aOR Range Research Articles

Assessment of Posttraumatic Stress Disorder and Educational Achievement in Sweden

Posttraumatic stress disorder (PTSD) has been associated with impaired educational performance. Previous studies on the disorder could not control for important measured and unmeasured confounders. To prospectively investigate the association between PTSD and objective indicators of educational attainment across the life span, controlling for familial factors shared by full siblings, psychiatric comorbidity, and general cognitive ability. This population-based cohort study included 2 244 193 individuals born in Sweden between January 1, 1973, and December 31, 1997, who were followed-up until December 31, 2013. Clusters of full siblings were used to account for familial factors. Data analyses were conducted between December 2018 and May 2020. International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses of PTSD in the Swedish National Patient Register. Eligibility to access upper secondary education after finishing compulsory education, finishing upper secondary education, starting a university degree, and finishing a university degree. Of the final cohort of 2 244 193 individuals (1 151 414 [51.3%] men) included in the analysis, 1 425 326 were assessed for finishing compulsory education (919 with PTSD), 2 001 944 for finishing upper secondary education (2013 with PTSD), and 1 796 407 and 1 356 741 for starting and finishing a university degree (2243 and 2254 with PTSD, respectively). Posttraumatic stress disorder was associated with lower odds of achieving each of the educational milestones during the study period, including 82% lower odds of finishing compulsory education (adjusted odds ratio [aOR], 0.18; 95% CI, 0.15-0.20), 87% lower odds of finishing upper secondary education (aOR, 0.13; 95% CI, 0.12-0.14), 68% lower odds of starting a university degree (aOR, 0.32; 95% CI, 0.28-0.35), and 73% lower odds of finishing a university degree (aOR, 0.27; 95% CI, 0.23-0.31). Estimates in the sibling comparison were attenuated (aOR range, 0.22-0.53) but remained statistically significant. Overall, excluding psychiatric comorbidities and adjusting for the successful completion of the previous milestone and general cognitive ability did not statistically significantly alter the magnitude of the associations. Posttraumatic stress disorder was associated with educational impairment across the life span, and the associations were not entirely explained by shared familial factors, psychiatric comorbidity, or general cognitive ability. This finding highlights the importance of implementing early trauma-informed interventions in schools and universities to minimize the long-term socioeconomic consequences of academic failure in individuals with PTSD.

Association Among Maltreatment, Bullying and Mental Health, Risk Behavior and Sexual Attraction in Chinese Students.

To identify the association between sexual attraction, childhood maltreatment and bullying victimization, and mental and behavioral health problems among Chinese adolescents. A cross-sectional study among Chinese high school students by multistage stratified cluster sampling was conducted using a self-reported questionnaire. Participants who were same- or both-sex attracted were identified as sexual minorities, and those who were opposite-sex attracted were identified as heterosexuals. Childhood maltreatment was assessed as physical, emotional, and sexual abuse, and bullying was assessed as traditional and cyberbullying. Psychological distress was assessed as depressive and anxiety symptoms, and self-destructive behavior was assessed as suicidal behavior and nonsuicidal self-injury. Logistic regression and path analysis were conducted to analyze the data. There were 1360 sexual minority and 15,020 heterosexual respondents. Sexual minority status was associated with increased risk of maltreatment (adjusted odds ratio [AOR] range: 1.25-2.46) and bullying (AOR range: 1.38-1.77) victimization, and a series of health problems (AOR range: 1.85-3.69). Furthermore, childhood maltreatment could partially explain the association of sexual minority status with psychological distress (indirect effect: β=0.026 for boys; β=0.086 for girls) and self-destructive behavior (β=0.056 for boys; β=0.125 for girls), and bullying could partially explain the association between sexual minority status and psychological distress (β=0.040 for boys; β=0.031 for girls). Sexual minority adolescents were more likely than heterosexuals to experience different forms of childhood victimization, which may put them at higher risk for mental and behavioral health problems. Interventions based on both family and school are essential.

