Abstract
Stress and disease: Examining the relationship between allostatic load and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
Monica Cornelius, PhD and Jin- Mann Sally Lin, PhD
Centers for Disease Control and Prevention, Atlanta, GA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Higher cumulative biologic stress as measured by allostatic load (AL) is associated with greater risk for many chronic conditions, including Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), a chronic multi-system condition characterized by reduced functioning associated with fatigue. While ME/CFS patients are more likely to have higher AL, it is not yet clear if higher AL contributed to ME/CFS or vice versa. Objectives: This study used longitudinal data to (1) assess the association between AL and CFS and (2) examine AL changes in ME/CFS. Methods: Subjects completing one-day clinical evaluations at both baseline (2004-2005) and follow-up (2007-2009) studies in Georgia, USA (n=319) were classified based on the 1994 research case definition for ME/CFS as follows: ME/CFS (n=56); Insufficient Symptoms or Fatigue (ISF) (n=138); and Non-Fatigued well (NF) (n=125). Logistic regression techniques assessed the association of AL Index (ALI) scores with illness characteristics controlling for socio-demographics. Illness severity status changes were calculated by classification changes from baseline to follow-up accounting for symptom severity. Results: Preliminary results showed that high ALI (>=4) was associated with worse health outcomes and greater fatigue in the ME/CFS group at baseline [ME/CFS vs. NF: OR=2.94, 95% CI= (1.20-7.19)] and follow-up OR=2.90 (1.28-6.56). There was a gradient in the proportion switching from high to low ALI over the ‘change to less severe status’ (21.79%), ’no change’ (12.63%) , and ‘change to more severe status’ (6.98%) categories, however it was not significant (p=0.13). Conclusions: Increased AL is associated with ME/CFS. The mechanisms contributing to increased stress may play a role in the development and/or continuation of ME/CFS. Further analysis is warranted for assessing ALI as a screening tool for illness management.
Chronic disease management and prevention Epidemiology Public health or related research
Abstract
Examining Health Status Among Mexican Migrants from Various Migrant Flows
Niko Verdecias, DrPH (c), MPH1, Ana Martinez-Donate, PhD2, Gudelia Rangel Gomez, PhD3, Eduardo Gonzalez-Fagoaga, PhD, MS4, Sylvia Guendelman, PhD, LCSW5, Christina Diaz, PhD6 and Xiao Zhang, PhD7
(1)Drexel University Dornsife School of Public Health, Philadelphia, PA, (2)Drexel University, Philadelphia, PA, (3)U.S. Mexico Border Health Commission, Mexico's section, Tijuana, Mexico, (4)US-Mexico Border Health Comission, Mexico, Tijuana, Mexico, (5)University of California Berkeley, Berkeley, CA, (6)University of Arizona, Tucson, AZ, (7)University of Wisconsin Carbone Cancer Center, Madison, WI
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
background:
Different explanations for the health advantages observed for Latino immigrants versus US born populations (i.e., the Latino health paradox) have been proposed. However, the health of Latino immigrants has rarely been studied using migratory flows instead of migrant stocks. The study of migratory flows can add to the picture of migrant health at different points of the migration process and inform the need for services and programs in sending, receiving and intermediate communities.
objectives:
In this study, we examined and compared the health and healthcare access of Mexican migrants following various migratory flows in order to gain a better understanding of changes in health and healthcare access along the migration continuum.
methods:
We used data from a 2013 cross-sectional probability survey of migrants from four migratory flows traveling through the City of Tijuana, Mexico (N=2412): Northbound (migrants traveling North from communities of origin), Deported (migrants deported from the U.S. to Mexico), Southbound and Border (migrants returning to communities of origin from the U.S. or another border region, respectively). Adjusted logistic and multinomial regression models were performed to compare health status, health behaviors, and healthcare access across these four migration flows.
