Overweight and obesity among foreign‐born and U.S.‐born Hispanics

Abstract

In this study, data from the New Immigrant Survey and the National Health and Nutrition Examination Survey are combined to examine patterns of overweight and obesity among U.S.‐born and foreign‐born Hispanics. Results indicate that, after using height and weight measures adjusted for self‐reporting bias, foreign‐born Hispanic men and women have substantially lower likelihoods of being overweight and obese than the U.S.‐born. However, both likelihoods increase as years in the U.S. accumulate for the foreign‐born. Controls for smoking behavior, physical activity, and the degree of dietary change do not reduce the strength of the positive relationship between years in the U.S. and overweight/obesity.     

The international sea‐bed authority without U.S. participation

Abstract

This paper focuses on the political dynamics of the International Sea‐Bed Authority‐on what is likely to happen if and when the Law of the Sea Treaty comes into effect without U.S. participation in the development of an international organization intended to be universal and permanent. The author has drawn heavily on his experience as Permanent Representative to UNESCO 1973–1977, and from service on delegations to numerous international conferences. His point of view tends to place great importance on the political role and structure of international organizations.     

“Inflammaging” and Estradiol among Older U.S. Women: A Nationally Representative Longitudinal Study

Despite accumulating small-sample and clinical evidence on “inflammaging,” no population-representative longitudinal studies have specifically examined women’s late-life inflammation trends. While a range of studies indicates estradiol’s immunomodulation role, evidence is contradictory on whether its effects are pro- or antiinflammatory among older women. Using longitudinal data from the first two waves of the National Social Life, Health and Aging Project—a national probability sample of older U.S. adults aged 57 to 85 years at baseline—this study began to fill these gaps. Findings suggested rather than being a lifelong process, older women’s inflammaging may have a biological window that closes with senescence. Moreover, their endogenous estradiol plays a proinflammatory rather than immunoprotective role. Nor does this sex steroid modulate age effects on women’s inflammation. More sex-specific basic research is needed on causal mechanisms underlying women’s late-life inflammaging patterns.     

Do gravidity and age affect pregnancy outcome?

Abstract

Fetal loss has generally been found to vary with gravidity, previous experience of fetal loss, and maternal age, but the literature is divided on the reasons for these associations. In this paper we examine pregnancy histories obtained retrospectively from a nationally representative one‐in‐one‐thousand sample of women in Australia aged 20 to 59 years. The relations of fetal loss ratios with both gravidity and previous outcome are consistent with heterogeneity of risk over the study population and a stopping rule, whereby high‐risk women undertake more pregnancies than low‐risk women to achieve the same number of live births. Evidence is presented that elevated loss ratios in the teens indicate not higher risk but a selection for short gestation intervals, while loss ratios beyond the mid‐thirties do not point unequivocally to a substantial increase in risk at the older reproductive ages.     

Association between Usual Sodium and Potassium Intake and Blood Pressure and Hypertension among U.S. Adults: NHANES 2005–2010

Objectives

Studies indicate high sodium and low potassium intake can increase blood pressure suggesting the ratio of sodium-to-potassium may be informative. Yet, limited studies examine the association of the sodium-to-potassium ratio with blood pressure and hypertension.

Methods

We analyzed data on 10,563 participants aged ≥20 years in the 2005–2010 National Health and Nutrition Examination Survey who were neither taking anti-hypertensive medication nor on a low sodium diet. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their associations with blood pressure, and logistic regression to assess their associations with hypertension.

Results

The average usual intakes of sodium, potassium and sodium-to-potassium ratio were 3,569 mg/d, 2,745 mg/d, and 1.41, respectively. All three measures were significantly associated with systolic blood pressure, with an increase of 1.04 mmHg (95% CI, 0.27–1.82) and a decrease of 1.24 mmHg (95% CI, 0.31–2.70) per 1,000 mg/d increase in sodium or potassium intake, respectively, and an increase of 1.05 mmHg (95% CI, 0.12–1.98) per 0.5 unit increase in sodium-to-potassium ratio. The adjusted odds ratios for hypertension were 1.40 (95% CI, 1.07–1.83), 0.72 (95% CI, 0.53–0.97) and 1.30 (95% CI, 1.05–1.61), respectively, comparing the highest and lowest quartiles of usual intake of sodium, potassium or sodium-to-potassium ratio.

Conclusions

Our results provide population-based evidence that concurrent higher sodium and lower potassium consumption are associated with hypertension.     

Differential mortality by ethnicity and nativity: Foreign‐ and native‐born Irish,Italians, and Jews in New York City, 1979–1981

Abstract

This paper compares the mortality experience of foreign‐ and native‐born Irish, Italians, and Jews in New York City in 1979–81. In most cases, denominator data were not available, so proportional mortality analysis was used. An estimation procedure was undertaken to show the degree to which standardized proportional mortality ratios approximate relative standardized mortality measures. Major and lifestyle‐related causes of death were examined, as were specific sites of cancer. While no consistent pattern merged which related nativity or ethnicity to the relative distribution of mortality, it does appear that the intra‐ethnic patterns of the Irish group were unique relative to those of the Italian and Jewish groups. Overall, this study suggests a number of interesting relationships between ethnicity, nativity, and the distribution of mortality by cause.     

