Search

Alfonso M Durán,1 Lorena M Salto,1 Justin Câmara,1 Anamika Basu,1 Ivette Paquien,1 W Lawrence Beeson,1,2 Anthony Firek,3 Zaida Cordero-MacIntyre,1,2 Marino De León1 1Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA; 2Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, USA; 3Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA Purpose: To determine whether dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) reduces neuropathic pain symptoms in Mexican-Americans with type 2 diabetes.Methods: Forty volunteers with type 2 diabetes enrolled in the “En Balance-PLUS” program, which provided weekly nutrition–diabetes education and daily supplementation with 1,000 mg docosahexaenoic acid (DHA)–200 mg eicosapentaenoic acid over 3 months. The study assessed self-reported neuropathic pain symptoms pre/postintervention using the short-form McGill Pain Questionnaire (SF-MPQ), monitored clinical laboratory values at baseline and 3 months, and performed baseline and 3-month metabolomic analysis of plasma samples.Results: A total of 26 participants self-reported neuropathic pain symptoms at baseline. After 3 months of omega-3 PUFA supplementation, participants reported significant improvement in SF-MPQ scores (sensory, affective, and visual analogue scale; P

Background: Evidence suggesting that a diet high in fruits and vegetables may be beneficial to bone health has sparked interest in the potential benefit of a vegetarian diet. However, other studies have raised a question regarding the adequacy of protein in such a diet.Objective: The aim of the present study was to take a whole foods approach in examining the effects of foods high in protein on the risk of wrist fracture (WF) in a cohort with a significant proportion consuming a meat-free diet.Design: A cohort study of women who completed two lifestyle surveys 25 years apart.Subjects: One thousand eight hundred and sixty-five peri- and postmenopausal women at the time of the first survey.Results: There was a significant interaction between meat consumption and foods high in vegetable protein. Among vegetarians, those who consumed the least vegetable protein intake were at highest risk for fracture. However, increasing levels of plant-based high-protein foods decreased WF risk, with a 68% reduction in risk (hazard ratio (HR) = 0.32, 95% confidence interval (CI) 0.13-0.79) in the highest intake group. Among those with lowest vegetable protein consumption, increasing meat intake decreased the risk of WF, with the highest consumption decreasing risk by 80% (HR = 0.20, 95% CI 0.06-0.66).Conclusions: The finding that higher consumption frequencies of foods rich in protein were associated with reduced WF supports the importance of adequate protein for bone health. The similarity in risk reduction by vegetable protein foods compared with meat intake suggests that adequate protein intake is attainable in a vegetarian diet. [ABSTRACT FROM AUTHOR]

With the growing number of epidemiologic publications on the relation between dietary factors and cancer risk, pooled analyses that summarize results from multiple studies are becoming more common. Here, the authors describe the methods being used to summarize data on diet-cancer associations within the ongoing Pooling Project of Prospective Studies of Diet and Cancer, begun in 1991. In the Pooling Project, the primary data from prospective cohort studies meeting prespecified inclusion criteria are analyzed using standardized criteria for modeling of exposure, confounding, and outcome variables. In addition to evaluating main exposure-disease associations, analyses are also conducted to evaluate whether exposure-disease associations are modified by other dietary and nondietary factors or vary among population subgroups or particular cancer subtypes. Study-specific relative risks are calculated using the Cox proportional hazards model and then pooled using a random- or mixed-effects model. The study-specific estimates are weighted by the inverse of their variances in forming summary estimates. Most of the methods used in the Pooling Project may be adapted for examining associations with dietary and nondietary factors in pooled analyses of case-control studies or case-control and cohort studies combined. [ABSTRACT FROM AUTHOR]

Context: Some epidemiologic studies suggest that elevated fruit and vegetable consumption is associated with a reduced risk of breast cancer. However, most have been case-control studies in which recall and selection bias may influence the results. Additionally, publication bias may have influenced the literature on associations for specific fruit and vegetable subgroups.Objective: To examine the association between breast cancer and total and specific fruit and vegetable group intakes using standardized exposure definitions.Data Sources/study Selection: Eight prospective studies that had at least 200 incident breast cancer cases, assessed usual dietary intake, and completed a validation study of the diet assessment method or a closely related instrument were included in these analyses.Data Extraction: Using the primary data from each of the studies, we calculated study-specific relative risks (RRs) that were combined using a random-effects model.Data Synthesis: The studies included 7377 incident invasive breast cancer cases occurring among 351 825 women whose diet was analyzed at baseline. For comparisons of the highest vs lowest quartiles of intake, weak, nonsignificant associations were observed for total fruits (pooled multivariate RR, 0.93; 95% confidence interval [CI], 0.86-1.00; P for trend =.08), total vegetables (RR, 0.96; 95% CI, 0.89-1.04; P for trend =.54), and total fruits and vegetables (RR, 0.93; 95% CI, 0.86-1.00; P for trend =.12). No additional benefit was apparent in comparisons of the highest and lowest deciles of intake. No associations were observed for green leafy vegetables, 8 botanical groups, and 17 specific fruits and vegetables.Conclusion: These results suggest that fruit and vegetable consumption during adulthood is not significantly associated with reduced breast cancer risk. [ABSTRACT FROM AUTHOR]

Purpose: To calibrate and compare intake of different fats and individual fatty acids as assessed with a food frequency questionnaire (FFQ) against that estimated with (i) a series of dietary recalls and; (ii) the relative fat concentration in an adipose tissue biopsy. The FFQ was specially designed for use in a cohort of Seventh-day Adventists. In preparation for a large cohort study investigating the effect of diet on risk of colon, prostate and breast cancer.Methods: The association of adipose tissue fatty acids and dietary fat intake was assessed in 49 black and 72 white Seventh-day Adventists subjects using 8 different 24-hour recalls, a 200-item food frequency questionnaire (FFQ) and adipose tissue biopsies from each subject.Results: Pearson correlation between fatty acids in adipose tissue and dietary intake as assessed by multiple 24-hour recalls were as follows: Linoleic acid: 0.77 in black and 0.71 in white subjects, respectively; Linolenic acid: 0.68 (blacks) and 0.62 (whites); Total Polyunsaturated fat (PUFA): 0.78 (blacks) and 0.70 (whites); Total Monounsaturated fat (MUFA): 0.35 (blacks) and 0.03 (whites); Total Saturated fat (SFA): 0.46 (blacks) and 0.56 (whites). Correlations between fatty acids in adipose tissue and dietary intake as assessed by FFQ were: Linoleic acid: 0.61 (blacks) and 0.52 (whites), respectively; Linolenic acid: 0.29 (blacks) and 0.49 (whites); PUFA: 0.62 (blacks) and 0.53 (whites); MUFA: 0.07 (blacks) and 0.31 (whites), SFA: 0.21 (blacks) and 0.31 (whites).Conclusions: Our study confirms findings of others that 24-hour recalls are valid for assessing dietary intake of different types of fat. The FFQ we developed and used in this study gave reasonably valid measures of fatty acid intake in our population and is thus suitable for use in large cohort studies. It had validity comparable to that observed for other FFQs. [ABSTRACT FROM AUTHOR]

