Adjustment For Educational Level Research Articles

Association of apolipoprotein B and apolipoprotein A1 levels with social determinants of health and coronary artery disease mortality in the United Kingdom Biobank - is there a need for consideration?

A higher prevalence of cardiovascular risk factors has previously been shown to be associated with adverse social determinants of health (SDoH) and to explain some of their impact on cardiovascular risk. Whether there is a relationship between lipid parameters, specifically apolipoprotein B (apoB), apolipoprotein A1 (apoA1), their ratio (apoB/apoA1), and SDoH, and whether coronary artery disease (CAD) mortality risk associated with circulating apoB and apoA1 is modified by SDoH was unclear. We investigated associations of apoA1, apoB, and apoB/apoA1 with the level of education and household income and their joint impact on CAD mortality in participants of the UK Biobank (UKB) with and without prevalent CAD at enrollment. Hazard ratios for CAD mortality were estimated after adjusting for SDoH and clinical covariates. In 292 804 participants without established CAD, apoB, and the apoB/apoA1 ratio were inversely associated with level of education and household income, whereas apoA1 was positively associated with household income. Adjustment for education level and household income coupled with the number of people living in the household did not attenuate the association between the apolipoprotein levels and incident CAD mortality rates. In a cohort of 13 826 participants with prevalent CAD, apoA1 levels were inversely associated with level of education. Higher apoB levels were only associated with greater CAD mortality risk after adjustment for risk factors. Risk estimation for CAD death through circulating apoA1 levels requires accounting for significant differences by sex. Circulating lipid parameters are associated with SDoH in individuals without CAD. CAD mortality risk estimation through apoA1 and apoB levels does not require accounting for SDoH.

Migração e mortalidade por câncer entre os migrantes colombianos nos EUA: um estudo com dados de declaração de óbito

Abstract We aim to compare cancer mortality rates of USA Colombian migrants (USA Colombians) to Colombians in their country of origin (CO Colombians). Using Colombian national mortality data and data on cancer deaths among Colombians residing in the states of California, Florida, and New York (USA Colombians) for the period 2008-2012, we estimated sex-specific and age-standardized mortality rates (ASMR), expressed per 100,000 persons. For comparisons between the two populations before and after adjustment for educational level, negative binomial regression models were used to compute Mortality Rate Ratios (MRR). CO Colombians had higher cancer mortality rates compared with USA Colombians (male MRR 1.4 [95%CI: 1.2-1.5], female MRR 1.5 [95%CI: 1.3-1.7]). These differences persisted for most cancers even after adjustment for education. CO Colombians had significantly higher mortality from gastric (MRR 2.6 in males and 2.8 in females) and cervical cancer (MRR 5.0) compared with US Colombians. Educational inequalities in cancer mortality were more pronounced among CO Colombians than among USA Colombians. Lower cancer mortality observed among USA Colombians cannot be attributed to differences in education, an indicator of socio-economic status. Rather, it is likely due to better access to preventive and curative healthcare in the USA.

Does Forward Head Posture Influence Somatosensory Evoked Potentials and Somatosensory Processing in Asymptomatic Young Adults?

The current investigation used somatosensory evoked potentials (SEPs) to assess differences in sensorimotor integration and somatosensory processing variables between asymptomatic individuals with and without forward head posture (FHP). We assessed different neural regions of the somatosensory pathway, including the amplitudes of the peripheral N9, spinal N13, brainstem P14, peak-to-peak amplitudes of parietal N20 and P27, and frontal N30 potentials. Central conduction time (N13-N20) was measured as the difference in peak latencies of N13 and N20. We measured these variables in 60 participants with FHP defined as a craniovertebral angle (CVA) < 50° and 60 control participants matched for age, gender, and body mass index (BMI) with normal FHP defined as CVA > 55°. Differences in variable measures were examined using the parametric t-test. Pearson's correlation was used to evaluate the relationship between the CVA and sensorimotor integration and SEP measurements. A generalized linear model (GLM) was used to compare the SEP measures between groups, with adjustment for educational level, marital status, BMI, and working hours per week. There were statistically significant differences between the FHP group and control group for all sensorimotor integration and SEP processing variables, including the amplitudes of spinal N13 (p < 0.005), brainstem P14 (p < 0.005), peak-to-peak amplitudes of parietal N20 and P27 (p < 0.005), frontal N30 potentials (p < 0.005), and the conduction time N13-N20 (p = 0.004). The CVA significantly correlated with all measured neurophysiological variables indicating that as FHP increased, sensorimotor integration and SEP processing became less efficient. FHP group correlations were: N9 (r = -0.44, p < 0.001); N13 (r = -0.67, p < 0.001); P14 (r = -0.58, p < 0.001); N20 (r = -0.49, p = 0.001); P27 (r = -0.58, p < 0.001); N30 potentials (r = -0.64, p < 0.001); and N13-N20 (r = -0.61, p < 0.001). GLM identified that increased working hours adversely affected the SEP measures (p < 0.005), while each 1° increase in the CVA was associated with improved SEP amplitudes and more efficient central conduction time (N13-N20; p < 0.005). Less efficient sensorimotor integration and SEP processing may be related to previous scientific reports of altered sensorimotor control and athletic skill measures in populations with FHP. Future investigations should seek to replicate our findings in different spine disorders and symptomatic populations in an effort to understand how improving forward head posture might benefit functional outcomes of patient care.