results:
The sample was predominately male (73.9%) with a lifetime total of ≥ 10 years living in the US (42.4%) or no migration history (37.9%). Compared to northbound migrants (our reference group), those from the border flow had better access to healthcare (insurance (AOR = 2.98; CI=2.13-4.16) and receipt (AOR = 1.48; CI=1.12-1.95)), but less likely to rate their health status as excellent or very good (AOR = 0.62; CI=0.47-0.83) and more likely to engage in at-risk drinking (AOR = 1.44; CI=1.04-1.98); southbound migrants were also less likely to rate their health as excellent or very good (AOR = 0.71; CI=0.53-0.94) and had higher odds of being overweight (AOR = 1.34; CI=1.00-1.79) or obese (AOR = 1.43; CI=1.04-1.97); and deportees exhibited the worst health profile with poorer healthcare access (insurance (AOR = 0.34; CI=0.23-0.52) and usual source of care (AOR = 0.53; CI=0.32-0.87)), higher odds of reporting stress (AOR=1.45; CI=1.12-1.89), and illicit drug use (AOR = 1.98; CI=1.09-3.59).
conclusion:
The health profile and levels of access to health care vary for Mexican migrants in different migratory flows. Migrants returning from the U.S., especially deportees, have a worse health profile and lower access to health care than migrants initiating their first or a new migratory movement. Migrants returning from the border region had a mixed profile with better access to care, but worse self-rated health status. The differences could reflect selection processes into migratory flows and/or the influence of recent migration contexts. These results can inform public health efforts at different ends of the migration continuum in addition to potentially having implications on new immigration policies.
Epidemiology Public health or related education Public health or related research Social and behavioral sciences
Abstract
Municipalities’ Policies and Ordinances for Chronic Disease Prevention in Maine
Michelle Mitchell, MSocSc1, Dawn Littlefield-Gordon, BS2 and Linda Ridell, MS3
(1)Partnerships For Health, Augusta, ME, (2)Maine Center for Disease Control and Prevention, Augusta, ME, (3)Health Economy, Cape Elizabeth, ME
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: The Environmental Indicators (EI) Tracking Project was developed in 2001 by Maine CDC. Its purpose was to track progress on local health promotion indicators using a systematic, statewide measure of key local policies and environments. Since 2001, multiple EI surveys have been conducted in various settings, including municipalities, school districts, hospitals, worksites and daycares. The most recent Municipality EI Survey was conducted in 2016.
Methods: The 38-question survey was conducted in May and June 2016. Municipal representatives knowledgeable about the policies and environments of the municipality were interviewed by telephone. Most often this was the town manager, town clerk, code enforcement officer or human resource manager. Descriptive analyses utilized frequency distributions. For each question, responses were totaled by type, such as “yes” or “no”. Responses were stratified by type of metropolitan area (urban or rural; urban, large rural, small rural, and isolated rural). Responses were also aggregated by public health district and by county. For tobacco results, GIS mapping was used to present geographic distribution of results.
Results: 483 of 491 municipalities completed the survey in 2016, for a response rate of 98%. Tobacco policies are evident in almost all municipalities, including tobacco bans in municipal buildings and grounds; bans at recreation fields, parks, and beaches; and bans at open air events. Nutrition policies are less widespread; 20% of municipalities report offering a farmers’ market. Though there is very high awareness of state laws, few municipalities (10%) have written policies supporting their employees’ breastfeeding, though 90% provide clean, private places for expressing breast milk. With respect to physical activity, almost all municipalities own or operate indoor recreation (25%) and/or outdoor recreation (68%) facilities. Unfortunately, most of the facilities are promoted through word-of-mouth with half or less promoted through websites, brochures, or other methods. Municipalities do have zoning rules allowing for a mix of residence and business. Few have sidewalks; those with sidewalks often lack budgets for repairing or maintaining them. Of those with sidewalks, most have policies requiring commercial and residential buildings to provide pedestrian access.
Conclusion: Results show that tobacco, nutrition, and physical activity policies and ordinances do exist at the municipal level in Maine, but that significant opportunities exist for expanding their scope; tobacco policies in particular are well developed. In 2016 a new tobacco and obesity prevention delivery model was implemented in Maine. The results from the 2016 survey will be used as a baseline from which to measure progress in future years at municipalities.