Introduction: Polypharmacy-defined as taking numerous medications that may not be clinically necessary-is becoming a significant concern among the older adult population. This study examined the associations between lifestyle behaviors and the number of prescribed medications in older adults (75 years and older) living in the counties of San Bernardino and Riverside., Methods: This study employed a cross-sectional survey to assess lifestyle behaviors and medication use in 611 older adults aged 75 or over. Bivariate correlation and linear regression analyses were used to assess potential relationships between lifestyle behaviors and the number of prescribed medications., Results: Fruit consumption ( P = 0.005), mild physical activity per week ( P < .001), and lifestyle index ( P = 0.003) had a highly significant inverse association with the number of prescribed medications. Fat consumption had a direct positive relationship with the number of prescribed medications ( P = 0.02)., Conclusion: Higher fat intake was directly linked to an increased need for medications, while regular physical activity, a higher fruit intake, and a healthy overall lifestyle were all associated with a lower likelihood of polypharmacy. Future research can explore the mechanisms linking these behaviors with medication usage., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Amid a global aging trend, particularly notable in the U.S., there is a growing focus on achieving enhanced longevity and well-being. We evaluated the association between lifestyle factors (sleep, diet, and healthy lifestyle index) and COVID-19 infection in an older adult population in San Bernardino and Riverside counties in Southern California, the United States. A sample of 380 older adults ≥75 years old were surveyed cross-sectionally and self-reported lifestyle behaviors and COVID-19 infection. The results revealed that half the participants reported COVID-19 infection. Participants who slept less than 7 hours or more than 8 hours/night had higher odds of COVID-19 infection than those who slept 7-8 hours/night (OR = 1.62, 95% CI: 1.03, 2.55). Healthy lifestyle behaviors were significantly associated with reduced COVID-19 infection (OR = 0.61, 95% CI: 0.40, 0.92). In conclusion, adequate sleep and healthy lifestyle behaviors may be protective against COVID-19 infection among older adults and should be investigated further., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ovarian reserve is one of the most important factors that influences the success of assisted reproductive technology (ART). Recently, the role of anti-müllerian hormone (AMH) in ART has been investigated as a marker for the prediction of ovarian response. We aim to examine this relationship within a large Iranian population., Materials and Methods: In this cross-sectional study, we obtained data from 1000 infertile couples who referred to the Research and Clinical Centre of Yazd Infertility Clinic for in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Serum AMH levels, oocyte count, numbers of fertilised oocytes, endometrial thickness, and percentage of mature oocytes were measured. The relationship between AMH serum levels and the number and quality of oocytes and embryos in ART cycles was analysed., Results: In the linear regression model, the log of the variables total dose of gonadotropin, two pronuclei (2PN), log oestradiol, total embryos, duration of stimulation, number of embryos transferred, protocol, and cause of infertility were significant predictors of log AMH., Conclusion: There appears to be a relationship between serum AMH levels in the early follicular phase and ovarian reserve. Higher serum AMH levels were also associated with shorter ART cycles.

This study examined the potential relationship between sleep, exercise, and depression with coronary heart disease (CHD) using the 2020 Behavioral Risk Factor Surveillance System (BRFSS) (n = 391 750) during the COVID-19 pandemic. CHD was defined as the presence of self-reported CHD or myocardial infarction (MI). Descriptive statistics were used to report variable frequencies and percentages. Logistic regression models were used to assess potential relationships between lifestyle behaviors (individually and for effect modification) and CHD, with additional sensitivity analysis comparing depressed subjects with non-depressed subjects. Sleep and exercise were assessed in the model for potential effect modification. Those with insufficient sleep and those who did not exercise were more likely to report CHD ( sleep OR = 1.09; 95% CI: 1.06, 1.12); ( exercise OR = 2.00; 95% CI: 1.95, 2.05), though the interaction term was non-significant. Those with self-reported depression were found to be associated with CHD (OR = 1.34; 95% CI: 1.30, 1.38). Among depressed individuals, insufficient sleep and no exercise exhibited a stronger association ( sleep OR = 1.19; 95% CI: 1.13,1.25); ( exercise OR = 2.13; 95% CI = 2.03, 2.23). Results support an association between sleep, exercise, and self-report of CHD, and this association is potentially magnified among depressed individuals, which may be further exacerbated by the COVID-19 pandemic., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Objective: To assess the associations of omega-3 and omega-6 fatty acids consumption, and the ratio between the two, with self-reported doctor told Systemic Lupus Erythematosus (SLE) diagnosis. Further, to assess whether initiation of omega-3 supplements intake was related to time/year of SLE diagnosis., Methods: Data from 42,398 women in the Adventist Health Study-2 cohort were used for this cross-sectional study. Unconditional logistic regression modeling was used for all analyses with the following candidate covariates: age, race, education, smoking, and body mass index (BMI)., Results: Compared to non-cases, participants with a diagnosis of SLE reported higher intakes of total omega-3 fatty acids and about the same intakes of omega-6 fatty acids. Overall, they had higher ratios of omega-3 to omega-6 fatty acids. When assessing odds ratios of SLE diagnosis by quartiles of omega-3 to omega-6 and DHA+EPA to omega-6, there was a positive significant trend (p trend = 0.005). Additionally, among those reporting intake of fish oil, 87% had initiated fish oil consumption around the time of SLE diagnosis. SLE was more likely to occur among Black women compared to White women, among ever smokers compared to never smokers, among overweight women compared to women with normal/underweight, and among women 50-59 years compared to those 30-49 year old. When a smaller 6 year follow-up study identified 64 incident SLE cases and assessed their omega-3 intake at baseline (6 years earlier and before the SLE diagnosis) their intake of omega-3 and fish oil was no different than among non-cases., Conclusion: We observed a significant positive association between the ratio of omega-3 to omega-6 fatty acids consumption and prevalence of SLE. Among those with prevalent SLE, their year of starting supplementation of omega-3 and fish oil was closely linked to year of SLE diagnosis. Further, baseline intake of omega-3 fatty acids was not increased among 64 incident SLE cases identified during 6 years of follow-up. Our surprising finding can best be explained by reverse causation. This could be an example of how public health information is assimilated and acted upon by a health conscious public., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To examine the influence of comorbid mental illness on hospitalization among adults reporting diabetes mellitus., Methods: This cross-sectional observational study used National Health Interview Survey (NHIS) data from 2000-2018 to examine hospitalization. Mental illness was defined as no to low psychological distress (NLPD), moderate psychological distress (MPD), and serious psychological distress (SPD) as per the Kessler-6 scale. Socio-demographic factors and health status were added as covariates in binary logistic regression., Results: This study involved 48,807 survey participants and reflected an estimated population of 17,524,418 adults with diabetes in the United States, of whom 19.9% were hospitalized in the year prior to the survey. Among those who were hospitalized, 71.5% exhibited None to Low Psychological Distress (NLPD), 17.7% reported Moderate Psychological Distress (MPD), and 10.8% reported Serious Psychological Distress (SPD). Conversely, among non-hospitalized individuals, the percentages were as follows: 83.2% had NLPD, 11.4% had MPD, and 5.3% had SPD. The odds ratio (OR) for hospitalization was found to be OR=1.31 (95% CI: 1.20, 1.43, p<0.0001) for MPD and OR=1.42 (95% CI: 1.28, 1.58, p<0.0001) for SPD, in comparison to those with no or low psychological distress., Conclusion: Among adults with diabetes mellitus, those with mental illness were more likely to be hospitalized than those without mental illness. Programs and policies to improve care among adults with both mental illness and diabetes may help to reduce hospitalizations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gettas et al.)

