Lisa C. McGuire

Increasing Trends in Waist Circumference and Abdominal Obesity among U.S. Adults

Objective: Some studies have shown that abdominal obesity may be a better predictor than overall obesity for disease risks and all‐cause mortality. This study sought to examine the recent trends in waist circumference (WC) among adults in the United States.

Trends in Traumatic Brain Injury in the U.S. and the public health response: 1995-2009

PROBLEM Traumatic Brain Injury (TBI) is a public health problem in the United States. In 2009, approximately 2.4 million [corrected] patients with a TBI listed as primary or secondary diagnosis were hospitalized and discharged alive (N=300,667) or were treated and released from emergency departments (EDs; N=2,077,350), outpatient departments (ODs; N=83,857), and office-based physicians (OB-P; N=1,079,338). In addition, 52,695 died with one or more TBI-related diagnoses. METHODS Federal TBI-related laws that have guided CDC since 1996 were reviewed. Trends in TBI were obtained by analyzing data from nationally representative surveys conducted by the National Center for Health Statistics (NCHS). FINDINGS CDC has developed and is implementing a strategy to reduce the burden of TBI in the United States. Currently, 20 states have TBI surveillance and prevention systems. From 1995-2009, the TBI rates per 100,000 population increased in EDs (434.1 vs. 686.0) and OB-Ps (234.6 vs. 352.3); and decreased in ODs (42.6 vs. 28.1) and in TBI-related deaths (19.9 vs. 16.6). TBI Hospitalizations decreased from 95.5 in 1995 to 77.9 in 2000 and increased to 95.7 in 2009. CONCLUSIONS The rates of TBI have increased since 1995 for ED and PO visits. To reduce of the burden and mitigate the impact of TBI in the United States, an improved state- and territory-specific TBI surveillance system that accurately measures burden and includes information on the acute and long-term outcomes of TBI is needed.

The associations among childhood headaches, emotional and behavioral difficulties, and health care use

BACKGROUND. Headaches are common among children and adolescents, particularly migraine and tension-type headaches. They contribute to missed school days, affect childrens peer and family relationships, and significantly impact childrens quality of life, often times into adulthood. OBJECTIVES. This study, based on responses to the Strengths and Difficulties Questionnaire, was designed to examine difficulties and impairments related to emotions, concentration, behavior, and social functioning among children with frequent or severe headaches (FSH). METHODS. We used a cross-sectional study of 9264 children aged 4–17 years from the 2003 National Health Interview Survey, an ongoing, computer-assisted personal interview survey of the noninstitutionalized US population. RESULTS. Approximately 6.7% of children experienced FSH during the previous 12 months. Overall, children with FSH were 3.2 times more likely than children without FSH to have a high level of difficulties and 2.7 times more likely to have a high level of impairment, suggesting potential mental health issues. More specifically, analyses revealed that children with FSH were significantly more likely than those without FSH to exhibit high levels of emotional, conduct, inattention-hyperactivity, and peer problems and were significantly more likely than children without FSH to be upset or distressed by their difficulties and to have their difficulties interfere with home life, friendships, classroom learning, and leisure activities. CONCLUSION. Because children with FSH experience notable pain, mental health issues, and functional limitations, integrated care using a biopsychosocial approach is warranted.

Trends in Sports- and Recreation-Related Traumatic Brain Injuries Treated in US Emergency Departments: The National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001-2012.

Importance:Sports- and recreation-related traumatic brain injuries (SRR-TBIs) are a growing public health problem affecting persons of all ages in the United States. Objective:To describe the trends of SRR-TBIs treated in US emergency departments (EDs) from 2001 to 2012 and to identify which sports and recreational activities and demographic groups are at higher risk for these injuries. Design:Data on initial ED visits for an SRR-TBI from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for 2001-2012 were analyzed. Setting:NEISS-AIP data are drawn from a nationally representative sample of hospital-based EDs. Participants:Cases of TBI were identified from approximately 500 000 annual initial visits for all causes and types of injuries treated in EDs captured by NEISS-AIP. Main Outcome Measure(s):Numbers and rates by age group, sex, and year were estimated. Aggregated numbers and percentages by discharge disposition were produced. Results:Approximately 3.42 million ED visits for an SRR-TBI occurred during 2001-2012. During this period, the rates of SRR-TBIs treated in US EDs significantly increased in both males and females regardless of age (all Ps < .001). For males, significant increases ranged from a low of 45.8% (ages 5-9) to a high of 139.8 % (ages 10-14), and for females, from 25.1% (ages 0-4) to 211.5% (ages 15-19) (all Ps < .001). Every year males had about twice the rates of SRR-TBIs than females. Approximately 70% of all SRR-TBIs were reported among persons aged 0 to 19 years. The largest number of SRR-TBIs among males occurred during bicycling, football, and basketball. Among females, the largest number of SRR-TBIs occurred during bicycling, playground activities, and horseback riding. Approximately 89% of males and 91% of females with an SRR-TBI were treated and released from EDs. Conclusion and Relevance:The rates of ED-treated SRR-TBIs increased during 2001-2012, affecting mainly persons aged 0 to 19 years and males in all age groups. Increases began to appear in 2004 for females and 2006 for males. Activities associated with the largest number of TBIs varied by sex and age. Reasons for the reported increases in ED visits are unknown but may be associated with increased awareness of TBI through increased media exposure and from campaigns, such as the Centers for Disease Control and Preventions Heads Up. Prevention efforts should be targeted by sports and recreational activity, age, and sex.

