Disparities in healthcare access experienced by Hispanic chronic kidney disease patients: a cross-sectional analysis.

BACKGROUND: Chronic kidney disease (CKD) is a public health concern, and the disease disproportionately affects Hispanics. Improved healthcare access for Hispanic CKD patients can reduce the disease burden. This study assesses the healthcare access disparities experienced by Hispanic CKD patients compared to Whites. METHODS: We analyzed three National Health and Nutrition Examination Survey (NHANES) datasets for 2013-2014, 2015-2016, and 2017-2018. The primary predictor variable was race, and the outcome variable was three domains of healthcare access: insurance status, having any routine place for healthcare, and having any health visits in the past year. Chi-square tests and unadjusted and adjusted multivariate logistic regressions were conducted. The models were adjusted for age, education, income, and CKD stages and were weighted to account for the sampling strategy. RESULTS: The sample size was 1864 CKD patients from three two-year cycles of NHANES datasets (2013-2014, 2015-2016, and 2017-2018). The final adjusted model found that Hispanic CKD patients were more likely to be uninsured (OR: 2.52, CI 1.66-3.83) and have no routine place for healthcare (OR: 1.68, CI 1.03-2.75) than White CKD patients, but did not have differences in healthcare visits in the past year. CONCLUSIONS: Hispanic CKD patients have limited healthcare access compared to White populations showing existing care access disparities experienced by them. Improved programs and policies are required to enhance kidney health among Hispanics and promote equity in CKD.

Food Parenting Practices Promoted by Childcare and Primary Healthcare Centers in Chile: What Influences Do These Practices Have on Parents? A Qualitative Study.

Chile, like many other countries in the world, is experiencing a high prevalence of childhood overweight. Among the factors influencing children's eating behaviors are the food parenting practices promoted by community organizations. More information is needed on the influences of these recommendations on the parenting practices of parents of preschoolers. This study examined what types of food parenting practices are promoted in childcare and primary healthcare centers and how these recommendations influence subsequent parental behavior. Interviews using photo-elicitation were conducted with 25 parents of Chilean preschoolers. The interviews were analyzed using inductive thematic analysis. Five themes were identified to describe food parenting practices promoted by community organizations and the influences that these practices had on parents of preschoolers. Healthcare centers were found to educate parents and provided a structured feeding. However, parents found their advice regarding dietary restriction challenging to follow. Childcare centers also provided information about healthy diet, food monitoring, and diversifying the child's diet in a way that was perceived as adequate. While childcare centers encouraged structured and autonomous food parenting practices in a positive and supportive manner, healthcare centers tended to provide more restrictive guidance that posed challenges for parents struggling with preschool nutritional care.

The Moderating Role of Race and Ethnicity in the Association Between Cognitive Performance and Functional Abilities in Later Life.

This study examined ethnic/racial influences on the relationship of cognitive performance and functional abilities of 2,713 older individuals from the National Health and Nutrition Examination Survey (NHANES). Functional domains included activities of daily living (ADL), instrumental ADL, and leisure and social activities. In adjusted logistic regression models, low cognitive performance as assessed by the Digit Symbol Substitution Test was found significantly associated with functional limitation in each domain. However, moderation analysis revealed that being Hispanic and non-Hispanic Black may weaken this association demonstrating protective effects of underrepresented ethnic/racial status. Future studies should investigate perceived discrimination and resilience.

Relationships of Low Cognitive Performance and Sleep Disorder With Functional Disabilities Among Older Adults.

ObjectivesThis study examined the relationships of low cognitive performance and sleep disorder with functional disabilities among older adults. Methods: NHANES 2011-2014 data on 3179 individuals [Mage=69.71] were analyzed. Functional domains included: activities of daily living (ADL), instrumental ADL (IADL) and leisure and social activities (LSA). Animal Fluency Test and the Digit Symbol Substitution Test assessed cognitive performance. Participants self-reported having physician-diagnosed sleep disorder. Results: Participants with both low cognitive performance and sleep disorder had 4- to 10-times greater odds for ADL, IADL, and LSA difficulties compared to the participants with no low cognitive performance/sleep disorder. Participants with only low cognitive performance and those with only sleep disorder were two to three times more likely to experience these difficulties. Discussion: Low cognitive performance and sleep disorder together or independently were associated with functional disabilities. Participants with both low cognitive performance and sleep disorder had higher odds of functional disabilities.

