The association of ambulatory blood pressure and caffeine in adolescents

Background: Although relatively little is known about the responsible factors, there is an increased prevalence of essential hypertension in youth. Our previous research using casual blood pressure (BP) suggests a role for caffeine intake. The objective of this study was to assess the association between caffeine intake and ambulatory BP patterns among adolescents and to replicate our previous findings that compared caffeine intake to BP values obtained at a single time point. Methods: Eighty-two African-American and non-Hispanic white adolescents (15 to 19 years old) with normal systolic BP selected foods and beverages for a 4-day sodium-controlled diet. Subjects were stratified into three groups based on the amount of caffeine in these foods. Ambulatory BP measures (24-h) were recorded during 1 day of the 4-day diet. The effects of ethnicity, caffeine, and the interaction of ethnicity and caffeine on BP were assessed for daytime and nighttime hours controlling for gender and body mass index. Results: The level of dietary caffeine was positively associated with daytime systolic BP (F2,76 = 3.1, P = .05, partial R2 = 0.07) and daytime diastolic BP (F = 3.532,76, P = .03, partial R 2 = 0.07). Caffeine’s effect on systolic BP was most pronounced for African-American subjects. These results replicated our earlier findings. There was no association between caffeine intake and nighttime BP. Conclusions: This investigation replicates and extends our previous findings that caffeine consumption impacts the BP of adolescents, during the daytime when sympathetic nervous system responses dominate BP control. Controlled studies that examine the pressor effects of caffeine intake at levels typical of the dietary patterns of today’s adolescents are needed

Association Between Dietary Quality of Rural Older Adults and Self-Reported Food Avoidance and Food Modification Due to Oral Health Problems

OBJECTIVES: To quantify the association between food avoidance and modification due to oral health problems, to examine the association between food practices and dietary quality, and to determine foods associated with these self-management behaviors. DESIGN: Cross-sectional. SETTING: Rural North Carolina. PARTICIPANTS: Six hundred thirty-five community-dwelling adults aged 60 and older. MEASUREMENTS: Demographic and food frequency data and oral health assessments were obtained during home visits. Avoidance (0, 1–2 foods, 3–14 foods) and modification (0–3 foods, 4–5 foods) due to oral health problems were assessed for foods representing oral health challenges. Food frequency data were converted into Healthy Eating Index-2005 (HEI-2005) scores. Linear regression models tested the significance of associations between HEI-2005 measures and food avoidance and modification. RESULTS: Thirty-five percent of participants avoided three to 14 foods, and 28% modified four to five foods. After adjusting for age, sex, ethnicity, poverty, education, and tooth loss, total HEI-2005 score was lower (P<.001) for persons avoiding more foods and higher for persons modifying more foods (P<.001). Those avoiding three to 14 foods consumed more saturated fat and energy from solid fat and added sugar and less nonhydrogenated fat than those avoiding fewer than three foods. Those who modified four to five foods consumed less saturated fat and solid fat and added sugar but more total grains than those modifying fewer than four foods. CONCLUSION: Food avoidance and modification due to oral health problems are associated with significant differences in dietary quality. Approaches to minimize food avoidance and promote food modification by persons having eating difficulties due to oral health conditions are needed

Oral Health Self-Care Behaviors of Rural Older Adults

Objectives: This analysis describes the dental self-care behaviors used by a multiethnic sample of older adults and delineates the associations of self-care behaviors with personal characteristics and oral health problems. Methods: A cross-sectional comprehensive oral health survey conducted with a random, multiethnic (African-American, American Indian, white) sample of 635 community-dwelling rural adults aged 60 years and older was completed in two rural southern counties. Results: Rural older adults engage in a variety of self-care behaviors, including the use of over-the-counter (OTC) medicine (12.1 percent), OTC dental products (84.0 percent), salt (50.9 percent), prayer (6.1 percent), and complementary therapies (18.2 percent). Some gender and ethnic class differences are apparent, with greater use by women of OTC medicine and salt and greater use by African-Americans and American Indians of OTC medicine and OTC dental products. The use of dental self-care behaviors appears to be driven by need. Those reporting oral pain, bleeding gums, and dry mouth have greater odds of engaging in most of the dental self-care behaviors, including the use of complementary therapies. Conclusions: The major factor leading to the use of self-care behaviors is need. Although oral pain does increase the use of self-care behaviors, so do bleeding gums and dry mouth. Research and practice should address self-care behaviors used for oral health problems in addition to pain. Investigators should expand analysis of dental self-care behavior and the relationship of self-care behavior to the use of professional services. Further research also should explore the use of complementary therapies in dental self-care

