Measuring Distributional Inequality: Relative Body Mass Index Distributions by Gender, Race/Ethnicity, and Education, United States (1999–2006)

Few studies consider obesity inequalities as a distributional property. This study uses relative distribution methods to explore inequalities in body mass index (BMI; kg/m2). Data from 1999–2006 from the National Health and Nutrition Examination Survey were used to compare BMI distributions by gender, Black/White race, and education subgroups in the United States. For men, comparisons between Whites and Blacks show a polarized relative distribution, with more Black men at increased risk of over or underweight. Comparisons by education (overall and within race/ethnic groups) effects also show a polarized relative distribution, with more cases of the least educated men at the upper and lower tails of the BMI distribution. For women, Blacks have a greater probability of high BMI values largely due to a right-shifted BMI distribution relative to White women. Women with less education also have a BMI distribution shifted to the right compared to the most educated women

Le soutien social peut-il protéger les hommes de la tentative de suicide ?

Cette étude tente d’examiner si le soutien social peut constituer un facteur de protection de la tentative de suicide chez les hommes et, le cas échéant, à identifier quelles sont les formes et les sources de soutien les plus importantes. Elle compare deux groupes d’hommes qui ont vécu des événements de vie sévères au cours des 12 derniers mois : 40 hommes admis à l’urgence d’un hôpital suite à une tentative de suicide et 40 hommes sans antécédent suicidaire. Les résultats indiquent que les hommes qui ont tenté de se suicider perçoivent moins de soutien disponible dans leur entourage et sont moins satisfaits du soutien reçu suite à l’événement le plus difficile survenu au cours de la dernière année. L’aide tangible et l’assurance de sa valeur sont les formes de soutien les plus importantes. L’étude souligne l’importance du soutien social dans la prévention des comportements suicidaires chez les hommes.The goal of this study is to investigate whether social support may constitute a protective factor for attempted suicide among men and, if so, to identify the most important sources and forms of support. The study compares two groups of men who experienced comparable stressful events during the last 12 months : 40 men admitted to hospital emergency following suicide attempts, and 40 men with no history of suicide attempts. Results indicate that the men who attempted suicide perceive less support available and are less satisfied with the support they received following the most difficult stressful event that occurred in the last year. Concrete help and reassurance of worth are the forms of support that appear to be of most importance. This study highlights the importance of social support in the prevention of suicidal behaviours among men.Este estudio intenta examinar si el apoyo social puede constituir un factor de protección de la tentativa de suicidio en los hombres y, en caso contrario, identificar cuáles son las formas y fuentes de apoyo más importantes. Compara dos grupos de hombres que han vivido experiencias graves en el curso de los últimos 12 meses: 40 hombres admitidos en urgencias de un hospital después de una tentativa de suicidio y 40 hombres sin antecedentes de suicidio. Los resultados indican que los hombres que han intentado suicidarse perciben menos ayuda disponible en su entorno y están menos satisfechos del apoyo recibido después del evento más difícil transcurrido en el curso del último año. La ayuda tangible y tener la seguridad de ser valiosos son las formas de apoyo más importantes. El estudio subraya la importancia del apoyo social en la prevención de los comportamientos suicidas en los hombres.Este estudo tenta examinar se o apoio social pode constituir um fator de proteção da tentativa de suicídio nos homens e, se for o caso, identificar quais são as formas e as fontes de apoio mais importantes. Ele compara dois grupos de homens que viveram acontecimentos de vida graves durante os últimos 12 meses: 40 homens recebidos na urgência de um hospital por uma tentativa de suicídio e 40 homens sem antecedente suicidário. Os resultados indicam que os homens que tentaram se suicidar recebem menos apoio disponível ao seu redor e são menos satisfeitos do apoio recebido após o acontecimento mais difícil que ocorreu durante o último ano. A ajuda tangível e a segurança de seu valor são as formas de apoio mais importantes. O estudo ressalta a importância do apoio social na prevenção dos comportamentos suicidários nos homens

Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 - 2013.

BACKGROUND: Literature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. We summarize fertility patterns in rural northeast South Africa over 21 years during dynamic social and epidemiological change. METHODS: We use data for females aged 15-49 from the Agincourt health and socio-demographic surveillance system (1993-2013). We use discrete time event history analysis to summarize patterns in the probability of any birth. RESULTS: Overall fertility declined in 2001-2003, increased in 2004-2011, and then declined in 2012-2013. South Africans showed a similar pattern. Mozambicans showed a different pattern, with strong declines prior to 2003 before stalling during 2004-2007, and then continued fertility decline afterwards. There was an inverse gradient between fertility levels and household socioeconomic status. The gradient did not vary by time or nationality. CONCLUSIONS: The fertility transition in rural South Africa shows a pattern of decline until the height of the HIV/AIDS pandemic, with a resulting stall until further decline in the context of ART rollout. Fertility patterns are not homogenous among groups

