Blood Pressure Changes After a Health Promotion Program Among Mexican Workers

Background: Cardiovascular disease is becoming increasingly prevalent in low and middle-income countries (LMIC), and high blood pressure (BP) is one of the main risk factors. The efficacy and sustainability of worksite health promotion (WHP) programs for BP reduction in LMIC have yet to be determined.Methods: This non-randomized company-based trial evaluated 6- and 12-months effects of a WHP intervention on BP among 2,002 participating workers from seven Mexican companies. Intervention and control groups were assigned at the company level. The intervention included nutrition counseling, physical exercise, and stress management components. Mixed models assessed differences in BP change between intervention and control companies in intent-to-treat (ITT), per-protocol (PerP), and as-treated (AsTr) analyses, and also within-group changes stratified by company, intervention component, and baseline cardiovascular risk factor levels. All analyses were adjusted for potential confounders. We accounted for missing data and loss to follow-up using inverse probability of censoring weighting.Results: ITT analyses revealed mean BP change differences of −1.1 mmHg at 12 months (95% CI: −2.9; 0.6) in intervention companies relative to control companies. PerP and AsTr analyses confirmed this finding. Within-group analyses showed consistent BP reductions at both 6 and 12 months. Substantial differences in BP changes ranging from diastolic −6.1 mmHg, (95% CI: −11.2; −1.2) to systolic −13.0 mmHg (95% CI: −16.0; −10.1) were found among individuals with diabetes at baseline in intervention companies relative to control companies.Conclusion: After 1 year, WHP was associated with modest but uncertain BP reductions. Substantial reductions were mainly observed among diabetic workers

Patients with stricturing or penetrating Crohn\u27s disease phenotypes report high disease burden and treatment needs

BACKGROUND: Crohn\u27s disease (CD) is a chronic autoimmune disease in which inflammation can progress to complications of stricturing and/or penetrating disease. Real-world data on burden of complicated CD phenotypes are limited. METHODS: We analyzed cross-sectional data from the SPARC IBD (Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease) registry from 2016 to 2020. Four mutually exclusive phenotype cohorts were created: inflammatory CD (CD-I), complicated CD (stricturing CD, penetrating CD, and stricturing and penetrating CD [CD-SP]). Statistical analyses were performed using CD-I as the reference. RESULTS: A total of 1557 patients were identified: CD-I (n = 674, 43.3%), stricturing CD (n = 457, 29.4%), penetrating CD (n = 166, 10.7%), and CD-SP (n = 260, 16.7%). Patients with complicated phenotypes reported significantly greater use of tumor necrosis factor inhibitors (84.2%-86.7% vs 66.0%; P \u3c .001) and corticosteroids (75.3%-82.7% vs 68.0%; P \u3c .001). Patients with CD-SP reported significantly more aphthous ulcer (15.4% vs 10.5%; P \u3c .05), erythema nodosum (6.5% vs 3.6%; P \u3c .05), inflammatory bowel disease-related arthropathy (25.8% vs 17.2%; P \u3c .01), liquid stools (24.2% vs 9.3%; P \u3c .001), nocturnal fecal incontinence (10.8% vs 2.5%; P \u3c .001), and CD-related surgery (77.7% vs 12.2%; P \u3c .001). CONCLUSIONS: Patients with complicated CD phenotypes reported higher rates of active CD-related luminal and extraintestinal manifestations, and underwent more surgeries, despite being more likely to have received biologics than those with CD-I. The potential for early recognition and management of CD-I to prevent progression to complicated phenotypes should be explored in longitudinal studies

Adherence to complementary feeding guidelines as a predictor of better health outcomes in infants six to twenty four months of age in Cambodia

