Association between diet quality and metabolic syndrome in overweight and obese postmenopausal women

Résumé Objectifs : Le syndrome métabolique (MetS) est un ensemble de composantes (obésité, résistance à l'insuline, intolérance au glucose, dyslipidémie, hypertension) qui sont associées à une augmentation du risque de diabète de type 2 et de maladies cardiovasculaires. Aux États-Unis, la fréquence du MetS atteint des proportions épidémiques avec une prévalence de 25% de la population. Les études nutritionnelles traditionnelles se sont concentrées sur l’effet d’un nutriment alors que les études plus récentes ont déterminé l’effet global de la qualité alimentaire sur les facteurs de risque. Cependant, peu d'études ont examiné la relation entre la qualité alimentaire et le MetS. Objectif: Déterminer l'association entre la qualité alimentaire et le MetS et ses composantes. Méthodes: La présence du MetS a été déterminée chez 88 femmes post-ménopausées en surpoids ou obèses, selon la définition du National Cholesterol Education Program Adult treatment Panel III alors que la qualité alimentaire a été évaluée selon le Healthy Eating Index (HEI). La sensibilité à l’insuline, la composition corporelle et le métabolisme énergétique ont été mesurés. Résultats: Le HEI corrélait négativement avec la plupart des mesures de masse grasse et du poids mais pas avec la sensibilité à l'insuline, l’hypertension et la plupart des marqueurs lipidiques. Cependant, l’HEI corrélait positivement avec LDL-C/ApoB et négativement avec le métabolisme énergétique. Conclusion: Les résultats démontrent que l’HEI est associé avec les mesures de gras corporel et la grosseur des LDL. Mots clés: Obésité, qualité alimentaire, métabolisme lipidique, syndrome métabolique.

Knowledge transfer intervention theory : a model grounded in the strategies used by intermediate agents in the context of education

La présente thèse se base sur les principes de la théorisation ancrée (Strauss & Corbin, 1998) afin de répondre au manque de documentation concernant les stratégies adoptées par des « agents intermédiaires » pour promouvoir l’utilisation des connaissances issues de la recherche auprès des intervenants en éducation. Le terme « agent intermédiaire » réfère aux personnes qui sont positionnées à l’interface entre les producteurs et les utilisateurs des connaissances scientifiques et qui encouragent et soutiennent les intervenants scolaires dans l’application des connaissances scientifiques dans leur pratique. L’étude s’inscrit dans le cadre d’un projet du ministère de l’Éducation, du Loisir et du Sport du Québec visant à améliorer la réussite scolaire des élèves du secondaire provenant de milieux défavorisés. Des agents intermédiaires de différents niveaux du système éducatif ayant obtenu le mandat de transférer des connaissances issues de la recherche auprès des intervenants scolaires dans les écoles visées par le projet ont été sollicités pour participer à l’étude. Une stratégie d’échantillonnage de type « boule-de-neige » (Biernacki & Waldorf, 1981; Patton, 1990) a été employée afin d’identifier les personnes reconnues par leurs pairs pour la qualité du soutien offert aux intervenants scolaires quant à l’utilisation de la recherche dans leur pratique. Seize entrevues semi-structurées ont été réalisées. L’analyse des données permet de proposer un modèle d’intervention en transfert de connaissances composé de 32 stratégies d’influence, regroupées en 6 composantes d’intervention, soit : relationnelle, cognitive, politique, facilitatrice, évaluative, de même que de soutien et de suivi continu. Les résultats suggèrent que les stratégies d’ordre relationnelle, cognitive et politique sont interdépendantes et permettent d’établir un climat favorable dans lequel les agents peuvent exercer une plus grande influence sur l’appropriation du processus de l’utilisation des connaissances des intervenants scolaire. Ils montrent en outre que la composante de soutien et de suivi continu est importante pour maintenir les changements quant à l’utilisation de la recherche dans la pratique chez les intervenants scolaires. Les implications théoriques qui découlent du modèle, ainsi que les explications des mécanismes impliqués dans les différentes composantes, sont mises en perspective tant avec la documentation scientifique en transfert de connaissances dans les secteurs de la santé et de l’éducation, qu’avec les travaux provenant de disciplines connexes (notamment la psychologie). Enfin, des pistes d’action pour la pratique sont proposées.