Indulgent Feeding Style Moderates the Association of Food Responsiveness to Body Mass Index Z-scores of Preschoolers.

OBJECTIVE: To investigate the moderating role of caregiver feeding styles in the association between preschool children's food-approaching eating behaviors and body mass index (BMI) z-scores. METHODS: This cross-sectional study examined 81 caregiver-preschooler dyads from low-income neighborhoods in Santiago, Chile. Moderated multiple linear regression analyses were used to determine the moderating effect of the indulgent feeding style in the relation between eating behaviors and BMI z-scores of preschool children. RESULTS: The indulgent caregiver feeding style moderated the association between food responsiveness and BMI z-scores of preschoolers. In an indulgent feeding style, food responsiveness was associated with higher child BMI z-scores (ß = 0.50; P < 0.001). There was no interaction between enjoyment of food and feeding styles in relation to children's BMI z-scores (ß = 0.17; P = 0.58). CONCLUSIONS AND IMPLICATIONS: An indulgent feeding style can be a risk factor for unhealthy weight outcomes in food responsive preschoolers, but not in those who enjoy food. Educating indulgent parents in the feeding context, and prioritizing children with food-approaching behaviors who are sensitive to external food cues may be effective for approaching childhood obesity.

Fecal and soil microbiota composition of gardening and non-gardening families.

Historically, humans have interacted with soils, which contain a rich source of microorganisms. Fruit and vegetable gardening is the primary interaction humans have with soil today. Animal research reveals that soil microorganisms can be transferred to the rodent intestine. However, studies on fecal and soil microbial changes associated with gardening in humans are lacking. The current case-controlled cohort study aimed to characterize the fecal and soil microbiota of gardening families (n = 10) and non-gardening (control) families (n = 9). Families included two adults and one child (5-18 years) for a total of 56 participants. All participants provided a fecal sample, soil sample, and diet history questionnaires before the gardening season (April) and during the peak of the gardening season (August). Healthy Eating Index (HEI-2015) scores and nutrient analysis were performed. Fecal and soil DNA were extracted and amplified. Sequence data were then processed and analyzed. Peak season gardening families tended to have greater fecal operational features, a greater Faith's Phylogenetic Diversity score, greater fiber intake, and higher abundances of fiber fermenting bacteria than peak control families. Soil endemic microbes were also shared with gardening participant's fecal samples. This study revealed that the fecal microbiota of gardening families differs from non-gardening families, and that there are detectable changes in the fecal microbial community of gardeners and their family members over the course of the gardening season. Additional research is necessary to determine if changes induced by gardening on the gut microbiota contribute to human health.

Exploring parents' perspectives on feeding their young children: a qualitative study using photo-elicitation in Chile.

OBJECTIVE: Childhood obesity is considered one of the most important public health problems around the world. Chile is currently one of the Latin American countries with a high prevalence of childhood obesity. Given that parents' food parenting practices shape their children's lifelong eating habits, addressing those practices is key to curbing later problems of obesity. However, studies of the influences on Chilean parents' food parenting practices are scarce. Hence, this study explores factors that influence food parenting practices of preschool-aged children in Chile. DESIGN: Qualitative research, using interviews with the photo-elicitation technique. SETTING: Metropolitan Region, Chile. PARTICIPANTS: Twenty-five parents from families recruited from public childcare centres. RESULTS: Through a thematic analysis with an inductive approach, we identified five themes that influence food parenting practices: (1) parents' previous experiences and how they determine their current goals and beliefs; (2) responses to the child's characteristics; (3) the influences of other family members, especially grandparents; (4) parents' nutritional knowledge; and (5) living contexts, especially limited budgets and lack of time. CONCLUSIONS: The study reveals multilevel influences, which converge at the family level, on food parenting practices. A family-centrerd approach that addresses the mentioned influences is necessary to improve the management of the childhood obesity problem in Chile.