Cross-cultural comparison of MMSE and RUDAS in German and Turkish patients with Alzheimer's disease.

Given the increasing cultural, linguistic diversity in Europe, there is a growing need for cognitive screening tools that minimize the influence of linguistic, cultural, and demographic differences as they are the first means to determine the need for further clinical evaluation of individuals with suspected cognitive impairment. This cross-sectional study compared performance on the Mini-Mental State Examination (MMSE) and the Rowland Universal Dementia Assessment Scale (RUDAS) in Alzheimer's Disease (AD) patients in relation to cultural, demographic, and immigration-related factors (acculturation, bilingualism). The study comprised Turkish immigrant (n = 21) and monolingual, nonimmigrant German (n = 20) and Turkish (n = 24) patients with AD. All participants were administered cognitive screening tools, measures of depression, and dementia severity. The mean MMSE total score was significantly higher in German patients with AD compared to both patient groups, but did not differ between native-born Turkish and Turkish immigrant groups. After adjustment for years of education, differences in MMSE performance were no longer significant between groups. Furthermore, bilingualism was associated with better performance on the MMSE in Turkish-immigrant patients. The mean RUDAS total scores were similar between groups with and without adjustment for educational level. Performance on the RUDAS was not associated with demographic and immigration-related variables. The findings highlight the need to consider the educational background, linguistic integration of older non-Western immigrants for the objective characterization of cognitive profiles. The results provide support for the use of the RUDAS, particularly, among older Turkish immigrants with lower educational levels and varying degrees of acculturation, bilingualism. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessment of Health Literacy and Self-reported Readiness for Transition to Adult Care Among Adolescents and Young Adults With Spina Bifida

Health literacy has been shown to play an important role in transitions of care in adult populations, with low health literacy associated with adverse health outcomes. The role of health literacy in the transition from pediatric to adult care has been less well studied. Among adolescents and young adults with spina bifida, high rates of unsuccessful transition have been shown, but how patient health literacy affects transition readiness remains unknown. To determine whether health literacy is associated with transition readiness in adolescents and young adults with spina bifida. This cross-sectional study involved collection of patient-reported questionnaires between June 2019 and March 2020 at a multidisciplinary spina bifida center at a single, free-standing children's hospital. Patient demographic and clinical characteristics were obtained from medical record review. Patients were aged 12 years or older with a diagnosis of spina bifida (myelomeningocele and nonmyelomeningocele) whose primary language was English or Spanish. Data analysis was performed from October 2020 to March 2021. Health literacy as assessed by the Brief Health Literacy Screening Tool. The primary outcome was total Transition Readiness Assessment Questionnaire (TRAQ) score, normalized into units of SD. Nested, multivariable linear regression models assessed the association between health literacy and TRAQ scores. The TRAQ and Brief Health Literacy Screening Tool were completed by 200 individuals (median [range] age, 17.0 [12.0-31.0] years; 104 female participants [52.0%]). Most of the patients were younger than 18 years (110 participants [55.0%]) and White (136 participants [68.0%]) and had myelomeningocele (125 participants [62.5%]). The mean (SD) TRAQ score was 3.3 (1.1). Sixty-six participants (33.0%) reported inadequate health literacy, 60 participants (30.0%) reported marginal health literacy, and 74 participants (37.0%) reported adequate health literacy. In univariable analysis, health literacy, age, type of spina bifida, level of education, self-administration vs completion of the questionnaires with assistance, ambulatory status, and urinary incontinence were associated with total TRAQ score. In all nested, sequentially adjusted, multivariable models, higher health literacy remained a significant, stepwise, independent variable associated with higher TRAQ score. In the fully adjusted model, having adequate compared with inadequate health literacy was associated with an increase in normalized TRAQ score of 0.49 SD (95% CI, 0.19-0.79). Patient-reported transition readiness is associated with health literacy, even after adjustment for education level and other demographic and clinical factors. Developing and implementing health literacy-sensitive care programs during the transition process may improve patient transition readiness.