Poverty, HIV, and barriers to education: street children's experiences in Tanzania

This article discusses the links between poverty, HIV/AIDS, and barriers to education, based on the first-hand experiences of ‘street children’ in northern Tanzania. Within the context of national levels of poverty, ‘cost-sharing’ in health and education sectors, and the AIDS epidemic, poor families in Tanzania are under considerable pressure, and increasing numbers of girls and boys are consequently seeking a living independently on the streets of towns and cities. My research with street children shows that some children orphaned by AIDS are subject to rejection and exploitation by the extended family after the death of their parent(s). They are exposed to considerable risks of abuse, sexual violence and HIV within the street environment. Here, I discuss the links between poverty, HIV and barriers to education, which compound young people’s vulnerability, and offer some policy recommendations in response to the young people’s experiences.

Ubiquitous computing in education : a SWOT analysis by students and teachers

Learning from anywhere anytime is a contemporary phenomenon in the field of education that is thought to be flexible, time and cost saving. The phenomenon is evident in the way computer technology mediates knowledge processes among learners. Computer technology is however, in some instances, faulted. There are studies that highlight drawbacks of computer technology use in learning. In this study we aimed at conducting a SWOT analysis on ubiquitous computing and computer-mediated social interaction and their affect on education. Students and teachers were interviewed on the mentioned concepts using focus group interviews. Our contribution in this study is, identifying what teachers and students perceive to be the strength, weaknesses, opportunities and threats of ubiquitous computing and computer-mediated social interaction in education. We also relate the findings with literature and present a common understanding on the SWOT of these concepts. Results show positive perceptions. Respondents revealed that ubiquitous computing and computer-mediated social interaction are important in their education due to advantages such as flexibility, efficiency in terms of cost and time, ability to acquire computer skills. Nevertheless disadvantages where also mentioned for example health effects, privacy and security issues, noise in the learning environment, to mention but a few. This paper gives suggestions on how to overcome threats mentioned.

Absence motivated by illness: A non-concurrent prospective study of physical education teachers in the municipal education system of the city of Campinas, São Paulo, Brazil

The object of this investigation was to identify and analize aspects of the health status related to absenteism in physical education teachers in the municipal education system of the city of Campinas, Brazil, as related to the medical leave program. The non-concurrent prospective study was accomplished by means of a comparison with teachers who work only in the classroom, refering to a three year period. In the variables of greatest interest, the Pearson non-parametric chi-square (X2) statistical test was adopted. Calculations of relative risk and level of confidence were made using the Epi-info computer program. Significant differences were observed in the following diagnostic groups favoring the not exposed group: i) Supplementary Classification of factors that exercise influence over the health status and access to health services and ii) Digestive system illness; while the physical education teachers showed a significant difference in: i) diseases of the musculoskeletal and connective tissue system and ii) Injuries and poisoing. Possible explications for some of the adverse effects as well as the protective ones that were observed include physical activity as a way of life along with being a physical education teacher and on the other side, peculiar behavior of epidemiological descriptive characteristics, like sex and age, within the socio-economic context of the country. © Copyright Moreira Jr. Editora.

Anemia and dementia among the elderly: the Sao Paulo Ageing & Health Study

Background: Anemia and dementia are common diseases among the elderly, but conflicting data are available regarding an association between these two conditions. We analyzed data from the Sao Paulo Ageing & Health Study to address the relationship between anemia and dementia. Methods: This cross-sectional observational study included participants aged 65 years and older from a deprived area of the borough of Butantan, Sao Paulo, Brazil. Data about demographics, education, income, and cognitive and daily life function were collected, as well as blood samples. Anemia and dementia were defined according to WHO and DSM-IV criteria, respectively. Results: Of the 2267 subjects meeting the inclusion criteria, 2072 agreed to participate in the study; of whom 1948 had a valid total blood count and were included in the analysis. Anemia was diagnosed in 203 (10.2%) participants and dementia in 99 (5.1%). The frequency of anemia was higher in patients with dementia according to univariate analysis (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17-3.41, p = 0.01), but this association was not present after adjusting for age (OR = 1.33, 95% CI = 0.76-2.33, p = 0.32). Further multivariate adjustment did not change the results. Conclusion: Although anemia and dementia are frequent disorders in older people, we found their relationship to be mediated exclusively by aging in this low-income population from Sao Paulo.

