Prevalence, Risk Factors, and Sequelae of Peripheral Neuropathy in a Population-Based Cohort of Mid-Life Women.

Peripheral neuropathy is a well-documented complication of diabetes, yet it remains an underappreciated condition in non-diabetic individuals. Studies of neuropathy in longitudinal or population-based samples are limited. The goal of this dissertation was to document the burden, risk factors, and sequelae of peripheral neuropathy in a population-based sample of Caucasian and African American women in the United States. This dissertation utilized 1996-2008 data from the Study of Women’s Health Across the Nation – Michigan site. Annual anthropometric and performance-based physical functioning measures were collected and peripheral neuropathy was assessed in 2008 using three independent assessment methods. We described the associations between individual characteristics and neuropathy, and determined if anthropometric and physical functioning trajectories differed between women who did and did not have prevalent neuropathy in 2008. The prevalence of peripheral neuropathy was substantial and ranged from 14.3% to 20.0% depending on assessment method. On average, body mass index, weight, and waist circumferences increased over time and differed significantly at baseline through 2008 between women who did and did not have neuropathy in 2008, even among women without diabetes. However, when we examined trajectories of anthropometric measures, slopes did not differ, suggesting that age-related increases in body size were constant over time between women who did and did not have peripheral neuropathy in 2008. On average, physical functioning declined over time and differed significantly between women who were and were not found to have neuropathy in 2008. Women who had peripheral neuropathy in 2008 had poorer physical functioning, and for some measures, a steeper rate of decline over time, than women who did not have neuropathy in 2008. This dissertation expands our understanding of the burden of peripheral neuropathy in mid-life women. The high prevalence of neuropathy is a growing public health problem and is underappreciated as a potential cause of functional decline. Clinicians should implement peripheral neuropathy testing for individuals of the general population who exhibit diminished functional capacity. The co-occurrence of peripheral neuropathy with obesity and poor physical functioning may explain the high prevalence of disability reported among women in the United States and deserves further research.Ph.D.Epidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/91439/1/kylitalo_3.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/91439/2/kylitalo_2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/91439/3/kylitalo_1.pd

Reproductive History and Chronic Hepatic Steatosis in the Michigan Study of Women's Health Across the Nation

Background: Reproductive history, particularly maternal age at most recent birth, may reflect lower risk for chronic disease and mortality due to socioeconomic factors, lifestyle behaviors, or genetics. Reproductive history has not been examined with respect to hepatic steatosis, the most common liver disease in the United States. Our objective was to examine the association between reproductive history and hepatic steatosis. Methods: We examined the association between reproductive history characteristics?specifically age at most recent birth?and the odds of moderate to severe hepatic steatosis using a population-based retrospective cohort study of women who underwent hepatic ultrasound at the Michigan site of the Study of Women's Health Across the Nation (n=331). Results: Women who gave birth at ≥35 years of age comprised 19% of the study population and were similar to other women regarding sociodemographic history and health behaviors. In multivariable analyses adjusting for age, race/ethnicity, chronic disease, and medications associated with hepatic steatosis, age at birth ≥35 years was associated with significantly decreased odds of hepatic steatosis (adjusted odds ratio [OR] 0.41, 95% confidence interval [CI] 0.20?0.87), which was attenuated after adjustment for waist circumference (OR 0.51, 95% CI 0.24?1.10). Other reproductive factors including gravidity, parity, miscarriages and abortions, recall of gestational weight gain, breastfeeding, age at first birth, and age at final menstrual period were not associated with hepatic steatosis. Conclusions: Women who were older at their most recent birth had a reduced odds of hepatic steatosis, possibly associated with their lower waist circumference.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140129/1/jwh.2014.4839.pd

Burnout and Substance Use in Collegiate Athletic Trainers

CONTEXT: The Smith Cognitive-Affective Model of Athletic Burnout suggests that athletic trainers (ATs) suffering from burnout may engage in substance use as a coping behavior. Increases in self-reported burnout symptoms are often associated with increases in heavy episodic drinking and tobacco use among various health care providers. However, this relationship has not been examined thoroughly. OBJECTIVE: To investigate the prevalence of substance use in ATs and identify relationships between symptoms of burnout and substance use among ATs. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 783 certified ATs working full time in the collegiate or university setting were sampled for this study. Graduate assistant and other part-time ATs were excluded. The survey was distributed via the National Athletic Trainers\u27 Association membership directory e-mail broadcast service. MAIN OUTCOME MEASURE(S): A 100-item online questionnaire consisting of items from previously used scales was used for this study. The survey included the Maslach Burnout Inventory and questions on substance use from the Monitoring the Future study. Multiple regression analyses were performed to analyze the survey data. All independent (Maslach Burnout Inventory subscales) and dependent (use of alcohol, tobacco, and marijuana) variables were mapped to the Smith Cognitive-Affective Model of Athletic Burnout to determine which dimensions of burnout altered the odds of self-reported substance use. RESULTS: Almost half (46.3%) of participants admitted to at least 1 binge-drinking episode. However, the use of cigarettes, smokeless tobacco, marijuana, and energy drinks during the previous month was less pronounced in the sample. Emotional exhaustion (B = .008, P = .023) and personal accomplishment (B = -.016, P = .02) were significantly correlated with binge drinking. Emotional exhaustion (Exp[B] = 1.017, P \u3c .001) was also significantly positively correlated with energy-drink consumption. CONCLUSIONS: Some ATs engaged in heavy episodic drinking. Emotional exhaustion and a decreased sense of personal accomplishment were significantly correlated with this behavior

