Publications by authors named "Margaret Carroll"

118 Publications

Anthropometric Reference Data for Children and Adults: United States, 2015-2018.

Vital Health Stat 3 2021 Jan(36):1-44

Based on nationally representative anthropometric data, the National Center for Health Statistics (NCHS) has published reference tables on the distribution of various body measurements for the U.S. population (1-5). National Health and Nutrition Examination Survey (NHANES) data are the primary source of body measurement information for the U.S. population. These measurements reflect the mean weight, height, length, and various circumferences of U.S. children and adults. Anthropometry is a measure of nutritional or general health status, dietary adequacy, and growth. This report presents anthropometric reference data from the years 2015-2018 for U.S. children and adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2021

Perspectives of partners of mothers who experience mental distress in the postnatal period: A systematic review and qualitative evidence synthesis.

Midwifery 2021 Feb 24;93:102868. Epub 2020 Oct 24.

School of Nursing and Midwifery, Trinity College Dublin, Ireland. Electronic address:

Objective: To offer insight and understanding on the perspectives of the partners of mothers who experience postnatal mental distress.

Background: Partners have an important role in identifying postnatal mental distress, supporting the mother, and encouraging help-seeking behaviours that may help reduce the associated long-term consequences on the mother and baby.

Design: A qualitative evidence synthesis.

Data Sources: Medline, CINAHL, EMBASE, Maternity and Infant Care, PsycINFO and Scopus were searched from their foundation to May 2017 and updated again in April 2019.

Review Methods: A total of 2928 studies were retrieved. Studies were screened for inclusion and included studies were assessed for methodological quality using the Critical Appraisal Skills Programme quality assessment tool. Study characteristics and findings were extracted and analysed using thematic synthesis methods.

Results: Twenty-five studies between 1998 and 2018, involving 270 partners from seven countries were included. Four main themes and nine associated subthemes were identified. These main themes were Knowledge, Relationships, Personal Impact and Disclosure.

Conclusions: This qualitative evidence synthesis provides clear, nonbiased findings on the perceptions of partners of mothers who experience postnatal mental distress. Partners lacked knowledge on how to identify postnatal mental distress and how to access help. The distress impacted on their relationship with the mother and baby, their health and raised questions about disclosure.

Relevance: The findings from this synthesis will contribute to the development of responsive care for families when a mother experiences postnatal mental distress.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.midw.2020.102868DOI Listing
February 2021

Fast Food Intake Among Children and Adolescents in the United States, 2015-2018.

NCHS Data Brief 2020 Aug(375):1-8

Fast food has been associated with higher caloric intake and poorer diet quality in children and adolescents (1). In 2011-2012, children and adolescents aged 2-19 years consumed on average 12.4% of their daily calories from fast food on a given day (2). This report presents 2015-2018 estimates of the percentage of calories consumed from fast food on a given day among U.S. children and adolescents by demographic characteristics and trends since 2003.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2020

Factors associated with maternal readmission to hospital, attendance at emergency rooms or visits to general practitioners within three months postpartum.

Eur J Obstet Gynecol Reprod Biol 2020 Nov 22;254:251-258. Epub 2020 Sep 22.

School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street Dublin 2, Ireland.

While most women remain healthy after giving birth to their baby, others experience complications that require medical attention or readmission to hospital. However, data on maternal attendance for medical care postpartum or readmission to hospital are not collected or reported routinely in many countries so the extent of health problems experienced remain unknown. Collecting data on the proportion of women who seek medical care in the early postpartum period may deepen understanding of risk factors, the consequences for women, their families and the maternity care system and, ultimately, help identify preventative strategies and processes.

Objective: To identify the factors associated with maternal rehospitalisation, attendance at emergency rooms or visits to general practitioners, the three main sources of medical services postpartum in Ireland, within the first three months postpartum.

Study Design: A prospective cohort study, embedded in a larger maternal health and morbidity study, with 1668 nulliparous women recruited from two maternity hospitals in Ireland. Univariate and multivariable logistic regression analyses were used to explore associations with postpartum rehospitalisation, emergency room attendance and general practitioner visits within the first three months postpartum, for maternal health-related reasons.

Results: Four percent (n = 66) of women were rehospitalised, 10% (n = 166) attended an emergency room, and 13.6% (n = 223) attended their general practitioner three or more times, regarding their own health. Women aged 24 years or less were more likely to attend their doctor (p = 0.02, AOR 2.13, 95% CI 1.08-4.21) compared to women aged 25-29 years, the reference category. Women who were obese or very obese were also more likely to attend their doctor three or more times (p = 0.01, AOR 1.79, 95% CI 1.15-2.79) and also more likely to attend an emergency room (p = 0.04, AOR 1.69, 95% CI 1.02-2.80) within three months postpartum, for their own health reasons.