Rural and urban migration to Europe in relation to cardiovascular disease risk: does it matter where you migrate from?

ObjectivesTo assess whether the environmental context (i.e. rural vs urban) in which individuals in low- and middle-income countries have resided most of their lives is associated with estimated cardiovascular disease (CVD) risk after migration to a high-income country. Study designData from the Research on Obesity and Diabetes among African Migrants (RODAM) study were used including 1699 Ghanaian participants aged 40–79 years who had migrated to Europe from Ghana (1549 of urban origin, 150 of rural origin). MethodsTen-year CVD risk was estimated using the Pooled Cohort Equation, with estimates ≥7.5% defining elevated CVD risk. Comparisons between urban and rural origin migrant groups were made using proportions and adjusted odds ratios (ORs). ResultsThe proportion of migrants with an elevated CVD-risk score was substantially higher among rural migrants than among urban migrants (45% vs. 37%, OR = 1.44, 95% confidence interval [CI]:1.03–2.02), which persisted after adjustment for education level, site of residence in Europe (London, Amsterdam or Berlin), length of stay in Europe, physical activity, energy intake and alcohol consumption (OR = 1.67, 95% CI: 1.05–2.67). ConclusionOur findings indicate that migrants who spent most of their lives in a rural setting before migration to Europe may have a higher CVD risk than those of urban origins. Further work is needed to confirm these findings in other migrant populations and to unravel the mechanisms driving the differential CVD risk between urban and rural migrants.

Increased Risk of Parkinson's Disease in Women after Bilateral Oophorectomy.

Results regarding the association between hormonal exposure and risk of Parkinson's disease (PD) are heterogeneous. To investigate the association of reproductive life characteristics with PD among postmenopausal women. The PARTAGE case-control included 130 female cases and 255 age-matched female controls. Information on gynecological history was obtained from a standardized questionnaire and PD was validated by neurological examination. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using conditional logistic regression. After adjustment for education level, smoking status, professional exposure to pesticides, and coffee and alcohol drinking, bilateral oophorectomy (OR = 3.55, 95%CI = 1.75-7.20), but neither menopause before age 50 years (OR = 1.24, 95%CI = 0.74-2.09) nor hormone therapy (HT; OR = 1.07, 95%CI = 0.62-1.86), was associated with PD. Our findings suggest that bilateral oophorectomy is associated with increased risk of PD. © 2021 International Parkinson and Movement Disorder Society.

Examining the lower range of the association between alcohol intake and risk of incident hospitalization with atrial fibrillation.

BackgroundEvidence is sparse on the association between alcohol intakes in the lower range and risk of atrial fibrillation (AF). We aimed to investigate self-reported low and moderate alcohol intakes and subsequent risk of incident AF among current drinkers.MethodsNorwegian population-based health examination surveys assessing self-reported daily alcohol intake (mean grams per day) were linked to health and population registers. Hazard ratios (HR) (95% confidence interval) for time to incident (first) hospitalization with AF by alcohol intake level were assessed by Cox regression, with adjustment for educational level and cardiovascular risk factors except blood pressure.ResultsThe study population included 234,392 participants (49% men). Incident hospitalization with AF was identified in 5043 (2.2%) persons during a mean follow-up of 9 years. Compared to a very low alcohol intake of <1 unit weekly, a moderate consumption in the range of 1 to <2 units daily increased the risk of incident AF by 18% (HR 1.18 [1.06–1.32]). The average risk of incident AF increased by 9% per daily alcohol unit of 12 g (HR 1.09 [1.03, 1.14]). In sex-stratified analyses significant associations were found in men only.ConclusionsWe found that less than two alcohol units/day significantly increased the risk of incident AF, however, in men only. Reduction of even a moderate alcohol intake may thus reduce the risk of AF at the population level.

