重症医学病房中早产儿死亡危险因素的单变量logistic 回归 分析研究

目的:探讨重症医学病房内早产儿的相关性危险因素对其死亡的影响.方法:回顾性收集我重症医学病房从2008年6月1日至2011年8月31日收治的早产患儿共45例,分组后,对相关死亡危险因素进行logistics回归分析研究.结果:45例早产儿死亡的相关危险因素为出生体重(OR=4.157),体重越低,死亡率越高.结论:加强孕期保健,优化围产期管理,促进胎儿成熟,加强对低出生体重儿的管理,可提高早产儿的存活率和存活质量.     

高危儿随访情况分析及其父母生命质量调查研究

目的:了解高危儿随访情况并对其父母生命质量进行调查。方法:选取2017年5月~2019年5月于西安交通大学医学院附属三二〇一医院儿童保健科就诊的400例高危儿作为研究对象,分析400例高危儿的高危因素,统计随访次数,分析随访次数1~2次的高危儿的失访原因,同时采用SF-36量表评估高危儿父母与正常儿父母的生命质量。结果:按照占比从高到低的顺序,400例高危儿的高危因素分别为早产、低出生体重、高胆红素血症、窒息和(或)缺氧缺血性脑病、颅内出血、母亲高危因素、吸入性肺炎及其他,占比分别为74.00%、18.50%、13.25%、6.75%、2.75%、2.50%、1.25%、2.00%。400例高危儿中随访次数1~2次183例,占比45.75%,3~5次57例,占比14.25%,≥6次人数160例,占比40.00%。183例随访次数1~2次高危儿失访原因主要是有问题再来医院、孩子正常、不了解随访重要性、自己有育儿经验、孩子小,不方便等。高危儿父母生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均低于正常儿父母(均P<0.05)。结论:高危儿的随访失访率相对较高,其主要原因可能与父母的主观意识有关,此外,高危儿父母生命质量降低,临床工作中可通过加强高危儿系统管理以及对高危儿父母的宣教力度,从而降低失访率,提高高危儿父母的生命质量。     

脐带血IGF-1浓度和DNA甲基化与巨大儿发生的相关性

为探究脐带血中胰岛素样生长因子Ⅰ(insulin-like growth factor 1,IGF-1)的浓度和基因甲基化变化与巨大儿发生的关系,选择152名正常妊娠足月分娩的产妇和新生儿为对象,其中68名巨大儿,84名正常出生体重儿.收集产妇及新生儿的基本信息和脐带血样品.采用双抗体夹心ABCELISA法测定脐带血IGF-1蛋白浓度,基质辅助激光解吸附电离飞行时间质谱分析技术(MALDITOF)测定脐带血IGF-1基因启动子区CpG位点的甲基化水平.结果显示,脐带血IGF-1启动子区CpG位点均呈低甲基化状态.以所有研究对象出生体重的上四分位数(4 260 g)为拐点,出生体重4 260g组的脐带血IGF-1浓度显著高于出生体重≥4 260 g组(P=0.015),且与出生体重呈正相关关系(r=0.242,P=0.011).表明在出生体重4 260 g范围内,脐带血IGF-1浓度的增加贡献于出生体重的增长.但当胎儿过大时,存在负反馈调节机制,使脐带血IGF-1浓度降低,以限制胎儿过度增长.这些结果提示,脐带血IGF-1浓度与出生体重呈双向性关联,两者均与处于低甲基化状态的脐带血IGF-1的甲基化程度无关.     