Epidemiology Planning of health education strategies, interventions, and programs
Abstract
Balance and dizziness problems among United States adults — Prevalence, risk factors, and sequelae
Howard J. Hoffman, MA1, Katalin G. Losonczy, MA1, Christa L. Themann, PHD, CCC-A2, Robert A. Dobie, MD3, Gregory A. Flamme, PhD4, Chuan-Ming Li, MD, PhD1, Anne E. Hogan, PhD5, Helen S. Cohen, EdD, OTR, FAOTA6 and Charles C. Della Santina, PhD, MD7
(1)National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, (2)National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, (3)The University of Texas Health Science Center at San Antonio, San Antonio, TX, (4)Western Michigan University, Kalamazoo, MI, (5)College of Health Professions, Pacific University, Hillsboro, OR, (6)Baylor College of Medicine, Houston, TX, (7)Johns Hopkins Medicine, The Johns Hopkins University, Baltimore, MD
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: This study examines the prevalence of self-reported balance and dizziness problems (BDP) during the past 12 months based on large, representative U.S. health surveys. Healthy People 2020 objectives demonstrate the importance of BDP by documenting a 5-fold increased risk of falling and, when falls occur in association with BDP, a 50% increased risk of injury.
Objective: Estimate prevalence, risk factors, and sequelae for BDP.
Methods: We analyzed data from the 2014 National Health Interview Survey (NHIS), a continuous, nationally-representative health interview survey administered by U.S. Census workers to 36,697 adults, aged 18+ years. Covariables were questions on hearing (self-reported difficulty, Gallaudet functional hearing scale, noise exposures, tinnitus), health (arthritis, asthma, cancer, cardiovascular disease, severe headaches/migraine, sinusitis, stroke), and medications use. BDP was classified based on responses to the question: "During the past 12 months, have you had a problem with dizziness, light-headedness, feeling as if you are going to pass out or faint, unsteadiness or imbalance?" We examined associations between BDP and socio-demographic, hearing, health, and functional variables using multivariable logistic models and report findings based on predicted margins to estimate adjusted risk ratios (RR) with 95% confidence intervals (CI).
Results: BDP prevalence was 14.8% (35.4 million adults), increasing from 11.7%, 15.8%, 19.7%, to 25.8% for ages 18-44, 45-64, 65-84, and 85+ years, respectively. Multivariable-adjusted analyses showed BDP associated with: female sex (RR=1.35, CI: 1.26-1.46), poverty-level income (RR=1.45; CI: 1.30-1.62), any hearing difficulty (RR=1.25; CI: 1.12-1.37), Gallaudet scale “at best, can hear shouting” (RR=1.40, CI: 121-162), very loud occupational noise (<5 years) (RR=1.20; CI: 1.06-1.36), loud leisure noise (RR=1.26; CI: 1.15-1.39), firearms noise (RR=1.10; CI:1.03-1.19), asthma (RR=1.08; CI: 1.00-1.18), sinusitis (RR=1.16; CI:1.06-1.26), arthritis (RR=1.24; CI: 1.14-1.35), used sleep medication last week (RR=1.28; CI: 1.19-1.38), cancer diagnosis (RR=1.32; CI:1.17-1.48), cardiovascular disease (RR=1.49; CI: 1.38-1.62), ever had stroke (RR=1.53; CI: 1.31-1.79), joint pain/aching/stiffness past month (OR=1.53; CI:1.42-1.65), use of prescription medications past year (RR=1.67; CI: 1.49-1.88), tinnitus (OR=1.91; CI: 1.75-2.08), and severe headaches/migraine (OR=2.04; CI: 1.87-2.23). Increased age was not associated with increased RR of BDP in the multivariable-adjusted model; instead, the chronic conditions and environmental exposures shown above were sufficient to account for the crude (unadjusted) two-fold increase in prevalence from 11.7% (age 18-44) to 25.8% (age 85+). Selected hearing loss etiologies (e.g., unexplained sudden onset, Meniere's, otosclerosis, ear injury-head/neck trauma, and ototoxic medications/drugs--gentamicin/cisplatin/antibiotics/anti-inflammatory) were increased with BDP. Earlier age at onset of hearing loss was not associated with BDP.
Conclusion: BDP prevalence ranged from substantial for young adults to very common for the oldest, yet these differences were accounted for in multivariable-adjusted analysis by chronic conditions and environmental exposures. Several hearing and chronic health conditions made significant contributions. However, the strongest associations were with tinnitus and severe headaches/migraine.
Chronic disease management and prevention Clinical medicine applied in public health Conduct evaluation related to programs, research, and other areas of practice Epidemiology Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Is antibiotics use a mediator or a risk factor for multiple sclerosis?