Contraceptive sterilization: A comparison of Mexican‐Americans and Anglos living in U.S. counties bordering Mexico

Abstract

Prior to the U.S.‐Mexico Border Survey of Maternal and Child Health and Family Planning conducted by the Centers for Disease Control in 1979, little information was available about the extent to which Mexican‐Americans in the U.S., relative to Anglos, were using male and female sterilization for contraceptive reasons. This paper compares Mexican‐Americans and Anglos for (a) prevalence of contraceptive sterilization; (b) social and demographic characteristics of users of contraceptive sterlization; and (c) tuning during the reproductive life cycle when contraceptive sterilization occurs. For both Mexican‐Americans and Anglos, contraceptive sterilization (male and female) was the second most prevalent method used. Anglos were more likely to use male than female sterilization (22.4 per cent and 19.5 per cent), while Mexican‐Americans were much more likely to use female than male sterilization (23.2 per cent and 5.8 per cent). Having an unwanted last live birth and/or high parity were important factors related to the use of female sterilization for both Mexican‐Americans and Anglos.     

Does routine ultrasound scanning improve outcome in pregnancy? Meta-analysis of various outcome measures.

OBJECTIVE--To evaluate the effectiveness of routine ultrasound scanning in pregnancy by a meta-analysis of various outcome measures. DESIGN--Meta-analysis of randomised controlled trials evaluating the effect of routine ultrasound scanning on perinatal mortality and morbidity. Live birth rate (that is, live births per pregnancy) is included as a measure of pregnancy outcome in addition to the conventional perinatal mortality. SUBJECTS--15,935 pregnancies (7992 in which routine ultrasound scanning was used and 7943 controls with selective scanning) from four randomised controlled trials. MAIN OUTCOME MEASURES--Perinatal mortality, live birth rate, rate of miscarriage, Apgar score < 7 at 1 minute, and number of induced labours. RESULTS--The live birth rate was identical in both screening and control groups (odds ratio = 0.99; 95% confidence interval 0.88 to 1.12) although the perinatal mortality was significantly lower in the group who had routine ultrasonography (0.64, 0.43 to 0.97). Differences in perinatal morbidity between the two groups as measured by the proportion of newborn babies with Apgar score < 7 at 1 minute were not significant (1.05; 0.93 to 1.19). CONCLUSION--Routine ultrasound scanning does not improve the outcome of pregnancy in terms of an increased number of live births or of reduced perinatal morbidity. Routine ultrasound scanning may be effective and useful as a screening for malformation. Its use for this purpose, however, should be made explicit and take into account the risk of false positive diagnosis in addition to ethical issues.     

The differences among Jewish communities—Maternal and paternal contributions

The haplotypes of Y chromosome (paternally inherited) and mtDNA (maternally inherited) were analyzed in representatives of six Jewish communities (Ashkenazic, North African, Near Eastern, Yemenite, Minor Asian/Balkanian, and Ethiopian). For both elements, the Ethiopian community has a mixture of typically African and typically Caucasian haplotypes and is significantly different from all others. The other communities, whose haplotypes are mostly Caucasian, are more closely related; significant differences that were found among some of them possibly indicate the effects of admixture with neighboring communities of non-Jews. The different contribution of the Y chromosome and mtDNA haplotypes to the significant differences among the communities can be explained by unequal involvement of males and females in the different admixtures. In all communities, except the Ethiopians, the level of diversity () for Y chromosome haplotypes is higher than that for mtDNA haplotypes, suggesting that in each community the people who become parents include more males than females. An opposite proportion (more females than males) is found among the Ethiopians. Correspondence to: U. Ritte     

Conservation and status of the fish communities inhabiting the Río Conchos basin and middle Rio Grande,México and U.S.A.

The Chihuahuan Desert region contains a numberof unique aquatic environments, but with fewexceptions, these have been little studied. Because of the dearth of information aboutthese environments and because many of the fishin the region are threatened with extinction orhave gone extinct, we sampled the RíoConchos basin and adjoining aquatic habitats inthe Rio Grande to assess the status of the fishof this region. Most sites showed some degreeof human-induced impacts. A number ofpotentially threatened fish were eitherabundant at only a few sites or rare or absentthroughout the localities sampled. Withoutconcerted binational efforts to conserve thefish of the region, further deletions to thenative fish fauna will likely occur.     

Skin and Soft Tissue Infections and Associated Complications among Commercially Insured Patients Aged 0–64 Years with and without Diabetes in the U.S.

Introduction

Skin and soft tissue infections (SSTIs) are common infections occurring in ambulatory and inpatient settings. The extent of complications associated with these infections by diabetes status is not well established.

Methods

Using a very large repository database, we examined medical and pharmacy claims of individuals aged 0–64 between 2005 and 2010 enrolled in U.S. health plans. Diabetes, SSTIs, and SSTI-associated complications were identified by ICD-9 codes. SSTIs were stratified by clinical category and setting of initial diagnosis.