脐带血IGF-1浓度和DNA甲基化与巨大儿发生的相关性研究

为探究脐带血中胰岛素样生长因子Ⅰ（insulin like growth factor 1, IGF-1）的浓度和基因甲基化变化与巨大儿发生的关系,选择152名正常妊娠足月分娩的产妇和新生儿为对象,其中68名巨大儿,84名正常出生体重儿.收集产妇及新生儿的基本信息和脐带血样品. 采用双抗体夹心ABC ELISA法测定脐带血IGF-1蛋白浓度,基质辅助激光解吸附电离飞行时间质谱分析技术（MALDI-TOF）测定脐带血IGF-1基因启动子区CpG位点的甲基化水平. 结果显示,脐带血IGF-1启动子区CpG位点均呈低甲基化状态. 以所有研究对象出生体重的上四分位数（4 260 g）为拐点,出生体重＜4 260g组的脐带血IGF 1浓度显著高于出生体重≥4 260 g组（P=0.015）,且与出生体重呈正相关关系（r=0.242,P=0.011）. 表明在出生体重＜4 260 g范围内,脐带血IGF-1浓度的增加贡献于出生体重的增长. 但当胎儿过大时,存在负反馈调节机制,使脐带血IGF-1浓度降低,以限制胎儿过度增长. 这些结果提示,脐带血IGF-1浓度与出生体重呈双向性关联,两者均与处于低甲基化状态的脐带血IGF-1的甲基化程度无关.     

西安市贫困大学生人格和幸福感的关系

目的:探讨西安市高校贫困大学生人格和主观幸福感的关系.方法:采用艾森克问卷和主观幸福感问卷对西安三所高校贫困生和非贫困生共337人进行测试.结果:(1)贫困生和非贫困生在精神质、内外向和神经质都存在显著差异;他们在总体主观幸福感、生活满意度和消极情感存在显著差异;(2)贫困大学生的神经质和内外向对他们的总体主观幸福感有影响;贫困生的神经质影响他们的生活满意度;贫困生的神经质、内外向和精神质影响着他们的积极情感,神经质和精神质对他们的消极情感产生影响.结论:贫困大学生的神经质对他们的幸福感的影响最大,其次是内外向和精神质.     

骨科住院患者满意度调查及影响因素分析

目的调查分析骨科住院患者护理满意度影响因素,以提高护理质量。方法采用横断面研究设计,选取2017年5月～2018年1月我院骨科住院患者为研究对象。应用自行设计的一般资料调查表收集患者一般资料,采用护理工作满意度调查表于患者出院时进行护理满意度调查,以评估护理质量,并以多因素Logistic回归分析护理满意度影响因素。结果本研究共调查骨科住院患者453例,其中椎体疾病156例,关节疾病80例,骨折217例。发放问卷453份,回收有效问卷453份,有效回收率为100%;护理满意度总分均值为(36.56±4.02)分,满意度分值最高的条目是护士向您介绍的检查、手术、用药、病房规章等注意事项和相应指导得分为(4.72±0.18)分。不同年龄段患者护理满意度比较,差异有统计学意义(F=5.723,P=0.001);护理满意度与患者性别无关(F=3.185,P=0.075;患者教育程度不同则护理满意有统计学差异(F=7.949,P0.000);患者是否享有医保与护理满意度无关(F=0.874,P=0.3);患者卧床天数及住院时间越长,则对护理满意度越差。多因素回归分析结果显示,与护理满意度独立相关因素为年龄(P=0.026,OR=0.200,95%CI:0.048±0.828)、卧床天数(P=0.044,OR=0.222,95%CI:0.051±0.961),并且年龄越大,卧床天数越长,患者的护理满意度越低。结论骨科住院患者护理满意度的影响因素包括年龄、教育程度、卧床天数和住院时间,其中年龄和卧床天数是护理满意度的独立影响因素。     