Associations between diet quality, blood pressure, and glucose levels among pregnant women in the Asian megacity of Jakarta.

BackgroundThe prevalence of gestational hypertension and diabetes in pregnancy is increasing worldwide. Diet is a modifiable factor that may influence these conditions, but few studies have examined the association between diet quality and blood pressure and glucose profiles among pregnant women. Data are especially scarce for women in low- and middle-income countries (LMICs), where 90% of global pregnancies occur, and in urban settings. We, therefore, assessed these associations among 174 pregnant women in the Asian megacity of Jakarta in a cross-sectional study of the Brain Probiotic and LC-PUFA Intervention for Optimum Early Life (BRAVE) project.MethodsTrained field-enumerators collected socio-demographic characteristics, measured Mid-Upper Arm Circumference (MUAC), and assessed diet by two 24-hour recalls, which were used to calculate the Alternate Healthy Eating Index for Pregnancy (AHEI-P). Blood pressure was measured by automated sphygmomanometer, and fasting blood glucose by capillary glucometer. General linear models were used to identify associations.ResultsThe median AHEI-P score was 47.4 (IQR 19.1–76.6). The middle tertile of the AHEI-P score (39.59–56.58) was associated with a 0.4 SD (standardized effect size, 95% CI -0.7 to -0.06; p = 0.02) lower diastolic blood pressure compared with the lowest tertile (<39.59), after adjustment for level of education, smoking status, MUAC, gestational age, history of hypertension, and family history of hypertension. However, no associations were found between the AHEI-P score and systolic blood pressure and blood glucose.ConclusionHigher diet quality was associated with lower diastolic blood pressure among pregnant women in an urban LMIC community, but not with systolic blood pressure and blood glucose. A behavioral change intervention trial would be warranted to confirm the influence of diet quality on blood pressure and glucose levels and among pregnant women, and even before pregnancy.

Job demands/control among people in paid work age 55-64 and their labour market status 11 years later

Abstract Background As discussions about extending working lives are ongoing, more knowledge is warranted on working conditions that are associated with labour market status in older age. Aim Among employees aged 55-64 years, associations between job demands/job control with their labour market status 11 years later were explored. Methods A population-based prospective cohort study using a job exposure matrix (JEM) and nationwide register data. All 616,818 individuals in Sweden who in 2001 were in paid work and aged 55-64, were assigned JEM values for job demands/control that were categorized into tertiles resulting in nine combinations of job demands/control (reference=medium control/medium demands). Follow-up was in 2012 regarding labour market status (paid work, old-age pension, low/no income, sickness absence emigrated, dead). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multinomial logistic regression (reference category=old-age pension) with adjustment for educational level, age, birth country, family situation and type of living area. Results Women in occupations with high control (OR low demands/high control 1.21, CI 1.06-1.39, medium demands/high control 1.32, CI 1.20-1.46, high demands/high control 1.29, CI 1.20-1.37); and men in occupations with high demands/high control (OR 1.11, CI 1.02-1.21) were more likely to be in paid work. Those in occupations with high demands at baseline were less likely to have low/no income at follow-up (OR women high demands/medium control 0.51, CI 0.37-0.68, high demands/high control 0.68, CI 0.50-0.92; men high demands/medium control 0.55, CI 0.31-0.96, high demands/high control 0.47, CI 0.32-0.74. Conclusions High job control combined with any level of demands for women and high demands for men aged 55-64 in 2001 were associated with higher OR of having main income from paid work in 2012, and high job demands combined with any level of job control were associated with lower OR of low/no income. Key messages Combinations of job demands and job control among workers aged 55-64 years in 2001 were associated with labour market situations in 2012. Using a job exposure matrix divided into tertiles allows for greater detail in measuring high, medium, and low demands and control than methods used in previous studies.

Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece.

