Assessment of the Effect of Visual Impairment on Mortality through Multiple Health Pathways: Structural Equation Modeling

PURPOSE. To estimate the direct effects of self-reported visual impairment (VI) on health, disability, and mortality and to estimate the indirect effects of VI on mortality through health and disability mediators. METHODS. The National Health Interview Survey (NHIS) is a population-based annual survey designed to be representative of the U.S. civilian noninstitutionalized population. The National Death Index of 135,581 NHIS adult participants, 18 years of age and older, from 1986 to 1996 provided the mortality linkage through 2002. A generalized linear structural equation model (GSEM) with latent variable was used to estimate the results of a system of equations with various outcomes. Standard errors and test statistics were corrected for weighting, clustering, and stratification. RESULTS. VI affects mortality, when direct adjustment was made for the covariates. Severe VI increases the hazard rate by a factor of 1.28 (95% CI: 1.07-1.53) compared with no VI, and some VI increases the hazard by a factor of 1.13 (95% CI: 1.07-1.20). VI also affects mortality indirectly through self-rated health and disability. The total effects (direct effects plus mediated effects) on the hazard of mortality of severe VI and some VI relative to no VI are hazard ratio (HR) 1.54 (95% CI: 1.28-1.86) and HR 1.23 (95% CI: 1.16-1.31), respectively. CONCLUSIONS. In addition to the direct link between VI and mortality, the effects of VI on general health and disability contribute to an increased risk of death. Ignoring the latter may lead to an underestimation of the substantive impact of VI on mortality

Perinatal Factors Associated with Cardiovascular Disease Risk among Preschool-Age Children in the United States: An Analysis of 1999–2008 NHANES Data

We examined the relationships between selected perinatal and early infancy factors (maternal smoking during pregnancy, infant low birthweight, breastfeeding, and early introduction of solid foods [<6 months of age] and increased BMI [≥85th, ≥95th percentiles for age, sex]), waist circumference (WC), C-reactive protein (CRP), triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein (HDL) cholesterol, and decreased HDL cholesterol during early childhood. The population-based sample included 3,644 3-to-6-year-old Non-Hispanic White (NHW), Hispanic, and Non-Hispanic Black (NHB) children who participated in the 1999–2008 National Health and Nutrition Examination Surveys. Analysis showed that breastfeeding was significantly protective against early childhood obesity (OR 0.43, 95% CI, 0.27–0.69) and the highest quintile for WC (OR 0.58, 95% CI, 0.37–0.32) among NHW, and against the highest quintile of non-HDL cholesterol among NHB (OR 0.56, 95% CI, 0.32–0.98). Additionally, NHW children were significantly more likely to be obese (OR 2.22, 95% CI 1.30–3.78) and have higher CRP levels (OR 1.63, 95% CI, 1.05–2.51) if their mothers smoked during pregnancy. These results support the observation that breastfeeding may be protective against early childhood obesity while maternal smoking during pregnancy is a risk factor for obesity and increased CRP levels among NHW young children

Working with cancer: health and employment among cancer survivors.

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Available online 4 August 2015PURPOSE: Cancer affects a growing proportion of US workers. Factors contributing to whether they continue or return to work after cancer diagnosis include: age, physical and mental health, health insurance, education, and cancer site. The purpose of this study was to assess the complex relationships between health indicators and employment status for adult cancer survivors. METHODS: We analyzed pooled data from the 1997-2012 US National Health Interview Survey (NHIS). Our sample included adults with a self-reported physician diagnosis of cancer (n = 24,810) and adults with no cancer history (n = 382,837). Using structural equation modeling (SEM), we evaluated the relationship between sociodemographic factors, cancer site, and physical and mental health indicators on the overall health and employment status among adults with a cancer history. RESULTS: The overall model for cancer survivors fit the data well (χ(2) (374) = 3654.7, P < .001; comparative fit index = 0.98; root mean square error of approximation = 0.04). Although black cancer survivors were less likely to report good-to-excellent health, along with Hispanic survivors, they were more likely to continue to work after diagnosis compared with their white counterparts. Health insurance status and educational level were strongly and positively associated with health status and current employment. Age and time since diagnosis were not significantly associated with health status or employment, but there were significant differences by cancer site. CONCLUSIONS: A proportion of cancer survivors may continue to work because of employment-based health insurance despite reporting poor health and significant physical and mental health limitations. Acute and long-term health and social support are essential for the continued productive employment and quality of life of all cancer survivors.The work was supported in part by a National Cancer Institute (NCI) fellowship at the National Institutes of Health (1F31CA153937); the National Institute for Occupational Safety and Health (NIOSH R01 OH03915); and the European Regional Development Fund Programme and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly (the University of Exeter Medical School)

