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INTRODUCTION Depression is expected to become the world's second leading disease burden, after cardiovascular disease, by 2020. (1) People with depression report poorer quality of life, affecting their social functioning [...], BACKGROUND/OBJECTIVES: To investigate the association between dietary patterns and prevalence and incidence 3 years later of depressive symptoms using data from the mid-aged cohort in the Australian Longitudinal Study on Women's Health. SUBJECTS/METHODS: Participants (aged 50-55 years) completed a food frequency questionnaire in 2001. Depressive symptoms were measured in 2001 and 2004 using the validated 10-item Centre for Epidemiologic Studies Depression scale. Multiple logistic regression was used for cross-sectional analysis (8369 women) and longitudinal analysis (7588) to assess the associations between dietary patterns and prevalence of depressive symptoms, and then for longitudinal analysis (6060) on their associations with the incidence of depressive symptoms in 2004, while adjusting for sociodemographic and lifestyle factors. RESULTS: Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the Mediterranean-style diet had a cross- sectional association with lower prevalence of depressive symptoms in 2001, adjusted odds ratio 0.82 (95% confidence interval 0.77-0.88); and longitudinally with lower incidence of depressive symptoms in 2004, adjusted odds ratio 0.83 (0.75-0.91). None of the associations found for other dietary patterns remained statistically significant after adjustment for confounders. A dose-response relationship was found cross-sectionally when women were grouped according to quintiles of Mediterranean-style diet (P- value for trend < 0.001). CONCLUSIONS: Consumption of a 'Mediterranean-style' dietary pattern by mid-aged women may have a protective influence against the onset of depressive symptoms. These findings suggest that dietary patterns have a potential role in the prevention and management of depressive symptoms. European Journal of Clinical Nutrition (2013) 67, 75-82; doi: 10.1038/ejcn.2012.193; published online 5 December 2012 Keywords: prospective cohort studies; depression; dietary pattern; Mediterranean diet

Focus group discussions on barriers to health care and attitudes toward family planning, reproductive health services, and condom use were conducted with 63 women at high risk for HIV due to their own injection drug use, sex with injection drug users, sex industry work, or a history of multiple sexually transmitted diseases. Barriers identified include the high cost of health care, perceived poor quality of care and experiences of discrimination and stigmatization, geographic accessibility, fear of legal/social services punitive actions, misperceptions about the efficacy of birth control methods and condom usage, lack of sterilization services, and lack of male involvement. Where possible, findings from the focus groups are supported with quantitative survey data from a sample of high-risk women (n = 723). Recommendations are made for improving care for high-risk women. [ABSTRACT FROM AUTHOR]

This article describes the main results of research work on chemicaland thermal treatment techniques from a special programme, subsidised by the Dutch government. The aim was development and demonstration of treatment processes for contaminated dredged sediments. Studied treatment processes were thio-leaching, EDTA-extraction, solvent- extraction, extraction with supercritical carbon dioxide, wet air oxidation and thermal desorption. All processes were performed on laboratory scale, some also on pilot scale or even at full scale. Three processes were selected as potential remediation processes based on their clean-up results (> 99% removal of specific contaminants): solvent-extraction, wet air oxidation and thermal desorption. Wet air oxidation ofslurred fines and thermal treatment of dewatered sediment were demonstrated successfully at full scale. The demonstrations were performedrespectively by the VerTech plant for wet air oxidation of sewage sludge at Apeldoorn and Ecotechniek's plant for thermal treatment of contaminated soil at Rotterdam. Pilot-plant testing of solvent-extraction with acetone in counter current was delayed due to mixing problemsin the settler-extractor. A description of the three selected processes is presented, as well as the performance characterised by treatment results, re-use of treated sediments, consumption of energy and raw materials, emissions to air and surface water, investment costs andoperational costs. (c) 1998 IAWQ. Published by Elsevier Science Ltd. [ABSTRACT FROM AUTHOR]