Application des connaissances scientifiques en prévention du suicide : Vérification d’une stratégie fondée sur la communauté de pratique

Cet article a pour objectif de décrire une expérience pilote fondée sur les principes d’action des communautés de pratique (CoP), afin de rapprocher chercheurs et milieux de pratique en prévention du suicide et favoriser une meilleure utilisation des connaissances scientifiques. Des professionnels (n = 15) de différents organismes concernés par la prévention du suicide au Québec et disséminés sur tout le territoire (Centres de prévention du suicide, centres jeunesse, direction de santé publique, milieux hospitaliers), ainsi que des chercheurs (n = 4) et un animateur de la communauté ont participé à cette expérience innovante. La CoP a permis d’obtenir des effets sur la réceptivité envers les connaissances, l’accès aux ressources et aux connaissances et le développement de collaboration entre les membres. Des conditions préalables semblent cependant nécessaires à des collaborations accrues entre recherche et pratique, notamment un rapprochement sur le plan des valeurs et une relation fondée sur la confiance et le respect de l’autre et la capacité d’investir du temps dans le développement de relations de travail.The objective of this article is to describe a pilot experiment based on community of practice (CoP) action principles and aimed at bridging the gap between suicide prevention researchers and practitioners and encouraging better utilization of research knowledge. Participants in this innovative experiment included professionals (n = 15) from a variety of Quebec organizations concerned with suicide prevention located throughout the province (suicide prevention centers, youth centers, public health department, hospital settings), researchers (n = 4) and one community animator. The CoP made it possible to obtain effects on receptivity to knowledge, access to resources and knowledge, and the development of collaboration between members. However, it would appear that certain preconditions are necessary for increased collaboration between researchers and practitioners, notably the development of greater common ground in terms of values and a relationship based on trust and mutual respect and the ability to invest time in the development of work relations

Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 – 2013

BACKGROUND: Literature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. We summarize fertility patterns in rural northeast South Africa over 21 years during dynamic social and epidemiological change. METHODS: We use data for females aged 15–49 from the Agincourt health and socio-demographic surveillance system (1993–2013). We use discrete time event history analysis to summarize patterns in the probability of any birth. RESULTS: Overall fertility declined in 2001–2003, increased in 2004–2011, and then declined in 2012–2013. South Africans showed a similar pattern. Mozambicans showed a different pattern, with strong declines prior to 2003 before stalling during 2004–2007, and then continued fertility decline afterwards. There was an inverse gradient between fertility levels and household socioeconomic status. The gradient did not vary by time or nationality. CONCLUSIONS: The fertility transition in rural South Africa shows a pattern of decline until the height of the HIV/AIDS pandemic, with a resulting stall until further decline in the context of ART rollout. Fertility patterns are not homogenous among groups.Thanks are due to key funding partners of the MRC/Wits Rural Public Health and Health Transitions Research Unit who have enabled the ongoing Agincourt Health and Socio-demographic Surveillance System: the Wellcome Trust, UK (grants 058893/Z/99/A, 069683/Z/02/Z, and 085477/Z/08/Z); the Medical Research Council, University of the Witwatersrand, and Anglo-American Chairman’s Fund, South Africa; the William and Flora Hewlett Foundation (grant 2008–1840), the Andrew W. Mellon Foundation, and the National Institute on Aging (NIA) of the National Institutes of Health (NIH), USA (grants 1R24AG032112-01 and 5R24AG032112- 03)

Breastfeeding, HIV exposure, childhood obesity, and prehypertension: a South African cohort study