Type 2 diabetes (T2D) is a public health issue that needs to be addressed. In the U.S., 11.3% of the population have diabetes. It is estimated that 90-95% of all diabetes cases are T2D cases. One of the best methods to address T2D is self-management. Prior research found a relationship between religiosity and T2D self-management. The purpose of this study was to examine religiosity and T2D self-management. This was a cross-sectional and qualitative study, which included Muslim adults, who have T2D and live in California. We utilized snowballing to recruit participants and the saturation concept to determine the number of participants. Additionally, we used semi-structured design for the interviews and focus groups. We had 30 participants for the interviews (however, only 25 provided demographic data) and 28 for the combined focus groups. Zoom was used to conduct the interviews and two focus groups. The grounded theory was used to deduce themes from the interviews and focus groups. The main themes for religiosity and self-management are Allah sustains life, everything will be ok/hope, faith gives strength, and the role of self within the fate concept. The themes for self-efficacy are diabetes requires new life approach, stress, and Islamic religious practices promote self-management. The main theme for perceived seriousness is taking action and making changes. Our findings provide significant insight about the relationship between religiosity, perceived seriousness, fatalism, and self-efficacy and self-management of T2D. A recommendation based on this study is that providers and health educators should be aware of the different experiences Muslims with T2D face, and tailor recommendations and programs based on that., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Purpose: Social disconnection, such as loneliness, is recognized as a significant public health concern in the United States, and young adult males may carry the greater burden of this issue when compared with their female peers. Little is known about the correlates of loneliness for this population. This study examines the social-ecological correlates of loneliness in young adult males., Methods: Males, aged 18 to 25 years, in the United States were recruited to take part in a cross-sectional electronic survey. Loneliness was assessed as a composite measure. The social-ecological correlates consisted of intrapersonal-level (e.g., social-demographic characteristics), interpersonal-level (e.g., adverse childhood experiences), community-level (e.g., life expectancy at the county level), and societal-level (e.g., idealized masculine gender) variables. A four-block hierarchical regression was performed with each block representing the respective social-ecological level., Results: Among the study sample ( n = 495), the intra- and interpersonal variables significantly shared 10% and an incremental 3%, respectively, of the explained variance in loneliness. Mental health diagnosis (β = 1.06, 95% confidence interval [CI]: [0.54, 1.59]), childhood physical and emotional abuse (β = 0.21, 95% CI: [0.02, 0.39]), and childhood sexual abuse (β = 0.30, 95% CI: [0.01, 0.60]) were significantly associated with greater loneliness., Conclusion: The findings highlight that the micro-level (intra- and interpersonal) correlates may be most important in predicting loneliness in young adult males. Specifically, young males with a mental health diagnosis and those with greater experiences of childhood adversity are at potentially greater risk for loneliness. Implications for research, programming, and policy are highlighted.

Purpose: We examined the intrapersonal, interpersonal, community, and societal correlates of a structural indicator of social connectedness (ie, social isolation) among a sample of young adult U.S. males., Design: Cross-sectional. Setting: Online survey., Subjects: Males (n = 495) aged 18-25 years residing in the U.S., Measures: Social isolation was assessed as an index measure of social integration (inverse scored). The correlates consisted of the following variables: 1) intrapersonal (eg, social-demographic characteristics), 2) interpersonal (eg, adverse childhood experiences; marital status), 3) community (eg, county-level mental distress rates), and 4) societal (eg, how powerful is society's image of the 'masculine man')., Analysis: Four-block hierarchical regression., Results: The intra- and interpersonal variables significantly shared 17% and an incremental 5%, respectively, of the explained variance in social isolation. Several intra- (eg, financial vulnerability β = -2.76, [95% CI: -4.40, -1.13]) and inter-personal (ie, childhood household dysfunction β = -.66, [95% CI: -1.18, -.14] ) factors were significantly associated with greater social isolation. Four intrapersonal factors (eg, gay or bisexual β = 2.31, [95% CI: .29, 4.33]) were significantly associated with lower social isolation., Conclusions: The current study's findings have important implications for understanding and shaping social connectedness in young adult U.S. males, with micro-level influences potentially being most important in predicting social isolation in this population.

Objective: The aim of our study was to assess the association between a diagnosis of Systemic Lupus Erythematosus (SLE) and dietary pattern as well as demographic factors among subjects in the Adventist Health Study-2 (AHS-2) cohort., Methods: Multivariable logistic regression modeling was used to assess the association between prevalence of self-reported SLE and dietary patterns (vegetarian, pesco-vegetarian and non-vegetarian). Potential confounding variables included were age, gender, race, education, and smoking history among 77,795 AHS-2 participants., Results: There was a dose-response association between the prevalence of SLE with vegetarian diets, ordered by content of animal meats. The stricter vegetarians had 25% lower odds of reporting that they were currently being treated for SLE (OR = 0.75, 95% CI 0.56, 1.02) with intermediate levels for the pesco-vegetarians who eat fish (OR 0.88, 95% CI 0.57, 1.36), compared to non-vegetarians. As expected, there were also significant associations between the prevalence of SLE with sex, race, age, and smoking. Significantly fewer men were diagnosed with SLE compared to women (OR = 0.14, 95% CI: 0.08, 0.22). Compared to non-Hispanic Whites, non-Hispanic Blacks were significantly more likely to report a diagnosis of SLE (OR 1.69, 95% CI 1.29, 2.21). A significantly lower proportion of 30-39 year olds (OR 0.51, 95% CI 0.29, 0.90) reported a diagnosis of SLE when compared to those 60 or older. Also, ever smokers were more likely to report prevalent SLE than those who had never smoked (OR 1.71, 95% CI 1.27, 2.31)., Conclusion: We found that vegetarians had lower odds of doctor-diagnosed SLE with an increasing trend in prevalence from stricter vegetarians to pesco-vegetarians to non-vegetarians. We also note that the association with other demographic factors in AHS-2 was similar to that found in other studies. Future studies may focus on assessing the incidence and severity of the disease among vegetarians and non-vegetarians.

Background: Omega-3 polyunsaturated fatty acids (PUFAs) have been proposed to improve chronic neuroinflammatory diseases in peripheral and central nervous systems. For instance, docosahexaenoic acid (DHA) protects nerve cells from noxious stimuli in vitro and in vivo. Recent reports link PUFA supplementation to improving painful diabetic neuropathy (pDN) symptoms, but cellular mechanisms responsible for this therapeutic effect are not well understood. The objective of this study is to identify distinct cellular pathways elicited by dietary omega-3 PUFA supplementation in patients with type 2 diabetes mellitus (T2DM) affected by pDN., Methods: Forty volunteers diagnosed with type 2 diabetes were enrolled in the "En Balance-PLUS" diabetes education study. The volunteers participated in weekly lifestyle/nutrition education and daily supplementation with 1000 mg DHA and 200 mg eicosapentaenoic acid. The Short-Form McGill Pain Questionnaire validated clinical determination of baseline and post-intervention pain complaints. Laboratory and untargeted metabolomics analyses were conducted using blood plasma collected at baseline and after three months of participation in the dietary regimen. The metabolomics data were analyzed using random forest, hierarchical clustering, ingenuity pathway analysis, and metabolic pathway mapping., Results: The data show that metabolites involved in oxidative stress and glutathione production shifted significantly to a more anti-inflammatory state post supplementation. Example of these metabolites include cystathionine (+90%), S-methylmethionine (+9%), glycine cysteine-glutathione disulfide (+157%) cysteinylglycine (+19%), glutamate (-11%), glycine (+11%), and arginine (+13.4%). In addition, the levels of phospholipids associated with improved membrane fluidity such as linoleoyl-docosahexaenoyl-glycerol (18:2/22:6) (+253%) were significantly increased. Ingenuity pathway analysis suggested several key bio functions associated with omega-3 PUFA supplementation such as formation of reactive oxygen species ( p = 4.38 × 10 -4 , z-score = -1.96), peroxidation of lipids ( p = 2.24 × 10 -5 , z-score = -1.944), Ca 2+ transport ( p = 1.55 × 10 -4 , z-score = -1.969), excitation of neurons ( p = 1.07 ×10 -4 , z-score = -1.091), and concentration of glutathione ( p = 3.06 × 10 -4 , z-score = 1.974)., Conclusion: The reduction of pro-inflammatory and oxidative stress pathways following dietary omega-3 PUFA supplementation is consistent with the promising role of these fatty acids in reducing adverse symptoms associated with neuroinflammatory diseases and painful neuropathy.