Results

We identified 2,227,401 SSTI episodes, 10% of which occurred in diabetic individuals. Most SSTIs were initially diagnosed in ambulatory settings independent from diabetes status. Abscess/cellulitis was the more common SSTI group in diabetic and non-diabetic individuals (66% and 59%, respectively). There were differences in the frequencies of SSTI categories between diabetic and non-diabetic individuals (p<0.01). Among SSTIs diagnosed in ambulatory settings, the SSTI-associated complication rate was over five times higher in people with diabetes than in people without diabetes (4.9% vs. 0.8%, p<0.01) and SSTI-associated hospitalizations were 4.9% and 1.1% in patients with and without diabetes, respectively. Among SSTIs diagnosed in the inpatient setting, bacteremia/endocarditis/septicemia/sepsis was the most common associated complication occurring in 25% and 16% of SSTIs in patients with and without diabetes, respectively (p<0.01).

Conclusions

Among persons with SSTIs, we found SSTI-associated complications were five times higher and SSTI-associated hospitalizations were four times higher, in patients with diabetes compared to those without diabetes. SSTI prevention efforts in individuals with diabetes may have significant impact on morbidity and healthcare resource utilization.     

Understanding U.S. Healthcare Providers’ Practices and Experiences with Molluscum Contagiosum

Introduction

Molluscum contagiosum is a common superficial skin infection caused by the poxvirus, Molluscum Contagiosum virus. The study objective is to obtain a better understanding of physician practices and experiences with molluscum contagiosum in order to focus informational and guidance material.

Methods

A cross-sectional survey to assess medical practitioners’ knowledge and practices with molluscum contagiosum was conducted using the 2009 DocStyles survey. Questions regarding category and number of molluscum contagiosum patients seen, treatments used and advice given to patients were included in the survey.

Results

Dermatologists saw the most cases, with the majority seeing 51–100 molluscum contagiosum cases/year. The most common cases seen were children with multiple lesions and adults with genital lesions. Respondents were most likely to recommend treatment to immunocompromised individuals, HIV patients, adults with genital lesions and children with multiple lesions. Cryotherapy was the top choice for all specialties with the exception of OB/GYNs, whose top choice was curettage. “Avoid intimate contact until lesions resolve”, “Avoid touching lesions to reduce further spread”, and “Don’t be concerned, this will go away” were the top advice choices.

Discussion

Most survey respondents have dealt with molluscum contagiosum in their practice during the previous year. Overall, respondents picked appropriate choices for treatment and advice given; however some ineffective or unnecessary treatments were chosen and recommendations to prevent spread were chosen infrequently. Knowledge gaps for appropriate transmission precaution advice might cause unnecessary spread or autoinoculation. This survey has demonstrated that molluscum contagiosum is a common infection seen by many types of practitioners and therefore guidance on treatment considerations and infection control is valuable.     

Maternal Mortality Reports—Case 3, C.M.A. Committee on Maternal and Child Care

These case reports are taken from the files of the State Department of Public Health which, together with the California Medical Association, now sponsors the statewide studies of all maternal mortalities. Selected cases are here presented from time to time as a matter of interest and illumination to all physicians concerned with the practice of obstetrics. They are prepared by the Committee on Maternal and Child Care. It is hoped that a review of such significant cases will help to improve the welfare of future California mothers.     

Maternal Mortality Reports—Case 5, C.M.A. Committee on Maternal and Child Care

These case reports are taken from the files of the State Department of Public Health which, together with the California Medical Association, now sponsors the statewide studies of all maternal mortalities. Selected cases are here presented from time to time as a matter of interest and illumination to all physicians concerned with the practice of obstetrics. They are prepared by the Committee on Maternal and Child Care. It is hoped that a review of such significant cases will help to improve the welfare of future California mothers.     

Maternal Mortality Reports—Case 4, C.M.A. Committee on Maternal and Child Care

These case reports are taken from the files of the State Department of Public Health which, together with the California Medical Association, now sponsors the statewide studies of all maternal mortalities. Selected cases are here presented from time to time as a matter of interest and illumination to all physicians concerned with the practice of obstetrics. They are prepared by the Committee on Maternal and Child Care. It is hoped that a review of such significant cases will help to improve the welfare of future California mothers.     

Ethnic Disparities in Emergency Severity Index Scores among U.S. Veteran’s Affairs Emergency Department Patients

BackgroundThe goal of these analyses was to determine whether there were systematic differences in Emergency Severity Index (ESI) scores, which are intended to determine priority of treatment and anticipate resource needs, across categories of race and ethnicity, after accounting for patient-presenting vital signs and examiner characteristics, and whether these differences varied among male and female Veterans Affairs (VA) ED patients.ConclusionsThe findings suggest the possibility that subgroups of VA patients receive different ESI ratings in triage, which may have cascading, downstream consequences for patient treatment quality, satisfaction with care, and trust in the health equity of emergency care.