Obesity at age 20 and the risk of miscarriages, irregular periods and reported problems of becoming pregnant: the Adventist Health Study-2

In a group of 46,000 North-American Adventist women aged 40 and above, we investigated the relationships between body mass index (BMI, kg/m(2)) at age 20 and the proportion of women who reported at least one miscarriage, periods with irregular menstruation or failing to become pregnant even if trying for more than one straight year. Approximately 31, 14 and 17 %, respectively, reported the three different problems related to reproduction. Positive age- and marital status adjusted relationships were found between BMI at age 20 and periods with irregular menstruation or failing to become pregnant even if trying for more than 1 year, but not with the risk of miscarriages. Women with BMI ≥ 32.5 kg/m(2) when aged 20 had approximately 2.0 (95 % CI: 1.6, 2.4) and 1.5 (95 % CI: 1.3, 1.9) higher odds for irregular periods or failing to get pregnant, respectively, than women with BMI in the 20–24.9 kg/m(2) bracket. These relationships were consistently found in a number of strata of the population, including the large proportion of the women who never had smoked or never used alcohol. Underweight (BMI < 18.5 kg/m(2)) when aged 20 marginally (approximately 15 %) increased the risk of failing to get pregnant within a year. Thus, obesity at age 20 increases the risk of reporting some specific reproductive problems, but not the risk of miscarriages. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10654-012-9749-8) contains supplementary material, which is available to authorized users

P-25 The association of the cumulative/lifetime duration of breast feeding and the development of post menopausal breast cancer. Results from Adventist Health study-2

Methods: We also modeled the outcome variable breast cancer using attained age model in Cox proportional hazard regression analysis to assess the association. The models consisted of the main exposures; duration of breast feeding and initiation of breast feeding adjusted for age, education, live birth, age at menarche, age at first birth, period between first child birth and last child birth, body mass index, exercise, hormone replacement therapy (HRT), use of birth control pills, and family history of breast cancer. Results: There was an inverse association between breast feeding and risk of breast cancer, 25% lower risk for those who have initiated breastfeeding, Months of breastfeeding was associated with risk of breast cancer, but the effect seems to be a threshold effect with any breastfeeding (1+ month) being protective compared to those who have not breastfed. Family history of breast cancer, recent HRT use, and higher education were associated with increased risk of breast cancer. Conclusions: Breast feeding is associated with some reduction in risk of breast cancer, but the findings did not reach statistical significance. However the study is limited to a few cases hence wide confidence intervals. Further studies are required to investigate this relationship with a study sample with enough cases. Key Words: Duration breastfeeding, women, post-menopausal, breast cance

P-24 Disparities of Breastfeeding patterns between Black and White Adventist Women in North America. Results from the Adventist Health Study (AHS) - 2

Background: Racial disparities of breast feeding have been reported in various studies, but few have evaluated the factors associated with racial discrepancies in breastfeeding. Method: We evaluated breastfeeding patterns among 26,926 white and 10,550 black parous females, aged 30 years and above, who were enrolled in the Adventist Health Study-2. We evaluated: 1) initiation of breastfeeding and 2) length (months/child) of breastfeeding using log linear binomial and multiple linear regression, respectively adjusting for age, education, parity, body mass index, marital status, country lived during young adult life (age 6-16), oral contraceptive use and dietary patterns. Results: Black women were less likely to initiate breastfeeding than white women (Prevalence Ratio=0.87, 95% Confidence Interval: 0.86-0.89) and breastfed on average 1.2 months shorter per child than white women. Older women were less likely to have breastfed their children (PR=0.97, 0.91, 0.87 and 0.95 for ages 41-50, 51-60, 61-70 and 80+ respectively compared to 30-40 year olds. Vegetarians were more likely to initiate breastfeeding than non-vegetarians (Prevalence ratio= 1.07-1.12). Conclusions: The racial difference on breastfeeding exist and remained virtually unchanged even after adjusting for a number of socio-economic factors including age, marital status, education and place lived during childhood and adolescence. The observed racial disparity warrants further study into possible factors that can explain the differences seen. Attitudes towards breastfeeding, in particular, need to be investigated among black and white females in the US. Key words: disparity, blacks, white women, breastfeeding, Adventists, North America

Health-Predictive Social-Environmental Stressors and Social Buffers Are Place Based: A Multilevel Example From San Bernardino Communities

Significant evidence demonstrates the powerful effects social determinants have on health-related perceptions, behaviors, and health outcomes. However, these factors are often studied out of context, despite the acknowledgement that social determinants of health are place based. This research aimed to demonstrate that health-related perceptions are dependent on where one lives. Via a community-based participatory study, participants were randomly selected from 3 residential regions varying distances from a freight railyard (nearest n = 300, middle n = 338, farthest n = 327), all mostly low-income, predominately Latino areas. Interview-administered surveys with adults were collected by bilingual trained community members (87% response) in English/Spanish. Adjusted-logistic regression models assessed residential region as a predictor of stressors (perceptions of community safety, community noise disturbance, health care access, food insecurity) and buffers (3 neighborhood cohesion variables), after adjusting for household income, race/ethnicity, gender, and age. Each region experienced a unique amalgam of stressors and buffers. In general, the region closest to the railyard experienced more stressors (odds ratio [OR] = 1.58; 95% CI 1.12-2.20) and less buffers (OR = 0.69; 95% CI 0.49-0.96) than the region furthest from the railyard. More than half of participants in each region reported 2 or more stressors and 2 or more buffers. In this seemingly homogenous study population, place remained important in spite of traditionally used socioeconomic factors, such as household income and race/ethnicity. Social determinants of health should be studied with regard to their environmental context, which will require interdisciplinary collaboration to improve multilevel research methods. Including the study of social buffers will also promote sustainable, positive change to reduce health disparities