In this study, we evaluated the status of and attitudes toward COVID-19 vaccination of healthcare workers in two major hospital systems (academic and private) in Southern California. Responses were collected via an anonymous and voluntary survey from a total of 2491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2103 (84%) were vaccinated. The bulk of the participants were middle-aged college-educated White (73%), non-Hispanic women (77%), and nursing was the most represented medical occupation (35%). Political affiliation, education level, and income were shown to be significant factors associated with vaccination status. Our data suggest that the current allocation of healthcare workers into dichotomous groups such as "anti-vaccine vs. pro-vaccine" may be inadequate in accurately tailoring vaccine uptake interventions. We found that healthcare workers that have yet to receive the COVID-19 vaccine likely belong to one of four categories: the misinformed, the undecided, the uninformed, or the unconcerned. This diversity in vaccine hesitancy among healthcare workers highlights the importance of targeted intervention to increase vaccine confidence. Regardless of governmental vaccine mandates, addressing the root causes contributing to vaccine hesitancy continues to be of utmost importance.

Polypharmacy, commonly described as the use of five or more prescribed medications, is a prevalent health issue among seniors because of the potential adverse side effects due to medication interactions. The main purpose of this study was to investigate the association between dietary patterns and number of medications used. We hypothesized that a plant-based diet and healthy lifestyle choices decreases morbidities and number of medications taken. Data on 328 participants, aged 60 years or older, were collected through questionnaires and measurements at the Loma Linda University Drayson Center in Loma Linda, CA, between 2015 and 2016. The dependent variable was the number of pills taken, used as counts, and the main exposure was the type of diet adopted. Negative binomial regression was used for analysis. Results suggest that a vegan diet reduces the number of pills by 58% compared to non-vegetarian (IRR=.42 [95% CI: .25-.70]), even after adjusting for covariates. Increases in age, body mass index (BMI), and presence of disease suggest an increased number of pills taken. A vegan diet showed the lowest amount of pills in this sample. Body mass index also had a significant positive association with the number of pills., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2021 The Author(s).)

Background: Concerns regarding the adequacy of vegetarian diets with respect to fracture risk continue., Objectives: We aimed to explore the influence of 5 previously defined dietary patterns on hip fracture risk and whether this association is modified by concomitant calcium and vitamin D supplementation., Methods: The Adventist Health Study 2 is a prospective cohort study in which participants were enrolled during 2002-2007; proportional hazards regression analyses were used to estimate fracture risk. Participants reside throughout the United States and Canada. A total of 34,542 non-Hispanic white peri- and postmenopausal women and men 45 y and older responded to the biennial hospital history form and were followed for a median of 8.4 y., Results: The study identified 679 incident hip fractures during 249,186 person-years of follow-up. Fracture risk varied according to dietary pattern, with a clear effect modification by concurrent supplementation with both vitamin D and calcium. In multivariable models, including adjustment for calcium and vitamin D supplementation, female vegans had 55% higher risk of hip fracture (HR: 1.55; 95% CI: 1.06, 2.26) than nonvegetarians (NVEGs), whereas there was no association between diet pattern and hip fracture risk in men. When further stratifying females on supplement use with both vitamin D and calcium, vegans taking both supplements were at no greater risk of hip fracture than the subjects with other dietary patterns including the NVEGs., Conclusions: Without combined supplementation of both vitamin D and calcium, female vegans are at high risk of hip fracture. However, with supplementation the excessive risk associated with vegans disappeared. Further research is needed to confirm the adequacy of a vegan diet supplemented with calcium and vitamin D with respect to risk of fracture., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Delay in primary care access for new patients to US Department of Veterans Affairs (VA) health care services has been a persistent problem. This article presents the evaluation of a quality improvement (QI) intervention that provided new patients with same-day primary care access. It involved redesign of an intake clinic (IC) through which new patients were initially seen and referred to primary care. The redesign included changes in clinic flow and reallocation of two full-time primary care providers (PCPs) from IC to their primary care teams., Methods: A pre-post retrospective study evaluating a QI intervention at a VA hospital examined 22,220 administrative patient records. Specifically, 9,909 new patients seen in the three years prior to implementation of VA-HONORS (preintervention group) were compared with 12,311 patients seen in the three years after implementation (postintervention group). Study outcomes were (1) number of days to first appointment with PCP, (2) proportion of patients receiving same-day primary care access, and (3) visit cycle time., Results: Preintervention, median first primary care appointment delay was 96 days, compared to 0 days postintervention (p < 0.001). Preintervention, 3.1% of new patients were able to obtain same-day primary care appointment, compared with 91.5% postintervention (p < 0.001). Median visit cycle time was 140 minutes preintervention vs. 148 minutes postintervention (p < 0.001)., Conclusions: New patients' same-day access system redesign at one VA hospital dramatically eliminated first primary care appointment delay. The redesign was feasible and sustainable for a sizable population and serves as a model for similar settings with new patients' primary care access delay., Competing Interests: Conflicts of Interest All authors report no conflicts of interest., (Copyright © 2020 The Joint Commission. All rights reserved.)

Purpose: En Balance , a culturally sensitive diabetes education program, improves glycemic control in Hispanics with type 2 diabetes. The program emphasized diet, physical activity, and other factors important for glycemic control. However, the individual contributions of these education factors are unclear. The purpose of this study is to assess the contribution of physical activity to the success of En Balance in improving the health of Mexican Americans with type 2 diabetes., Methods: A retrospective study was conducted with plasma samples collected pre- and post-3-month study. Samples from 58 (18 males and 40 females) Hispanic subjects with type 2 diabetes were analyzed for the concentration of kynurenines, known to decrease in response to exercise. After three months, health outcomes for the active group (decreased kynurenines) and the rest of the cohort were evaluated by paired Wilcoxon signed-rank test., Results: Half of the subjects had increased kynurenine levels at the end of the educational program. We found that the subjects in the active group with decreased kynurenine concentrations displayed statistically greater improvements in fasting blood glucose, A1C, cholesterol, and triglycerides despite weight loss being higher in the group with increased kynurenine concentrations., Conclusions: En Balance participants with decreased kynurenine levels had significantly improved glycemic control. These data suggest that physical activity significantly contributes to the success of the En Balance education program. This analysis indicates that diabetes public health educators should emphasize the benefit of physical activity on glycemic control even in the absence of major weight loss., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Dequina A. Nicholas et al.)

