Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016

OBJECTIVE: Healthcare providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample. METHODS: Adults 20-64 years (n=11,467) from National Health and Nutrition Examination Study between 2011 and 2016 were analyzed, with weight status, and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease and type 2 diabetes mellitus). Lifestyle modification advice by healthcare providers included increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of above. RESULTS: High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared to osteoarthritis (7.4%), type 2 diabetes (5.7%) and coronary heart disease (3.7%). Those with type 2 diabetes received considerably frequent advice (56.5%; 95%CI: 52.4%-60.6%) than those with high blood pressure (31.4%; 95%CI:29.3%-33.6%) and cholesterol (27.0%; 95%CI:24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded BMI and comorbidity (all P<0.001). After adjusting for comorbid conditions, advice were more commonly reported among women, those overweight/obese, non-white, or insured. Remarkably low proportion of overweight (21.4: 95%CI: 18.7-24.3%) and obese (44.2%;95%CI:41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice. CONCLUSION: Prevalence of lifestyle modification advised by healthcare providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainably strategies reducing chronic condition burden

Ability of Dental Students to Deliver Oxygen in a Medical Emergency

This study was conducted to evaluate the ability of dental students to administer emergency oxygen to a patient during a simulated emergency. Forty third‐year (D3) and fourth‐year (D4) dental students were recruited and asked to demonstrate their ability in managing a simulated angina attack. Students were tested on their knowledge related to emergency medical protocols, the time taken to obtain oxygen, and operation of the oxygen equipment. Of the subjects tested, 68 percent independently identified the need for oxygen and the correct location of the equipment in the dental school. Only 15 percent of the students completed the experiment within a predetermined optimal time frame, and 50 percent of all students did not successfully operate the tank regulator to administer oxygen correctly. Although most participants in the study were able to verbalize the proper protocol for managing medical emergencies, the chairside execution in this situation demonstrates room for improvement. Incorporation of periodic simulation exercises, in addition to classroom education, is likely to improve the ability of dental students to manage medical emergencies.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153567/1/jddj002203372009734tb04721x.pd

Psychometric Evaluation of a 13‐Point Measure of Students’ Overall Competence in Community‐Based Dental Education Programs

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153670/1/jddj0022033720168010tb06207x.pd

Leisure-Time Sedentary Behavior, Alcohol Consumption, and Sexual Intercourse Among Adolescents Aged 12-15 Years in 19 Countries From Africa, the Americas, and Asia

BACKGROUND: The association between sedentary behavior and sexual behavior has not been investigated among adolescents. // AIM: The aim of this study was to: (i) investigate the association between leisure-time sedentary behavior and sexual intercourse, and (ii) test for mediation by alcohol consumption, drug use, physical activity, bullying victimization, parental support/ monitoring, loneliness, and depressive symptoms in a large global sample of young adolescents. // METHODS: Data were analyzed from 34,674 adolescents aged 12-15 years participating in the Global School-based Student Health Survey. Participants reported the number of hours spent in leisure-time sedentary behavior on a typical day (8 hours). Data on alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms were considered as potential mediators. // OUTCOME: Participants reported whether or not they had sexual intercourse in the past 12 months (yes/no). // RESULTS: The prevalence of past 12-month sexual intercourse was 11.9%, whereas the prevalence of 8 hours per day of leisure-time sedentary behavior were 26.7%, 35.6%, 21.4%, 11.5%, and 4.9%, respectively. There was a dose-dependent relationship between sedentary behavior and odds of reporting sexual intercourse: compared with 8 hours/day of sedentary behavior were 1.12 (0.94-1.33), 1.22 (1.01-1.48), 1.34 (1.08-1.66), and 1.76 (1.37-2.27), respectively. There was no significant interaction by sex. The largest proportion of the association between sedentary behavior and sexual intercourse was explained by alcohol use (% mediated 21.2%), with other factors explaining an additional 11.2%. // CLINICAL TRANSLATION: Interventions to reduce leisure-time sedentary and/or alcohol consumption may contribute to a reduction in the proportion of adolescents engaging in sexual intercourse at a young age. The strengths and limitations of this study are the large, representative sample of adolescents from 19 countries. However, the cross-sectional design means causality or temporal associations could not be established. // CONCLUSIONS: In young adolescents, leisure-time sedentary behavior is positively associated with odds of having sexual intercourse in both boys and girls, in a dose-dependent manner. Alcohol consumption seems to be a key mediator of this relationship

Lower Limb Muscle Strength and Muscle Mass Are Associated With Incident Symptomatic Knee Osteoarthritis: A Longitudinal Cohort Study

Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p&lt;0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms

Syndemic effects of HIV risk behaviors: results from the NHANES study

The aim of the present study is to use the syndemic framework to investigate risk of contracting HIV in the US population. Cross-Sectional analyses from The National Health and Nutrition Examination Survey. We extracted and aggregated data on HIV antibody test, sociodemographic characteristics, alcohol use, drug use, depression, sexual behaviors and sexually transmitted disease (STDs) from cycle 2009-2010 to 2015-2016.We carried out weighted regression among young adults (20-39 years) and adults (40-59 years) separately. 5,230 men and 5,794 women aged 20 years to 59 years were included in the present analyses. 0.8% men and 0.2% women were tested for HIV-positive. Each increasing HIV risk behavior, was associated with elevated odds of being tested for HIV-positive (1.15, 95% CI: 1.15 to 1.15) among young adults and adults (1.61, 95% CI: 1.61 to 1.61). Multi-faceted, community-based interventions are urgently required to reduce incidence of HIV in the USA

Human Immunodeficiency Virus Infection and Diverse Physical Health Outcomes: An Umbrella Review of Meta-analyses of Observational Studies

BACKGROUND: Our aim was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies and physical health outcomes associated with human immunodeficiency virus (HIV) but not acquired immunodeficiency syndrome. METHODS: We performed an umbrella review of observational studies. Evidence was graded as convincing, highly suggestive, suggestive, weak, or nonsignificant. RESULTS: From 3413 studies returned, 20 were included, covering 55 health outcomes. Median number of participants was 18 743 (range 403-225 000 000). Overall, 45 (81.8%) of the 55 unique outcomes reported nominally significant summary results (P < .05). Only 5 outcomes (9.0%; higher likelihood of presence of breathlessness, higher chronic obstructive pulmonary disease [COPD] prevalence, maternal sepsis, higher risk of anemia, and higher risk of all fractures among people living with HIV [PLWHIV]) showed suggestive evidence, with P values < 10-3; only 3 (5.5%; higher prevalence of cough in cross-sectional studies, higher incidence of pregnancy-related mortality, and higher incidence of ischemic heart disease among PLWHIV in cohort studies) outcomes showed stronger evidence using a stringent P value (<10-6). None of the unique outcomes presented convincing evidence (Class I), yet 3 outcomes presented highly suggestive evidence, 5 outcomes presented suggestive evidence, and 37 outcomes presented weak evidence. CONCLUSIONS: Results show highly suggestive and suggestive evidence for HIV and the presence of a cough, COPD, ischemic heart disease, pregnancy-related mortality, maternal sepsis, and bone fractures. Public health policies should reflect and accommodate these changes, especially in light of the increases in the life expectancy and the incidence of comorbidities in this population

Are young female suicides increasing? A comparison of sex-specific rates and characteristics of youth suicides in Australia over 2004-2014

BACKGROUND: Australian mortality statistics suggest that young female suicides have increased since 2004 in comparison to young males, a pattern documented across other Western high-income countries. This may indicate a need for more targeted and multifaceted youth suicide prevention efforts. However, sex-based time trends are yet to be tested empirically within a comprehensive Australian sample. The aim of this study was to examine changes over time in sex-based rates and characteristics of all suicides among young people in Australia (2004-2014). METHODS: National Coronial Information System and Australian Bureau of Statistics data provided annual suicide counts and rates for 10-24-year-olds in Australia (2004-2014), stratified by sex, age group, Indigenous status and methods. Negative binomial regressions estimated time trends in population-stratified rates, and multinomial logistic regressions estimated time trends by major suicide methods (i.e., hanging, drug poisoning). RESULTS: Between 2004 and 2014, 3709 young Australians aged 10-24 years died by suicide. Whilst, overall, youth suicide rates did not increase significantly in Australia between 2004 and 2014, there was a significant increase in suicide rates for females (incident rate ratio [IRR] 1.03, 95% confidence interval [CI] 1.01 to 1.06), but not males. Rates were consistently higher among Aboriginal/Torres Strait Islander youth, males, and in older (20-24-years) as compared to younger (15-19 years) age groups. Overall, the odds of using hanging as a method of suicide increased over time among both males and females, whilst the odds of using drug-poisoning did not change over this period. CONCLUSIONS: We showed that suicide rates among young females, but not young males, increased over the study period. Patterns were observed in the use of major suicide methods with hanging the most frequently used method among both sexes and more likely among younger and Aboriginal/Torres Strait Islander groups. Findings highlight the need to broaden current conceptualizations of youth suicide to one increasingly involving young females, and strengthen the case for a multifaceted prevention approach that capitalize on young females' greater help-seeking propensity