Is Acculturation Associated with the Cognitive Performance of Older Hispanics?

BACKGROUND: Hispanics in the United States are disproportionately affected by Alzheimer's disease and related dementias. Little is known about the impact of acculturation on cognitive performance. OBJECTIVE: This study examined the association between acculturation and cognitive performance among older Hispanics. METHODS: We analyzed cross-sectional data of 616 Hispanic participants in the National Health and Nutrition Examination Survey (NHANES) 2011-2014 [average age = 67.15 years, %Female = 51.46, %less than high-school graduate = 52.60]. Cognitive performance was measured by two neuropsychological tests: Animal Fluency Test (AFT) and Digit Symbol Substitution Test (DSST). We used two single-item proxy measures to quantify acculturation: nativity status (non-US-born residing < 15 years in the US (low acculturation), non-US-born residing ≥15 years in the US, and US-born (high acculturation)); and language acculturation (only/mostly Spanish (low acculturation), Spanish and English, only/mostly English (high acculturation)). We used adjusted linear regression to evaluate associations between acculturation and cognitive performance. RESULTS: Results indicated poorer cognitive performance among the low-acculturated groups for both nativity and linguistic measures. Participants who were non-US-born living ≥15 years (p = 0.02) and speaking only/mostly Spanish or Spanish and English (p = 0.01 and 0.006 respectively) had significantly lower AFT scores compared to US-born and only/mostly English-speaking groups. Participants who were non-US-born living < 15 years (p < 0.0001) or non-US-born living ≥15 years (p < 0.0001) and speaking only/mostly Spanish (p = 0.0008) scored lower on the DSST than the US-born and only/mostly English-speaking participants. CONCLUSION: In summary, low acculturation is associated with poorer cognitive performance among older Hispanics. Acculturation might be an important attribute to help understand cognitive decline and dementias among Hispanics.

Influencias familiares en las prácticas de alimentación materna a niños preescolares de familias vulnerables de la Región Metropolitana de Chile / Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile

Objetivo: Explorar las influencias de integrantes del grupo familiar en las prácticas de alimentación de madres hacia preescolares, en familias de barrios vulnerables en la Región Metropolitana de Santiago, Chile. Diseño: Estudio cualitativo. Lugar: Nueve jardines infantiles de la Región Metropolitana, Santiago, Chile. Participantes: Veinticuatro madres y un padre de hijos preescolares. Método: Se realizaron 25 entrevistas semiestructuradas con técnica de foto-elicitación y su posterior análisis temático inductivo de las influencias familiares. Resultados: Las participantes describieron que las influencias familiares sobre las prácticas de alimentación que aplicaban en sus hijos preescolares dependían de la estructura familiar y de la cercanía entre familiares. Algunas de estas influencias afectan directamente la conducta alimentaria del niño, especialmente en familiares que cohabitan juntos, mientras que otras estaban mediadas por las relaciones generadas entre padres y otros miembros de la familia. El padre, en familias biparentales, y abuelos del preescolar son los familiares más influyentes. Los padres participan en la alimentación del niño y generalmente se alinean a las prácticas de alimentación con la madre. Los abuelos enriquecen la experiencia alimentaria de preescolares ofreciendo preparaciones caseras, expresando afecto con los alimentos, incluso opciones poco saludables, y apoyando a padres a diversificar y estructurar la alimentación del niño. Conclusiones: El impacto de familiares y sus dinámicas en las prácticas alimentarias parentales y la alimentación de preescolares varían según la cercanía o cohabitación entre familiares. El desarrollo de estrategias de prevención y tratamiento de obesidad infantil debería considerar un enfoque familiar en familias vulnerables.(AU)