Accumulating evidence links nut consumption with an improved risk of metabolic syndrome (MetS); however, long-term trials are lacking. We examined the effects of a daily dose of walnuts for two years on MetS in a large elderly cohort. A total of 698 healthy elderly participants were randomly assigned to either a walnut supplemented or a control diet. The participants in the walnut group were provided with packaged walnuts (1, 1.5, or 2 oz. or ~15% of energy) and asked to incorporate them into their daily habitual diet. The participants in the control group were asked to continue with their habitual diet and abstain from eating walnuts and other tree nuts. Intake of n-3 fatty acid supplements was not permitted in either group. Fasting blood chemistries, blood pressure, and anthropometric measurements were obtained at baseline and at the end of intervention. A total of 625 participants (67% women, mean age 69.1 y) completed this two-year study (90% retention rate). Triglycerides decreased in both walnut (-0.94 mg/dl) and control (-0.96 mg/dl) groups, with no significant between-group differences. There was a non-significant decrease in systolic and diastolic blood pressure in the walnut group (-1.30 and -0.71 mm Hg, respectively) and no change in the control group. Fasting blood glucose decreased by ~1 point in both the walnut and control groups. There were no significant between-group differences in the development or reversion of MetS. In conclusion, supplementing the diet of older adults with a daily dose of walnuts had no effect on MetS status or any of its components, although the walnut group tended to have lower blood pressure., Competing Interests: S.R., E.R., and J.S. have received research funding through their institutions from the California Walnut Commission, Folsom, CA, USA. E.R. and J.S. are nonpaid members of the California Walnut Commission Scientific Advisory Council. E.R. was a paid member of the California Walnut Commission Health Research Advisory Group. J.S. has received honoraria from the California Walnut Commission for presentations. All other authors declare no conflict of interest.

Background: A novel coronavirus disease (COVID-19) was reported in Wuhan, China late December 2019. The disease has as of the end of March 2020, affected over 35 countries (with over 570,000 cases and 26,000 deaths) worldwide. This includes the U.S., where cases are increasing by the thousands every day (100,000 cases with 1500 deaths as of April 2020). We set out to investigate new or increased stressful life events (SLEs) as a result of this pandemic in the U.S., Methods: In this exploratory qualitative study, we examined new or heightened SLEs during an active phase of this outbreak. We used a list of SLEs acquired from the first phase of our study, whereby we conducted open-ended surveys and performed an in-depth focus group. We applied Lazarus and Folkman's transactional model of stress and coping to understand diverse focus-group participants' appraisal of events. We coded survey data and applied sentiment analysis., Results: Participants varied in perceived threat and challenge appraisals of COVID-19, indicating both calm and fear. From 267 coded and sentiment analyzed events from survey text, 95% were predominantly negative; 112 (42%) very negative and 142 (53%) moderately negative. Social capital was unanimously emphasized upon as monumental for example: family, friends or technology mediated. We additionally identified seven major themes of SLEs due to the pandemic., Limitations: Our sample profile is not inclusive of all subsets of the population., Conclusions: Participants mostly shared similar frustrations and a variety of SLEs such as fear of the unknown and concern for loved ones as a result of COVID-19., Competing Interests: None.Appendix 1Full List of Coded SLEs.Appendix 1Rank by coding frequencyDescription of SLE1Death of a loved one2Racism3Discrimination includes implicit bias and stereotyping4Financial hardship and economic crisis5Personal health issues6Loved one’s health issues7Unemployment, loss of job or means of livelihood8Poverty, minimum wages and inadequate basic needs9Parenting challenges10Work related challenges and stressesDebt12Acculturation and assimilation challenges conflicts13Job seeking and lack of jobs or career growthLoneliness, Isolation including separation from familyImmigration challenges including fear of deportation and loss of status16Divorce or separation from significant17Eviction, foreclosure, loss of housing and homelessness18Educational challenges including costHardly any (unique) struggles20Harsh (current) political climateMarriage and issues with significant othersMental health issues including clinical diagnoses23Family problems and conflictInternal conflicts25Chronic or prolonged illnesses or terminal disease and associated challengesRelocationAging challenges28Experiencing or recovering from major disease outbreaks or natural disasters including severely inclement weather29Accidents and injury including car accidentCultural and ethnic obligations, woes or disappointmentFamily or loved one in distressHealth insurance, lack of it, cost or lossNavigating systems, particularly governmentTransportation issues including car breaking downChildcare difficulties including cost36Assortment of hate crimes32Housing instability, cost and challengesOne’s children in distressSaving for the future and retirementUnsafe or low-quality environment and neighborhoodsBeing undocumented in the US and the uncertainty42Environmental nuisances and discomfortLegal issuesPoor or low access to amenities including health, education, environmentUnexpected major financial obligations46Burden of caring for sick or old family membersDeath of a petDisaster in home countryFamily expectations and obligations financially and or culturallyFear of mistreatment by law enforcementHaving and recovery from major health proceduresMajor home repairsMortgage, rent and cost of housing challengesReverse racism or discrimination55Aging or sick family in home countryBeing in or experiencing war or combatBeing the victim of a crimeConflict with close friends or loved onesDealing with costly medical procedures or needsDisabilityDomestic or other violenceExperience or encounter of police brutality or partialityHelplessness when witnessing injusticePregnancy and newbornsSubstance misuse and addictionWork life imbalance67Betrayal by family or loved oneExhaustion and sleep deprivationFood deserts and food insecurityMiscarriagesPolitical instability or war in home countrySocial interactions or obligationsViolence including domestic74Childhood traumaReligious woesXenophobiaSome SLEs were tied: had the same number of codes as referenced by participants in their open-ended text Appendix 2Focus Group Participants by Profession.Appendix 21.Frontline Healthcare Worker2.Public Health; Community Engagement3.Television Production4.Assistant Professor5.Environmental Educator, Community Organizer/Community Engagement6.Federal Quality Assurance Analyst7.IT support8.Public Health Emergency Preparedness9.Substitute Teacher and Graduate Student10.Federal Regulation Writer11.Prevention Health Specialist12.College Professor.13.Military Officer in the US Armed Forces Equal Opportunity, Diversity & Community Liaison Professional14.Racial, Inclusion and Equality Professional15.Developmental Psychologist

The association between dietary patterns and CVD risk factors among non-Hispanic whites has not been fully studied. Data from 650 non-Hispanic white adults who participated in one of two clinical sub-studies (about 2 years after the baseline) of the Adventist Health Study-2 (AHS-2) were analysed. Four dietary patters were identified using a validated 204-item semi-quantitative FFQ completed at enrolment into AHS-2: vegans (8·3 %), lacto-ovo-vegetarians (44·3 %), pesco-vegetarians (10·6 %) and non-vegetarians (NV) (37·3 %). Dietary pattern-specific prevalence ratios (PR) of CVD risk factors were assessed adjusting for confounders with or without BMI as an additional covariable. The adjusted PR for hypertension, high total cholesterol and high LDL-cholesterol were lower in all three vegetarian groups. Among the lacto-ovo-vegetarians the PR were 0·57 (95 % CI 0·45, 0·73), 0·72 (95 % CI 0·59, 0·88) and 0·72 (95 % CI 0·58, 0·89), respectively, which remained significant after additionally adjusting for BMI. The vegans and the pesco-vegetarians had similar PR for hypertension at 0·46 (95 % CI 0·25, 0·83) and 0·62 (95 % CI 0·42, 0·91), respectively, but estimates were attenuated and marginally significant after adjustment for BMI. Compared with NV, the PR of obesity and abdominal adiposity, as well as other CVD risk factors, were significantly lower among the vegetarian groups. Similar results were found when limiting analyses to participants not being treated for CVD risk factors, with the vegans having the lowest mean BMI and waist circumference. Thus, compared with the diet of NV, vegetarian diets were associated with significantly lower levels of CVD risk factors among the non-Hispanic whites.