Intake of dietary magnesium and the prevalence of the metabolic syndrome among U.S. adults.

Objective: Limited data suggest that people with the metabolic syndrome have lower intakes or circulating concentrations of magnesium than those who do not have the syndrome. The aim of this study was to examine the associations between dietary intake of magnesium and the prevalence of the metabolic syndrome in a nationally representative sample of U.S. adults.

Gender Differences in Coronary Heart Disease and Health-Related Quality of Life: Findings from 10 States from the 2004 Behavioral Risk Factor Surveillance System

BACKGROUND Our objective was to examine differences in health-related quality of life (HRQOL) between people with coronary heart disease (CHD) and those without this condition in a population-based sample of U.S. adults and to examine the interaction between CHD and diabetes on HRQOL. METHODS AND RESULTS We performed a cross-sectional analysis of data from 50,573 participants aged >or=18 years from 10 states of the 2004 Behavioral Risk Factor Surveillance System (BRFSS). Data were self-reported. HRQOL was assessed with the Centers for Disease Control and Prevention (CDC) HRQOL-4 measures. After adjusting for age, gender, race or ethnicity, educational status, marital status, employment status, smoking status, body mass index (BMI), and alcohol use, the percentages of women without CHD who, during the previous 30 days, reported experiencing >or=14 physically unhealthy days, >or=14 mentally unhealthy days, and >or=14 activity-limitation days were 7.5%, 10.4%, and 3.6%, respectively, compared with 16.5% (odds ratio [OR] = 2.49, 95% confidence interval [CI] 2.02, 3.07), 14.5% (OR = 1.58, 95%, CI 1.22, 2.04), and 8.4% (OR = 2.56, 95% CI 1.98, 3.30) for women with CHD. The adjusted percentages of men without CHD who reported experiencing >or=14 physically unhealthy days, >or=14 mentally unhealthy days, and >or=14 activity-limitation days were 5.6%, 6.0%, and 3.0%, respectively, compared with 10.1% (OR = 1.85, 95% CI 1.47, 2.32), 8.7% (OR = 1.32, 95% CI 1.00, 1.74), and 6.4% (OR = 1.99, 95% CI 1.49, 2.66) for men with CHD. A higher adjusted percentage of women with CHD reported experiencing >or=14 physically unhealthy days (p < 0.001) and >or=14 mentally unhealthy days (p = 0.002) but not >or=14 activity-limitation days (p = 0.090) than men with CHD. CONCLUSIONS People with CHD have significantly impaired HRQOL compared with those without CHD. HRQOL among women with CHD is worse than that among men with CHD.

Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey

Objective: Congestive heart failure (CHF) has been associated with insulin resistance, but few studies have examined its relationship with metabolic syndrome (MetS). Little is known about whether insulin resistance explains the association between MetS and CHF. Design: Population-based, cross-sectional surveys. Setting: Third National Health and Nutrition Examination Survey (NHANES III). Participants: Data from 5549 men and non-pregnant women aged ⩾40 years in NHANES III were analysed. Results: About 4% of men and 3% of women had CHF between 1988 and 1994 in the US. The age-adjusted prevalence of CHF was significantly higher in African Americans (4.1%), in Mexican Americans (8.5%) and in those of other ethnic origin (6.7%) than in white people (2.5%). People with MetS had nearly twice the likelihood of self-reported CHF (adjusted odds ratio 1.8; 95% confidence interval 1.1 to 3.0) after adjustment for demographic and conventional risk factors such as sex, ethnicity, age, smoking, total cholesterol, left ventricular hypertrophy, and probable or possible myocardial infarction determined by electrocardiography. However, this association was attenuated after further adjustment for insulin resistance as measured by the homoeostasis model assessment (HOMA). >90% of the association between MetS and CHF was explained by the HOMA. Conclusions: MetS was associated with about a twofold increased likelihood of self-reported CHF and it may serve as a surrogate indicator for the association between insulin resistance and CHF.

Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study

To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States.

Emergency department visits for traumatic brain injury in older adults in the United States: 2006-08.

Introduction: Traumatic brain injury (TBI) can be complicated among older adults due to age-related frailty, a greater prevalence of chronic conditions and the use of anticoagulants. We conducted this study using the latest available, nationally-representative emergency department (ED) data to characterize visits for TBI among older adults. Methods: We used the 2006–2008 National Hospital Ambulatory Medical Care – Emergency Department (NHAMCS-ED) data to examine ED visits for TBI among older adults. Population-level estimates of triage immediacy, receipt of a head computed tomography (CT) and/or head magnetic resonance imaging (MRI), and hospital admission by type were used to characterize 1,561 sample visits, stratified by age <65 and ≥65 years of age. Results: Of ED visits made by persons ≥65 years of age, 29.1% required attention from a physician within 15 minutes of arrival; 82.1% required a head CT, and 20.9% required hospitalization. Persons ≥65 years of age were 3 times more likely to receive a head CT or MRI compared to younger patients presenting with TBI (adjusted odds ratio [aOR] 3.2; 95% confidence interval [CI], 1.8–5.8), and were 4 times more likely to be admitted to an intensive care unit, step-down unit, or surgery (aOR 4.1; 95% CI 2.1–8.0) compared to younger patients presenting with TBI, while controlling for sex and race. Conclusion: Results demonstrate increased emergent service delivery for older persons presenting with TBI. As the United States population ages and continues to grow, TBI will become an even more important public health issue that will place a greater demand on the healthcare system.

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status

We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%–25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care.