Severe tooth loss in older adults as a key indicator of compromised dietary quality

Objective. Poor oral health influences the dietary quality of older individuals. The objective of the present study was to relate the number of teeth to adherence to the 2005 Dietary Guidelines for Americans among an ethnically diverse sample of older adults, Design. A block cluster design was used to obtain a sample of older adults, Data were weighted to census data for ethnicity and gender, Dietary intakes were assessed using an FFQ and converted into Healthy Eating Index-2005 (HEI-2005) scores, Setting. Two counties in North Carolina, USA, with large African-American and American Indian populations, Subjects. Community-dwelling older adults (N635), Results. Three hundred and twenty-six participants had severe tooth loss (0–10 teeth remaining), compared with 305 participants with 11+ teeth, After controlling for socio-economic factors, those with 0–10 teeth had lower total HEI-2005 scores and consumed less Total Fruit, Meat and Beans, and Oils, and more energy from Solid Fat, Alcohol and Added Sugar, compared with those with 11+ teeth, Less than 1 % of those with 0–10 teeth and 4 % of those with 11+ teeth met overall HEI-2005 recommendations, Those with 0–10 teeth were less likely to eat recommended amounts of Total Vegetables, Dark Green and Orange Vegetables, and energy from Solid Fat, Alcohol and Added Sugar, Conclusions. Older adults with severe tooth loss are less likely than those with moderate to low tooth loss to meet current dietary recommendations, Nutrition interventions for older adults should take oral health status into consideration and include strategies that specifically address this as a barrier to healthful eating

Use of tobacco products among rural older adults: prevalence of ever use and cumulative lifetime use

Tobacco use is a well-documented contributor to morbidity and mortality in the US and worldwide. Information on the comprehensive use of tobacco products is lacking, particularly smokeless tobacco in its various forms. Data from 635 older (>_60 years) African American, American Indian and White adults in rural North Carolina were analyzed to assess current and lifetime use of cigarettes, cigars, pipe, snuff and chewing tobacco. Participants were classified as being current, former or never users of each product, Lifetime use of each product was determined by asking about typical intensity of use per day and length of time the product has been used. About 70% of participants were current or former users of any tobacco product, and about one-third of participants currently used at least one product. Variations in use were observed by ethnicity and sex, particularly for cigarettes, snuff and chewing tobacco. Variations were also seen according to other demographic and health characteristics. These data add to a limited body of literature on lifetime use of smoked and smokeless tobacco products, and are useful in identifying the impact of these products on morbidity and mortality, particularly for vulnerable populations

Food Selection and Eating Patterns: Themes Found among People with Type 2 Diabetes Mellitus

Objective: The objective of this study was to examine the beliefs and perspectives among people with type 2 diabetes mellitus about dietary requirements, food selection and eating patterns, and attitudes about self-management practices. Design: Semistructured, in-depth interviews explored participants’ experiences with diabetes prior to their diagnosis, participants’ understanding of the guidelines for the nutritional management of diabetes, how participants applied their understanding of dietary guidelines to daily food selection and eating patterns, and the social and personal themes influencing participants’ food selection and eating patterns. Subjects: Interviews were conducted with members of a convenience sample of 45 men and women diagnosed with type 2 diabetes for at least 1 year. Analyses Performed: Interviews were coded using a conceptual matrix derived from participants’ statements. Common characteristics were grouped, and broad themes were identified. Results: Eating patterns were influenced by participants’ knowledge of diabetes management. Challenges that participants encountered when applying nutrition recommendations were linked to their prior eating practices. Dietary self-efficacy, social support, and time management were identified as mediating variables that can influence dietary behaviors. Implications: Diabetes nutrition education programs should increase awareness of eating history, spousal support, and time management practices. Future research should include the refinement and validation of a nutritional management model of diabetes