To investigate the association between plasma concentration of vitamin B 12 and B 12 intake from supplements, fortified foods, and animal source foods among vegetarians and non-vegetarians, we conducted a cross-sectional analysis among 728 participants of the Adventist Health Study 2 (AHS-2) calibration study. The median age of participants was 58 years, 65.4% were female, and 50.3% were White. We used six 24 h dietary recalls to measure B 12 intake, serum vitamin B 12 , and holotranscobalamin (holoTC) concentration. B 12 supplements had a significantly positive association with plasma B 12 among all subjects ( p trend < 0.001), especially among vegans and lacto-ovo vegetarians ( p trend < 0.001). Among non-users of B 12 supplements, B 12 intake from milk substitutes was significantly positively associated with holoTC ( p trend < 0.004) and serum B12 ( p trend < 0.030). In non-vegetarians, holoTC was significantly positively associated with B 12 intake from eggs, while serum B 12 was significantly positively associated with B 12 intake from milk in the upper tertile compared to the lower, and B 12 intake from meat in the middle compared to the lower tertile intake ( p < 0.011). Supplements containing B 12 followed by B 12 intake from milk substitutes were significant contributors of plasma vitamin B 12 concentration., Competing Interests: The authors declare no conflict of interest.

BACKGROUND Development of post-transplant diabetes mellitus after kidney transplant (PTDM) significantly increases kidney graft loss and mortality. Several risk factors for PTDM have been reported, including Hispanic ethnicity and the use of calcineurin inhibitors and corticosteroids. The incidence and impact of PTDM in the Hispanic kidney transplant population is unknown. MATERIAL AND METHODS We retrospectively reviewed the medical records of 155 Hispanic and 124 Caucasian patients, who were not diabetics and underwent kidney transplant between January 2006 and December 2011. We analyzed their clinical outcomes at 12 months post-transplant, including the incidence of PTDM, acute rejection rates, and patient and graft survival. RESULTS Hispanics who developed PTDM (n=22) were more than 10 years older and had higher body mass index (BMI) than Hispanics without PTDM (p<0.001 and p=0.001, respectively). Caucasians with PTDM (n=13) were non-significantly older (2.5 years) and had higher BMI than Caucasians without PTDM (p=0.526, p=0.043, respectively). The incidence of PTDM was not significantly different between Hispanics and Caucasians treated with tacrolimus-based immunosuppression (14.2% and 10.5%, respectively). CONCLUSIONS PTDM did not cause significant difference in short-term outcomes after kidney transplant in Hispanics or Caucasians. Larger multicenter prospective and long-term clinical trials are needed to validate these findings.

Background: There is a positive association between ambient fine particulate matter ≤ 2.5 μm in aerodynamic diameter (PM 2.5 ) and incidence and mortality of lung cancer (LC), but few studies have assessed the relationship between ambient PM 2.5 and LC among never smokers., Objectives: We assessed the association between PM 2.5 and risk of LC using the Adventist Health and Smog Study-2 (AHSMOG-2), a cohort of health conscious nonsmokers where 81% have never smoked., Methods: A total of 80,285 AHSMOG-2 participants were followed for an average of 7.5 years with respect to incident LC identified through linkage with U.S. state cancer registries. Estimates of ambient air pollution levels at participants' residences were obtained for 2000 and 2001, the years immediately prior to the start of the study., Results: A total of 250 incident LC cases occurred during 598,927 person-years of follow-up. For each 10-μg/m 3 increment in PM 2.5 , adjusted hazard ratio (HR) with 95% confidence interval (CI) for LC incidence was 1.43 (95% CI: 1.11, 1.84) in the two-pollutant multivariable model with ozone. Among those who spent > 1 hr/day outdoors or who had lived 5 or more years at their enrollment address, the HR was 1.68 (95% CI: 1.28, 2.22) and 1.54 (95% CI: 1.17, 2.04), respectively., Conclusion: Increased risk estimates of LC were observed for each 10-μg/m 3 increment in ambient PM 2.5 concentration. The estimate was higher among those with longer residence at enrollment address and those who spent > 1 hr/day outdoors. Citation: Gharibvand L, Shavlik D, Ghamsary M, Beeson WL, Soret S, Knutsen R, Knutsen SF. 2017. The association between ambient fine particulate air pollution and lung cancer incidence: results from the AHSMOG-2 study. Environ Health Perspect 125:378-384; http://dx.doi.org/10.1289/EHP124.

Childhood obesity is associated with a greater chance of a lifetime of obesity. Evidence suggests dairy at recommended levels could be beneficial in maintaining normal weight and body composition. We assessed whether dairy consumption is associated with anthropometric indicators of health (z-scores for weight-for-age (WAZ); height-for-age (HAZ) and body mass index (BMIZ); waist-to-height ratio (WHtR); fat-free mass (FFM); and fat mass (FM)) in adolescents. In a cross-sectional study, 536 males and females ages 12-18 completed a 151-item semi-quantitative web-based food frequency questionnaire that included 34 dairy-containing foods. Dairy foods were categorized into milk, cheese, sweetened dairy, and total dairy. Anthropometrics were measured during school visits. Total dairy intake was associated with WAZ (β = 0.25 (95% CI: 0.01, 0.49), p = 0.045) and HAZ (β = 0.28 (95% CI: 0.04, 0.52), p = 0.021). In boys, total dairy was associated with WHtR (β = 0.02 (95% CI: 0.00, 0.04), p = 0.039), FFM (β = 4.83 (95% CI: 1.79, 7.87), p = 0.002), and FM (β = 3.89 (95% CI: 0.58, 7.21), p = 0.021), and cheese was associated with FFM (β = 4.22 (95% CI: 0.98, 7.47), p = 0.011). Dairy consumption seems to influence growth in both genders, and body composition and central obesity in boys. Prospective studies are needed to identify how types of dairy relate to growth, body composition, and central obesity of adolescents.