BackgroundAlthough combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD). We assessed the prevalence of CVD risk and its contributing factors in adult PLHIV versus general population controls in Greece.SettingsCross-sectional comparison of PLHIV (Athens-Multicenter-AIDS-Cohort-Study; AMACS) versus general population controls (National health examination survey; EMENO).MethodsAll HIV-infected adults with ≥1 measurement of interest (blood pressure, lipids, glucose, weight, height) between 2012–2014 and all EMENO participants (2014–2016) were included. Ten-year total CVD risk was estimated using the Framingham (FRS) or the Systematic Coronary Risk Evaluation (SCORE) equations.Results5839 PLHIV (median age:41.6 years, 85.4% males) and 4820 controls (median age:48 years, 48.4% males) were included. Adjusting for age, sex and origin, PLHIV were more likely to be current smokers (adjusted OR:1.53 [95% CI:1.35–1.74]) and dyslipidemic (aOR:1.18; [1.04–1.34]), less likely to be obese (aOR:0.44 [0.38–0.52], with no differences in hypertension, diabetes or high (≥20%) FRS but with greater odds of high (≥5%) SCORE (aOR:1.55 [1.05–2.30]). Further adjustment for educational level, anti-HCV positivity and BMI showed higher prevalence of hypertension in PLHIV.ConclusionsDespite the relative absence of obesity, PLHIV have higher prevalence of traditional CVD risk factors and higher risk of fatal CVD compared to general population. Regular screening and early management of CVD risk factors in PLHIV should be of high priority for CVD prevention.

Assisted reproductive technology treatment and risk of ovarian cancer-a nationwide population-based cohort study.

Does hormone stimulation during assisted reproductive technology (ART) treatment increase the risk of ovarian cancer? No increased risk of ovarian cancer was found among ART-treated women, with the exception of ART-treated women with endometriosis. Previous studies on the association between ovarian stimulation during ART and ovarian cancer have shown conflicting results. The risk of ovarian cancer varies according to the cause of infertility, and only a few studies on ART treatment and risk of ovarian cancer have had sufficient data to address this issue. Endometriosis has been linked to an increased risk of ovarian cancer. Women undergoing ART treatment during 1994-2015 were registered in the Danish IVF register. Data were linked with data from the Danish Cancer Register and socio-demographic population registers using an individual person identification number assigned to people residing in Denmark. All women undergoing ART treatment were age-matched with a random sample of the female background population and followed for up to 22years. After relevant exclusions, the population consisted of 58 472 ART-treated women and 625 330 untreated women, all with no previous malignancies. Ovarian cancer risk was assessed using multivariable cox regression analyses with adjustment for educational level, marital status, parity and treatment year. Results are shown as hazard ratios (HRs) with corresponding CIs. In total, 393 (0.06%) women were diagnosed with ovarian cancer during follow-up (mean 9.7years). Women treated with ART had an increased risk of ovarian cancer (HR 1.20, 95% CI 1.10-1.31), which diminished over time. The increased risk was apparent among women with female factor infertility (HR 1.36, 95% CI 1.25-1.48), whereas no female factor infertility was associated with a lower risk (HR 0.87, 95% CI 0.76-1.00). The risk was increased among women with endometriosis (HR 3.78, 95% CI 2.45-5.84), whereas no increased risk was found among ART-treated women with polycystic ovary syndrome, other female causes of infertility and unexplained infertility. The association between ART treatment and ovarian cancer is likely influenced by increased detection due to multiple ultrasound scans during ART treatment. Undergoing ART treatment without the presence of endometriosis was not associated with an increased risk of ovarian cancer, which is reassuring. Whether ART treatment increases the risk of ovarian cancer among women with endometriosis needs further investigation. This work was supported by a PhD grant to D.V. from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Funding for establishing the Danish National ART-couple II cohort was achieved from Ebba Rosa Hansen Foundation. The funders had no influence on data collection, analyses or results presented. The authors have no conflicts of interest to declare.

Glycaemic control and excess risk of major coronary events in patients with type 2 diabetes: a population-based study

ObjectiveThe purpose of the study was to investigate the excess risk of acute myocardial infarction (AMI) and death from coronary artery disease (coronary heart disease, CHD) in relation to age,...