Influence of children's oral health-related quality of life on school performance and school absenteeism

Objective: This study assessed the relation of child oral health-related quality of life with school performance and school absenteeism. Methods: We followed a cross-sectional design with a multistage random sample of 312 12-year-old schoolchildren living in Brazil. The participants completed the child perceptions questionnaire (CPQ1114) that provides information about psychological factors, while their parents or guardians answered questions on their socioeconomic status measured by parents' education level and household income. A dental examination of each child provided information on the prevalence of caries and dental trauma. Data on school performance, which included the results of baseline Brazilian language (Portuguese) tests, and school absenteeism (school days missed) were obtained from the school register. Multilevel linear regression was used to investigate the association among psychological and socioeconomic status and children's school performance. Results: In the multiple model, after adjusting for individual covariates, being a girl was associated with higher school performance (P < 0.05), whereas low household income (P < 0.05), higher mean of CPQ1114 (P < 0.05), and higher school days missed (P < 0.001) were identified as individual determinants of lower school performance. When the school-level covariates were included in the model, the association between subjects' level characteristics and school performance still persisted. Conclusion: Children's school performance and absence were influenced by psychological and socioeconomic conditions.

Efforts and Models of Education for Parents: the Danish Approach

The report examines the relationship between day care institutions, schools and so called “parents unfamiliar to education” as well as the relationship between the institutions. With in Danish public and professional discourse concepts like parents unfamiliar to education are usually referring to environments, parents or families with either no or just very restricted experience of education except for the basic school (folkeskole). The “grand old man” of Danish educational research, Prof. Em. Erik Jørgen Hansen, defines the concept as follows: Parents who are distant from or not familiar with education, are parents without tradition of education and by that fact they are not able to contribute constructively in order to back up their own children during their education. Many teachers and pedagogues are not used to that term; they rather prefer concepts like “socially exposed” or “socially disadvantaged” parents or social classes or strata. The report does not only focus on parents who are not capable to support the school achievements of their children, since a low level of education is usually connected with social disadvantage. Such parents are often not capable of understanding and meeting the demands from side of the school when sending their children to school. They lack the competencies or the necessary competence of action. For the moment being much attention is done from side of the Ministries of Education and Social Affairs (recently renamed Ministry of Welfare) in order to create equal possibilities for all children. Many kinds of expertise (directions, counsels, researchers, etc.) have been more than eager to promote recommendations aiming at achieving the ambitious goal: 2015 95% of all young people should complement a full education (classes 10.-12.). Research results are pointing out the importance of increased participation of parents. In other word the agenda is set for ‘parents’ education’. It seems necessary to underline that Danish welfare policy has been changing rather radical. The classic model was an understanding of welfare as social assurance and/or as social distribution – based on social solidarity. The modern model looks like welfare as social service and/or social investment. This means that citizens are changing role – from user and/or citizen to consumer and/or investor. The Danish state is in correspondence with decisions taken by the government investing in a national future shaped by global competition. The new models of welfare – “service” and “investment” – imply severe changes in hitherto known concepts of family life, relationship between parents and children etc. As an example the investment model points at a new implementation of the relationship between social rights and the rights of freedom. The service model has demonstrated that weakness that the access to qualified services in the field of health or education is becoming more and more dependent of the private purchasing power. The weakness of the investment model is that it represents a sort of “The Winner takes it all” – since a political majority is enabled to make agendas in societal fields former protected by the tripartite power and the rights of freedom of the citizens. The outcome of the Danish development seems to be an establishment of a political governed public service industry which on one side are capable of competing on market conditions and on the other are able being governed by contracts. This represents a new form of close linking of politics, economy and professional work. Attempts of controlling education, pedagogy and thereby the population are not a recent invention. In European history we could easily point at several such experiments. The real news is the linking between political priorities and exercise of public activities by economic incentives. By defining visible goals for the public servants, by introducing measurement of achievements and effects, and by implementing a new wage policy depending on achievements and/or effects a new system of accountability is manufactured. The consequences are already perceptible. The government decides to do some special interventions concerning parents, children or youngsters, the public servants on municipality level are instructed to carry out their services by following a manual, and the parents are no longer protected by privacy. Protection of privacy and minority is no longer a valuable argumentation to prevent further interventions in people’s life (health, food, school, etc.). The citizens are becoming objects of investment, also implying that people are investing in their own health, education, and family. This means that investments in changes of life style and development of competences go hand in hand. The below mentioned programmes are conditioned by this shift.

