-risk sex behaviors. The study demonstrates how the effects of structural and cultural factors on sex behavior differ for men and women.

Gender, race, class and self-reported sexually transmitted disease incidence

Multivariate analysis of data from two nationally representative surveys of adult men and women indicates that the likelihood of a self-reported sexually transmitted disease (STD) infection varies by gender, race and socioeconomic status, even after accounting for differences in sexual and health care behaviors. Women and black respondents are more than three times as likely to report an STD infection as men and white respondents; men and women with 12 or fewer years of education are about 30% less likely than those with more schooling to report having had an STD. Income, welfare status and access to health care have no significant association with self-reported STD incidence, but sexual behavior is strongly related. Men and women who have engaged in anal intercourse, have paid for sex or have had one-night stands are significantly more likely than those who avoid these behaviors to report an STD. Further, the likelihood of an STD dramatically increases with the lifetime number of sex partners reported: Compared with men and women who have had only one partner, those who report 2-3 partners are five times as likely to have had an STD; the odds are as high as 31:1 for those who report 16 or more partners.

Determinants of contraceptive choice among single women in the United States

Data from the 1983 National Survey of Unmarried Women are used to analyze characteristics that affect contraceptive decision-making among single women aged 20-29 who are exposed to the risk of pregnancy. Factors found to affect whether these women use a relatively effective method such as the pill or the IUD, use coitus-dependent methods or use no method include family structure at age 15, educational level, work status, religious affiliation, fertility relative to desired fertility, and past contraceptive failure. Bivariate analyses revealed notable differences between whites and blacks in contraceptive behavior. Multivariate analyses showed that while the decision to use a contraceptive method was somewhat affected by race, method choice was not. Overall, contraceptive decision-making was relatively unaffected by race, length of the relationship and current living arrangement.