Sex differences in infant health following ART-treated, subfertile, and fertile deliveries

Among infants following ART-treated, subfertile, and fertile deliveries to determine (1) the presence and magnitude of sex differences in health outcomes and (2) whether the presence of sex differences varied among maternal fertility groups. Retrospective cohort analysis of infants born in Massachusetts (MA) in 2004-2013 who were conceived by ART. The Society for Assisted Reproductive Technology Clinic Outcome Reporting System was linked to the Pregnancy to Early Life Longitudinal data system, which links birth certificates to hospital discharge records for MA mothers and infants. Included were singletons born via ART-treated, subfertile, and fertile deliveries. Multivariable logistic regression was used to model the association between infant sex and health outcomes, controlling for maternal demographic and health characteristics. A total of 16,034 ART-treated, 13,277 subfertile, and 620,375 fertile singleton live births were included. For all three groups, males had greater odds of being preterm (AOR range 1.15-1.2), having birth defects (AOR range 1.31-1.71), experiencing respiratory (AOR range 1.33-1.35) and neurologic (AOR range 1.24-1.3) conditions, and prolonged hospital stay (AOR range 1.19-1.25) compared to females. The interaction between maternal fertility group and infant sex for all infant outcomes was nonsignificant, denoting that the presence of sex differences among fertile, subfertile, and ART groups did not vary. Sex differences in birth outcomes of infants following ART-treated, subfertile, and fertile deliveries exist but the magnitude of these differences does not vary among these maternal fertility groups.

Discrimination, Sexual Orientation Discrimination, and Severity of Tobacco Use Disorder in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.

Tobacco use is more prevalent among sexual minority populations relative to heterosexual populations. Discrimination is a known risk factor for tobacco use. However, the relationship between exposure to different forms of discrimination, such as racial or ethnic discrimination and sexual orientation discrimination, and tobacco use disorder (TUD) severity has not been examined. Using data from the 2012-2013 National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36 309 US adults), we conducted multivariable logistic regression analyses to examine the associations among racial or ethnic discrimination, sexual orientation discrimination, and TUD severity for lesbian or gay-, bisexual-, and heterosexual-identified adults. Consistent with the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), past-year moderate-to-severe TUD was defined as the presence of ≥4 DSM-5 TUD symptoms. Higher levels of lifetime racial or ethnic discrimination were associated with significantly greater odds of past-year moderate-to-severe TUD among sexual minorities (adjusted odds ratio [AOR] = 1.03, 95% confidence interval [CI] = 1.01-1.05) and heterosexuals (AOR = 1.04, 95% CI = 1.03-1.05). Stressful life events, mood disorder, and anxiety disorder had significant associations with moderate-to-severe TUD among sexual minorities (AOR range: 1.86-5.22, p < .005) and heterosexuals (AOR range: 1.71-3.53, p < .005). Among sexual minorities, higher levels of racial or ethnic and/or sexual orientation discrimination were associated with greater odds of any TUD (AOR = 1.02, 95% CI = 1.01-1.03). Sexual minorities and heterosexuals who experience higher levels of racial or ethnic discrimination are at heightened risk of having moderate-to-severe TUD. Exposure to higher levels of discrimination also increases the risk of having any TUD among sexual minority adults. Health providers and tobacco cessation professionals should be cognizant of the minority stressors experienced by their clients and their potential impact on TUD severity. This study is the first to show how experiences of racial or ethnic and sexual orientation discrimination are associated with DSM-5 TUD severity among sexual minority and heterosexual populations. Individuals exposed to multiple minority stressors may have increased vulnerability for developing TUD and related adverse health consequences. Our study underscores the importance of considering racial or ethnic discrimination and the multiple minority statuses that individuals may hold. Eliminating all forms of discrimination and developing interventions that are sensitive to the role that discrimination plays in TUD severity may attenuate the tobacco use disparities between sexual minority and heterosexual adults.

Prevalence of 12-month mental and substance use disorders in sexual minority college students in Mexico.