Factors associated with smoking cessation using the 2005 National Health Interview Survey

Objectives. The objective of this study is to compare the socio-demographic, behavioral, and access to care characteristics of smokers who have quit smoking for one or more years and current smokers who have made an attempt to quit smoking within the last year. ^ Methods. Data from the 2005 National Health Interview Survey (NHIS) were used to compare current smokers who have tried to quit (n=2747) and former smokers who have quit for one or more years (n=6194). The data was analyzed using STATA 9.0 to perform statistical calculations. ^ Results. Age, education, race and income were associated with smoking status. Respondents aged 65 and older were 36 times more likely to have quit smoking. Education and income had higher odds ratios among quitters (OR=1.27 and OR=1.21) and Non-Hispanic Whites were the most likely to have quit smoking compared to Hispanics and Blacks. Adults with health insurance coverage were 3.44 times more likely to have quit smoking. ^ Discussion. Existing research suggests that individual factors relating to demographics behavior and access to care can impact a smoker's ability to quit smoking. This paper discusses the factors that affect cessation and which populations would benefit from additional research and targeted smoking cessation programs. ^

The relationship between food preparation time, time spent grocery shopping, and BMI

Recent data have shown that the percentage of time spent preparing food has decreased during the past few years, and little information is know about how much time people spend grocery shopping. Food that is pre-prepared is often higher in calories and fat compared to foods prepared at home from scratch. It has been suggested that, because of the higher energy and total fat levels, increased consumption of pre-prepared foods compared to home-cooked meals can lead to weight gain, which in turn can lead to obesity. Nevertheless, to date no study has examined this relationship. The purpose of this study is to determine (i) the association between adult body mass index (BMI) and the time spent preparing meals, and (ii) the association between adult BMI and time spent shopping for food. Data on food habits and body size were collected with a self-report survey of ethnically diverse adults between the ages of 17 and 70 at a large university. The survey was used to recruit people to participate in nutrition or appetite studies. Among other data, the survey collected demographic data (gender, race/ethnicity), minutes per week spent in preparing meals and minutes per week spent grocery shopping. Height and weight were self-reported and used to calculate BMI. The study population consisted of 689 subjects, of which 276 were male and 413 were female. The mean age was 23.5 years, with a median age of 21 years. The fraction of subjects with BMI less than 24.9 was 65%, between 25 and 29.9 was 26%, and 30 or greater was 9%. Analysis of variation was used to examine associations between food preparation time and BMI. ^ The results of the study showed that there were no significant statistical association between adult healthy weight, overweight and obesity with either food preparation time and grocery shopping time. Of those in the sample who reported preparing food, the mean food preparation time per week for the healthy weight, overweight, and obese groups were 12.8 minutes, 12.3 minutes, and 11.6 minutes respectively. Similarly, the mean weekly grocery shopping for healthy, overweight, and obese groups were 60.3 minutes per week (8.6min./day), 61.4 minutes (8.8min./day), and 57.3 minutes (8.2min./day), respectively. Since this study was conducted through a University campus, it is assumed that most of the sample was students, and a percentage might have been utilizing meal plans on campus, and thus, would have reported little meal preparation or grocery shopping time. Further research should examine the relationships between meal preparation time and time spent shopping for food in a sample that is more representative of the general public. In addition, most people spent very little time preparing food, and thus, health promotion programs for this population need to focus on strategies for preparing quick meals or eating in restaurants/cafeterias. ^

Disparities in asthma prevalence: The influence of sociodemographic and workplace factors