Comparison of pre-injury recalled Health Status (HS) data of trauma patients and HS of the general population

PurposeSignificant differences exist between retrospectively collected pre-injury Health Status (HS) of trauma patients and the HS of the general population. Compared to the general population, the trauma population includes a larger proportion of individuals with a low level of socio-economic status. The aim was to compare retrospectively collected pre-injury HS with HS of a sample of Dutch individuals not only adjusted for age and gender, but also for educational level. MethodsWithin three months post-trauma, pre-injury HS (n = 2987) was collected by using the EuroQol-five-dimension-3-level (EQ-5D-3L) questionnaire. Data were abstracted from the Brabant Injury Outcome Surveillance. The reference cohort (n = 1839) included a sample of the Dutch general population. Multiple regression was used to compare HS of both cohorts. ResultsA higher recalled pre-injury EQ-5D-3L score of the injury cohort was reported compared to the HS of the reference cohort after adjustment for age (β = 0.014 [95% CI: 0.001,0.027] for males and β = 0.018 [95% CI: −0.001, 0.036] for females). After adjustment for age and educational level, the Beta showed a ≥10% increasement: males; unadjusted β = 0.006 [95% CI: −0.007, 0.019] to β = 0.014 [95% CI: 0.001, 0.027] after age adjustment to β = 0.020 [95% CI: 0.007, 0.033] after adjustment for age and educational level, females; unadjusted β = −0.018 [95% CI: −0.035, −0.001] to β = 0.018 [95% CI: −0.001, 0.036] after age adjustments to β = 0.025 [95% CI: 0.007, 0.043] after adjustments for age and educational level. After adjustment for age, gender and educational level, the injury cohort reported prior to the trauma less problems on the ‘pain/discomfort’ (OR = 0.522 [95% CI: 0.454, 0.602]) and the ‘anxiety/depression’ (OR = 0.745 [95% CI: 0.619, 0.897]) dimensions, as compared to the reference cohort. In contrast, the injury cohort reported significantly more problems on the ‘self-care’ dimension (OR = 1.497 [95% CI: 0.1.112, 2.016]) prior to the trauma. ConclusionsInjured patients report better recalled pre-injury HS compared to the HS of the reference cohort. After adjustment for educational level, the difference in HS between the injury cohort and the reference cohort increases, underlining that other confounders might also influence HS.

Abstract P237: Relation of Egg Intake to Blood Pressure: The International Study on Macro/Micronutrients and Blood Pressure (INTERMAP)

Background: Data regarding associations of egg intake, a major source of dietary cholesterol, with blood pressure (BP) are limited, especially from large, diverse population samples, and findings have been inconsistent. Methods: Associations between egg intake and BP were examined using data on 4680 men and women, aged 40-59 years, between 1996 and 1999, from the INTERMAP study that included 17 population samples in the United States (US), United Kingdom (UK), China and Japan. Data were collected from four 24-hour dietary recalls, 2 timed 24-hour urine collections and 8 BP measurements. Egg intake was calculated as amount consumed per day using the Nutrient Data Software for Research (University of Minnesota, USA). Multivariable linear regression models were used to estimate differences in BP per 2-SD of egg intake (50.71g/day). Country-specific regression coefficients were pooled, weighted by inverse of their variance to estimate overall association. Results: Of 4680 participants, 50% were women. Daily egg intake was highest among individuals from Japan (mean 37.74, SD 24.3g/day). With adjustment for age, sex, population sample, and average dietary energy intake/day, egg intake was significantly associated with SBP in both the pooled sample and the US sample. With each 2-SD higher egg intake, US mean SBP was significantly higher by 2mmHg (Model 1-Table). The associations remained significant with further adjustment for education level, family history of hypertension, smoking status, and use of dietary supplement (Model 2-Table). With further adjustment for urinary sodium and urinary potassium or BMI, the associations were no longer significant. No association was found for other countries, and for DBP. Conclusion: An adverse association between egg intake and SBP was observed in the US but not in other countries. Notably, this association was strongly attenuated by urinary sodium, urinary potassium and BMI. Further research is needed to better understand the relation of egg intake and BP.