Rates of child malnutrition in Cambodia have continued to rise throughout the last ten years despite marginal improvements in food security. After 6 months of age, when complementary feeding often begins, rates of stunting in Cambodia increase from 16% to 42% (CDHS, 2010). Given that the first two years of life are the most important for physical and cognitive development, addressing the health consequences that result from malnutrition is a priority. In the current thesis, I hypothesized that a) infants whose caregivers adhered to at least 80% of Cambodia’s complementary feeding guidelines were less likely to have had diarrhea in the last two weeks, to be anemic or to be stunted and b) infants whose caregivers adhered to at least 80% of the guidelines would have greater dietary diversity than infants whose caregivers did not adhere. To test these hypotheses, I utilized data from a cross sectional survey conducted by The Joint Program for Children, Food Security, and Nutrition in Cambodia. Infant caregivers were defined as adhering to the guidelines if they complied with at least 80% of each one of Cambodia’s five complementary feeding recommendations. I utilized logistic regression to estimate the risk of diarrhea, anemia and stunting among infants whose caregivers adhered compared to those whose caregivers did not adhere to the guidelines. Only 36 (5.1%) caregivers adhered to at least 80% of Cambodia’s complementary feeding guidelines. I did not observe any excess risk for diarrhea in the preceding two weeks, anemia or stunting among infants whose caregivers did not adhere to the feeding guidelines. There was minimal difference in dietary diversity between the two groups. Consumption of meat, grains, legumes, dairy, and vitamin A rich foods varied by at most 13% between infants whose caregivers adhered and did not adhere to the guidelines. My results indicate that the overwhelming majority of families in Cambodia are not adhering to Cambodia’s current complementary feeding guidelines. Furthermore, adherence is not associated with greater dietary diversity or better pediatric health outcomes. Future studies should consider testing the utility of guidelines that incorporate recommendations for dietary diversity to improve health outcomes.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Parental occupational exposures and risk of childhood cancer

Childhood cancer remains the second most common cause of death in children living in the United States and Europe. Research to date has revealed little about the etiology of these diseases, and established risk factors are limited to certain rare genetic syndromes and polymorphisms, ionizing radiation, and congenital abnormalities. Parental occupational exposures have been associated with increased risk of some childhood cancers, including leukemia and brain tumors. However, studies on maternal exposures, and those that examine the rarer cancers, are largely lacking. For the present analyses, we utilized two datasets and examined associations between (1) parental occupational social contact and risk of hematopoietic, central nervous system (CNS) and bone cancers, (2) industry types and retinoblastoma and (3) exposure to harmful environmental agents and retinoblastoma. Our first population-based case-control study utilized a linkage of four Danish data-registries, and included 4,112 cases and 411,200 age-matched controls. High occupational social contact, jobs that have regular contact with young children or the sick, was examined from (1) conception to birth and (2) birth to diagnosis. Acute lymphoblastic leukemia (ALL) and bone cancer were inversely associated with high maternal occupational social contact from conception to birth (OR: 0.82, 95% CI: 0.64-1.04) and birth to diagnosis (OR: 0.59, 95% CI: 0.39-0.91). Children of fathers with high occupational social contact from birth to diagnosis had an increased risk of bone cancers, particularly in rural areas (OR: 1.68, 95% CI: 1.07-2.64). Parental high social contact was associated with increased risk of astrocytoma, with strongest associations found in first born children (maternal contact: OR: 1.54, 95% CI: 1.02-2.32; paternal contact: OR: 1.82, 95% CI: 1.05-3.17). Our second study utilized the same Danish dataset and examined the role of occupational industry type during two biologically relevant time periods (1) 90 days preconception to conception for fathers and (2) conception to birth for mothers and risk of retinoblastoma among offspring. Parents were grouped into major industry headings created from Danish industry codes, an extended version of the International Standard Industrial Classification of All Economic Activities. We observed increased risk of all retinoblastoma among fathers in the food and drink industry (OR: 2.27, 95% CI: 1.24-4.16) and those who sell groceries (OR: 3.56, 95% CI: 1.42-8.91). Bilateral disease was associated with paternal work in supermarkets (OR: 4.03, 95% CI: 1.52-10.71) and transportation on land (OR: 4.03, 95% CI: 1.52-10.71). For maternal occupation, we estimated an increased risk of all retinoblastoma for hospital workers or clinicians (OR: 2.05, 95% CI: 1.34-3.14). In our final multicenter study on non-familial retinoblastoma, parents of 187 unilateral and 95 bilateral cases and 155 friend controls were interviewed by telephone. Exposure information was collected retroactively through a detailed occupational questionnaire which asked fathers to report every job held in the 10 years before conception, and mothers one month prior to and during the index pregnancy. We estimated elevated odds ratios for unilateral and bilateral retinoblastoma among offspring of fathers who were exposed to polycyclic aromatic hydrocarbons (PAHs) or paints in the 10 years prior to conception. However, only for exposure to paints did confidence limits exclude the null for bilateral disease (OR: 8.76, 95% CI: 1.32-58.09). Maternal prenatal exposure to at least one of the 9 agents was related to increased risk of unilateral disease in their children (OR: 5.25, 95% CI: 1.14-24.16).Our results support the notion of a role of infections for some cancer types. Studies on the risk factors for retinoblastoma are rare and our results suggest that some parental occupational exposures may cause childhood retinoblastoma

Blood Pressure Changes After a Health Promotion Program Among Mexican Workers.