Objective: To explore family members’ influences on mothers’ feeding practices of preschoolers in Chilean families residing in vulnerable neighborhoods from the Metropolitan Region of Santiago, Chile. Design: Qualitative study. Location: Nine child care centers in Región Metropolitana, Santiago, Chile. Participants: Twenty-four mothers and one father of preschool children. Method: Photo-elicitation techniques were applied to 25 semi-structured interviews and their subsequent inductive thematic analysis of family influences. Results: The participants described that the family influences on their feeding practices depended on the family structure and the interpersonal closeness between relatives. Some influences directly affected child eating behavior, especially in relatives who live together, while others were mediated by the relationships generated between parents and other members of the family. Fathers, in two-parent families, and grandparents are the most influential relatives on the participants’ feeding practices. Generally, fathers participated and were in line with the mother's feeding practices of their children. Grandparents enriched their grandchildren's eating experiences by offering homemade preparations, expressing affection with food, including unhealthy options, and supporting parents to diversifying and structuring feeding practices. Conclusions: According to their interpersonal closeness or cohabitation, parental feeding practices and child eating behaviors were impacted by family members and their dynamics. The development of strategies to prevent and treat childhood obesity should consider a family approach in vulnerable families.(AU)

Association of Family Nutrition and Physical Activity with Preschooler's Working Memory: A Cross-Sectional Study among Mexican Children.

Healthy eating and active lifestyles are associated with children's healthy weight and cognitive development. This study examines whether family behaviors relevant for nutrition and activity levels are associated with children's working memory, independent of their weight status. A convenience sample of child-caregiver dyads (n = 85 dyads) were recruited from a public preschool serving a low-income community in central Mexico. Caregivers reported the frequency of ten family behaviors using the Family Nutrition and Physical Activity screening tool. Children completed a test of their ability to recall four words after a 60-s distraction task, an assessment of working memory. Multiple linear regression models were used to test the association of children's working memory with each family behavior, adjusting for children's sex, age, mother's age and education, and subjective social status and then also adjusting for children's age- and sex-specific body mass index percentile (BMI-P) and covariates. Higher frequency of breakfast intake was significantly associated with working memory (ß = 0.57, p = 0.013). This association was independent of children's BMI-P. Other family behaviors (frequent family mealtimes, limiting screen time, and others) were not significantly associated with children's working memory. Frequent breakfast intake could benefit young children's working memory, regardless of their weight status. This association merits further investigation.

[Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile]. / Influencias familiares en las prácticas de alimentación materna a niños preescolares de familias vulnerables de la Región Metropolitana de Chile.

OBJECTIVE: To explore family members' influences on mothers' feeding practices of preschoolers in Chilean families residing in vulnerable neighborhoods from the Metropolitan Region of Santiago, Chile. DESIGN: Qualitative study. LOCATION: Nine child care centers in Región Metropolitana, Santiago, Chile. PARTICIPANTS: Twenty-four mothers and one father of preschool children. METHOD: Photo-elicitation techniques were applied to 25 semi-structured interviews and their subsequent inductive thematic analysis of family influences. RESULTS: The participants described that the family influences on their feeding practices depended on the family structure and the interpersonal closeness between relatives. Some influences directly affected child eating behavior, especially in relatives who live together, while others were mediated by the relationships generated between parents and other members of the family. Fathers, in two-parent families, and grandparents are the most influential relatives on the participants' feeding practices. Generally, fathers participated and were in line with the mother's feeding practices of their children. Grandparents enriched their grandchildren's eating experiences by offering homemade preparations, expressing affection with food, including unhealthy options, and supporting parents to diversifying and structuring feeding practices. CONCLUSIONS: According to their interpersonal closeness or cohabitation, parental feeding practices and child eating behaviors were impacted by family members and their dynamics. The development of strategies to prevent and treat childhood obesity should consider a family approach in vulnerable families.

Role of Community Health Workers in Addressing Dementia: A Scoping Review and Global Perspective.

The current increase in global dementia prevalence deserves public health intervention. While limited access to health care and a shortage of health care workers are significant shortcomings, utilizing community health workers (CHWs) could be a promising way to improve dementia care through cost-effective approaches. This scoping review synthesizes existing research on roles of CHWs in dementia-related services. PubMed, CINAHL, Scopus, CABI Global Health, Web of Science, PsycINFO, and Cochrane Library were searched from inception to October 2, 2019, and yielded 1,594 articles. Five broad areas emerged as potential roles of CHWs from 10 eligible articles: educational and community awareness, screening for dementia, screening for HIV-associated dementia, utilization of health care systems and other dementia-related resources by patients, and services to dementia caregivers. This scoping review sheds light on important contributions of CHWs in addressing dementia among vulnerable communities/groups around the world.