Conclusion: Findings indicate that considerable proportions of women seek medical care from various healthcare sources postpartum. These medical visits are not routinely reported and point to the need for interventions regarding the care, management and services available to first-time mothers birthing in Ireland, with specific attention on preventative postpartum health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2020.09.018DOI Listing
November 2020

Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study.

Women Birth 2020 Sep 11. Epub 2020 Sep 11.

School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier St., Dublin 2, Ireland.

Objective: To compare labour and birth outcomes between nulliparous women who used versus did not use intrapartum epidural analgesia.

Design: Prospective cohort study.

Setting: Two maternity hospitals in Ireland.

Population: A total of 1221 nulliparous women who gave birth vaginally or by emergency caesarean section.

Methods: Multinomial logistic regression was used to analyse categorical outcomes, with results presented as ratios of relative risks (RRR). For dichotomous outcomes we used logistic regression, with results presented as odds ratios (OR).

Main Outcome Measures: Mode of birth, IV syntocinon use, pyrexia (≥38°C), antibiotic treatment, first stage labour ≥10h, second stage labour ≥2h, blood loss (≥500mls, ≥1000mls), perineal trauma. Neonatal outcomes included APGAR score ≥7 at 1min and 5min, admission to neonatal intensive care unit, and infant feeding method.

Results: Women using EA were more likely to require a vacuum-assisted birth (RRR 3.35, p<0.01) or forceps-assisted birth (RRR 11.69, p<0.01). Exposure to EA was associated with significantly greater risk of ≥10h first (OR 6.72, p=0.01) and ≥2h second (OR 2.25, p<0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p<0.01), antibiotics (OR 2.97, p<0.01) and a greater probability of pyrexia (OR 10.26, p<0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p<0.01). No differences were observed between groups in neonatal outcomes.

Conclusions: Our data shows significant associations between EA use and several intrapartum outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wombi.2020.09.001DOI Listing
September 2020

Trends in Obesity Prevalence by Race and Hispanic Origin-1999-2000 to 2017-2018.

JAMA 2020 Sep;324(12):1208-1210

National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2020.14590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455882PMC
September 2020

Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018.

NCHS Data Brief 2020 Feb(360):1-8

Obesity is associated with serious health risks (1). Severe obesity further increases the risk of obesity-related complications, such as coronary heart disease and end-stage renal disease (2,3). From 1999-2000 through 2015-2016, a significantly increasing trend in obesity was observed (4). This report provides the most recent national data for 2017-2018 on obesity and severe obesity prevalence among adults by sex, age, and race and Hispanic origin. Trends from 1999-2000 through 2017-2018 for adults aged 20 and over are also presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2020

Predictors of choice of public and private maternity care among nulliparous women in Ireland, and implications for maternity care and birth experience.

Health Policy 2020 05 22;124(5):556-562. Epub 2020 Feb 22.

School of Nursing and Midwifery, Trinity College Dublin, Ireland. Electronic address:

Maternity care in Ireland is provided through a mixture of free public and fee-based private or semi-private services. We examined factors associated with choice of care pathway among nulliparous women and how this influences the care they receive and their experience of childbirth using data from a prospective cohort study. Complete data were available for 1,789 women on choice of care pathway and birth outcomes, and for 1,336 women on birth experience. Maternal age (marginal effect [ME] 1.6 percentage points [ppts], p < 0.01), socioeconomic status (ME 0.5ppts, p < 0.01) and being born in Ireland (ME 10.3ppts, p < 0.01) were all positively associated with choosing private care, but level of risk in early pregnancy did not influence this decision. Intervention rates in public and semi-private care were comparable, but women in private care were more likely to receive epidural anaesthesia (odds ratio [OR] 1.65, p < 0.01) and give birth by caesarean section (ratio of relative risks [RRR] 1.98, p < 0.01). Private care was also associated with longer hospital stays (28 % longer, p < 0.01). Increased risk was negatively correlated with birth experience in public and semi-private care, but not in private care. Policies promoting the allocation of maternity care resources by level of risk, along with the standardisation of clinical practice across care pathways, could reduce rates of obstetric intervention and address risk-based disparities in birth experience outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2020.02.008DOI Listing
May 2020

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section.

BMC Pregnancy Childbirth 2020 Mar 6;20(1):143. Epub 2020 Mar 6.

Trinity College Dublin, Dublin, Ireland.

Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries.

Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women.

Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.

Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS in multiparous women, interventions that are feasible and safe and that have been shown to lead to decreasing repeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. This may best be done using an implementation science approach that can modify evidence-based interventions in response to changing clinical circumstances.

Trial Registration: The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-020-2829-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059398PMC
March 2020

Trends in Apolipoprotein B, Non-high-density Lipoprotein Cholesterol, and Low-density Lipoprotein Cholesterol for Adults Aged 20 and Over, 2005-2016.