Mental health disparities have been documented among sexual minority college students, but there is a dearth of evidence from developing countries. The aim is to estimate the prevalence of 12-month mental and substance use disorders across a range of sexual identities among first-year college students in Mexican universities, and test whether there is an association between sexual identity and disorders and whether the association is moderated by gender. The University Project for Healthy Students, a web-based survey conducted as part of the World Health Organization's World Mental Health International College Student initiative, recruited 7874 students from nine Mexican universities in 2016 and 2017. Logistic regressions estimated the association of sexual identity with 12-month major depressive episode, generalized anxiety disorder, panic disorder, alcohol abuse/dependence, and drug abuse/dependence, with interaction terms for gender. Compared to heterosexual students reporting no same-sex attraction (SSA), heterosexual students with SSA (AORs range 1.77-3.67) and lesbian/gay and bisexual students (AORs range 2.22-5.32) were at a higher risk for several disorders. Asexual students were at higher risk for drug abuse/dependence (AOR = 3.64). Students unsure of their sexual identity were at a higher risk for major depressive episode, panic disorder, and drug abuse/dependence (AORs range 2.25-3.82). Gender differences varied across sexual identity and disorder. These findings are the first empirical report of sexual minority psychiatric disparities among a college student population from a developing nation and underscore the importance of clinical interventions that address mental health needs among sexual minority college students.

Serum free testosterone and asthma, asthma hospitalisations and lung function in British adults

ObjectiveWe examined the relation between serum-free testosterone and asthma, wheeze, asthma hospitalisations and lung function in older adults.DesignCross-sectional study.SettingUK.Participants256 419 adults aged 40 to 69 years, recruited from 2006 to...

Dietary Patterns, Physical Activity, and Socioeconomic Associations in a Midwestern Cohort of Healthy Reproductive-Age Women.

To characterize dietary patterns and physical activity in a diverse cohort of Midwestern reproductive-age women and to determine associations between these lifestyle factors, socioeconomic factors, and obesity. In this cross-sectional study, 185 women completed validated food frequency and physical activity questionnaires. Dietary patterns were identified through principal component analysis. Sociodemographic characteristics associated with dietary pattern adherence and physical activity participation were identified through linear regression. Associations between lifestyle factors and obesity were assessed through logistic regression. Two dietary patterns were identified: a "Prudent" pattern characterized by consumption of fruits, vegetables, olive oil, and nuts and a "Western" pattern including meat, refined carbohydrates, and high-calorie drinks. African-American women and women without a college degree were more likely to adhere to the Western dietary pattern than other women. Women in areas with higher socioeconomic deprivation had lower levels of physical activity, especially leisure-time exercise. Women who completed college participated in more leisure-time exercise and had less physically demanding occupations. Obesity was associated with increasing adherence to the Western dietary pattern in a dose-dependent fashion (aOR range 2.68-4.33, 95% CI range 0.69-16.61) but was not associated with adherence to the Prudent pattern (aOR range 0.46-1.06, 95% CI range 0.13-3.41). Increased physical activity was associated with reduced odds of obesity (aOR range 0.28-0.30, 95% CI range 0.10-0.93). This study highlights dietary and physical activity patterns associated with obesity in reproductive-age women. Lifestyle interventions focused on minimizing consumption of the Western diet and increasing physical activity may provide an opportunity to reduce obesity among reproductive-age women.

Providing Health Physicals and/or Health Monitoring Services in Mental Health Clinics: Impact on Laboratory Screening and Monitoring for High Risk Populations.