From culture to chromosomes: A mother-child dyadic study of acculturation, telomere lengths and body fat.

Studies suggest that telomere lengths, a biomarker of aging, could also capture the physiological weathering attributable to poor health behaviors and adverse experiences, particularly those experienced in early life. For these reasons, we propose that telomere lengths may be a pivotal biomarker for measuring the heightened susceptibility to illness resulting from the cumulative exposure to acculturation to the US culture. This binational study used an Actor-Partner Interdependence Model to test if maternal acculturation to the US moderates the cross-sectional associations of telomere lengths with percentage of body fat (PBF) among Mexican women, among their children, and the intergenerational associations of mother and children telomere lengths with each other's PBF. Low income Mexican child-mother dyads (n â€‹= â€‹108 dyads) were recruited to participate in this cross-sectional study in Mexico and the US. The pooled dataset included measurements of maternal acculturation to the US, mother and children's salivary telomere lengths, PBF measured through bioelectrical impedance, and demographic characteristics. Results showed that the influences of maternal acculturation in the associations of telomere lengths with PBF were different for mothers and their children: Among mothers with higher maternal acculturation to the US, longer salivary telomere lengths were associated with lower PBF. In contrast, among mothers with lower maternal acculturation to the US, salivary telomere lengths were not associated with PBF. There were no significant associations between children's salivary telomere lengths and PBF, and the null associations did not vary across different levels of maternal acculturation to the US. Future longitudinal studies are needed to determine whether acculturation to the US (experienced through immigration or remotely) influences the association of telomere length attrition with obesity risks among immigrant and non-immigrant Mexican children and adults.

Re-thinking Physical Activity Programs for Older Brazilians and the Role of Public Health Centers: A Randomized Controlled Trial Using the RE-AIM Model.

Background: Explored the role of public health centers in the delivery of physical activity programs to older Brazilians. Methods: Total of 114 older adults (81% women) from public health centers across the city of Florianopolis, Brazil, were randomized into three groups: behavior change group (n = 36), traditional exercise group (n = 52), and control group (n = 26). The behavioral change group included 12 weekly meetings (2 h each). The traditional exercise group offered a 12-week exercise class. Individuals in the control group participated only in measurements. Program evaluation included a mixed-methods approach following the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). Trained interviewers conducted 12 focus groups and 32 interviews with participants in the program, professionals delivering the programs, community health workers, and local and city administrators overseeing public health centers. Participants completed health, quality of life, and fitness assessments at four time points. Results: The study reached 11.5% of the eligible population in the community. Older adults' resistance to change and limited understanding of behavior change science by public health center staff hindered program reach. Physician encouraging patient participation and personal invitations by community health workers were perceived as favorable factors. Results of program effectiveness and maintenance suggest that behavior change strategies may be better suited than traditional exercise classes for decreasing sedentary time and increasing moderate-to-vigorous physical activity, as well as improving participants' quality of life. Only 14% of public health centers in the city adopted the programs. Heavy workload of health educators delivering the programs and limited physical space for program delivery were barriers for adoption. The fidelity of program delivery was high and indicates that the programs are culturally-appropriate for the Brazilian context and feasible for implementation by local health educators. Conclusions: Our findings support the potential for dissemination of behavior change and traditional exercise programs to older adults through public health centers in Brazil. REBEC: RBR-9pkxn2 (retrospectively registered) Register April 20, 2019.