Natl Health Stat Report 2019 09(127):1-16

Objectives-Guidelines for lowering cholesterol have focused on total and lowdensity lipoprotein cholesterol (LDL-C). Although the emphasis remains on LDL-C, more attention is now being given to apolipoprotein B (apo B) and non-high-density lipoprotein cholesterol (non-HDL-C). This report presents trends in mean apo B, non-HDL-C, and LDL-C in adults aged 20 and over from 2005-2006 through 2015-2016. Methods-Data from the 2005-2016 National Health and Nutrition Examination Surveys were used to conduct trend analyses. Means and standard errors of the mean for apo B (n = 13,802), non-HDL-C (n = 30,921), and LDL-C (n = 13,559) are presented overall and by sex, stratified by age, race and Hispanic origin, and body mass index (BMI) category for each 2-year survey cycle. Trends over time were tested using orthogonal contrast matrices and piecewise and multiple linear regression. Results-In men, apo B declined from 98 mg/dL in 2005-2006 to 93 mg/dL in 2011-2012, but did not change after 2011-2012. Declining trends were also seen for men in non-HDL-C (147 to 141 mg/dL) and LDL-C (116 to 114 mg/dL) from 2005-2006 to 2015-2016. For women, age-adjusted mean apo B declined from 94 mg/dL in 2005-2006 to 91 mg/dL in 2015-2016. Non-HDL-C and LDL-C in women did not change significantly from 2005-2006 to 2011-2012, but non-HDL-C declined from 141 mg/dL in 2011-2012 to 133 mg/dL in 2015-2016, and LDL-C declined from 117 mg/dL in 2011-2012 to 111 mg/dL in 2015-2016. With the exception of LDL-C in men, these trends persisted after controlling for age, race and Hispanic origin, BMI, and lipid-lowering medication use. Conclusions-From 2005-2006 to 2015-2016, significant but different declining trends in apo B, non-HDL-C, and LDL-C were seen in men and women. In general, differences in age, race and Hispanic origin, BMI category, and lipid-lowering medication use did not explain the trends.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2019

The association of nativity/length of residence and cardiovascular disease risk factors in the United States.

Prev Med 2020 01 9;130:105893. Epub 2019 Nov 9.

National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD 20782, USA. Electronic address:

Differences by nativity status for cardiovascular disease (CVD) risk factors have been previously reported. Recent research has focused on understanding how other acculturation factors, such as length of residence, affect health behaviors and outcomes. This study examines the association between CVD risk factors and nativity/length of US residence. Using cross-sectional data from 15,965 adults in the 2011-2016 National Health and Nutrition Examination Surveys (analyzed in 2018), prevalence ratios and predicted marginals from logistic regression models are used to estimate associations of CVD risk factors (i.e., hypertension, hypercholesterolemia, diabetes, overweight/obesity and smoking) with nativity/length of residence (<15 years, ≥15 years) in the US. In sex-, age-, education- and race and Hispanic origin- adjusted analyses, a higher percentage of US (50 states and District of Columbia) born adults (86.4%) had ≥1 CVD risk factor compared to non-US born residents in the US <15 years (80.1%) but not ≥15 years (85.1%). Compared to US born counterparts, regardless of length of residence, hypertension overall and smoking among non-Hispanic white and Hispanic adults were lower among non-US born residents. Overweight/obesity overall and diabetes among Hispanic adults were lower among non-US born residents in the US <15 years. In contrast, non-US born non-Hispanic Asian residents in the US <15 years had higher prevalence of diabetes. Non-US born adults were less likely to have most CVD risk factors compared to US born adults regardless of length of residence, although, for smoking and diabetes this pattern differed by race and Hispanic origin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ypmed.2019.105893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340142PMC
January 2020

Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: An overview of systematic reviews.

PLoS One 2019 24;14(10):e0224313. Epub 2019 Oct 24.

School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland.

Concern has been expressed globally over rising caesarean birth rates. Recently, the International Federation of Gynaecology and Obstetrics (FIGO) called for help from governmental bodies, professional organisations, women's groups, and other stakeholders to reduce unnecessary caesareans. As part of a wider research initiative, we conducted an overview of systematic reviews of antenatal and intrapartum interventions, and reports of evidence based recommendations, to identify and highlight those that have been shown to be effective for reducing caesarean birth, promoting vaginal birth and reducing fear of childbirth. Following registration of the review protocol, (PROSPERO 2018 CRD42018090681), we searched The Cochrane Database of Systematic Reviews, PubMed, CINAHL and EMBASE (Jan 2000-Jan 2018) and searched for grey literature in PROSPERO, and on websites of health professional and other relevant bodies. Screening and selection of reviews, quality appraisal using AMSTAR-2, and data extraction were performed independently by pairs of at least two reviewers. Excluding reviews assessed as 'critically low' on AMSTAR-2 (n = 54), 101 systematic reviews, and 10 reports of evidence based recommendations were included in the overview. Narrative synthesis was performed, due to heterogeneity of review methodology and topics. The results highlight twenty-five interventions, across 17 reviews, that reduced the risk of caesarean, nine interventions across eight reviews that increased the risk of caesarean, eight interventions that reduced instrumental vaginal birth, four interventions that increased spontaneous vaginal birth, and two interventions that reduced fear of childbirth. This overview of reviews identifies and highlights interventions that have been shown to be effective for reducing caesarean birth, promoting vaginal births and reducing fear of childbirth. In recognising that clinical practices change over time, this overview includes reviews published from 2000 onwards only, thus providing contemporary evidence, and a valuable resource for clinicians when making decisions on practices that should be implemented for reducing unnecessary caesarean births safely. Protocol Registration: PROSPERO 2018 CRD42018090681. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018090681.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224313PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812784PMC
March 2020

Toll-like receptor 2 stimulation augments esophageal barrier integrity.