孕晚期膳食摄入量对新生儿出生体重及胎盘系数影响的研究

目的：探讨孕妇孕晚期膳食摄入量对新生儿出生体重及胎盘系数的影响。方法：纳入241例在2017年10月—2018年1月于上海市新华医院产科分娩的健康产妇,在分娩后72小时内进行回顾性孕晚期食物频率问卷调查,并收集孕妇身高、孕前体重、年龄、分娩方式,和新生儿性别、出生体重、胎龄、胎盘重量,计算胎盘系数（胎盘系数=胎盘重量/出生体重）。根据2013Fenton生长曲线新生儿胎龄别体重将新生儿分为小于胎龄儿组、适于胎龄儿组和大于胎龄儿组。结果：经多因素Logistic回归分析显示,对于体重大于胎龄儿,增加孕晚期能量（OR=0.998, 95%CI: 0.996～1.000）和碳水化合物（OR=0.027, 95%CI: 0.975～0.998）摄入量能够降低其发生率;对于新生儿体重小于胎龄,增加蛋白质摄入（OR=0.977, 95%CI: 0.956～1.000）能够降低其发生率,而碳水化合物供能比增加（OR=1.074, 95%CI: 1.010～1.142）则会增加其发生率。线性回归分析显示,增加孕晚期脂肪摄入量（β=0.020, 95%CI: 0.001～0.039）会增大胎盘系数。结论：孕晚期膳食摄入量影响新生儿出生体重及胎盘系数。     

巨大儿与足月适于胎龄儿2岁以内的体格及智能发育的对照研究

目的：了解出生体重对婴儿早期体格及智能发育的影响,为巨大儿的早期保健及健康教育提供理论依据。方法：在我院2007年1月～2009年12月出生的巨大儿及足月适于胎龄儿中,随机选取50例足月巨大儿作为观察组（除外生后低血糖、窒息、高胆红素血症者）,及50例与之匹配的足月适于胎龄儿作为对照组。两组孕周、生后评分、性别比例、父母收入、喂养方式比较差异无统计学意义。定期检查和记录两组的各体格及智能发育评估指标,了解两组婴儿体重指数及智能发育特点,采用Gesell发育诊断量表对两组进行评价。结果：观察组出生后3、6、9、12、18、24个月的超重发生率均显著高于对照组,差异均有统计学意义（P〈0.05）,观察组随年龄增长体重指数有下降趋势,6月龄时体重指数最高,24月时最低;观察组6月时大运动发育商数为（100.86±3.34）,对照组则为（104.58±3.19）,差异有统计学意义（P〈0.05）,12月时,观察组的发育商数已接近正常,两组大运动、精细运动、适应行为、语言和个人-社会性行为5个方面的的差异均无统计学意义（P〉0.05）。结论：巨大儿在2岁以内的体重指数显著高于足月适于胎龄儿;较重的体重负荷可对其生后6月内的大运动造成不良影响。     

研究生核心自我评价与主观幸福感的关系研究

采用问卷法调查了396名硕士研究生,探讨研究生主观幸福感的特点,及其与核心自我评价的关系.结果显示:(1)在生活满意度上,性别主效应显著;在积极情感和消极情感上,性别、年龄的主效应和交互效应均不显著.(2)自尊对生活满意度和积极情感有显著的预测作用;自我效能感对生活满意度、积极情感和消极情感均有显著预测作用;神经质对消极情感和生活满意度有显著的预测作用;内控性对主观幸福感的预测作用不显著.     

巨大儿与足月适于胎龄儿2 岁以内的体格及智能发育的对照研究

目的：了解出生体重对婴儿早期体格及智能发育的影响,为巨大儿的早期保健及健康教育提供理论依据。方法：在我院2007 年1 月～2009 年12 月出生的巨大儿及足月适于胎龄儿中,随机选取50 例足月巨大儿作为观察组(除外生后低血糖、窒息、高胆 红素血症者),及50 例与之匹配的足月适于胎龄儿作为对照组。两组孕周、生后评分、性别比例、父母收入、喂养方式比较差异无统 计学意义。定期检查和记录两组的各体格及智能发育评估指标,了解两组婴儿体重指数及智能发育特点,采用Gesell发育诊断量 表对两组进行评价。结果：观察组出生后3、6、9、12、18、24 个月的超重发生率均显著高于对照组,差异均有统计学意义(P<0.05), 观察组随年龄增长体重指数有下降趋势,6 月龄时体重指数最高,24 月时最低;观察组6 月时大运动发育商数为(100.86± 3.34), 对照组则为(104.58± 3.19),差异有统计学意义(P<0.05),12 月时,观察组的发育商数已接近正常,两组大运动、精细运动、适应行 为、语言和个人- 社会性行为5 个方面的的差异均无统计学意义(P>0.05)。结论：巨大儿在2 岁以内的体重指数显著高于足月适于 胎龄儿;较重的体重负荷可对其生后6 月内的大运动造成不良影响。     