Anthropometric cutoff points to identify lipodystrophy characteristics in people living with HIV/AIDS: an observational study / Puntos de corte antropométricos para identificar las características de la lipodistrofia en personas que viven con VIH/SIDA: un estudio observacional

Introduction: currently, there is no consensus regarding accurate and low-cost methods for diagnosing lipodystrophy in people living with HIV/ AIDS (PLWHA). The aim of this study was to propose anthropometric cutoff points for the diagnosis of lipodystrophy among PLWHA. Methods: we included 106 PLWHA (men = 65, women = 41) who are under antiretroviral therapy and have been clinically classified into either a "lipodystrophy" or "non-lipodystrophy" group. Anthropometric measurements included 19 regions of body perimeters and 6 skinfold thickness measures. The Youden index was used to establish anthropometric cutoff points for the diagnosis of lipodystrophy, using the mean values of the anthropometric data (referred to as "original") along with the "Z index" (ZI) values, which were adjusted by the "Phantom Strategy." The cutoff points were proposed when "original" anthropometric measurements and ZI values had a statistical significance of p < 0.01 and an area under the curve (AUC) higher than 70%. The size effect was assessed to verify the influence of lipodystrophy on each anthropometric measure. Results: our data analysis proposes sex-specific cutoff points for the diagnosis of lipodystrophy in PLWHA - 17 points using the "original" anthropometric measurements, and 20 using the ZI values (average effect size between 1.0 and 1.1, and AUC = 76.7% and 78%). Conclusions: our study proposes accurate cutoff points for the diagnosis of lipodystrophy using "original" anthropometric measurements and ZI values adjusted by the "Phantom Strategy." Our findings support the use of anthropometric measurements as a simplified method for diagnosing lipodystrophy and monitoring body composition alterations in people living with HIV/AIDS

Introducción: no existe consenso con respecto a métodos precisos y de bajo coste para diagnosticar la lipodistrofia en personas que viven con VIH/SIDA (PVVS). El objetivo de este estudio es proponer puntos de corte antropométricos para el diagnóstico de lipodistrofia entre las PVVS. Métodos: se incluyeron 106 PVVS (hombres = 65, mujeres = 41) en tratamiento antirretroviral que se clasificaron clínicamente en dos grupos de "lipodistrofia" o "no lipodistrofia". Las mediciones antropométricas incluyeron 19 regiones de parámetros corporales y 6 medidas de pliegues cutáneos. El índice de Youden se utilizó para establecer puntos de corte antropométricos para el diagnóstico de lipodistrofia utilizando la media de los datos antropométricos (denominados "originales") junto con los valores del "índice Z" (IZ), que fueron ajustados por la "estrategia Phantom". Los puntos de corte se propusieron cuando las mediciones antropométricas "originales" y los valores de IZ fueron estadísticamente significativos con un valor p < 0,01 y un área bajo la curva (AUC) superior al 70%. Se evaluó el tamaño del efecto para verificar la influencia de la lipodistrofia en cada medida antropométrica. Resultados: se propusieron puntos de corte específicos según el sexo para el diagnóstico de lipodistrofia en PVVS: 17 puntos usando las medidas antropométricas "originales" y 20 usando los valores de IZ (tamaño del efecto promedio entre 1.0 y 1.1, y AUC = 76.7% y 78%). Conclusiones: se propusieron puntos de corte antropométricos para el diagnóstico de lipodistrofia. Las mediciones antropométricas son un método simplificado para diagnosticar y monitorear los cambios de composición corporal en las PVVS

Anthropometric cutoff points to identify lipodystrophy characteristics in people living with HIV/AIDS: an observational study.

INTRODUCTION: Introduction: currently, there is no consensus regarding accurate and low-cost methods for diagnosing lipodystrophy in people living with HIV/AIDS (PLWHA). The aim of this study was to propose anthropometric cutoff points for the diagnosis of lipodystrophy among PLWHA. Methods: we included 106 PLWHA (men = 65, women = 41) who are under antiretroviral therapy and have been clinically classified into either a "lipodystrophy" or "non-lipodystrophy" group. Anthropometric measurements included 19 regions of body perimeters and 6 skinfold thickness measures. The Youden index was used to establish anthropometric cutoff points for the diagnosis of lipodystrophy, using the mean values of the anthropometric data (referred to as "original") along with the "Z index" (ZI) values, which were adjusted by the "Phantom Strategy." The cutoff points were proposed when "original" anthropometric measurements and ZI values had a statistical significance of p < 0.01 and an area under the curve (AUC) higher than 70%. The size effect was assessed to verify the influence of lipodystrophy on each anthropometric measure. Results: our data analysis proposes sex-specific cutoff points for the diagnosis of lipodystrophy in PLWHA - 17 points using the "original" anthropometric measurements, and 20 using the ZI values (average effect size between 1.0 and 1.1, and AUC = 76.7% and 78%). Conclusions: our study proposes accurate cutoff points for the diagnosis of lipodystrophy using "original" anthropometric measurements and ZI values adjusted by the "Phantom Strategy." Our findings support the use of anthropometric measurements as a simplified method for diagnosing lipodystrophy and monitoring body composition alterations in people living with HIV/AIDS.