Providing physical health care in specialty mental health clinics is a promising approach to improving the health status of adults with serious mental illness, but most programs examined in prior studies are not financially sustainable. This study assessed the impact on quality of care of a low-cost program implemented in New York State that allowed mental health clinics to be reimbursed by Medicaid for provision of health monitoring and health physicals (HM/HP). Medicaid claims data were analyzed with generalized linear multilevel models to examine change over time in quality of physical health care associated with HM/HP services. Recipients of HM/HP services were compared to control clinic patients [Per protocol (PP)] and with non-recipients of HM/HP services from both intervention and control clinics [As-Treated (AT)]. HM/HP clinic patients, regardless of receipt of HM/HP services, were compared with control clinic patients [Intent-to-Treat (ITT)]. Analyses were conducted with adjustment for patient demographic and clinical characteristics and prior year service use. The PP and AT analyses found significant improvement in measure of blood glucose screening for patients on antipsychotic medication and HbA1C testing for patients with diabetes (AOR range 1.26-1.33) and the AT analysis found significant improvement in cholesterol screening for patients on antipsychotic medication (AOR 1.24). However, ITT analysis found no significant changes in quality of care in HM/HP clinic caseloads relative to control clinics. The low-cost HM/HP program has the potential to benefit patients who receive supported services, but its impact is limited by remaining barriers to service implementation.

Association of Primary Humoral Immunodeficiencies With Psychiatric Disorders and Suicidal Behavior and the Role of Autoimmune Diseases

The hypothesis that disrupted immune function is implicated in the pathophysiology of psychiatric disorders and suicide is gaining traction, but the underlying mechanisms are largely unknown. Primary humoral immunodeficiencies (PIDs) are rare deficiencies of the immune system-mainly dysfunction of antibody production-and are associated with adverse health problems, such as recurrent infections and autoimmune diseases. To establish whether PIDs that affect antibody function and level are associated with lifetime psychiatric disorders and suicidal behavior and whether this association is explained by the co-occurrence of autoimmune diseases. This population- and sibling-based cohort study included more than 14 million individuals living in Sweden from January 1, 1973, through December 31, 2013. Register-based data on exposure, outcomes, and covariates were collected through December 31, 2013. Individuals with a record of PID were linked to their full siblings, and a family identification number was created. Data were analyzed from May 17, 2019, to February 21, 2020. Lifetime records of PID and autoimmune disease. Lifetime records of 12 major psychiatric disorders and suicidal behavior, including suicide attempts and death by suicide. A lifetime diagnosis of PID affecting immunoglobulin levels was identified in 8378 patients (4947 women [59.0%]; median age at first diagnosis, 47.8 [interquartile range, 23.8-63.4] years). A total of 4776 clusters of full siblings discordant for PID was identified. After adjusting for comorbid autoimmune diseases, PIDs were associated with greater odds of any psychiatric disorder (adjusted odds ratio [AOR], 1.91; 95% CI, 1.81-2.01) and any suicidal behavior (AOR, 1.84; 95% CI, 1.66-2.04). The associations were also significant for all individual psychiatric disorders (range of AORs, 1.34 [95% CI, 1.17-1.54] for schizophrenia and other psychotic disorders to 2.99 [95% CI, 2.42-3.70] for autism spectrum disorders), death by suicide (AOR, 1.84; 95% CI, 1.25-2.71), and suicide attempts (AOR, 1.84; 95% CI, 1.66-2.04). In the sibling comparisons, the associations were attenuated but remained significant for aggregated outcomes (AOR for any psychiatric disorder, 1.64 [95% CI, 1.48-1.83]; AOR for any suicidal behavior, 1.37 [95% CI, 1.14-1.66]), most individual disorders (range of AORs, 1.46 [95% CI, 1.23-1.73] for substance use disorders to 2.29 [95% CI, 1.43-3.66] for autism spectrum disorders), and suicide attempts (AOR, 1.41; 95% CI, 1.17-1.71). Joint exposure for PID and autoimmune disease resulted in the highest odds for any psychiatric disorder (AOR, 2.77; 95% CI, 2.52-3.05) and any suicidal behavior (AOR, 2.75; 95% CI, 2.32-3.27). The associations with psychiatric outcomes (AORs, 2.42 [95% CI, 2.24-2.63] vs 1.65 [95% CI, 1.48-1.84]) and suicidal behavior (AORs, 2.43 [95% CI, 2.09-2.82] vs 1.40 [95% CI, 1.12-1.76]) were significantly stronger for women than for men with PID. Primary humoral immunodeficiencies were robustly associated with psychopathology and suicidal behavior, particularly in women. The associations could not be fully explained by co-occurring autoimmune diseases, suggesting that antibody dysfunction may play a role, although other mechanisms are possible. Individuals with both PID and autoimmune disease had the highest risk of psychiatric disorders and suicide, suggesting an additive effect. Future studies should explore the underlying mechanisms of these associations.