Background: Accurate assessment of diet in study populations is still a challenge. Some statistical strategies that use biomarkers of dietary intake attempt to compensate for the biasing effects of reporting errors., Objective: The objective was to correlate biomarkers of dietary intake with 2 direct measures of dietary intake., Methods: Subjects provided repeated 24-h dietary recalls and 2 food-frequency questionnaires (FFQs) separated by ∼3 y. Correlations between biomarkers and reported dietary intakes as measured by the recalls and FFQs were de-attenuated for within-person variability. The Adventist Health Study-2 (AHS-2) has a large database of biomarkers of dietary intake (blood, urine, adipose tissue) from a calibration study (909 analytic subjects) representing the cohort. Participants were black and non-black Adventists in the United States and Canada., Results: Dietary items with higher-valued de-attenuated correlations (≥0.50) between biomarkers and recalls included some fatty acids (FAs), the non-fish meats, fruit (non-black subjects), some carotenoids, vitamin B-12 (non-black subjects), and vitamin E. Moderately valued correlations (0.30-0.49) were found for very long chain ω-3 (n-3) FAs, some carotenoids, folate, isoflavones, cruciferous vegetables, fruit (black subjects), and calcium. The highest correlation values in non-black and black subjects were 0.69 (urinary 1-methyl-histidine and meat consumption) and 0.72 (adipose and dietary 18:2 ω-6), respectively. Correlations comparing biomarkers with recalls were generally similar for black and non-black subjects, but correlations between biomarkers and the FFQ were slightly lower than corresponding recall correlations. Correlations between biomarkers and a single FFQ estimate (the usual cohort situation) were generally much lower., Conclusions: Many biomarkers that have relatively high-valued correlations with dietary intake were identified and were usually of similar value in black and non-black subjects. These may be used to correct effects of dietary measurement errors in the AHS-2 cohort, and in some cases they also provide evidence supporting the validity of the dietary data., (© 2016 American Society for Nutrition.)

Background: According to the American Cancer Society, prostate cancer accounts for ∼27% of all incident cancer cases among men and is the second most common (noncutaneous) cancer among men. The relation between diet and prostate cancer is still unclear. Because people do not consume individual foods but rather foods in combination, the assessment of dietary patterns may offer valuable information when determining associations between diet and prostate cancer risk., Objective: This study aimed to examine the association between dietary patterns (nonvegetarian, lacto-ovo-vegetarian, pesco-vegetarian, vegan, and semi-vegetarian) and prostate cancer incidence among 26,346 male participants of the Adventist Health Study-2., Design: In this prospective cohort study, cancer cases were identified by matching to cancer registries. Cox proportional hazards regression analysis was performed to estimate HRs by using age as the time variable., Results: In total, 1079 incident prostate cancer cases were identified. Around 8% of the study population reported adherence to the vegan diet. Vegan diets showed a statistically significant protective association with prostate cancer risk (HR: 0.65; 95% CI: 0.49, 0.85). After stratifying by race, the statistically significant association with a vegan diet remained only for the whites (HR: 0.63; 95% CI: 0.46, 0.86), but the multivariate HR for black vegans showed a similar but nonsignificant point estimate (HR: 0.69; 95% CI: 0.41, 1.18)., Conclusion: Vegan diets may confer a lower risk of prostate cancer. This lower estimated risk is seen in both white and black vegan subjects, although in the latter, the CI is wider and includes the null., (© 2016 American Society for Nutrition.)

The alanine to threonine amino acid substitution at codon 54 (Ala54Thr) of the intestinal fatty acid binding protein (FABP2) has been associated with elevated levels of insulin and blood glucose as well as with dyslipidemia. The aim of this study was to characterize the effect of this FABP2 polymorphism in Mexican-Americans with type 2 diabetes (T2D) in the context of a three-month intervention to determine if the polymorphism differentially modulates selected clinical outcomes. For this study, we genotyped 43 participant samples and performed post-hoc outcome analysis of the profile changes in fasting blood glucose, HbA1c, insulin, lipid panel and body composition, stratified by the Ala54Thr polymorphism. Our results show that the Thr54 allele carriers (those who were heterozygous or homozygous for the threonine-encoding allele) had lower HDL cholesterol and higher triglyceride levels at baseline compared to the Ala54 homozygotes (those who were homozygous for the alanine-encoding allele). Both groups made clinically important improvements in lipid profiles and glycemic control as a response to the intervention. Whereas the Ala54 homozygotes decreased HDL cholesterol in the context of an overall total cholesterol decrease, Thr54 allele carriers increased HDL cholesterol as part of an overall total cholesterol decrease. We conclude that the Ala54Thr polymorphism of FABP2 modulates HDL cholesterol in Mexican-Americans with T2D and that Thr54 allele carriers may be responsive in interventions that include dietary changes.

Inland southern California is a region of public health concern, especially for children, given the area's perennially poor air quality and increasing sources of local pollution. One elementary school specifically is located only a few hundred yards from the San Bernardino Railyard, one of the busiest goods movement facilities in California, potentially increasing respiratory problems. Through ENRRICH (Environmental Railyard Research Impacting Community Health) Project, we assessed association of proximity to a major freight railyard on adverse respiratory health in schoolchildren. Respiratory screening was provided for children at two elementary schools: one near the railyard and a socio-demographically matched comparison school 7 miles away. Screening included testing for airway inflammation (FE NO), lung function (peak expiratory flow, PEF) and parent reported respiratory symptoms. Parental questionnaires collected additional information. Log-binomial and linear regression assessed associations. Children attending school near the railyard were more likely to exhibit airway obstruction with higher prevalence of abnormal PEF (<80%): prevalence ratio (PR) = 1.59 (95% CI 1.19-2.12). The association with inflammation was less clear. Children at the exposure school, who had lived 6 months or longer at their current address (vs. all children at that school) were more likely to have values suggesting inflammation (FE NO > 20 ppb) (PR = 1.44, 95% CI 1.02-2.02) and present with a trend for increased adverse respiratory symptoms. Children attending school near the railyard were significantly more likely to display respiratory health challenges. Ideally these low-income, low resource communities should be supported to implement sustainable intervention strategies to promote an environment where children can live healthier and thrive.

Importance: Colorectal cancers are a leading cause of cancer mortality, and their primary prevention by diet is highly desirable. The relationship of vegetarian dietary patterns to colorectal cancer risk is not well established., Objective: To evaluate the association between vegetarian dietary patterns and incident colorectal cancers., Design, Setting, and Participants: The Adventist Health Study 2 (AHS-2) is a large, prospective, North American cohort trial including 96,354 Seventh-Day Adventist men and women recruited between January 1, 2002, and December 31, 2007. Follow-up varied by state and was indicated by the cancer registry linkage dates. Of these participants, an analytic sample of 77,659 remained after exclusions. Analysis was conducted using Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. The analysis was conducted between June 1, 2014, and October 20, 2014., Exposures: Diet was assessed at baseline by a validated quantitative food frequency questionnaire and categorized into 4 vegetarian dietary patterns (vegan, lacto-ovo vegetarian, pescovegetarian, and semivegetarian) and a nonvegetarian dietary pattern., Main Outcomes and Measures: The relationship between dietary patterns and incident cancers of the colon and rectum; colorectal cancer cases were identified primarily by state cancer registry linkages., Results: During a mean follow-up of 7.3 years, 380 cases of colon cancer and 110 cases of rectal cancer were documented. The adjusted hazard ratios (HRs) in all vegetarians combined vs nonvegetarians were 0.78 (95% CI, 0.64-0.95) for all colorectal cancers, 0.81 (95% CI, 0.65-1.00) for colon cancer, and 0.71 (95% CI, 0.47-1.06) for rectal cancer. The adjusted HR for colorectal cancer in vegans was 0.84 (95% CI, 0.59-1.19); in lacto-ovo vegetarians, 0.82 (95% CI, 0.65-1.02); in pescovegetarians, 0.57 (95% CI, 0.40-0.82); and in semivegetarians, 0.92 (95% CI, 0.62-1.37) compared with nonvegetarians. Effect estimates were similar for men and women and for black and nonblack individuals., Conclusions and Relevance: Vegetarian diets are associated with an overall lower incidence of colorectal cancers. Pescovegetarians in particular have a much lower risk compared with nonvegetarians. If such associations are causal, they may be important for primary prevention of colorectal cancers.