The role of perceived effectiveness of policy measures in predicting recycling behaviour in Hong Kong

Hong Kong is a compact and ‘land-hungry’ city where recycling has become an important measure for treating waste and reducing the demand on the limited landfills. The objectives of this paper are to extend the model of recycling attitude and behaviour to explain the relationship between perceived policy effectiveness and recycling behaviour. Previous studies on recycling attitude and behaviour had widely adopted the Theory of Planned Behaviour (TPB) and the Norm Activation Model (NAM), and drawn policy implications from them. Nevertheless, little research has been conducted to investigate the role of perceived effectiveness of policy measures in predicting recycling behaviour. To address this, a model that integrates the TPB and NAM was proposed in this study, and a street survey was conducted to investigate the case. The results illustrate that recycling intention is influenced by subjective norms, perceived behavioural control, moral norms, and awareness of consequences, as well as a newly proposed construct, namely perceived policy effectiveness. The study proved self-reported recycling behaviour (direct behaviour) and support for policy measures (indirect behaviour) are influenced by recycling intention. All in all the Government should provide more recycling bins, guidelines on recycling activities, and should accent what it has been doing to facilitate and encourage recycling

The Relationship Between Spiritual Well-Being and Burnout In Collegiate Athletic Trainers

Context: Spiritual well-being is the expression of one\u27s spirituality as measured in the dimensions of existential and religious well-being. The Smith Cognitive Affective Model of Athletic Burnout suggests that personality factors such as spiritual well-being and the use of religious coping methods may affect burnout as well as its causes and outcomes. This has not been examined in collegiate athletic trainers (ATs). Objective: To investigate the relationship between spiritual well-being and burnout in collegiate ATs. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A total of 783 certified ATs employed full time in the collegiate setting participated. Part-time employees (eg, graduate assistants, interns) were excluded. Main Outcome Measure(s): A 100-item online questionnaire was created for this study. It used items from previously developed scales, including the Spiritual Well-Being Scale, the Brief RCOPE, the Maslach Burnout Inventory, and substance-use questions from the Monitoring the Future study. Participants were able to complete the survey in approximately 10–15 minutes. Multiple regression analyses were used to analyze survey data. We mapped all independent (existential well-being, religious well-being, positive and negative religious coping) and dependent variables (situational variables, Maslach Burnout Inventory burnout subscales, substance use, and intention to leave) onto the Smith Cognitive-Affective Model of Athletic Burnout to determine which variables altered burnout levels, substance use, and intention to leave. Tests of mediation or moderation were conducted when appropriate. Results: Existential well-being was a significant positive predictor of social support and a significant negative predictor of work-family conflict, decreased sense of personal accomplishment, emotional exhaustion, depersonalization, intention to leave the profession, and binge drinking. Existential well-being also served as a mediator or moderator in several components of the model. Conclusions: Existential well-being was a protective factor against burnout as well as some of the causes and effects of burnout in collegiate ATs

Metabolic Health, Obesity, and Renal Function: 2013–2018 National Health and Nutrition Examination Surveys

Rising rates of metabolic syndrome, obesity, and mortality from chronic kidney disease (CKD) have prompted further investigation into the association between metabolic phenotypes and CKD. Purpose: To report the frequency of strictly defined metabolic phenotypes, renal function within each phenotype, and individual risk factors associated with reduced renal function. We utilized the 2013–2018 National Health and Nutrition Examination Surveys (NHANES) and complex survey sample weighting techniques to represent 220 million non-institutionalized U.S. civilians. Metabolic health was defined as having zero of the risk factors defined by the National Cholesterol Education Program with the exception of obesity, which was defined as BMI ≥ 30 kg/m2 in non-Asians and BMI ≥ 25 kg/m2 in Asians. The metabolically healthy normal (MUN) phenotype comprised the highest proportion of the population (38.40%), whereas the metabolically healthy obese (MHO) was the smallest (5.59%). Compared to the MHN reference group, renal function was lowest in the strictly defined MUN (B = −9.60, p < 0.001) and highest in the MHO (B = 2.50, p > 0.05), and this persisted when an increased number of risk factors were used to define metabolic syndrome. Systolic blood pressure had the strongest correlation with overall eGFR (r = −0.25, p < 0.001), and individuals with low HDL had higher renal function compared to the overall sample. The MUN phenotype had the greatest association with poor renal function. While the MHO had higher renal function, this may be due to a transient state caused by renal hyperfiltration. Further research should be done to investigate the association between dyslipidemia and CKD