Robot-assisted locomotor training did not improve walking function in patients with chronic incomplete spinal cord injury: A randomized clinical trial

Objective: To assess the effects of robot-assisted locomotor training in patients with chronic incomplete spinal cord injury. Design: Randomized single-blind controlled clinical trial. Setting: The intervention site was an outpatient clinic, and pre- and post-evaluations were performed in a rehabilitation hospital. Patients: A total of 24 subjects with American Spinal Injury Association Impairment Scale grades C or D, >?2 years post-injury. Interventions: Subjects were randomized to 60 days of robot-assisted locomotor training, or to usual care. Methods: Walking function, lower extremity muscle strength and balance were assessed single-blinded pre- and post-intervention. Results: After a 9-year recruitment period, only 24 of the planned 30 subjects had been enrolled (mean time since injury 17 (standard deviation (SD) 20) years for all subjects). Walking function, lower extremity muscle strength and balance improved modestly in both groups, with no statistically significant group difference in walking function or muscle strength, whereas postural control declined significantly in the intervention group, compared with controls (p?=?0.03). Conclusion: Late-onset robot-assisted locomotor training did not re-establish independent walking function. A modest, but non-significant, effect was seen on muscle strength and balance. However, significant between-group differences were found only in postural control in the control group

Manually assisted body-weight supported locomotor training does not re-establish walking in non-walking subjects with chronic incomplete spinal cord injury: A randomized clinical trial

Objective: To assess the effects of manually assisted body-weight supported locomotor training in subjects with chronic incomplete spinal cord injury. Design: Randomized controlled clinical trial. Subjects: Twenty subjects with American Spinal Injury Association Impairment Scale grades C or D and > 2 years post-injury. Methods: Random allocation to 60 days of body-weight supported locomotor training, or usual care, which might include over-ground walking. Walking function, lower extremity muscle strength and balance were blindly evaluated pre-/post-intervention. Results: A small, non-significant improvement in walking function was observed (0.1 m/s (95% confidence interval (95% CI) –0.2, 0.4)), but subjects without baseline gait function, did not re-establish walking. The effect on lower extremity muscle strength was 2.7 points (95% CI –1.4, 6.8). No difference was observed in balance measures. Conclusion: Subjects with chronic incomplete spinal cord injury without baseline walking function were unable to re-establish gait with manually assisted body-weight supported locomotor training. A modest, non-significant, improvement was found in strength and walking speed. However, due to study recruitment problems, an effect size that was smaller than anticipated, and large functional heterogeneity among study subjects, the effect of late-onset body-weight supported locomotor training is not clear. Future studies should include larger numbers of subjects with less functional loss and greater functional homogeneity. Intensive training should probably start earlier post-injury

Are perceptions of community safety associated with respiratory illness among a low-income, minority adult population?

Abstract Background Growing evidence suggests social disadvantage magnifies the harmful health effects of environmental hazards; however, there is limited research related to perceptions of risk among individuals who live near such environmental hazard sites. We explored the association between individual-level perception of community safety and respiratory illness among low-income, minority adults who live in a region with routine poor air quality exacerbated by the emissions of a nearby freight railyard. Methods Interview-administered household surveys were collected (87% response rate; n = 965) in English/Spanish from varying distances surrounding a freight railyard (analytic total n = 792: nearest region n = 215, middle n = 289, farthest n = 288). Illness outcome was an affirmative response to doctor-diagnosed asthma, bronchial condition, emphysema, COPD, or prescribed-inhaler usage. Respiratory symptoms outcome was an affirmative response to chronic cough, chronic mucus, or wheezing. The independent variable was perceived community safety. Results Outcome prevalences were similar across environmental hazard regions; 205 (25.9%) were diagnosed-illness cases and 166 (21.0%) diagnosis-free participants reported symptoms. Nearly half (47.5%) of participants reported lack of perceived community safety, which was associated with environmental hazard region (p <  0.0001). In multivariable log-binomial regression models adjusting for covariables (age, gender, race/ethnicity, smoking status, smoke exposure, residential duration, and distance from the railyard) respiratory illness diagnosis was associated with lack of perceived community safety (PR = 1.39; 95% CI 1.09, 1.76). Sensitivity analyses showed a non-significant but increasing trend in the strength of association between safety perceptions and illness diagnoses with closer proximity to the railyard. Conclusions Our findings contribute to the literature that individuals’ perceptions of community safety are associated with adverse respiratory health among a population living in high air pollution exposure areas