Allergy 2019 12 25;74(12):2449-2460. Epub 2019 Jul 25.

Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Background: Germline-encoded innate immune pattern recognition receptors (PRR) are expressed at epithelial surfaces and modulate epithelial defenses. Evidence suggests that stimulation of the Toll-like receptor (TLR) family of PRR may regulate epithelial barrier integrity by upregulating tight junction (TJ) complex protein expression, but it is not known whether this mechanism is utilized in esophageal epithelial cells. TJ complex proteins maintain intact barrier function and are dysregulated in atopic disorders including eosinophilic esophagitis.

Methods: Pattern recognition receptors expression was assessed in EoE and control primary esophageal epithelial cells, demonstrating robust expression of TLR2 and TLR3. The three-dimensional air-liquid interface culture (ALI) model was used to test whether TLR2 or TLR3 stimulation alters epithelial barrier function using an in vitro model of human epithelium. Transepithelial electrical resistance (TEER) and FITC-Dextran permeability were evaluated to assess membrane permeability. ALI cultures were evaluated by histology, immunohistochemistry, Western blotting, and chromatin immunoprecipitation (ChIP).

Results: TLR3 stimulation did not change TEER in the ALI model. TLR2 stimulation increased TEER (1.28- to 1.31-fold) and decreased paracellular permeability to FITC-Dextran, and this effect was abolished by treatment with anti-TLR2 blocking antibody. TJ complex proteins claudin-1 and zonula occludens-1 were upregulated following TLR2 stimulation, and ChIP assay demonstrated altered histone 4 acetyl binding at the TJP1 enhancer and CLDN1 enhancer and promoter following zymosan treatment, implying the occurrence of durable chromatin changes.

Conclusions: Our findings implicate the TLR2 pathway as a potential regulator of esophageal epithelial barrier function and suggest that downstream chromatin modifications are associated with this effect.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/all.13968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083217PMC
December 2019

Diabetes and Prediabetes Among Adults in Los Angeles County and the United States, 1999-2006 and 2007-2014.

Natl Health Stat Report 2019 04(123):1-8

Objective-This report presents the prevalence of diagnosed diabetes, undiagnosed diabetes, total diabetes, and prediabetes among adults aged 20 and over in Los Angeles County and the United States in 1999-2006 and 2007-2014. The prevalence of diagnosed diabetes, total diabetes, and prediabetes in 2007-2014 are presented by age, sex, and race and Hispanic origin. Methods-Data are from in-home interviews and laboratory testing conducted as part of the National Health and Nutrition Examination Survey (NHANES). Los Angeles County has been selected with certainty in every NHANES cycle since 1999. Sample persons in Los Angeles County were selected and sample weights constructed so that estimates represent the county. Prevalence and 95% confidence intervals for diagnosed, undiagnosed, total diabetes, and prediabetes were estimated using self-reported diagnosis of diabetes, plasma fasting glucose, and hemoglobin A1c. Differences in prevalence were tested between Los Angeles County and the United States, between 1999-2006 and 2007-2014, and among demographic subgroups. Results-The age-adjusted prevalence of total diabetes among adults in Los Angeles County increased from 10.5% in 1999-2006 to 14.4% in 2007-2014. In 2007-2014, 40.2% of adults in Los Angeles County had prediabetes. There were no significant differences in the overall prevalence of diagnosed diabetes, undiagnosed diabetes, total diabetes, or prediabetes between Los Angeles County and the United States in 1999-2006 or 2007-2014. The prevalence of diagnosed diabetes, total diabetes, and prediabetes increased with age in both Los Angeles County and the United States. The prevalence of total diabetes was higher in non-Hispanic black adults, Hispanic adults, and Mexican-American adults than in non-Hispanic white adults in both Los Angeles County and the United States.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2019

Stop, think, reflect, realize-first-time mothers' views on taking part in longitudinal maternal health research.

Health Expect 2019 06 21;22(3):415-425. Epub 2019 Feb 21.

School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.

Background: Longitudinal cohort studies gather large amounts of data over time, often without direct benefit to participants. A positive experience may encourage retention in the study, and participants may benefit in unanticipated ways.