Background: Evidence on the association between breastfeeding and later childhood obesity and blood pressure (BP) is inconsistent, especially in HIV-prevalent areas where, until recently, HIV-infected women were discouraged from breastfeeding, but obesity is increasingly prevalent. Methods and findings: The Siyakhula cohort (2012–2014), a population-based prospective cohort study, collected data over 3 visits on HIV-negative children ages 7 to 11 years in rural South Africa. We used weight (body mass index [BMI]), fat, and BP as outcome variables and incorporated early life (including mother’s age at delivery and HIV status) and current life factors (including maternal education and current BMI). Our primary exposure was breastfeeding duration. We dichotomized 3 outcome measures using pre-established thresholds for clinical interpretability: (1) overfat: ≥85th percentile of body fat; (2) overweight: >1 SD BMI z score; and (3) prehypertension: ≥90th percentile for systolic BP (SBP) or diastolic BP (DBP). We modelled each outcome using multivariable logistic regression, including stopping breastfeeding, then early life, and finally current life factors. Of 1,536 children (mean age = 9.3 years; 872 girls; 664 boys), 7% were overfat, 13.2% overweight, and 9.1% prehypertensive. Over half (60%) of the mothers reported continued breastfeeding for 12+ months. In multivariable analyses, continued breastfeeding between 6 and 11 months was associated with approximately halved odds of both being overfat (adjusted odds ratio [aOR] = 0.43, 95% confidence interval [CI] 0.21–0.91, P = 0.027) and overweight (aOR = 0.46, CI 0.26–0.82, P = 0.0083), but the association with prehypertension did not reach statistical significance (aOR = 0.72, CI 0.38–1.37, P = 0.32). Children with a mother who was currently obese were 5 times more likely (aOR = 5.02, CI 2.47–10.20, P < 0.001) to be overfat and over 4 times more likely to be overweight (aOR = 4.33, CI 2.65–7.09, P < 0.001) than children with normal weight mothers. Differences between HIV-exposed and unexposed children on any of the outcomes were minimal and not significant. The main study limitation was that duration of breastfeeding was based on maternal recall. Conclusions: To our knowledge, this is the first study examining and quantifying the association between breastfeeding and childhood obesity in an African setting with high HIV prevalence. We observed that breastfeeding was independently associated with reduced childhood obesity for both HIV-exposed and unexposed children, suggesting that promoting optimal nutrition throughout the life course, starting with continued breastfeeding, may be critical to tackling the growing obesity epidemic. In the era of widespread effective antiretroviral treatment for HIV-infected women for life, these data further support the recommendation of breastfeeding for all women

Comparative evidence of years lived with reproductive-age morbidity in sub-Saharan Africa (2010‒2019)

Background: Despite remarkable progress in reducing maternal mortality, maternal morbidities remain high, particularly in sub-Saharan Africa (SSA). This study estimates the life years that women of reproductive ages spend in poor health due to indirect maternal morbidities and measures how much each morbidity compromises the reproductive-age life expectancy. Methods: Demographic and Health Survey data from 23 SSA countries were used to estimate age-specific mortality prevalence in reproductive-age women and construct life tables to estimate the survival function and reproductive-age life expectancy (RALE) with and without HIV and anaemia using the Sullivan method. Results: HIV (4.9Š) and anaemia (34.3Š) prevalence is high among SSA women. These conditions compromise women's health by an average of 14.3 years (CI 95Š, 14.3‒14.4), approximately 42Š of RALE life years. On average, SSA women spend 11.6 years (11.6‒11.7) with anaemia, 1.7 years (1.7‒1.8) with HIV, and 1.1 years (1.1‒1.2) with both conditions. Conclusions: The morbidities that women carry with them in these ages affect not only their health status but that of their infants as well. The high burden of life years with reproductive-age morbidities among SSA women highlights that to achieve healthy lives for women and children as part of Sustainable Development Goal 3, morbidity prevention and management measures will need to be enhanced over the entire reproductive-age span. Contribution: This study provides comparative evidence of the excess disease burden on the healthy lives of SSA women due to reproductive-age morbidities and quantifies the average number of years SSA women live with reproductive-age morbidities

Exclusive breastfeeding and cognition, executive function, and behavioural disorders in primary school-aged children in rural South Africa: A cohort analysis

Background Exclusive breastfeeding (EBF) is associated with early child health; its longer-term benefits for child development remain inconclusive. We examine the associations between EBF, HIV exposure, and other maternal/child factors and the cognitive and emotional-behavioural development of children aged 7–11 y. Methods and Findings The Vertical Transmission Study (VTS) supported EBF in HIV-positive and HIV-negative women; between 2012 and 2014, HIV-negative VTS children (332 HIV exposed, 574 HIV unexposed) were assessed in terms of cognition (Kaufman Assessment Battery for Children Second Edition [KABC-II]), executive function (Developmental Neuropsychological Assessment Second Edition [NEPSY-II]), and emotional-behavioural functioning (parent-reported Child Behaviour Checklist, [CBCL]). We developed population means by combining the VTS sample with 629 same-aged HIV-negative children from the local demographic platform. For each outcome, we split the VTS sample into scores above or at/below each population mean and modelled each outcome using logistic regression analyses, overall and stratified by child sex. There was no demonstrated effect of EBF on overall cognitive functioning. EBF was associated with fewer conduct disorders overall (adjusted odds ratio [aOR] 0.44 [95% CI 0.3–0.7], p ≤ 0.01), and there was weak evidence of better cognition in boys who had been exclusively breastfed for 2–5 mo versus ≤1 mo (Learning subscale aOR 2.07 [95% CI 1.0–4.3], p = 0.05). Other factors associated with better child cognition were higher maternal cognitive ability (aOR 1.43 [95% CI 1.1–1.9], p = 0.02, Sequential; aOR 1.74 [95% CI 1.3–2.4], p < 0.001, Planning subscales) and crèche attendance (aOR 1.96 [95% CI 1.1–3.5], p = 0.02, Sequential subscale). Factors positively associated with executive function were home stimulation (aOR 1.36 [95% CI 1.0–1.8], p = 0.04, Auditory Attention; aOR 1.35 [95% CI 1.0–1.8], p = 0.05, Response Set) and crèche (aOR 1.74 [95% CI 1.0–3.0], p = 0.05, Animal Sorting). Maternal mental health problems and parenting stress were associated with increased emotional-behavioural problems on the total CBCL (aOR 2.44 [95% CI 1.3–4.6], p = 0.01; aOR 7.04 [95% CI 4.2–11.9], p < 0.001, respectively). Maternal HIV status was not associated with any outcomes in the overall cohort. Limitations include the nonrandomised study design and lack of maternal mental health assessment at the child’s birth. Conclusions EBF was associated with fewer than average conduct disorders and weakly associated with improved cognitive development in boys. Efforts to improve stimulation at home, reduce maternal stress, and enable crèche attendance are likely to improve executive function and emotional-behavioural development of children