Solvent extraction is one of the possibilities to clean-up polluted sediments. It is especially attractive when the sediment mainly consists of clay particles polluted with contaminants which are not, or not easily, biodegradable. Using acetone as extracting agent the extraction process has been investigated at laboratory scale for treating sediment of the Petroleum Harbour in Amsterdam. This sediment is characterised by a substantial percentage of particles with diameter < 63 mu m, a high percentage of organic matter (about 12% on dry matter basis), a high concentration of PAH (500--2,000 mg total EPA-PAH per kgdry matter) and a high concentration of mineral oil (6,000--10,000 mg/kg dry matter). Based on the laboratory scale experiments a processdesign has been made of a complete solvent-extraction process with acetone. The main process steps in this design consist of a countercurrent flow extractor, a separator for the sediment. a post-treatment step to remove residual acetone from the sediment, a distillation column to recover the acetone for reuse and to concentrate the pollutantsand a polishing stop for the water to be discharged. The sediment treatment costs, with this system are estimated at 115 NGL per tonne dry matter to be treated. (c) 1998 IAWQ. Published by Elsevier Science Ltd. [ABSTRACT FROM AUTHOR]

Context: Prior to the COVID-19 pandemic, home visiting services for low-income children and families were provided almost entirely in person. Little is known about clients' experience of home visiting provided virtually by video or phone instead of, or in addition to, in-person home visiting., Objective: To explore the views of clients in the California Work Opportunity and Responsibility to Kids (CalWORKs) Home Visiting Program (HVP) across California during the first 2 years of the pandemic., Setting: Forty counties in California., Participants: CalWORKs HVP clients, currently enrolled or who left the program in the 6 months prior to each survey., Main Outcome Measures: Clients' ratings of participation in and experiences with the CalWORKs HVP services, as well as unmet needs., Results: We collected 1617 surveys from clients across 3 survey rounds. Pandemic-related restrictions resulted in decreased frequency of home visits and a shift from in person to primarily virtual visits. As in-person home visit frequency decreased, there were significant declines in clients' level of agreement that they learned child development skills (P = .04), received parenting services (P = .015) or activities (P < .001), or received infant and child nutrition services (P = .003). There were no declines in level of agreement that the CalWORKs HVP improved the quality of life of clients and their children., Discussion: Clients consistently rated the CalWORKs HVP as positively contributing to their and their children's well-being, regardless of the shift from in person to virtual visits. Clients' participation in some program components decreased over the evaluation. However, it is unknown if clients received fewer referrals, were hesitant to pursue the referrals, or if fewer services were available. Continued research is needed to evaluate the merits and disadvantages of virtual visits as in-person home visits resume postpandemic., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Context: In-person home visiting programs that provide evidence-based parenting and child development support improve outcomes for low-income children and families. The COVID-19 pandemic led to a shift from primarily in-person to virtual home visiting services, and little is known about clients' experience of home visiting in this context., Objective: To describe the experience of clients in the California Work Opportunity and Responsibility to Kids (CalWORKs) Home Visiting Program (HVP) across California during the first 2 years of the pandemic., Design: Three repeated cross-sectional surveys over a 2-year period. Clients' free-text responses to open-ended questions were analyzed using a directed content analysis approach., Setting: Forty-one counties in California., Participants: Current CalWORKs HVP clients and those who left the program in the 6 months prior to each survey., Main Outcome Measures: Clients' experience of the CalWORKs HVP., Results: Five main themes emerged: (1) benefits received from the program; (2) life challenges; (3) COVID-19-related or other program changes; (4) client dissatisfaction and suggestions for improvement; and (5) appreciation for the program. Clients valued the practical, financial, parenting, and interpersonal support provided to themselves and their children. Almost three-quarters commented on life challenges experienced during the program. Significant programmatic changes related to COVID-19 pandemic public health safety and organizational constraints impacted clients both positively and negatively. Very few clients experienced overt dissatisfaction with the program. Many clients expressed appreciation for the program, particularly the individualized and relational support offered by a consistent home visitor., Conclusions: The findings provide insights into the benefits and challenges experienced by clients receiving evidence-based home visiting services. The findings highlight the ongoing life challenges faced by clients who experience poverty, and how those challenges were exacerbated by a global pandemic. The CalWORKs HVP may buffer the substantial personal stresses clients experience related to parenting in the context of poverty and major public health challenges., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