Objective: To explore first-time mothers' experiences of taking part in a longitudinal cohort study and completing self-administered surveys during pregnancy and at 3, 6, 9 and 12 months' postpartum.

Design: Content analysis of comments written by participants in the Maternal health And Maternal Morbidity in Ireland study's five self-completion surveys, a multisite cohort study exploring women's health and health problems during and after pregnancy. This paper focuses on what women wrote about taking part in the research. Ethical approval was granted by the site hospitals and university.

Setting And Participants: A total of 2174 women were recruited from two maternity hospitals in Ireland between 2012 and 2015.

Findings: A total of 1000 comments were made in the five surveys. Antenatally, barriers related to surveys being long and questions being intimate. Postpartum, barriers related to being busy with life as first-time mothers. Benefits gained included gaining access to information, taking time to reflect, stopping to think and being prompted to seek help. Survey questions alone were described as valuable sources of information.

Discussion And Conclusions: Findings suggest that survey research can "give back" to women by being a source of information and a trigger to seek professional help, even while asking sensitive questions. Understanding this can help researchers construct surveys to maximize benefits, real and potential, for participants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hex.12861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543136PMC
June 2019

National Center for Health Statistics Data Presentation Standards for Proportions.

Vital Health Stat 2 2017 Aug(175):1-22

The National Center for Health Statistics (NCHS) disseminates information on a broad range of health topics through diverse publications. These publications must rely on clear and transparent presentation standards that can be broadly and efficiently applied. Standards are particularly important for large, cross-cutting reports where estimates cannot be individually evaluated and indicators of precision cannot be included alongside the estimates. This report describes the NCHS Data Presentation Standards for Proportions. The multistep NCHS Data Presentation Standards for Proportions are based on a minimum denominator sample size and on the absolute and relative widths of a confidence interval calculated using the Clopper-Pearson method. Proportions (usually multiplied by 100 and expressed as percentages) are the most commonly reported estimates in NCHS reports.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2017

Manganese toxicity is targeting an early step in the dopamine signal transduction pathway that controls lateral cilia activity in the bivalve mollusc Crassostrea virginica.

Comp Biochem Physiol C Toxicol Pharmacol 2018 Nov 17;213:1-6. Epub 2018 Jul 17.

Department of Biology, Medgar Evers College, 1638 Bedford Ave, Brooklyn, NY 11225, USA. Electronic address:

Manganese is a neurotoxin causing manganism, a Parkinson-like clinical disorder. Manganese has been shown to interfere with dopaminergic neurotransmission, but the neurotoxic mechanism involved is not fully resolved. In the bivalve mollusc Crassostrea virginica also known as the eastern oyster, beating rates of lateral cilia of the gill are controlled by dopaminergic-serotonergic innervation originating from their cerebral and visceral ganglia. Terminal release of dopamine activates D2-like receptors on these gill cells inhibiting adenylyl cyclase and slowing cilia beating rates. In C. virginica, manganese treatment disrupts this dopaminergic innervation of the gill, preventing the normal cilio-inhibitory response of lateral cells to dopamine. In this study an adenylyl cyclase activator (forskolin) and two different inhibitors (MDL-12,330A and SQ 22,536) were used to determine if manganese had any effects on the adenylyl cyclase step of the dopamine D2 receptor signal transduction pathway. The results showed that neither the adenylyl cyclase activator nor the inhibitors were affected by manganese in the control of lateral ciliary activity. This suggests that in C. virginica the mechanism of manganese toxicity on the dopaminergic control of lateral ciliary activity is targeting an early step in the D2R signal transduction pathway, which may involve interference with D2 receptor activation or alternatively some other downstream signaling activity that does not affect adenylyl cyclase.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cbpc.2018.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103847PMC
November 2018

Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016.

JAMA 2018 06;319(23):2419-2429

National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, Maryland.

Importance: Differences in obesity by sex, age group, race and Hispanic origin among US adults have been reported, but differences by urbanization level have been less studied.

Objectives: To provide estimates of obesity by demographic characteristics and urbanization level and to examine trends in obesity prevalence by urbanization level.

Design, Setting, And Participants: Serial cross-sectional analysis of measured height and weight among adults aged 20 years or older in the 2001-2016 National Health and Nutrition Examination Survey, a nationally representative survey of the civilian, noninstitutionalized US population.

Exposures: Sex, age group, race and Hispanic origin, education level, smoking status, and urbanization level as assessed by metropolitan statistical areas (MSAs; large: ≥1 million population).

Main Outcomes And Measures: Prevalence of obesity (body mass index [BMI] ≥30) and severe obesity (BMI ≥40) by subgroups in 2013-2016 and trends by urbanization level between 2001-2004 and 2013-2016.