Coping styles and symptomatic manifestation of first-episode psychosis: Focus on cognitive performance

Cognitive deficits are widely observed in patients with psychosis and represent one of most important determinants of functional outcomes. It has been shown that patients with psychosis prefer maladaptive coping strategies over active coping styles. However, it remains unknown whether cognitive impairments are related to coping styles in psychotic disorders. Therefore, the aim of this study was to assess whether cognitive deficits observed in patients with first-episode psychosis (FEP) might impact the use of specific coping strategies. We recruited 40 FEP patients and 35 healthy controls. In our study, FEP patients were more likely to use maladaptive coping styles after adjustment for education level and medication effects. The use of maladaptive coping strategies was associated with greater impairments of visuospatial/constructional abilities and language skills in FEP patients. In addition, lower odds of using adaptive coping were related to higher levels of depressive symptoms in the group of patients. Adaptive coping was associated with better global cognitive performance in healthy controls. Our results indicate that cognitive impairments, especially worse performance of visuospatial/constructional abilities and language skills, might be related to the preference of maladaptive coping strategies. Lower odds of using adaptive coping styles might be associated with more severe depressive symptomatology.

Ethnic Differences in Health Literacy Among Young Adults in Amsterdam.

Background:Ethnic differences in health commence early in life. Ethnic minority young adults have a greater prevalence of unhealthier lifestyles and poorer health outcomes than their peers. Variations in health literacy could contribute to these ethnic inequalities in health but have not yet been investigated in this group.Objective:This study investigated ethnic differences in performance-based and self-reported health literacy in young adults and examined whether these differences are explained by educational level, language difficulties, or cultural distance.Methods:Young adults (age 18–25 years) from Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Turkish, and Moroccan ethnic backgrounds (N = 2,215) participated in the HELIUS (HEalthy Life in an Urban Setting) study, a cohort study in Amsterdam, the Netherlands. Performance-based health literacy was measured by the Rapid Estimate of Adult Literacy in Medicine in Dutch (REALM-D). Self-reported health literacy was measured by the Chew's Set of Brief Screening Questions (SBSQ). The association between ethnicity and health literacy, and the role of background characteristics was assessed by linear regression analyses.Key Results:Performance-based health literacy was low (REALM-D <60; range, 0–66) among 17% of the participants. After adjustment for educational level, average levels of REALM-D were lower among participants from a Ghanaian, Turkish, and Moroccan background than those from a Dutch background, whereas the two Surinamese groups did not differ from the Dutch group. Additional adjustment for language difficulties and cultural distance did not explain the differences between the five ethnic minority groups. Self-reported health literacy was low (SBSQ <3; range, 0–4) among 3% of the participants. There were no differences in levels of SBSQ between the ethnic minority groups and the Dutch group.Conclusions:We found ethnic differences in performance-based health literacy, which largely remained after adjustment for educational level. Further research is needed to gain insight into how young adults from different ethnic groups appraise and apply health information in various contexts. [HLRP: Health Literacy Research and Practice. 2018;2(4):e192–e204.]Plain Language Summary:We investigated ethnic differences in health literacy among young adults (age 18–25 years) living in the Netherlands. Compared to the Dutch group, some ethnic minority groups scored lower on performance-based health literacy, independent of educational level. Self-reported health literacy did not differ between Dutch and ethnic minority groups.

Health literacy among older adults is associated with their 10-years\u2019 cognitive functioning and decline - the Doetinchem Cohort Study

BackgroundMany older adults have low levels of health literacy which affects their ability to participate optimally in healthcare. It is unclear how cognitive decline contributes to health literacy. To study this, longitudinal data are needed. The aim of this study was therefore to assess the associations of cognitive functioning and 10-years’ cognitive decline with health literacy in older adults.MethodsData from 988 participants (mean age = 65.3) of the Doetinchem Cohort Study were analyzed. Health literacy was measured by the Brief Health Literacy Screening. Memory, mental flexibility, information processing speed, and global cognitive functioning were assessed at the same time as health literacy and also 10 years earlier. Logistic regression analyses were performed, adjusted for age, gender, and educational level.ResultsHigher scores on tests in all cognitive domains were associated with a lower likelihood of having low health literacy after adjustment for confounders (all ORs < 0.70, p-values<.001). Similar associations were found for past cognitive functioning (all ORs < 0.75, p-values<.05). Before adjustment, stronger cognitive decline was associated with a greater likelihood of having low health literacy (all ORs > 1.37, p-values<.05). These associations lost significance after adjustment for educational level, except for the association of memory decline (OR = 1.40, p = .023, 95% CI: 1.05 to 1.88).ConclusionOlder adults with poorer cognitive functioning and stronger cognitive decline are at risk for having low health literacy, which can affect their abilities to promote health and self-manage disease. Low health literacy and declining cognitive functioning might be a barrier for person-centered care, even in relatively young older adults.