Sibship, physical activity, and sedentary behavior: a longitudinal, observational study among Mexican-heritage sibling dyads

Abstract Background Shared genetic and environmental factors suggest that family relationships are important predictors of obesity-related behaviors, yet little is known about how siblings influence physical activity and sedentary behaviors. This study examined physical activity and sedentary behavior between sibling dyads across summer and fall time points and determined if birth order and gender modify the relationship between sibling behaviors. Methods Mexican-heritage families residing in colonias along the United States-Mexico border were recruited using promotoras de salud to participate in summer and school year surveys. Eighty-seven sibling dyads had complete data for the physical activity sub-study: 21 older brother-younger brother, 21 older brother-younger sister, 23 older sister-younger brother, and 22 older sister-younger sister dyads. Physical activity and sedentary behavior were measured using a validated 7-day recall instrument to create summary measures of weekly active, moderate-to-vigorous physical activity (MVPA) metabolic equivalents (MET), sitting, and screen time minutes. We used linear regression analyses to examine changes over time and the association between older and younger sibling behavior. Results During summer, older siblings (mean age = 11.2 years) reported 1069 active minutes and 1244 sitting minutes per week; younger siblings (mean age = 8.3 years) reported 1201 active minutes and 1368 sitting minutes per week. Younger brothers reported fewer active minutes (mean = − 459.6; p = 0.01) and fewer MVPA MET-minutes (mean = − 2261.7; p = 0.02) of physical activity during the fall. Within all 87 dyads, older sibling physical activity was significantly associated with younger sibling active minutes (B = 0.45;p = 0.004) and MET-minutes (B = 0.45;p = 0.003) during summer but not fall; older sibling sedentary behavior was significantly associated with younger sibling sitting (B = 0.23;p = 0.01) and screen time minutes (B = 0.23;p = 0.004) during fall but not summer. After stratifying by gender dyad groups, younger brother behavior was strongly associated with older brother behavior at both time points. Conclusion Younger siblings appear to emulate the physical activity behaviors of their older siblings during non-school summer months and sedentary behaviors of older siblings during school-time fall months, especially older brother-younger brother dyads. Family-based interventions to increase physical activity and decrease sedentary behavior are growing in popularity, but more work is needed to understand the role of sibling influences

Progression from metabolically benign to at-risk obesity in perimenopausal women: a longitudinal analysis of study of women across the nation (SWAN)

Background: Little is known about the natural history of progression from a metabolically benign overweight/obese (MBO) to at-risk overweight/obese (ARO) phenotype. Improved understanding would help clinicians focus on controlling risk factors that predispose an obese individual to progression.Methods: Using discrete-time proportional hazard modeling on data from the Study of Women\u27s Health Across the Nation (SWAN), we examined the incident progression from MBO (less than two metabolic syndrome abnormalities) to ARO (two or more metabolic syndrome abnormalities) and factors associated with progression over a 7-year period.Results: Of 866 MBO women at baseline, 43% progressed to the ARO phenotype. Compared with those who remained MBO, those who progressed had higher baseline BMI and a higher prevalence of cardiometabolic abnormalities (elevated glucose, triglycerides, blood pressure and low high-density lipoprotein cholesterol). In multivariable analyses, an increase in body mass index was associated with a modest increase in the risk of progression. Although all cardiometabolic abnormalities were associated with an increased risk, the baseline impaired fasting glucose showed the strongest association with the risk of progression [hazard ratio 3.24; 95% confidence interval 2.10, 4.92; P \u3c .001]. Physical activity played a protective role in decreasing the risk of progression [hazard ratio 0.86; 95% confidence interval 0.80, 0.92; P \u3c .001].Conclusions: Increasing obesity and the presence of cardiometabolic abnormalities increase the risk of progression, whereas physical activity is the only lifestyle factor protective against progression from metabolically benign to the at-risk overweight/obese phenotype, a state that is unanimously associated with an elevated risk of cardiovascular morbidity and mortality