Results: Complete data on weight, height, and urbanization level were available for 10 792 adults (mean age, 48 years; 51% female [weighted]). During 2013-2016, 38.9% (95% CI, 37.0% to 40.7%) of US adults had obesity and 7.6% (95% CI, 6.8% to 8.6%) had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs (42.4% vs 31.8%, respectively; adjusted difference, 9.8 percentage points [95% CI, 5.1 to 14.5 percentage points]); however, the age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs (38.9% vs 31.8%, respectively; adjusted difference, 4.8 percentage points [95% CI, -2.9 to 12.6 percentage points]). The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs (42.5% vs 38.1%, respectively; adjusted difference, 4.3 percentage points [95% CI, 0.2 to 8.5 percentage points]) and among women living in non-MSAs compared with women living in large MSAs (47.2% vs 38.1%, respectively; adjusted difference, 4.7 percentage points [95% CI, 0.2 to 9.3 percentage points]). Similar patterns were seen for severe obesity except that the difference between men living in large MSAs compared with non-MSAs was significant. The age-adjusted prevalence of obesity and severe obesity also varied significantly by age group, race and Hispanic origin, and education level, and these patterns of variation were often different by sex. Between 2001-2004 and 2013-2016, the age-adjusted prevalence of obesity and severe obesity significantly increased among all adults at all urbanization levels.

Conclusions And Relevance: In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity and severe obesity in 2013-2016 varied by level of urbanization, with significantly greater prevalence of obesity and severe obesity among adults living in nonmetropolitan statistical areas compared with adults living in large metropolitan statistical areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2018.7270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583043PMC
June 2018

Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016.

JAMA 2018 06;319(23):2410-2418

National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia.

Importance: Differences in childhood obesity by demographics and urbanization have been reported.

Objective: To present data on obesity and severe obesity among US youth by demographics and urbanization and to investigate trends by urbanization.

Design, Setting, And Participants: Measured weight and height among youth aged 2 to 19 years in the 2001-2016 National Health and Nutrition Examination Surveys, which are serial, cross-sectional, nationally representative surveys of the civilian, noninstitutionalized population.

Exposures: Sex, age, race and Hispanic origin, education of household head, and urbanization, as assessed by metropolitan statistical areas (MSAs; large: ≥ 1 million population).

Main Outcomes And Measures: Prevalence of obesity (body mass index [BMI] ≥95th percentile of US Centers for Disease Control and Prevention [CDC] growth charts) and severe obesity (BMI ≥120% of 95th percentile) by subgroups in 2013-2016 and trends by urbanization between 2001-2004 and 2013-2016.

Results: Complete data on weight, height, and urbanization were available for 6863 children and adolescents (mean age, 11 years; female, 49%). In 2013-2016, the prevalence among youth aged 2 to 19 years was 17.8% (95% CI, 16.1%-19.6%) for obesity and 5.8% (95% CI, 4.8%-6.9%) for severe obesity. Prevalence of obesity in large MSAs (17.1% [95% CI, 14.9%-19.5%]), medium or small MSAs (17.2% [95% CI, 14.5%-20.2%]) and non-MSAs (21.7% [95% CI, 16.1%-28.1%]) were not significantly different from each other (range of pairwise comparisons P = .09-.96). Severe obesity was significantly higher in non-MSAs (9.4% [95% CI, 5.7%-14.4%]) compared with large MSAs (5.1% [95% CI, 4.1%-6.2%]; P = .02). In adjusted analyses, obesity and severe obesity significantly increased with greater age and lower education of household head, and severe obesity increased with lower level of urbanization. Compared with non-Hispanic white youth, obesity and severe obesity prevalence were significantly higher among non-Hispanic black and Hispanic youth. Severe obesity, but not obesity, was significantly lower among non-Hispanic Asian youth than among non-Hispanic white youth. There were no significant linear or quadratic trends in obesity or severe obesity prevalence from 2001-2004 to 2013-2016 for any urbanization category (P range = .07-.83).

Conclusions And Relevance: In 2013-2016, there were differences in the prevalence of obesity and severe obesity by age, race and Hispanic origin, and household education, and severe obesity was inversely associated with urbanization. Demographics were not related to the urbanization findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2018.5158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393914PMC
June 2018

Knowledge, confidence, skills and practices among midwives in the republic of Ireland in relation to perinatal mental health care: The mind mothers study.

Midwifery 2018 Sep 18;64:29-37. Epub 2018 May 18.

School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland. Electronic address:

Objective: The study aimed to identify midwives' competency in perinatal mental health care in terms of their knowledge, confidence, skill and educational priorities, and to explore their clinical practices in relation to the assessment and management of perinatal mental health problems.

Research Design: An exploratory descriptive study design was used on a sample of 438 midwives in the Republic of Ireland. Data were collected over a two-month period in 2016 using an anonymous, self-completed survey designed by the research team.

Findings: The majority of midwives cared for women with perinatal mental health problems in their clinical practice; however, beyond depression and anxiety, their knowledge of perinatal mental health problems was quite limited. Similarly, midwives reported a lack of skill in opening a discussion with women on sensitive issues, such as sexual abuse, intimate partner violence and psychosis, and providing information to women's partners/families. The findings indicated that midwives adopted a selective approach to screening for perinatal mental health problems, with a tendency not to inquire about sensitive topics, or address them only with women deemed at-risk.