Validation of overweight children's fruit and vegetable intake using plasma carotenoids

Assessing dietary intake in children is difficult and limited validated tools exist. Plasma carotenoids are nutritional biomarkers of fruit and vegetable intake and therefore suitable to validate reported dietary intakes. The aim of this study was to examine the comparative validity of a food frequency questionnaire (FFQ), completed by parents reporting child fruit and vegetable intake compared to plasma carotenoid concentrations. A sample of children aged 5-12 years (n = 93) from a range of weight categories were assessed. Dietary intake was measured using a 137-item semi-quantitative FFQ. Plasma carotenoids were measured using reverse phase high-performance liquid chromatography. Pearson correlation coefficients between reported dietary intake of carotenoids and plasma carotenoid concentrations were strongest after adjustment for BMI (beta-carotene (r = 0.56, P < 0.05), alpha-carotene (r = 0.51, P < 0.001), cryptoxanthin (r = 0.32, P < 0.001)). Significantly lower levels (P < 0.05) of all plasma carotenoids, except lutein, were found among overweight and obese children when compared to healthy weight children. Parental report of children's carotenoid intakes, using a FFQ can be used to provide a relative validation of fruit and vegetable intake. The lower plasma carotenoid concentrations found in overweight and obese children requires further investigation.     

Overweight,Obesity and Underweight Is Associated with Adverse Psychosocial and Physical Health Outcomes among 7-Year-Old Children: The ‘Be Active,Eat Right’ Study

Background

Limited studies have reported on associations between overweight, and physical and psychosocial health outcomes among younger children. This study evaluates associations between overweight, obesity and underweight in 5-year-old children, and parent-reported health outcomes at age 7 years.

Methods

Data were used from the ‘Be active, eat right’ study. Height and weight were measured at 5 and 7 years. Parents reported on child physical and psychosocial health outcomes (e.g. respiratory symptoms, general health, happiness, insecurity and adverse treatment). Regression models, adjusted for potential confounders, were fitted to predict health outcomes at age 7 years.

Results

The baseline study sample consisted of 2,372 children mean age 5.8 (SD 0.4) years; 6.2% overweight, 1.6% obese and 15.0% underweight. Based on parent-report, overweight, obese and underweight children had an odds ratio (OR) of 5.70 (95% CI: 4.10 to 7.92), 35.34 (95% CI: 19.16; 65.17) and 1.39 (95% CI: 1.05 to 1.84), respectively, for being treated adversely compared to normal weight children. Compared to children with a low stable body mass index (BMI), parents of children with a high stable BMI reported their child to have an OR of 3.87 (95% CI: 1.75 to 8.54) for visiting the general practitioner once or more, an OR of 15.94 (95% CI: 10.75 to 23.64) for being treated adversely, and an OR of 16.35 (95% CI: 11.08 to 24.36) for feeling insecure.

Conclusion

This study shows that overweight, obesity and underweight at 5 years of age is associated with more parent-reported adverse treatment of the child. Qualitative research examining underlying mechanisms is recommended. Healthcare providers should be aware of the possible adverse effects of childhood overweight and also relative underweight, and provide parents and children with appropriate counseling.     