Association Between Municipal Food Policy Councils and Local Policies that Support Healthy Eating: A National Survey of Community Policy Supports

Abstract Objectives Community efforts to improve access to nutritious foods are one strategy to reduce food insecurity, promote healthy eating, and prevent diet-related chronic diseases. Food policy councils (FPCs) can facilitate relationships between food systems players and implementation of local policy efforts to increase access to healthier foods. This study examined associations between FPCs with local policy supports for healthy food access. Methods We used data from CDC's 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living, a nationally representative survey of U.S. municipalities with population ≥1000 (n = 2029). We calculated the prevalence of FPCs, overall and by municipal characteristics including population size, census region, rural/urban status, poverty prevalence, median education level, and racial/ethnic composition. We used multivariable logistic regression to examine cross-sectional associations between FPCs and four types of supports for healthy food access (approaches to help open or improve food stores; practices to support farmers markets; transportation-related supports; and community planning documents). Results Overall, 7.6% of municipalities reported having a local or regional FPC. FPCs were reported more frequently among larger municipalities with ≥50,000 people (29.2%, 95% confidence interval (CI): 21.6–36.8) compared to smaller municipalities (4.3% for &amp;lt;2500 people; 7.0% for 2500–49,999 people) and among western municipalities (13.2%, CI: 9.6–16.8) compared to other Census regions (5.9% for south; 6.5% for northeast; 7.6% for midwest). After multivariable adjustment, municipalities with FPCs had significantly higher odds of having all four types of policy supports for healthy food access, compared to those without FPCs (aOR range: 2.4–3.4). Among municipalities with a FPC (n = 156), 41% reported a local government employee or elected official as a member and 46% had a designated health or public health representative. Conclusions Although FPCs are uncommon, municipalities that reported having a local or regional FPC were more likely to report having policy supports for healthy food access for their residents. Funding Sources Funding was solely for author's time from their institutions.

PTSD’s risky behavior criterion: Associated risky and unhealthy behaviors and psychiatric correlates in a nationally representative sample

Criterion E2 (“reckless or self-destructive behavior”) was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/self-destructive behavior, we examined the prevalence and associations of RUBs (e.g., substance misuse, risky sexual behaviors) with criterion E2 endorsement. Further, we examined associations between criterion E2 and psychiatric conditions (e.g., depressive disorders, anxiety disorders) in a population-based sample of trauma-exposed adults. We analyzed data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed lifetime DSM-5 psychiatric conditions and self-reported RUBs. Among trauma-exposed adults (n = 23,936), multiple logistic regressions examined criterion E2′s associations with RUBs and psychiatric conditions. After adjusting for covariates, all RUBs were associated with E2 endorsement (AOR range: 1.58–3.97; most prevalent RUB among those who endorsed E2: greater substance use than intended [57.0 %]) except binge eating, and E2 endorsement was associated with increased odds of PTSD, bipolar disorder, substance use disorders, and schizotypal, borderline, and antisocial personality disorders (AOR range: 1.65–2.75), and decreased odds of major depressive disorder (AOR = 0.76). Results support the clinical significance of criterion E2 through identifying associated RUBs and distinct correlates. These results may inform screening and intervention strategies for at-risk populations.