Conclusions: Timely and appropriate care is required to ensure the best outcomes for women with perinatal mental health problems and their families. A greater understanding of perinatal mental health among midwives is required to enable them to provide support and information to women and their families, and to identify when specialist intervention is required. Education and other structural supports, such as care pathways and documentation, is required to train and support midwives in their key role of caring for, and collaborating with, women with perinatal mental health problems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.midw.2018.05.006DOI Listing
September 2018

Prevalence of daily flossing among adults by selected risk factors for periodontal disease-United States, 2011-2014.

J Periodontol 2018 08;89(8):933-939

Dental Devices Branch, Division of Anesthesiology, General Hospital, Infection Control, and Dental Devices, Office of Device Evaluation, Center for Devices and Radiological Health, U.S. Food and Drug Administration, White Oak, MD.

Background: Daily flossing prevalence was determined among adults ≥30 years old in the United States, by demographic and risk factors for periodontal disease, including current tobacco use and diabetes.

Methods: Data from the 2011-2014 National Health and Nutrition Examination Survey were analyzed for 8,356 adults. Flossing prevalence was estimated. Logistic regression analysis examined the association between daily flossing and demographic and risk factors for periodontal diseases.

Results: Daily flossing among adults was 31.6% (standard error [SE] = 0.8). There were significant differences among the categories of flossing according to age, sex, race/Hispanic origin, poverty status, education, current tobacco use, and diabetes status. In adjusted analyses, current tobacco users (odds ratio [OR]: 0.82; 95% confidence index [CI] 0.68, 0.99) had lower odds of daily flossing than non-tobacco users; there was no significant difference between adults with and without diabetes (OR 0.75; 95% CI 0.52, 1.08).

Conclusion: Approximately one-third of adults in the United States reported that they floss daily. Daily flossing was higher among women, those with higher income, and non-Hispanic Asian and Hispanic adults, but it was lower among current tobacco users.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.17-0572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434526PMC
August 2018

Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016.

JAMA 2018 04;319(16):1723-1725

National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, Maryland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2018.3060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876828PMC
April 2018

Prevalence of Obesity Among Youths by Household Income and Education Level of Head of Household - United States 2011-2014.

MMWR Morb Mortal Wkly Rep 2018 Feb 16;67(6):186-189. Epub 2018 Feb 16.

Obesity prevalence varies by income and education level, although patterns might differ among adults and youths (1-3). Previous analyses of national data showed that the prevalence of childhood obesity by income and education of household head varied across race/Hispanic origin groups (4). CDC analyzed 2011-2014 data from the National Health and Nutrition Examination Survey (NHANES) to obtain estimates of childhood obesity prevalence by household income (≤130%, >130% to ≤350%, and >350% of the federal poverty level [FPL]) and head of household education level (high school graduate or less, some college, and college graduate). During 2011-2014 the prevalence of obesity among U.S. youths (persons aged 2-19 years) was 17.0%, and was lower in the highest income group (10.9%) than in the other groups (19.9% and 18.9%) and also lower in the highest education group (9.6%) than in the other groups (18.3% and 21.6%). Continued progress is needed to reduce disparities, a goal of Healthy People 2020. The overall Healthy People 2020 target for childhood obesity prevalence is <14.5% (5).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15585/mmwr.mm6706a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815488PMC
February 2018

Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study.

J Clin Nurs 2018 May 13;27(9-10):1872-1883. Epub 2018 Mar 13.

School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.

Aims And Objectives: To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period.

Background: Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period.

Design: The research used a descriptive design.

Methods: A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care.

Results: Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers.

Conclusions: Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice.

Relevance To Clinical Practice: Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with confidence and competence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocn.14252DOI Listing
May 2018

Process evaluation for OptiBIRTH, a randomised controlled trial of a complex intervention designed to increase rates of vaginal birth after caesarean section.

Trials 2018 Jan 5;19(1). Epub 2018 Jan 5.

School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.

Background: Complex interventions encompassing several interconnecting and interacting components can be challenging to evaluate. Examining the underlying trial processes while an intervention is being tested can assist in explaining why an intervention was effective (or not). This paper describes a process evaluation of a pan-European cluster randomised controlled trial, OptiBIRTH (undertaken in Ireland, Italy and Germany), that successfully used both quantitative and qualitative methods to enhance understanding of the underlying trial mechanisms and their effect on the trial outcome.

Methods: We carried out a mixed methods process evaluation. Quantitative and qualitative data were collected from observation of the implementation of the intervention in practice to determine whether it was delivered according to the original protocol. Data were examined to assess the delivery of the various components of the intervention and the receipt of the intervention by key stakeholders (pregnant women, midwives, obstetricians). Using ethnography, an exploration of perceived experiences from a range of recipients was conducted to understand the perspective of both those delivering and those receiving the intervention.