Flavonoids are suggested to reduce disease risk. Since dietary habits are acquired during early life, describing age and time trends of flavonoid intake and major food sources are important for monitoring and disease prevention in later life. We aimed to describe total flavonoid intake and food sources and to investigate age and time trends of flavonoid intake in 3-18-year-olds, from the Dortmund Nutritional and Anthropometric Longitudinally Designed study from 1985 to 2016. Intake was assessed annually using 3-d weighed food records (WFR). Flavonoid values were assigned using the United States Department of Agriculture database. Foods contributing to intake were determined. Age and time trends in total flavonoid and isoflavone density were analysed by sex with PROC MIXED. In total, 1312 children completed 10 758 WFR. Across all ages, daily mean total flavonoid density was lower in boys compared with girls (134 v. 146 mg/4184 kJ) and no difference in median isoflavone density (0·04 mg/4184 kJ per d) was found. The top five foods contributing to total flavonoid intake were apple with peel (15·0/17·1 %), strawberries (5·9/6·1 %), chocolate spread (3·9/3·5 %), orange juice (3·5/3·4 %) and pasta (3·5/3·4 %) for boys and girls, respectively. Overall, in boys, total flavonoid density decreased over the course of age and time. In girls, there was no association with age or time. In both sexes, isoflavone density followed a U-shaped age trend with no change over time. From a public health perspective, the overall observed downwards trend of flavonoid intake in boys deserves attention. Future initiatives should be tailored at maintaining a high flavonoid density as children age, specifically among boys.

Purpose: The aim of the present study was to derive overall and sex-specific dietary patterns associated with inflammatory biomarkers in a general population sample from Northern Germany., Methods: The present analysis included 1158 participants (477 men, 681 women, mean age: 53.1 years; mean body mass index: 26.2 kg/m 2 ) of the Food Chain Plus (FoCus) cohort in Kiel, Germany. Participants completed a semi-quantitative food frequency questionnaire and provided blood samples. Reduced rank regression with C-reactive protein (CRP) and Interleukin 6 (IL-6) as response variables was used to derive dietary patterns. After a mean follow-up of 1.7 years, a second blood sample was obtained in a subsample of 112 individuals. Multiple regression models were used to examine the association between dietary patterns at baseline and inflammatory biomarkers at follow-up., Results: The overall pattern characterised by high intakes of soft drinks, meat, potatoes and sauce, and low intakes of other cereals (except pasta/rice), wine, nuts, seeds, vegetarian dishes, vegetable oil, and fish was positively associated with CRP (OR 2.20; 95% CI 1.12, 4.35) and IL-6 (OR 3.14; 95% CI 1.26, 7.87) at follow-up. In men, the dietary pattern was higher in soft drinks, processed meat and low in cereals and plant-based fats. In women, the pattern was characterised by soft drinks, meat, vegetables and low in other cereals, wine, nuts, and seeds. The association between sex-specific patterns with inflammatory biomarkers was weaker for CRP., Conclusion: We identified dietary patterns positively associated with established biomarkers of chronic low-grade inflammation.

Purpose: Flavonoid consumption during adolescence could contribute to preventing adult onset of type 2 diabetes mellitus. We investigated the prospective association between habitual intake of flavonoids from fruit and vegetables (FlavFV) during adolescence and risk markers of type 2 diabetes in early adulthood., Methods: This analysis included participants of the DONALD Study, who had provided a fasting blood sample in adulthood (18-39 years), data on FlavFV-intake during adolescence (females: 9-15 years, males: 10-16 years) and relevant covariates. Habitual FlavFV-intake was either estimated using repeated 3-day weighed dietary records (n = 268), or the validated biomarker hippuric acid (uHA)-excretion in repeated 24-h urine samples (n = 241). Multivariable linear regressions were performed to analyse the prospective associations of FlavFV or uHA with homeostasis model assessment insulin sensitivity (HOMA2-%S), hepatic steatosis index (HSI), fatty liver index (FLI) and a pro-inflammatory score., Results: Higher FlavFV-intake was independently related to higher HOMA2-%S among females (P trend  = 0.03), but not among males. Both FlavFV-intake and uHA-excretion were inversely associated with HSI (P trend  < 0.0001 and P trend  = 0.02, respectively) and the pro-inflammatory score (P trend  = 0.02 and P trend  = 0.008, respectively), but not with FLI., Conclusions: Our data indicate that flavonoid consumption from fruit and vegetables during adolescence is associated with a favourable risk factor profile for type 2 diabetes in early adulthood.