Working with cancer: Health and employment among cancer survivors

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Purpose: Cancer affects a growing proportion of US workers. Factors contributing to whether they continue or return to work after cancer diagnosis include: age, physical and mental health, health insurance, education, and cancer site. The purpose of this study was to assess the complex relationships between health indicators and employment status for adult cancer survivors. Methods: We analyzed pooled data from the 1997-2012 US National Health Interview Survey (NHIS). Our sample included adults with a self-reported physician diagnosis of cancer (n = 24,810) and adults with no cancer history (n = 382,837). Using structural equation modeling (SEM), we evaluated the relationship between sociodemographic factors, cancer site, and physical and mental health indicators on the overall health and employment status among adults with a cancer history. Results: The overall model for cancer survivors fit the data well (χ2 (374) = 3654.7, P < .001; comparative fit index = 0.98; root mean square error of approximation = 0.04). Although black cancer survivors were less likely to report good-to-excellent health, along with Hispanic survivors, they were more likely to continue to work after diagnosis compared with their white counterparts. Health insurance status and educational level were strongly and positively associated with health status and current employment. Age and time since diagnosis were not significantly associated with health status or employment, but there were significant differences by cancer site. Conclusions: A proportion of cancer survivors may continue to work because of employment-based health insurance despite reporting poor health and significant physical and mental health limitations. Acute and long-term health and social support are essential for the continued productive employment and quality of life of all cancer survivors.The work was supported in part by a National Cancer Institute (NCI) fellowship at the National Institutes of Health (1F31CA153937); the National Institute for Occupational Safety and Health (NIOSH R01 OH03915); and the European Regional Development Fund Programme and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly (the University of Exeter Medical School)

Changes in Youth Cigarette Use Following the Dismantling of an Antitobacco Media Campaign in Florida

We examined the association of the termination of a successful youth-targeted antitobacco media campaign ("truth") and changes in smoking rates among youths aged 12-17 years in Florida. Six telephone-based surveys were completed during the active media campaign (1998-2001), and 2 postcampaign surveys were completed in 2004 and 2006 (each n ~1,800). Prevalence of current smoking among youth observed during the campaign continued to decrease in the first postcampaign survey; however, by the second follow-up survey, youth smoking rates had increased significantly for youth aged 16 years or older. Our findings support the need for consistent antitobacco messaging to reduce the prevalence of youth smoking

Does the Site of Anterior Tracheal Puncture Affect the Success Rate of Retrograde Intubation? A Prospective, Manikin-Based Study

Background. Retrograde intubation is useful for obtaining endotracheal access when direct laryngoscopy proves difficult. The technique is a practical option in the “cannot intubate / can ventilate” scenario. However, it is equally useful as an elective technique in awake patients with anticipated difficult airways. Many practitioners report difficulty successfully advancing the endotracheal tube due to anatomical obstructions and the acute angle of the anterograde guide. The purpose of this study was to test whether a more caudal tracheal puncture would increase the success rate. Methods. Twenty-four anesthesiology residents were randomly assigned to either a cricothyroid or a cricotracheal puncture group. Each was instructed how to perform the technique and then attempted it on a manikin at their assigned site. Data collection included whether the trachea was intubated, the number of attempts required, and the total time. Results. Both groups displayed a high degree of success. While the group assigned to the cricotracheal site required significantly more time to perform the procedure, they accomplished it in fewer attempts than the cricothyroid group. Conclusion. Retrograde intubation performed via a cricotracheal puncture site, while more time consuming, resulted in fewer attempts to advance the endotracheal tube and may reduce in vivo laryngeal trauma

A Report of Florida’s Cancer History, Risk Factors, and Screening Behaviors: Data from the National Health Interview Survey

To target populations at greatest risk ofdeveloping cancer, it is vital to understand the patterns ofrisk factors and screening behaviors along with cancer surveillance data. This study provides data on the prevalence of self-reported cancer history, can- cer risk factors, and cancer screening behaviors in Florida and compares them to rates in the rest ofthe U.S. Data were ob- tained from the National Health Interview Survey (NHIS), an annual, cross-sectional household survey of the U.S. civilian non-institutionalized population. We analyzed pooled data from the 2000 and 2005 Cancer Control Modules. Compared to the rest ofthe U.S., Floridians reported a lower prevalence ofcurrent smoking, risky drinking, and obesity, and a greater pre- valence ofProstate Specific Antigen (PSA) testing. However, Floridians reported a greater prevalence ofcancer history and a lower prevalence of physical activity, concern for sun protection, lifetime colorectal cancer screening, lifetime breast exam, life- time mammography screening, and lifetime and past year Pap test. The data indicate that Florida lags behind the rest of the U.S. in several areas, particularly cancer screening, and falls short ofthe Healthy People 2020 objectives for health behaviors and screening. These results provide information for key stakeholders and public health policy makers to effectively target Flor- ida residents at greatest risk for cancer and those not receiving recommended cancer screenings. This study also represents a model ofvaluable state-level evaluations that can be conducted using NHIS data. These types ofanalyses can provide a great- er understanding of state-level variations and lead to more effective public health interventions aimed at reducing cancer bur- den