Results: Engagement by stakeholders with the different components of the intervention varied from minimal intensity of women's engagement with antenatal classes, to moderate intensity of engagement with online resources, to high intensity of clinicians' exposure to the education sessions provided. The ethnography determined that, although the overall culture in the intervention site did not change, smaller, more individual cultural changes were observed. The fidelity of the delivery of the intervention scored average quality marks of 80% and above on repeat assessments.

Conclusion: Nesting a process evaluation within the trial enabled the observation of the mode of action of the intervention in its practice context and ensured that the intervention was delivered with a good level of consistency. Implementation problems were identified as they arose and were addressed accordingly. When dealing with a complex intervention, collecting and analysing both quantitative and qualitative data, as we did, can greatly enhance the process evaluation.

Trial Registration: Current Controlled Trials Register, ISRCTN10612254 . Registered on 3 April 2013.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-017-2401-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756437PMC
January 2018

Prevalence of Obesity Among Adults, by Household Income and Education - United States, 2011-2014.

MMWR Morb Mortal Wkly Rep 2017 Dec 22;66(50):1369-1373. Epub 2017 Dec 22.

Studies have suggested that obesity prevalence varies by income and educational level, although patterns might differ between high-income and low-income countries (1-3). Previous analyses of U.S. data have shown that the prevalence of obesity varied by income and education, but results were not consistent by sex and race/Hispanic origin (4). Using data from the National Health and Nutrition Examination Survey (NHANES), CDC analyzed obesity prevalence among adults (aged ≥20 years) by three levels of household income, based on percentage (≤130%, >130% to ≤350%, and >350%) of the federal poverty level (FPL) and individual education level (high school graduate or less, some college, and college graduate). During 2011-2014, the age-adjusted prevalence of obesity among adults was lower in the highest income group (31.2%) than the other groups (40.8% [>130% to ≤350%] and 39.0% [≤130%]). The age-adjusted prevalence of obesity among college graduates was lower (27.8%) than among those with some college (40.6%) and those who were high school graduates or less (40.0%). The patterns were not consistent across all sex and racial/Hispanic origin subgroups. Continued progress is needed to achieve the Healthy People 2020 targets of reducing age-adjusted obesity prevalence to <30.5% and reducing disparities (5).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15585/mmwr.mm6650a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751581PMC
December 2017

Prevalence of Obesity Among Adults and Youth: United States, 2015-2016.

NCHS Data Brief 2017 10(288):1-8

Obesity is associated with serious health risks. Monitoring obesity prevalence is relevant for public health programs that focus on reducing or preventing obesity. Between 2003–2004 and 2013–2014, there were no significant changes in childhood obesity prevalence, but adults showed an increasing trend. This report provides the most recent national estimates from 2015–2016 on obesity prevalence by sex, age, and race and Hispanic origin, and overall estimates from 1999–2000 through 2015–2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2017

Total and High-density Lipoprotein Cholesterol in Adults: United States, 2015-2016.

NCHS Data Brief 2017 10(290):1-8

High total cholesterol (≥ 240 mg/dL) and low high-density lipoprotein (HDL) cholesterol (< 40 mg/dL) levels are risk factors for cardiovascular disease, the leading cause of U.S. deaths (1–3). From 2007–2008 to 2013–2014, declining trends were observed in high total and low HDL cholesterol prevalence (4). This report provides 2015–2016 estimates for high total and low HDL cholesterol and trends based on available comparable data through 2015–2016. Analysis is based on measured cholesterol.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2017

Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Aged ≥18 Years - Los Angeles County, 1999-2006 and 2007-2014.

MMWR Morb Mortal Wkly Rep 2017 Aug 18;66(32):846-849. Epub 2017 Aug 18.

Hypertension is an important and common risk factor for heart disease and stroke, two of the leading causes of death in adults in the United States. Despite considerable improvement in increasing the awareness, treatment, and control of hypertension, undiagnosed and uncontrolled hypertension remain public health challenges (1). Data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension, as well as awareness, treatment, and control of hypertension among adults aged ≥18 years in Los Angeles County compared with adults aged ≥18 years in the United States during 1999-2006 and 2007-2014. During 2007-2014, the prevalence of hypertension was 23.1% among adults in Los Angeles County, lower than the prevalence of 29.6% among all U.S. adults. Among adults with hypertension in Los Angeles County, substantial improvements from 1999-2006 to 2007-2014 were found in hypertension awareness (increase from 73.8% to 84.6%), treatment (61.3% to 77.2%), and control (28.5% to 48.3%). Similar improvements were also seen among all U.S. adults. Although the prevalence of hypertension among adults in Los Angeles County meets the Healthy People 2020 (https://www.healthypeople.gov/) goal of ≤26.9%, continued progress is needed to meet the Healthy People 2020 goal of ≥61.2% for control of hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15585/mmwr.mm6632a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657669PMC
August 2017