Profiles of people with type 2 diabetes mellitus: the extremes of glycemic control

For people with diabetes, hemoglobin A1c (HbA1c) is a measure of blood glucose control and an indication of the risk of developing diabetes complications. However, a given HbA1c value does not provide information about the diabetes self-management practices or philosophies of individuals in poor (HbA1c >8.0%) or excellent (HbA1c<6.5%) control. To contrast the experiences and attitudes of people at the extremes of glycemic control, interviews were conducted among 44 individuals (40–65 years old) diagnosed with diabetes for over 1 year. The participants were identified based upon their HbA1c value from a larger sample of people with type 2 diabetes that included African Americans, women, and persons with low income. Narratives were analyzed using a case-based and conceptually clustered matrix approach. The life course concept (life histories and natural transitions in roles and responsibilities across the life span) and the explanatory model of illness (individuals‘ beliefs about the causes, consequences, and treatment of a disease) provided the framework for the interview guide and the analysis of the narratives. Two self-management philosophy groups emerged from participants with excellent control (Committed [n=15] and Tentative [n=7]) and three groups were identified among the poorly controlled group (Hopeful [n=8], Hassled [n=6], and Overwhelmed [n=8]). Perseverance, coping skills, and age at diagnosis were life course concepts that distinguished participants within these groups. From the explanatory model of illness, beliefs about the cause of the disease, physical changes, and accepting the consequence of the disease influenced differences in these self-management philosophies. The profiles of people at the extremes of glycemic control can help those treating people with diabetes or seeking to improve self-management interventions understand differences in self-management philosophies and concentrate on specific issues hindering self-care control

How many mailouts? Could attempts to increase the response rate in the Iraq war cohort study be counterproductive?

<p>Abstract</p> <p>Background</p> <p>Low response and reporting errors are major concerns for survey epidemiologists. However, while nonresponse is commonly investigated, the effects of misclassification are often ignored, possibly because they are hard to quantify. We investigate both sources of bias in a recent study of the effects of deployment to the 2003 Iraq war on the health of UK military personnel, and attempt to determine whether improving response rates by multiple mailouts was associated with increased misclassification error and hence increased bias in the results.</p> <p>Methods</p> <p>Data for 17,162 UK military personnel were used to determine factors related to response and inverse probability weights were used to assess nonresponse bias. The percentages of inconsistent and missing answers to health questions from the 10,234 responders were used as measures of misclassification in a simulation of the 'true' relative risks that would have been observed if misclassification had not been present. Simulated and observed relative risks of multiple physical symptoms and post-traumatic stress disorder (PTSD) were compared across response waves (number of contact attempts).</p> <p>Results</p> <p>Age, rank, gender, ethnic group, enlistment type (regular/reservist) and contact address (military or civilian), but not fitness, were significantly related to response. Weighting for nonresponse had little effect on the relative risks. Of the respondents, 88% had responded by wave 2. Missing answers (total 3%) increased significantly (p < 0.001) between waves 1 and 4 from 2.4% to 7.3%, and the percentage with discrepant answers (total 14%) increased from 12.8% to 16.3% (p = 0.007). However, the adjusted relative risks decreased only slightly from 1.24 to 1.22 for multiple physical symptoms and from 1.12 to 1.09 for PTSD, and showed a similar pattern to those simulated.</p> <p>Conclusion</p> <p>Bias due to nonresponse appears to be small in this study, and increasing the response rates had little effect on the results. Although misclassification is difficult to assess, the results suggest that bias due to reporting errors could be greater than bias caused by nonresponse. Resources might be better spent on improving and validating the data, rather than on increasing the response rate.</p

Profiles of people with type 2 diabetes mellitus: the extremes of glycemic control

For people with diabetes, hemoglobin A1c (HbA1c) is a measure of blood glucose control and an indication of the risk of developing diabetes complications. However, a given HbA1c value does not provide information about the diabetes self-management practices or philosophies of individuals in poor (HbA1c >8.0%) or excellent (HbA1cType 2 diabetes mellitus Diabetes Self-management Health education African American USA