Context: Several studies investigated lifestyle indices to account for interrelations between lifestyle behaviors and cardiovascular disease risk. So far, no systematic review has been conducted. Thus, the aim is to summarize the evidence of associations between lifestyle indices and cardiovascular disease risk in observational prospective studies., Evidence Acquisition: A systematic literature search was conducted in two databases in February 2018. Multivariable-adjusted risk estimates were combined using random effects models comparing the highest with the lowest healthy lifestyle score. Additionally, meta-analyses for cardiovascular disease types, such as stroke and heart failure, were conducted. Heterogeneity was assessed using I 2 index., Evidence Synthesis: The search identified 27 studies, of which 22 were included in the meta-analyses. Most lifestyle indices included physical activity, smoking, diet, alcohol consumption, and body weight. A healthy lifestyle was associated with a reduced risk of 66% for cardiovascular disease (95% CI=0.28, 0.41, I 2 =79.1%), 60% for stroke, and 69% for heart failure. A dose-response effect for adherence to an increasing number of healthy behaviors and cardiovascular disease risk was observed. Statistical heterogeneity was found, suggesting that the definition of the lifestyle indices and components varied substantially between the studies., Conclusions: Adherence to several healthy lifestyle behaviors simultaneously was associated with a 66% reduced cardiovascular disease risk compared with adopting none or only one behavior. Despite heterogeneity of indices, consistent inverse associations across studies underscore the relevance of adopting healthy behaviors at all. More research on other lifestyle behaviors, such as sleep duration or sedentary behavior in combination, is warranted., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Type 2 diabetes is characterized by impaired glucose metabolism. Bioactive compounds in fruits and vegetables such as polyphenols have been suggested to influence glucose metabolism., Objective: The aim of the current study was to systematically review the literature and conduct dose-response meta-analyses to summarize evidence of polyphenol exposure in association with incident type 2 diabetes., Design: Prospective epidemiologic studies published before January 2018 were searched through 2 databases. Log-transformed multivariable adjusted hazard and odds ratios were combined in a random-effects model. Meta-analyses comparing extreme quantiles of polyphenol exposure were further explored with the use of linear and nonlinear dose-response meta-analyses., Results: Eighteen studies investigated the association between polyphenols (51 different compounds in total) and type 2 diabetes. A comparison of extreme quantiles revealed inverse associations for intakes of polyphenols (HR: 0.56; 95% CI: 0.34, 0.93), flavonoids (HR: 0.88; 95% CI: 0.81, 0.96), flavonols (HR: 0.92; 95% CI: 0.85, 0.98), flavan-3-ols (HR: 0.89; 95% CI: 0.81, 0.99), catechins (HR: 0.86; 95% CI: 0.75, 0.97), anthocyanidins (HR: 0.86; 95% CI: 0.81, 0.91), isoflavones (HR: 0.92; 0.86, 0.97), daidzein (HR: 0.89; 95% CI: 0.83, 0.95), genistein (HR: 0.92; 95% CI: 0.86, 0.99), and stilbenes (HR: 0.44; 95% CI: 0.26, 0.72), and biomarkers of daidzein (HR: 0.81; 95% CI: 0.66, 0.99) and genistein (HR: 0.79; 95% CI: 0.62, 0.99). In the dose-response meta-analysis, nonlinear associations were observed for intakes of polyphenols, flavonoids, flavanones, anthocyanidins, anthocyanins, and biomarkers of genistein. A linear dose-response association was observed for phenolic acids., Conclusions: This study adds to the evidence showing that diets rich in polyphenols, and particularly flavonoids, play a role in the prevention of type 2 diabetes. For most associations evidence for nonlinearity was found, suggesting a recommendable amount of intake associated with the lowest risk of type 2 diabetes. Therefore, future studies are warranted in which nonlinear associations are further explored.