Childhood overweight in the United States: A quantile regression approach

The prevalence of overweight children in the United States has increased dramatically over the past two decades, and is creating well-known public health problems. Moreover, there is also evidence that children who are not overweight are becoming heavier. We use quantile regression models along with standard ordinary least squares (OLS) models to explore the correlates of childhood weight status and overweight as measured by the Body Mass Index (BMI). This approach allows the effects of covariates to vary depending on where in the BMI distribution a child is located. Our results indicate that OLS masks some of the important correlates of child BMI at the upper and lower tails of the weight distribution. For example, mother's education has no effect on black children, but is associated with improvements in BMI for overweight white boys and underweight white girls. Conversely, mother's cognitive aptitude has no effect on white boys, but is associated with BMI improvements for underweight black children and overweight white girls. Further, we find that underweight white children and black girls experience similar improvements in BMI as they get older, but that for black boys there is little if any association between age and BMI anywhere in the BMI distribution.     

DXA measurements confirm that parental perceptions of elevated adiposity in young children are poor

Objective: To compare parental assessments of child body weight status with BMI measurements and determine whether children who are incorrectly classified differ in body composition from those whose parents correctly rate child weight. Also to ascertain whether children of obese parents differ from those of non‐obese parents in actual or perceived body weight. Research Methods and Procedures: Weights, heights, BMI, and waist girths of New Zealand children ages 3 to 8 years were determined. Fat mass, fat percentage, and lean mass were measured by DXA (n = 96). Parents classified child weight status as underweight, normal‐weight, slightly overweight, or overweight. Centers for Disease Control and Prevention 2000 percentiles of BMI were used. Results: Parents underestimated child weight status. Despite having 83% more fat mass than children with BMI values below the 85th percentile, only 7 of 31 children with BMI values at or above the 85th percentile were rated as slightly overweight or overweight. In the whole sample, participants whose weight status was underestimated by parents (40 of the 96 children) had l9% less fat mass but similar lean mass as children whose weight status was correctly classified. However, children of obese and non‐obese parents did not differ in body composition or anthropometry, and obese parents did not underestimate child weight more than non‐obese parents. Discussion: Because parents underestimate child weight, but BMI values at or above the 85th percentile identify high body fat well, advising parents of the BMI status of their children should improve strategies to prevent excessive fat gain in young children.     

Predictors of accurate maternal perception of their preschool child's weight status among Hispanic WIC participants

Childhood obesity is a growing problem in the United States. Parental perception of their children's weight status is a key factor that needs to be considered when developing prevention programs for preschool children. Using a randomly selected sample of participants of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles County, we assessed accuracy of maternal perceptions of their children's weight status by comparing children's weight classification to the mothers' response to the question “Do you consider your child to be overweight, underweight or about right weight for (his) (her) height?” Additionally, we identified possible predictors of accurate maternal perception of their children's weight status by conducting a logistic regression model with child's gender, child's birth weight, maternal age, maternal BMI, maternal education, maternal acculturation level, and maternal language preference as potential predictors. Almost all mothers in the study classified their overweight or obese child as being about the right weight (93.6% and 77.5% of mothers, respectively). Maternal BMI and child's birth weight were the only predictors of maternal perception of their child's weight. Both were negatively associated with accuracy, with higher maternal BMI and higher infant birthweight associated with less accurate maternal perception of child weight. Parents need to be educated on the importance of childhood obesity and how to identify if their children are overweight or obese. If parents fail to recognize that their overweight child is overweight, then it is unlikely that they will recognize that interventions targeting obesity are relevant to their families.     

Prenatal Parental Separation and Body Weight,Including Development of Overweight and Obesity Later in Childhood

Background

Early parental separation may be a stress factor causing a long-term alteration in the hypothalamic-pituitary-adrenal-axis activity possibly impacting on the susceptibility to develop overweight and obesity in offspring. We aimed to examine the body mass index (BMI) and the risk of overweight and obesity in children whose parents lived separately before the child was born.