Background: Socio-demographic factors are associated with increased emergency department (ED) use among patients with epilepsy. However, there has been limited spatial analysis of such visits., Design and Methods: California ED visit at the patient ZIP Code level were examined using Kulldorf's spatial scan statistic to identify clusters of increased risk for epilepsy-related visits. Logistic regression was used to examine the relative importance of patient socio-demographics, Census-based and hospital measures., Results: During 2009-2011 there were 29,715,009 ED visits at 330 hospitals, of which 139,235 (0.5%) had epilepsy (International Classification of Disease-9 345.xx) as the primary diagnosis. Three large urban clusters of high epilepsy-related ED visits were centred in the cities of Los Angeles, Oakland and Stockton and a large rural cluster centred in Kern County. No consistent pattern by age, race/ethnicity, household structure, and income was observed among all clusters. Regression found only the Los Angeles cluster significant after adjusting for other measures., Conclusions: Geospatial analysis within a large and geographically diverse region identified a cluster within its most populous city having an increased risk of ED visits for epilepsy independent of selected socio-demographic and hospital measures. Additional research is necessary to determine whether elevated rates of ED visits represent increased prevalence of epilepsy or an inequitable system of epilepsy care. Significance for public healthThere have been few spatial analyses regarding treatment for epilepsy. This paper significantly expands upon previous work by simultaneously considering multiple urban centres and sparsely populated agricultural and desert/mountain areas in a large state. Furthermore, most epilepsy studies involve one system of care or funding source (such as Department of Veterans Affairs, Medicare, Medicaid, or private insurance plans). This paper considers all funding sources at community-based hospitals. Patient socio-demographics, area-based summaries of socio-demographics, and basic hospital characteristics explain most of the observed spatial variation in rates of emergency department (ED) visits related to epilepsy. However, preliminary spatial analysis demonstrated that an area within downtown Los Angeles did have a higher rate of epilepsy-related visits compared to the rest of the state. A more comprehensive surveillance approach with ED visit data could be readily applied to other large geographic areas and be useful both for on-going monitoring and public health intervention.

High levels of serum long chain saturated fatty acids (LCSFAs) have been associated with inflammation in type 2 diabetes. Dietary SFAs can promote inflammation, the secretion of IgG antibodies, and secretion of the proinflammatory cytokine IL-1β. This study characterizes anti-LCSFA IgG antibodies from patients with type 2 diabetes. Serum samples from several cohorts with type 2 diabetes were analyzed for the presence of anti-LCSFA IgG, the cytokine IL-1β, and nonesterified fatty acids. Anti-LCSFA IgG was isolated from patient samples and used for in vitro characterization of avidity and specificity. A cohort participating in En Balance, a diabetes health education program that improved diabetes management, tested positive for anti-LCSFA IgG. Following the 3-month program, the cohort showed a significant reduction in anti-LCSFA IgG levels. Anti-LCSFA antibodies isolated from these patients demonstrated high avidity, were specific for long chain SFAs, and correlated with serum fatty acids in patients with managed type 2 diabetes. Interestingly, anti-LCSFA IgG neutralized PA-induced IL-1β secretion by dendritic cells. Our data shows that nonesterified SFAs are recognized by IgG antibodies present in human blood. The identification of anti-LCSFA IgG antibodies in human sera establishes a basis for further exploration of lipid induced immune responses in diabetic patients.

Aims: Physical activity is well recognized for its bone health benefit. We examined the benefit of walk/run/jog on bone health using broadband ultrasound attenuation (BUA) of the calcaneus., Methodology: Caucasian and African American males (n=593) and females (n=1,106) had their calcaneal BUA measured two years later after enrollment into the AHS-2. The association between calcaneal BUA (dB/Mhz) and the distance of walk/run/ jog level per week (miles) was assessed using multiple linear regression., Results: In a multivariable model adjusted for important covariates, BUA was positively associated with BMI ( P < .001), total calcium intake ( P =0.31), total protein intake ( P =0.38) and inversely associated with age ( P < .001) and smoking ( P < .05). Compared to women who did not walk/ run/ jog, women walking 10 or more miles per week had an increase in BUA by 4.08 (dB/Mhz) ( P trend =0.03). Similarly, compared to men who did not walk/ run/ jog, men walking 10 or more miles per week had an increase in BUA by 5.97 (dB/Mhz) ( P trend =0.01)., Conclusions: We concluded that BUA is positively associated with walk/ run/jog after accounting for age, BMI, smoking status, calcium intake, protein intake and estrogen usage., Competing Interests: COMPETING INTERESTS Authors have declared that no competing interests exist.

Aims: The beneficial effect of physical activity on reducing hip fracture risk has been supported in many previous studies. The present cohort study explores the relationship between total daily physical activity expressed as MET-hour/day and hip fracture risk among men over 50 years of age and postmenopausal women (n=22,836)., Methodology: Associations between self-reported hip fracture incidence and total daily physical activity and selected lifestyle factors were assessed using Cox proportional hazard regression., Results: In gender-specific multivariable models, total activity above average (≥ 51 MET-hours per day for men, ≥ 48 MET-hours per day for women) compared to those with sedentary lifestyle (< 40 MET-hours per day) reduced the risk of hip fracture by 60% among men (HR=0.40, 95%CI: 0.23-0.70) (Ptrend=0.002) and 48% among women (HR=0.52, 95%CI: 0.32-0.84) (Ptrend=0.01)., Conclusion: Our findings suggest that a moderate level of physical activity and avoiding a sedentary lifestyle can reduce the risk of hip fracture among the elderly., Competing Interests: Authors have declared that no competing interests exist.

Objective: In contrast to non-vegetarians, vegetarians consume more legumes and meat analogues as sources of protein to substitute for meat intake. The present study aimed to assess the association between foods with high protein content (legumes, meat, meat analogues) by dietary pattern (vegetarians, non-vegetarians) and hip fracture incidence, adjusted for selected lifestyle factors., Design: A prospective cohort of Adventist Health Study-2 (AHS-2) enrollees who completed a comprehensive lifestyle and dietary questionnaire between 2002 and 2007., Setting: Every two years after enrolment, a short questionnaire on hospitalizations and selected disease outcomes including hip fractures was sent to these members., Subjects: Respondents (n 33,208) to a baseline and a follow-up questionnaire., Results: In a multivariable model, legumes intake of once daily or more reduced the risk of hip fracture by 64% (hazard ratio = 0·36, 95% CI 0·21, 0·61) compared with those with legumes intake of less than once weekly. Similarly, meat intake of four or more times weekly was associated with a 40% reduced risk of hip fracture (hazard ratio = 0·60, 95% CI 0·41, 0·87) compared with those whose meat intake was less than once weekly. Furthermore, consumption of meat analogues once daily or more was associated with a 49 % reduced risk of hip fracture (hazard ratio = 0·51, 95% CI 0·27, 0·98) compared with an intake of less than once weekly., Conclusions: Hip fracture incidence was inversely associated with legumes intake and, to a lesser extent, meat intake, after accounting for other food groups and important covariates. Similarly, a high intake of meat analogues was associated with a significantly reduced risk of hip fracture.