Flavonoids have been implicated in the prevention of cardiovascular diseases (CVD). In a prospective approach, we investigated whether habitual flavonoid intake from fruit, vegetables and juices (FlavFVJ) during adolescence is associated with adult levels of serum lipids, one of the main CVD risk factors. This analysis included healthy participants from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study, who had provided a fasting blood sample in adulthood (aged 18-39 years), data on FlavFVJ intake during adolescence (females: 9-15 years, males: 10-16 years)-estimated either from multiple 3-day weighed dietary records ( n = 257), or from validated biomarker hippuric acid (uHA) excretion from multiple 24-h urine samples ( n = 233)-together with information on relevant covariates. In multivariable linear regression analyses, a higher FlavFVJ intake during adolescence was independently associated with higher serum high-density lipoprotein cholesterol (HDL-C) levels among males ( P trend = 0.038); however, the inclusion of adult waist circumference attenuated this association ( P trend = 0.053). FlavFVJ was not associated with triglycerides (TG), total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C; all P trend ≥ 0.1), nor was uHA excretion with any serum lipid outcome among males (all P trend ≥ 0.5). Neither FlavFVJ intake nor uHA excretion was associated with serum lipids among women (all P trend ≥ 0.1). However, a higher flavonoid intake from fruit and vegetables was independently related to lower LDL-C levels ( P trend = 0.021), while a higher intake from juices was associated with higher LDL-C levels ( P trend = 0.016) among females. In conclusion, a higher flavonoid intake from fruit, vegetables and/or juices during adolescence may be linked to cholesterol levels in early adulthood in a sex- and food source-specific manner., Competing Interests: The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Context: Isoflavones have been suggested to play a role in disease prevention. The accuracy of assessing exposure to isoflavones might be improved by using them as biomarkers., Objective: A systematic review of observational studies on the association of isoflavone biomarkers with the risk of chronic disease and mortality was conducted. Meta-analyses of specific biomarker and disease combinations were performed., Data Sources: PubMed and Web of Science databases were searched., Data Extraction: Two authors screened the titles and abstracts of candidate publications. The third author was consulted to resolve discrepancies. Forty studies were included and their quality assessed. PRISMA-P guidelines were followed., Data Analysis: Eight different isoflavone biomarkers were investigated in association with cancer (26 studies), mortality (2 studies), cardiovascular disease (3 studies), metabolic syndrome risk factors (7 studies), and other outcomes (2 studies). Meta-analyses of studies on individual isoflavonic compounds were conducted for breast and prostate cancer and type 2 diabetes. Higher daidzein and genistein concentrations were associated with lower risk of breast cancer and diabetes. Only daidzein concentrations were inversely associated with risk of prostate cancer. For the remaining endpoints, evidence for associations was inconsistent and scarce, perhaps owing to heterogeneity in study exposures and outcomes., Conclusions: Further research using biomarker information is warranted., (© The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Epidemiologic studies have suggested an inverse association between flavonoids and cardiovascular disease (CVD). However, the results might have been influenced by the use of dietary assessment methods, which are error prone. The aim of this paper was to systematically review and analyse the literature for evidence of associations between polyphenol biomarkers and CVD and mortality risk in observational studies. Eligible studies were identified through PubMed, Web of Science, and reference lists. Multivariable adjusted associations were extracted. Data were log-transformed and pooled using the random effects model. In total, eight studies were included, investigating 16 different polyphenol biomarkers in association with CVD and mortality. Blood and urine were used as biospecimens, and enterolactone, a lignan metabolite, was most often investigated. Three meta-analyses were conducted investigating the association between enterolactone, and all-cause and CVD mortality, and non-fatal myocardial infarction. A 30% and 45% reduced all-cause and CVD mortality risk were revealed at higher enterolactone concentrations. Furthermore, inverse associations were observed between polyphenol biomarkers and all-cause mortality, kaempferol, and acute coronary syndrome. There is evidence to suggest that enterolactone is associated with a lower CVD mortality risk. This emphasises the importance of the role of the microbiota in disease prevention. To strengthen the evidence, more studies are warranted.