Methods

A follow-up study was conducted using data from the Aarhus Birth Cohort in Denmark and included 2876 children with measurements of height and weight at 9-11-years-of-age, and self-reported information on parental cohabitation status at child birth and at 9-11-years-of-age. Quantile regression was used to estimate the difference in median BMI between children whose parents lived separately (n = 124) or together (n = 2752) before the birth. We used multiple logistic regression to calculate odds ratio (OR) for overweight and obesity, adjusted for gender, parity, breast feeding status, and maternal pre-pregnancy BMI, weight gain during pregnancy, age and educational level at child birth; with and without possible intermediate factors birth weight and maternal smoking during pregnancy. Due to a limited number of obese children, OR for obesity was adjusted for the a priori confounder maternal pre-pregnancy BMI only.

Results

The difference in median BMI was 0.54 kg/m² (95% confidence intervals (CI): 0.10; 0.98) between children whose parents lived separately before birth and children whose parents lived together. The risk of overweight and obesity was statistically significantly increased in children whose parents lived separately before the birth of the child; OR 2.29 (95% CI: 1.18; 4.45) and OR 2.81 (95% CI: 1.05; 7.51), respectively. Additional, adjustment for possible intermediate factors did not substantially change the estimates.

Conclusion

Parental separation before child birth was associated with higher BMI, and increased risk of overweight and obesity in 9-11-year-old children; this may suggest a fetal programming effect or unmeasured difference in psychosocial factors between separated and non-separated parents.     

Prevalence and determinants of obesity in children in public schools of Sintra, Portugal

Objective: To assess the prevalence of and the factors related to overweight and obesity in a sample of children from the region of Sintra, Portugal. Methods and Procedures: Cross‐sectional study, stratified for freguesia with random selection of schools. Height, weight, triceps skinfold, upper arm and waist circumferences were measured, and overweight/obesity defined according to international criteria. Breast‐feeding, number of daily meals and parents' height and weight data were also collected. Results: One thousand two hundred and twenty‐five children aged 6–10 years were assessed. Overall prevalence of overweight and obesity was 35.6% (23% overweight and 12.6% obesity). Overweight or obese children had higher triceps skinfold, upper arm circumference, arm muscle area, and waist circumference than their normal weight counterparts (P < 0.001). On multivariate analysis, relatively to a child without obese progenitors, a child with one obese progenitor had an obesity risk multiplied by 2.78 (95% confidence interval (CI): 1.76–4.38), while a child with two obese progenitors had a risk multiplied by 6.47 (95% CI: 5.59–16.19). Conversely, being picky was significantly related with a smaller risk of obesity: for boys, odds ratio (OR) = 0.15 (95% CI: 0.04–0.63); for girls, OR = 0.19 (95% CI: 0.06–0.64). Finally, no relationships were found between obesity, birth weight, birth height or breast‐feeding. Discussion: Prevalence of overweight and obesity are elevated among children of the Sintra region in Portugal compared to most other regions of Europe. The relationship with the parents' nutritional state stresses the need to target families for preventing obesity.     