Correlates of smoking quit attempts: Florida Tobacco Callback Survey, 2007

<p>Abstract</p> <p>Objective</p> <p>The public health burden of tobacco-associated diseases in the USA remains high, in part because many people's attempts to quit are unsuccessful. This study examined factors associated with having lifetime or recent attempts to quit smoking among current smokers, based on a telephone survey of Florida adults.</p> <p>Methods</p> <p>Data from the 2007 telephone-based Florida Behavioral Risk Factor Surveillance System (BRFSS) and its follow-up survey, the Tobacco Callback Survey, were used to assess determinants of having ever attempted to quit smoking and attempted to quit smoking in the past 12 months. All analyses were conducted using SAS.</p> <p>Results</p> <p>Among 3,560 current smokers, 41.5% reported having tried to quit smoking in the past 12 months while 83.4% reported having ever tried to quit. Having a history of a tobacco-related medical condition was significantly associated with both recent (Adjusted Odds Ratio (AOR) 1.41 [Confidence Interval 1.19–1.65]) and lifetime quit attempts (AOR 1.43 [1.15–1.79]). Greater nicotine dependence and being advised by a physician to quit smoking were also positively associated with lifetime quit attempts.</p> <p>Receipt of healthcare provider advice to quit smoking in the past 12 months and a strong belief that quitting following a long history of regular smoking would not result in health benefits and belief that there are health benefits to quitting smoking were associated with lifetime quit attempts.</p> <p>Conclusion</p> <p>Targeted smoking cessation interventions are needed for smokers with selected medical conditions and with high nicotine dependence. The importance of physician advice in encouraging individuals to quit is further highlighted.</p

Immune Activation Is Associated With Increased Gut Microbial Translocation in Treatment-Naive, HIV-Infected Children in a Resource-Limited Setting

BACKGROUND: Gut damage resulting in microbial translocation (MT) is considered a major cause of immune activation (IA) in HIV infection, but data in children are limited, particularly in the absence of antiretroviral therapy. METHODS: Sixty perinatally HIV-infected, antiretroviral therapy–naive children, aged 2–12 years, were evaluated for plasma levels of lipopolysaccharide, DNA sequences encoding bacterial ribosomal 16 second (16S) RNA (16S rDNA) and soluble CD14 concurrently with markers of CD4 and CD8 T-cell IA and immune exhaustion (IE), CD4 counts, and plasma viral load. At study entry, participants were classified into immune categories (ICs): IC1 (CD4% > 25), IC2 (CD4% 15–25), and IC3 (CD4% < 15). Age-matched HIV-uninfected children served as controls. Data were evaluated at study entry and at 12 months. RESULTS: Levels of MT, IA, and IE were increased in patients as compared with controls, were highest in patients in IC3 group, and did not change over 12 months. MT products lipopolysaccharide and 16S rDNA correlated with each other and each correlated with plasma viral load, soluble CD14, and T-cell IA and IE. There was a correlation of IA with IE. CD4 counts and percentage were inversely correlated with MT products and underlying CD4 activation. CONCLUSIONS: In a natural history cohort of HIV-infected children not on therapy, MT was more pronounced in the most severely immunocompromised patients and was associated with IA. Strategies to reduce MT may help to reduce IA and prevent CD4 depletion

Racial Disparities in Quality-Adjusted Life-Years Associated With Diabetes and Visual Impairment

OBJECTIVE Compare differences in health-related quality of life among blacks and whites to examine if race, diabetes, and visual impairment (VI) present a triple disadvantage in terms of quality-adjusted life expectancy. RESEARCH DESIGN AND METHODS Data were analyzed from the 2000–2003 Medical Expenditure Panel Survey, a nationally representative survey that contains the EuroQol 5D (EQ-5D). The EQ-5D generates health utility values that provide a measure of the morbidity associated with various health states, such as having moderate or severe problems with mobility. The EQ-5D score can be linked with life expectancy data to calculate quality-adjusted life-years (QALYs), the number of years of optimal health an individual is expected to live. Multivariate analyses were conducted to estimate and compare differences in QALYs by diabetes status, VI status, and race. RESULTS Whites had a higher quality-adjusted life expectancy across all diabetes/VI comparisons. Overall, blacks with diabetes and VI had the fewest number of QALYs remaining (19.6 years), and whites with no impairment had the greatest number of QALYs remaining (31.6 years). Blacks with diabetes only had 1.7 fewer years of optimal health (fewer QALYs) than whites with diabetes. Within individuals with both diabetes and VI, however, this gap more than doubled, with blacks experiencing 3.5 fewer QALYs than whites. CONCLUSIONS Although efforts to target and reduce racial health disparities associated with diabetes appear to be effective, black communities may be contributing to a greater overall burden of illness given poorer infrastructure and less accommodation for disabilities such as VI