Background: African American infants in San Francisco suffer a mortality rate two to three times higher than Whites, yet prior discussion groups with African American residents suggested they were unaware of this disparity., Methods: Social marketing techniques were used to develop and implement three campaigns to increase awareness. The campaign themes were (1) infant mortality disparities, (2) proper infant sleep position, and (3) taking action to reduce disparities. Mediums to carry messages included bus ads, radio ads, church fans, and posters and cards distributed at clinics, daycares, agency waiting rooms, and community organizations. Campaign effectiveness was evaluated using telephone surveys of African Americans., Results: Almost 62% report some exposure to Campaign 1, 48.5% to Campaign 2, and 48.9% to Campaign 3. Chi-square analyses reveal a statistically ignificant increase in awareness of the disparity (39.6% vs. 62.7%, p < .0005, odds ratio [OR] = 2.5, confidence interval [CI] = 2.1-3.2). Although there was no overall significant increase in knowledge about proper sleep position, respondents who report any exposure to this campaign are more likely to know about sleep position (70.7% vs. 63.8%, p < .0001, OR = 2.2, CI = 1.6-3.2)., Conclusions: Social marketing is an effective tool to increase disparity awareness, especially among groups disproportionately affected by the disparity.

Unlabelled: African American infant mortality rates (IMR) in San Francisco have remained 2.5 to three times those of Whites for over 20 years., Methods: A 69-item telephone survey of African American residents in four neighborhoods with the most African American births assessed awareness of IMR disparities, associated risks, and social capital., Results: Of the 804 respondents, 57% were not aware of the IMR disparity. Higher levels of awareness occurred in those volunteering (OR 1.5, CI 1.1-2.0), participating in efforts to benefit the African American community (OR 1.8, CI 1.3-2.4), sensing that they belonged in their neighborhood (OR 1.7, CI 1.2-2.3), and being aware of a local African American-led initiative to improve infant health (OR 2.3, CI 1.7-3.9). Lack of awareness can be a barrier to a population's engagement in improving its overall health., Conclusion: Lack of awareness of IMR disparities and risk factors exists in the San Francisco African American population and is related to less social capital. Improving awareness is a prerequisite for implementing community level interventions.

Objectives: To improve local Maternal and Child Health programs' capacity to collect and analyze data to support core public health functions, the California Maternal and Child Health Branch (CAMCHB) and the University of California San Francisco Family Health Outcomes project (FHOP) entered into a cooperative agreement. FHOP utilizes a 6-pronged strategy: face-to-face training, telephone technical assistance, on-site consultation, development of automated analytic tools, development of written guidelines, and web dissemination of data and materials. We evaluated the acceptability and effectiveness of these approaches., Methods: Local Health Jurisdiction (LHJ) staff completed a self-administered questionnaire on use of and satisfaction with FHOP's services. A 34-item assessment tool was used to independently evaluate each 5-year community assessment plan submitted by LHJs to the CAMCHB. Administrative data on the use of FHOP's service was also considered. Correlational analyses were done to determine if use of FHOP services and materials was related to more adequate plans., Results: LHJs with higher overall adequacy scores on their plans had an overall higher level of use of FHOP's products and services. LHJs with higher adequacy scores reported calling FHOP for technical assistance more frequently, using FHOP's book - "Developing an Effective Planning Process: A Guide for Local MCH Programs," and using FHOP's automated tools including EpiBC, an EpiINFO based program for birth certificate analysis, and Microsoft Excel data analysis templates., Conclusion: This 6-pronged strategy is well utilized and accepted by local MCH staff and appears to have some degree of association with better quality of local MCH plan documents.