Background: Cardiovascular disease is becoming increasingly prevalent in low and middle-income countries (LMIC), and high blood pressure (BP) is one of the main risk factors. The efficacy and sustainability of worksite health promotion (WHP) programs for BP reduction in LMIC have yet to be determined. Methods: This non-randomized company-based trial evaluated 6- and 12-months effects of a WHP intervention on BP among 2,002 participating workers from seven Mexican companies. Intervention and control groups were assigned at the company level. The intervention included nutrition counseling, physical exercise, and stress management components. Mixed models assessed differences in BP change between intervention and control companies in intent-to-treat (ITT), per-protocol (PerP), and as-treated (AsTr) analyses, and also within-group changes stratified by company, intervention component, and baseline cardiovascular risk factor levels. All analyses were adjusted for potential confounders. We accounted for missing data and loss to follow-up using inverse probability of censoring weighting. Results: ITT analyses revealed mean BP change differences of -1.1 mmHg at 12 months (95% CI: -2.9; 0.6) in intervention companies relative to control companies. PerP and AsTr analyses confirmed this finding. Within-group analyses showed consistent BP reductions at both 6 and 12 months. Substantial differences in BP changes ranging from diastolic -6.1 mmHg, (95% CI: -11.2; -1.2) to systolic -13.0 mmHg (95% CI: -16.0; -10.1) were found among individuals with diabetes at baseline in intervention companies relative to control companies. Conclusion: After 1 year, WHP was associated with modest but uncertain BP reductions. Substantial reductions were mainly observed among diabetic workers

High parental occupational social contact and risk of childhood hematopoietic, brain and bone cancers.

BackgroundThe etiology of childhood cancer is largely unknown, though some research suggests an infectious origin of hematopoietic, central nervous system (CNS) and bone cancers.MethodsWe examined parental occupational social contact as a proxy for exposure to infectious agents and risk of childhood cancer. This population-based case-control study utilized a linkage of four Danish data-registries, and included 3581 cases (<17 years, diagnosed 1973-2012) and 358,100 age-matched controls. We examined the risks of leukemia, lymphoma, CNS and bone cancer related to high occupational social contact from (1) conception to birth and (2) birth to diagnosis.ResultsAcute lymphoblastic leukemia (ALL) and bone cancer were inversely associated with high maternal social contact from conception to birth (OR: 0.86, 95% CI: 0.67-1.10) and birth to diagnosis (OR: 0.54, 95% CI: 0.34-0.86). Children of fathers with high social contact from birth to diagnosis had an increased risk of bone cancers, particularly in rural areas (OR: 1.65, 95% CI: 1.03-2.63). Parental social contact was associated with increased risk of astrocytoma, with strongest associations found in first-born children (maternal: OR: 1.54, 95% CI: 1.02-2.32; paternal: OR: 1.82, 95% CI: 1.05-3.17).ConclusionOur results support the notion of a role of infections for some cancer types

High parental occupational social contact and risk of childhood hematopoietic, brain and bone cancers.

BackgroundThe etiology of childhood cancer is largely unknown, though some research suggests an infectious origin of hematopoietic, central nervous system (CNS) and bone cancers.MethodsWe examined parental occupational social contact as a proxy for exposure to infectious agents and risk of childhood cancer. This population-based case-control study utilized a linkage of four Danish data-registries, and included 3581 cases (<17 years, diagnosed 1973-2012) and 358,100 age-matched controls. We examined the risks of leukemia, lymphoma, CNS and bone cancer related to high occupational social contact from (1) conception to birth and (2) birth to diagnosis.ResultsAcute lymphoblastic leukemia (ALL) and bone cancer were inversely associated with high maternal social contact from conception to birth (OR: 0.86, 95% CI: 0.67-1.10) and birth to diagnosis (OR: 0.54, 95% CI: 0.34-0.86). Children of fathers with high social contact from birth to diagnosis had an increased risk of bone cancers, particularly in rural areas (OR: 1.65, 95% CI: 1.03-2.63). Parental social contact was associated with increased risk of astrocytoma, with strongest associations found in first-born children (maternal: OR: 1.54, 95% CI: 1.02-2.32; paternal: OR: 1.82, 95% CI: 1.05-3.17).ConclusionOur results support the notion of a role of infections for some cancer types