Jinma Ren, PhD1, Huijuan Ni2, Minchul Kim, PhD1, Kimberly Cooley3, Reuben Valenzuela4 and Carl Asche, PhD1
(1)University of Illinois College of Medicine at Peoria, Peoria, IL, (2)Illinois State University, Edwards, IL, (3)OSF Healthcare System, Peoria, IL, (4)OSF Saint Francis Medical Center, Peoria, IL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Previous studies have reported contradictory associations between antibiotics use and multiple sclerosis (MS), which leads more to the ongoing dispute. However, no study has examined whether antibiotics use is a mediator instead of a risk factor for MS. Thus, our study aimed to apply MacArthur approach to examine their intrinsic relationships among antibiotics use, allergy disease and MS.
Methods: A 1:3 matched case-control study was performed using the National Ambulatory Medical Care Survey database from 2006 to 2013 in the USA. MS cases were identified based on the ICD-9 code “340” in any diagnosis position. MS cases were matched to their controls based on year, age (difference≤3 years), gender, race, payer type and region utilizing SAS 9.4. Allergy diseases and antibiotics prescriptions were extracted by ICD-9 code and drug classification code, respectively. Logistic regressions and MacArthur approach were used to identify the relationship between antibiotics use and MS.
Results: The weighted prevalence of MS was 133.7 per 100,000 visits. Total 829 MS patients and 2441 controls were matched. Patients with respiratory tract allergies and other non-skin allergies were more likely to use penicillin (Odds ratio [OR]=7.69 and 8.16, respectively, p<0.001 for all) and other antibiotics (OR=3.83, p<0.001; OR=2.88, p=0.009, respectively). Respiratory tract allergies (OR=0.26, p<0.001), skin allergies (OR=0.39, P=0.022) and other non-skin allergies (OR=0.13, p=0.047) were inversely associated with the risk of MS, and it existed an interaction between penicillin use and non-skin allergies (p=0.026). According to MacArthur approach, penicillin use mediated respiratory tract allergies and other non-skin allergies with MS.
Conclusion: It suggests that antibiotics use should be considered as a mediator instead of a risk factor for MS. More studies are needed to examine whether antibiotics use also mediates other risk factors of MS, such as C. pneumonia infection, vitamin D deficiency and smoking.
Biostatistics, economics Chronic disease management and prevention Epidemiology
Abstract
Maternal and household determinants of oral rehydration therapy use in children under 5 years with diarrhea: A tri-country, multi-period, cross-sectional pooled analysis of Demographic Health Surveys
Philimon Gona, PhD1, Vasco Chikwasha, MSc2, Clara Gona, PhD3 and Sowmya Rao, PhD4
(1)University of Massachusetts Boston, Boston, MA, (2)University of Zimbabwe College of Health Sciences, Harare, Zimbabwe, (3)MGH Institute for Health Professions, Boston, MA, (4)Boston University, Boston
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Diarrhea is the 2nd leading cause of death in children <5 years(U5) with most deaths attributable to dehydration. Oral rehydration therapy (ORT), “the most important medical advance of this century”. Over 3million, or ¼ of children U5 in the developing world die from preventable dehydration caused by diarrhea. Repeated bouts of diarrhea weaken children and contribute to protein-energy malnutrition. Mothers are the firstline of defense, administering ORT at home. ORT has been shown to save >1millon children annually from 1990-1995. We conducted a tri-country (Zimbabwe, Zambia, & Malawi), multi-period (2004/10 & 2010/15) analysis of USAID-funded Demographic Health Surveys (DHS) to assess maternal and household determinants of ORT use. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were obtained from multivariable logistic regression to assess the association of period, country, and wealth index to ORT use, accounting for complex sampling design The prevalence of ORT during 2004/10 was 21%, 61%, and 61%; and during 2010/15 was 41%, 65%, and 73%, for Zimbabwe, Zambia, and Malawi, respectively. Relative to Zimbabwe during 2004/10, aOR (95% CI) for Zambia was 6.6[4.7-9.3], and Malawi 7.1[4.9-10.2]. During 2010/15 aORs were lower, 3.0[2.4-3.7] & 4.6[3.5-5.0], respectively. Higher quintiles of wealth index were significantly associated with ORT use in only Zimbabwe during 2010/15 for but not for Zambia or Malawi. The association of predictors was not uniform either across countries or periods studied. Wealth Index, a measure of household’s cumulative living standard, is an important determinant, particularly in Zimbabwe, suggesting need for poverty alleviation policies and programs.
Biostatistics, economics Epidemiology Public health or related research