Social support and ovarian cancer incidence – A Swedish prospective population-based study

ObjectiveLow social support is associated with worse prognosis for epithelial ovarian cancer (EOC) patients. However, few studies have explored the relation between low social support and incidence of EOC. The aim of this prospective nested case-control study was to examine whether self-perceived low social support was associated with the incidence of EOC. MethodsThe Swedish Cancer Registry was used to identify participants in the Västerbotten Intervention Programme (VIP) comprising 58,000 women, who later developed EOC. Each case was matched to four cancer free controls. The VIP uses the Social Support questionnaire, a modified version of the validated questionnaire “The Interview Schedule for Social Interaction” (ISSI) measuring quantitative (AVSI) and qualitative (AVAT) aspects of social support. ResultsThe risk of EOC in relation to AVSI and AVAT was similar between the 239 cases and the 941 controls after adjustment for educational level, smoking, BMI, Cambridge Physical Activity Index and age (aOR 0.85, 95% CI 0.72–1.01 and aOR 0.54, 95% CI 0.16–1.81). Lagtime was found to have no impact. A decreased risk of serous ovarian cancer was seen in women with fewer persons available for informal socializing (aOR 0.75, 95% CI 0.59–0.95). Adjusted analyses showed non-significant odds ratios below 1.0 in the vast majority of histotypes. ConclusionsA general trend towards a decreased risk of ovarian cancer associated with low AVSI and AVAT was identified. Solely the serous subtype was significantly associated with low scores of AVSI. Prospective pathophysiological and epidemiological studies regarding social support are needed.

Abstract P125: Reverse Causality of the Relationship Between Dietary Cholesterol and Serum Low Density Lipoprotein Cholesterol Associated With Education and Employment: the INTERLIPID Study

Introduction: The upper limit of recommended dietary cholesterol has been abolished recently from guidelines in Japan and US even though high intake is known to increase serum cholesterol levels. Reverse causality has been involved, reflecting availability of widespread information with consequent lifestyle modifications among knowledgeable people. People with higher serum cholesterol are more likely to modify diet than those with lower serum cholesterol, especially among more educated; if enough people do this, dietary cholesterol will not relate to serum cholesterol or will relate inversely. Hypothesis: We assessed the hypothesis that lifestyle modifications separately by those with high education level and employment status reverse the positive relationship between dietary cholesterol and serum low density lipoprotein cholesterol (LDL-C); therefore, the positive relationship between dietary cholesterol and LDL-C would prevail after adjustment for education level and employment status. Methods: A population-based, random sample, cross-sectional study (INTERLIPID) which was an ancillary study of the International Study of Macronutrients and Blood Pressure (INTERMAP), conducted a survey between 1996 and 1999. Among 1,145 Japanese individuals ages 40-59 years, 106 were excluded because of special diets, use of lipid lowering drugs, hormone replacement, and missing data, leaving 1,039 individuals (533 men and 506 women). Dietary cholesterol was assessed from four 24-h dietary recalls and LDL-C was measured by enzymatic methods on an auto-analyzer. A standard questionnaire inquired about years of education and employment status. Results: Linear regression analysis revealed an inverse association between dietary cholesterol and LDL-C in men (coefficient, -0.04 [95%CI, -0.08 to -0.01]), no significant association when adjusted for education and its interaction term with dietary cholesterol in men (coefficient, 0.05 [95%CI, -0.03 to 0.14]), and a significant positive relation when adjusted for employment and its interaction term in men (coefficient, 0.13 [95%CI, 0.01 to 0.26]). With adjustment for education and employment and their interactions, a significant positive relation was recorded again in men (coefficient, 0.16 [95%CI, 0.03 to 0.29]). These relationships were not observed in women. Conclusions: In Japanese men, education, employment, and their interaction terms with dietary cholesterol reversed an observed inverse relationship between dietary cholesterol and LDL-C. A positive relation prevailed between dietary cholesterol and LDL-C after adjustment for education level and employment status.