The Effect of Obesity on Pediatric Tibia Fractures

BackgroundChildhood obesity affects nearly one fifth of all children in the United States. Understanding the unique injury characteristics and treatment of tibia fractures in this population has become increasingly important. This study aims to explore the different injury characteristics between tibia fractures in obese and non-obese children.Methods215 skeletally immature children aged 2-18 who sustained tibia fractures between 2007.2019 were retrospectively reviewed. Patients were analyzed by weight group: underweight, normal weight, overweight, and obese as defined by body mass index (BMI) percentile based upon age. Analyses were performed on dichotomized groups: underweight and normal weight versus overweight and obese. Chi-square or Fisher’s exact test was used to compare differences in categorical outcome between the 2-category BMI class variables; Wilcoxon test was used to compare continuous outcomes. A multivariate logistic regression model was used to evaluate BMI associations while controlling for age, sex, race, and mechanism of injury.ResultsDistribution of BMI in the cohort included 6.5% underweight, 45.6% normal weight, 16.7% overweight and 31.2% obese. Overweight and obese children sustained fractures from low energy mechanisms at more than double the rate of normal and underweight children (20.5% versus 9.7%, p=0.028). Overweight and obese children sustained physeal fractures at a rate of 54.4% in comparison with 28.6% in their normal and underweight peers (p<0.0001, OR 2.50 (95% CI, 1.26-4.95)). Overweight and obese children sustained distal 1/3 tibia fractures at a higher rate of 56.9% compared to under and normal weight children at 33.9% (p=0.003, OR 2.24 (95% CI, 1.17-4.30)). Overweight and obese children underwent unplanned changes in treatment at a lower rate than normal and underweight children at 1% versus 8% rates of treatment change, respectively (p=0.013, OR 0.076 (95%CI, 0.009-0.655)). No significant differences were found in the rates of operative treatment, repeat reduction, post treatment complications, or physical therapy.ConclusionOverweight children sustain tibia fractures from low energy mechanisms at higher rates than their peers. Similarly, obese and overweight patients have higher rates of physeal injuries and higher rates of distal 1/3 tibia fractures. Complication rates are similar between obese and non-obese children undergoing treatment for tibia fractures. Level of Evidence: III     

Child wellbeing and income inequality in rich societies: ecological cross sectional study

Objectives To examine associations between child wellbeing and material living standards (average income), the scale of differentiation in social status (income inequality), and social exclusion (children in relative poverty) in rich developed societies.Design Ecological, cross sectional studies.Setting Cross national comparisons of 23 rich countries; cross state comparisons within the United States.Population Children and young people.Main outcome measures The Unicef index of child wellbeing and its components for rich countries; eight comparable measures for the US states and District of Columbia (teenage births, juvenile homicides, infant mortality, low birth weight, educational performance, dropping out of high school, overweight, mental health problems).Results The overall index of child wellbeing was negatively correlated with income inequality (r=−0.64, P=0.001) and percentage of children in relative poverty (r=−0.67, P=0.001) but not with average income (r=0.15, P=0.50). Many more indicators of child wellbeing were associated with income inequality or children in relative poverty, or both, than with average incomes. Among the US states and District of Columbia all indicators were significantly worse in more unequal states. Only teenage birth rates and the proportion of children dropping out of high school were lower in richer states.Conclusions Improvements in child wellbeing in rich societies may depend more on reductions in inequality than on further economic growth.     

BMI and Health‐Related Quality of Life in Adults 65 Years and Older

Objective: To examine relationships of BMI with health‐related quality of life in adults 65 years and older. Research Methods and Procedures: In 1996, a health survey was mailed to all surviving participants ≥ 65 years old from the Chicago Heart Association Detection Project in Industry Study (1967 to 1973). The response rate was 60%, and the sample included 3981 male and 3099 female respondents. BMI (kilograms per meter squared) was classified into four groups: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9), and obese (≥30.0). Main outcome measures were Health Status Questionnaire‐12 scores (ranging from 0 to 100) assessing eight domains: health perception, physical functioning, role limitations‐physical, bodily pain, energy/fatigue, social functioning, role limitations‐mental, and mental health. The higher the score, the better the outcome. Results: With adjustment for age, race, education, smoking, and alcohol intake, obesity was associated with lower health perception and poorer physical and social functioning (women only) but not impaired mental health. Overweight was associated with impaired physical well‐being among women only. Both underweight men and women reported impairment in physical, social, and mental well‐being. For example, multivariable‐adjusted health perception domain scores for women were 50.8 (underweight), 62.7 (normal weight), 60.5 (overweight), and 52.1 (obese), respectively. Associations weakened but remained significant with further adjustment for comorbidities. Discussion: Compared with normal‐weight people, both underweight and obese older adults reported impaired quality of life, particularly worse physical functioning and physical well‐being. These results reinforce the importance of normal body weight in older age.