Adverse childhood experiences, internalizing/externalizing symptoms, and associated prescription opioid misuse: A mediation analysis

Adverse childhood experiences (ACEs) are associated with mental health and substance use problems, but lesser known is how they interconnect. The objective of this study was to examine how internalizing and externalizing symptoms mediate the association of ACEs with prescription opioid misuse in order to understand how ACEs interconnect with mental health and substance use problems. Adults aged 18 or older from the National Epidemiological Survey on Alcohol and Related Conditions Wave 3 (NESARC-III) conducted in 2012–2013 were included (N = 36,309). The prescription opioid misuse outcomes examined include prescription opioid misuse status, early-onset status of prescription opioid misuse, frequency of past-year prescription opioid misuse, and opioid use disorder. A natural effect model and regression analyses were used to conduct the mediation analyses. We found that respondents with higher ACE scores had greater odds of reporting past-year and lifetime prescription opioid misuse and DSM-V-diagnosed opioid use disorder as well as early onset of prescription opioid misuse (AORs range from 1.06 to 1.12). These associations are partially mediated by internalizing and externalizing symptoms. The findings suggest that internalizing and externalizing symptoms may be potential pathways through which ACEs are associated with prescription opioid misuse. Our results underscore the importance of preventing ACEs and reducing risk for internalizing and externalizing symptoms after exposure, which may reduce later prescription opioid misuse.

Disinfection By-Product Exposures and the Risk of Musculoskeletal Birth Defects.

Epidemiological studies suggest that exposure to water disinfection by-products (DBPs) may increase the risk of certain birth defects. However, evidence for musculoskeletal defects (MSDs) is limited. Previous MSD studies have not examined DBPs beyond trihalomethanes (THMs) and have not separately examined limb or diaphragm defects which may have distinct developmental etiologies. We calculated adjusted odds ratios (aORs) in a registry-based case-control study of birth defects in Massachusetts with complete quarterly 1999-2004 data on four THMs and five haloacetic acids (HAAs). We matched 10 controls each to 187 MSD cases based on week of conception. Weight-averaged town-level first-trimester DBP exposures were individually assigned based on residence at birth. We adjusted THM models for exposure to the sum of five HAAs (HAA5), and HAA models for the sum of four THMs (THM4). We detected positive exposure-response associations for all grouped MSDs with THM4 quintiles (aOR range: 1.90-3.18) and chloroform quartiles (aOR range: 1.30-2.21), and for reduction of upper or lower limbs with chloroform quartiles (aOR range: 2.39-3.52). We detected elevated aORs for diaphragmatic hernia with DBP9 (sum of THM4 and HAA5), and chloroform and bromodichloromethane tertiles and an exposure-response relationship for THM4 tertiles (aOR range: 1.67-1.80). This is the first epidemiological study to examine HAAs in relation to MSDs. Given the indirect nature of our exposure assessment data and small case numbers, the exposure-response relationships that we detected for THM4 and chloroform warrant further investigation.

Close Relations Matter: The Association Between Depression and Refugee Status in the Canadian Longitudinal Study on Aging (CLSA).

This study examined the prevalence and social determinants of depression among refugee and non-refugee adults aged 45-85 in the Canadian Longitudinal Study on Aging. Bivariate analyses and multivariable binary logistic regression analyses were conducted. The prevalence of depression was higher in a sample of 272 refugees (22.1%) and 5059 non-refugee immigrants (16.6%), compared to 24,339 native-born Canadians (15.2%). The adjusted odds ratio (aOR) of depression for refugees were not attenuated when controlling factors such as, (1) socioeconomic status, (2) health conditions and behaviours, (3) social isolation and online social networking (aORs range from 1.61 to 1.70, p's < 0.05). However, when social support representing close personal relationships was included, the odds of depression for refugees were reduced to non-significance (aOR = 1.30, 95% CI 0.97-1.74, p = 0.08). Refugees' excess vulnerability to depression is mainly attributable to lower levels of affectionate social support. Targeted interventions in nurturing supportive interpersonal relationships for refugees are warranted.