Direct Estimation of the Mitochondrial DNA Mutation Rate in Drosophila melanogaster

Mitochondrial DNA (mtDNA) variants are widely used in evolutionary genetics as markers for population history and to estimate divergence times among taxa. Inferences of species history are generally based on phylogenetic comparisons, which assume that molecular evolution is clock-like. Between-species comparisons have also been used to estimate the mutation rate, using sites that are thought to evolve neutrally. We directly estimated the mtDNA mutation rate by scanning the mitochondrial genome of Drosophila melanogaster lines that had undergone approximately 200 generations of spontaneous mutation accumulation (MA). We detected a total of 28 point mutations and eight insertion-deletion (indel) mutations, yielding an estimate for the single-nucleotide mutation rate of 6.2 × 10−8 per site per fly generation. Most mutations were heteroplasmic within a line, and their frequency distribution suggests that the effective number of mitochondrial genomes transmitted per female per generation is about 30. We observed repeated occurrences of some indel mutations, suggesting that indel mutational hotspots are common. Among the point mutations, there is a large excess of G→A mutations on the major strand (the sense strand for the majority of mitochondrial genes). These mutations tend to occur at nonsynonymous sites of protein-coding genes, and they are expected to be deleterious, so do not become fixed between species. The overall mtDNA mutation rate per base pair per fly generation in Drosophila is estimated to be about 10× higher than the nuclear mutation rate, but the mitochondrial major strand G→A mutation rate is about 70× higher than the nuclear rate. Silent sites are substantially more strongly biased towards A and T than nonsynonymous sites, consistent with the extreme mutation bias towards A+T. Strand-asymmetric mutation bias, coupled with selection to maintain specific nonsynonymous bases, therefore provides an explanation for the extreme base composition of the mitochondrial genome of Drosophila

Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis

Background Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001–13. Methods We used data from 21 villages of the Agincourt Health and socio-Demographic Surveillance System (HDSS). We calculated the probabilities of death from birth to age 5 years and from age 15 to 60 years, life expectancy at birth, and cause-specific and age-specific mortality by sex (not in children <5 years), time period, and socioeconomic status (household wealth) quintile for HIV/AIDS and tuberculosis, other communicable diseases (excluding HIV/AIDS and tuberculosis) and maternal, perinatal, and nutritional causes, non-communicable diseases, and injury. We also quantified differences with relative risk ratios and relative and slope indices of inequality. Findings Between 2001 and 2013, 10 414 deaths were registered over 1 058 538 person-years of follow-up, meaning the overall crude mortality was 9·8 deaths per 1000 person-years. We found significant socioecomonic status gradients for mortality and life expectancy at birth, with outcomes improving with increasing socioeconomic status. An inverse relation was seen for HIV/AIDS and tuberculosis mortality and socioeconomic status that persisted from 2001 to 2013. Deaths from non-communicable diseases increased over time in both sexes, and injury was an important cause of death in men and boys. Neither of these causes of death, however, showed consistent significant associations with household socioeconomic status. Interpretation The poorest people in the population continue to bear a high burden of HIV/AIDS and tuberculosis mortality, despite free antiretroviral therapy being made available from public health facilities. Associations between socioeconomic status and increasing burden of mortality from non-communicable diseases is likely to become prominent. Integrated strategies are needed to improve access to and uptake of HIV testing, care, and treatment, and management of non-communicable diseases in the poorest populations