Asthma is a serious and continuing health problem that affects millions of Americans. Our study was conducted in response to this serious health problem and for purposes of addressing the issue of potential health disparities as outlined in Healthy People 2010. Data from sub-populations of subjects who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999-2004 were used to complete the following specific aims: (1) to update nationally-based estimates of the prevalence of current and lifetime (ever) asthma among adults in the United States (U.S.) and describe by gender the relationships between potential risk factors (e.g., sociodemographics and lifestyle) and asthma; (2) to describe demographic characteristics among working adults in the U.S. and update estimates of the prevalence of asthma in this sub-population, stratified by occupation and industry; and 3) to determine the utility of adapting a population-based Job Exposure Matrix (JEM) for classifying workplace exposures to asthmagens. ^ Our findings suggest the prevalence of asthma among U.S. adults is continuing to rise, with women having a higher prevalence of asthma than men. Living below the poverty threshold, obesity, and prior history of smoking remain important determinants of asthma. Our study also adds to the increasing evidence that health care workers (HCWs) and those employed in education remain at high risk and that appropriate evaluation and control measures need to be implemented. Over 78% of HCWs and 71% of teachers in our study were females suggesting that further exploration of gender-specific risk factors of asthma in working populations is needed. ^ Our study also addressed the feasibility of adapting a population-based asthma-specific JEM to NHANES (1999-2004). We were not able to apply the asthma-specific JEM due to the broad occupational categories within NHANES. This represents a missed opportunity to examine the association between workplace exposures and asthma in U.S. working adults. However, we have identified steps that may be implemented in future population-based studies that would allow the asthma-specific JEM (and other population-based job exposure matrices) to be used in future studies of the U.S. working population.^

Process evaluation of intervention program for prevention of early sexual activity and alcohol use among Hispanic teenagers

Hispanic teens are a high-risk population for initiation of early sexual activity and alcohol use which in turn has numerous social and health consequences. One strategy to address prevention of these behaviors is to implement a capacity building intervention that promotes parent child communication, encompasses their cultural values and community participation. This study describes the process evaluation of a pilot intervention program amongst Hispanic teens and their families living along the Texas-Mexico border. “Girls Lets Talk” is a small group intervention with 10-14 year old teens and their female adult family members that involves education regarding effects of alcohol use and sexual activity as well as activities for monitoring and refusal skills to prevent risky behaviors. Two waves of the program each consisting of at least seven mother daughter dyads were conducted. During the designing process, community advisory board meetings and focus groups were held to review course materials and ensure they were appropriate to the Mexican American culture. Parent and adolescent surveys were administered at the beginning and end of the intervention to assess for psychosocial outcome variables. All sessions received high mean satisfactory scores (mean of 4.00 or better on a five point scale) for both adult and adolescent participants. Qualitative feedback was obtained via debriefing sessions to evaluate experience as well as alter recruitment strategies. A Wilcoxon Sign Rank analysis of the pre and post intervention surveys was done that showed significant changes in some outcome variables such as intentions and confidence for monitoring behaviors for adults and beliefs regarding sexual activity. “Girls Lets Talk” is a promising example of how a process evaluation plan can help develop a theory based health promotion program using the community based participatory research approach. The intervention may also be effective in altering intentions and enhancing self-efficacy among parents and teens in order to decrease risky behaviors such as early sexual activity and alcohol use.^

A study of the determinants of the utilization of preventive health care service among Chicanos

This study examines the individual and health care system determinants of two types of preventive health care practice behaviors, having a routine physical exam or a preventive dental exam, in the past year among Chicanos in the Southwestern United States. The study utilizes the Health System Model, developed by Aday and Andersen in 1974, to analyze the relative effect of education, income and occupation on the use of discretionary health care, controlling for other individual and health care system determinants.^ The study is based on a sample of 4,111 Mexican origin adults, drawn from the Hispanic Health and Nutrition Examination Survey (HHANES). This sample is representative of Mexican American residing in the Southwestern United States.^ The study tests the hypothesis that education is the most important social class predictor of preventive health care practice behavior. The fully elaborated model tests the hypothesis that individual determinants alone are insufficient to explain the use of preventive health care services among Chicanos.^ The study found that education and income are statistically significant social class indicators only as it relates to having a preventive dental exam. Education is not the most important social class predictor of either preventive health care practice behavior. Health care system determinants are key predictors of both behaviors. Need, as measured by self-perceived health status of teeth and gender, is as important a determinant as having dental insurance coverage as it relates to having a preventive dental exam. Implications for health programs to effectively reach Chicano target groups and remove access barriers to their use of discretionary health care services are discussed. ^

Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^