Socioeconomic Disparities in Carotid Revascularization Procedures

Several studies have demonstrated healthcare disparities in postoperative outcomes after carotid endarterectomy and carotid artery stenting, including increased hospital mortality, postoperative stroke, and readmission rates. The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures. Records of adults from 2007 to 2014 were retrospectively identified, and patients with appropriate International Classification of Diseases Ninth Revision Clinical Modification codes for carotid endarterectomy or carotid artery stenting were identified. Primary outcomes were unadjusted rates and adjusted odds ratios (aORs) of postoperative in-hospital mortality, stroke, combined stroke/mortality, and cardiovascular complications. Data were sourced from the State Inpatient Databases data from California, Florida, Kentucky, Maryland, and New York during the years 2007 to 2014. Patients undergoing carotid revascularization procedures. The effects of race and insurance status as independent variables and as effect modifiers on postoperative outcomes. Multivariable logistic regression models were used to examine the associations between race and/or insurance status with respect to study outcomes. Race, but not payer status, was significantly associated with adverse outcomes after carotid artery procedures, with blacks, Hispanics, and other non-Caucasian races demonstrating a significantly greater risk of postoperative stroke and mortality (aOR range 1.24-1.59). This relationship persisted even when stratified by procedure type (aOR range 1.25-1.56) and symptomatology (aOR range 1.51-1.63). These results suggest that disparities in postoperative outcomes after carotid artery procedures are associated with race but not with primary insurance status. Multiple contributing factors exist, including racial inequities in prevalence of comorbidities, health literacy, and procedure type performed.

Associations between physical health conditions and posttraumatic stress disorder according to age

Objectives Posttraumatic stress disorder (PTSD) is associated with various physical health conditions. However, it is unclear whether the relationship between PTSD and physical health conditions differs according to age. This study aims to examine the associations between PTSD and physical health conditions across four adult age categories. Methods We analyzed data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed past-year DSM-5 PTSD. Multiple regression analyses examined associations between PTSD (reference = no PTSD) with number and type of physical health conditions in each age category (18–34: “younger adults,” 35–49: “middle-aged adults,” 50–64: “young-old adults,” 65+: “older adults”). Results The prevalence of nearly all physical health conditions increased according to age, whereas the prevalence of PTSD tended to decrease with age. After adjustment, PTSD was associated with a greater number of physical health conditions among all age categories (b range: 0.62–1.29). Regardless of age category, PTSD was associated with increased odds of cardiovascular and musculoskeletal conditions (AOR range: 1.54–2.34). PTSD was also associated with increased odds of gastrointestinal, hepatobiliary, endocrine/metabolic, respiratory, neurologic conditions, cancer, sleep disorders, and anemia among select age categories (AOR range: 1.70–3.31). For most physical health conditions, the largest effect sizes emerged for younger and middle-aged adults. Conclusions PTSD is associated with many physical health conditions across the age spectrum, particularly among younger and middle-aged adults. Results may inform targeted screening and intervention strategies to mitigate risk of physical health conditions among adults with PTSD.

Who are the missing men? Characterising men who never tested for HIV from population-based surveys in six sub-Saharan African countries.

IntroductionWe sought to characterize men who had never tested for HIV, understand factors associated with not testing, and measure survey HIV test uptake among never testers. We analysed nationally representative Demographic and Health Surveys of six African countries from 2013 to 2016: Ethiopia, Malawi, Zimbabwe, Rwanda, Lesotho and Zambia.MethodsEligible men were household residents or overnight visitors aged 15 to 59 years. We analysed questionnaire responses on HIV testing, known behavioural risk factors, and corresponding HIV laboratory results. We used survey‐weighted logistic regression to identify factors associated with never testing for HIV.ResultsApproximately double the proportion of men had never tested for HIV compared to women (Malawi: 30% vs. 17%, p < 0.0001; Zimbabwe: 35% vs. 19%, p < 0.0001; Lesotho: 34% vs. 15%, p < 0.0001; Zambia: 36% vs. 20%, p < 0.0001); although, less of a differential existed in Ethiopia (54% vs. 56%, p = 0.12) and Rwanda (19% vs. 14%, p < 0.0001). When offered a test during the survey, 85% to 99% of sexually active men who reported never previously testing, accepted testing. HIV positivity ranged from <0.05% to 14% for never tested men. After adjusting for age, factors associated with never having tested for HIV were never being married (aOR range: 1.46 to 10.39), not having children (aOR: 1.36 to 3.59) and lower education (less than primary education aOR: 2.77 to 5.59).ConclusionsAlthough higher proportions of men than women had never tested for HIV, 85% to 99% of men did accept a test when offered. Finding opportunities to offer HIV testing to single men without children, older men who have never tested, and those disadvantaged with less schooling and employment, alongside other facility and community‐based services, will be important in identifying those living with undiagnosed HIV and improving men's health.

Health Care Provider Attitudes Toward Safety of Selected Hormonal Contraceptives in Breastfeeding Women.

Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women. Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and ≥ 1 month postpartum. Approximately 68% of public-sector providers considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34-0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47-0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20-0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26-0.65). The majority of office-based physicians considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC's contraceptive guidance (aOR 0.40, 95% CI 0.21-0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum. A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women.

Selected acculturation factors and birth defects in the National Birth Defects Prevention Study, 1997-2011.

Acculturation has been examined with respect to various pregnancy adverse outcomes, including birth defects. Given the mixed and limited findings on the association between nativity and birth defects, we sought to further explore parental nativity and years lived in the U.S. across a range of defects. Data from the National Birth Defects Prevention Study were used for this analysis. Infants with one of 46 major isolated birth defects (30 noncardiac/16 cardiac conditions) and infants without birth defects (controls) born during 1997-2011 were included. We examined parental nativity (foreign-born mothers, fathers, and both parents combined compared to a referent of both U.S.-born parents) and the number of years lived in the U.S. (≤5/6+ years). Descriptive statistics and logistic regression analyses were performed to estimate crude/adjusted odds ratios and 95% confidence intervals. Compared to U.S.-born mothers, foreign-born mothers tended to be older (25+ years), of Hispanic or Other race/ethnicity and were less likely to have reported drinking, smoking, illicit drug use, or having taken folic acid. In the adjusted analysis, seven findings among both parents reporting a foreign-birth were significant, including an increased association with spina bifida, anotia/microtia, and diaphragmatic hernia (aORs range: 1.3-1.7), and a reduced association with craniosynostosis and gastroschisis (aORs = 0.7). A generally protective effect was observed among foreign-born subjects living in the U.S. ≤5 years. We found that nativity was associated with some selected isolated defects, although the direction of effect varied by phenotype and by a number of years residing in the U.S.

Maternal genetic markers for risk of celiac disease and their potential association with neural tube defects in offspring.

BackgroundWe examined the association between the maternal genotype for celiac disease‐associated variants and risk of neural tube defects (NTDs).MethodsWe conducted a case–control study, using data from the National Birth Defects Prevention Study. We evaluated 667 cases (women with an offspring with NTD) and 743 controls (women with an offspring without a birth defect). We classified women as having low, intermediate, or high risk of celiac disease based on human leukocyte antigen (HLA) variants. We used logistic regression to assess the relationship between HLA celiac risk group (low, intermediate, high) and risk of NTDs. Fifteen non‐HLA variants (identified from genome‐wide association studies of celiac disease) were individually evaluated and modeled additively.ResultsThere was no association between HLA celiac risk group and NTDs (intermediate vs. low risk: aOR, 1.0; 95% CI, 0.8–1.3; high vs. low risk: aOR, 0.8; 95% CI, 0.5–1.3). Of the fifteen non‐HLA variants, we observed five significant associations after accounting for multiple comparisons. Three negative associations were observed with rs10903122, rs13314993, rs13151961 (aOR range: 0.69–0.81), and two positive associations were observed with rs13003464 and rs11221332 (aOR range: 1.27–1.73).ConclusionIf confirmed, our results suggest that the maternal variants related to celiac disease may be involved in the risk of NTDs.