INTRODUCCIÓN: Introducción: no existe consenso con respecto a métodos precisos y de bajo coste para diagnosticar la lipodistrofia en personas que viven con VIH/SIDA (PVVS). El objetivo de este estudio es proponer puntos de corte antropométricos para el diagnóstico de lipodistrofia entre las PVVS. Métodos: se incluyeron 106 PVVS (hombres = 65, mujeres = 41) en tratamiento antirretroviral que se clasificaron clínicamente en dos grupos de "lipodistrofia" o "no lipodistrofia". Las mediciones antropométricas incluyeron 19 regiones de parámetros corporales y 6 medidas de pliegues cutáneos. El índice de Youden se utilizó para establecer puntos de corte antropométricos para el diagnóstico de lipodistrofia utilizando la media de los datos antropométricos (denominados "originales") junto con los valores del "índice Z" (IZ), que fueron ajustados por la "estrategia Phantom". Los puntos de corte se propusieron cuando las mediciones antropométricas "originales" y los valores de IZ fueron estadísticamente significativos con un valor p < 0,01 y un área bajo la curva (AUC) superior al 70%. Se evaluó el tamaño del efecto para verificar la influencia de la lipodistrofia en cada medida antropométrica. Resultados: se propusieron puntos de corte específicos según el sexo para el diagnóstico de lipodistrofia en PVVS: 17 puntos usando las medidas antropométricas "originales" y 20 usando los valores de IZ (tamaño del efecto promedio entre 1.0 y 1.1, y AUC = 76.7% y 78%). Conclusiones: se propusieron puntos de corte antropométricos para el diagnóstico de lipodistrofia. Las mediciones antropométricas son un método simplificado para diagnosticar y monitorear los cambios de composición corporal en las PVVS.

Use of Geographic Information Systems in Physical Activity Interventions: a Systematic Review.

INTRODUCTION: The promotion of physical activity is inextricably dependent on the environment. This systematic review summarizes studies that used geographic information systems to account for the role of geographic features in the design, implementation, or evaluation of interventions that promoted physical activity. METHODS: Pubmed, ProQuest/PsycInfo, and Cochrane Library were searched for physical activity interventions that employed geographic information systems. The search was conducted with an algorithm that included 10 geographic, 28 intervention, and 9 physical activity search terms. Data were systematically reviewed using a standardized form based on the PICOS framework (participants, interventions, comparison, outcomes, and study design). Quality of the studies included was independently rated on 14 criteria (Registration number CRD42016046011). RESULTS: Search yield 12,518 published articles, of which, 19 studies satisfied our inclusion criteria. Proximity to recreational areas and neighborhood walkability were the most common geographic factors measured in studies of physical activity interventions. Interventions focused on supporting physical activity by providing recreational spaces and adequate infrastructure to participants. Fifteen intervention studies assessed socioeconomic environmental factors along with physical environmental factors. Support groups were introduced by 4 of the interventions to offset social environmental barriers in the geographical environment. Given the lack of consistency in measurements of physical activity, and long-term assessments, it was not possible to determine if findings are attributable to the geographic environment or a novelty effect. CONCLUSION: More research is needed to better understand the physical and social factors within the geographic environment that work as barriers or facilitators of physical activity changes.

Weight Matters-Factors Influencing Eating Behaviors of Vulnerable Women.

Women from low socioeconomic backgrounds are more affected by obesity than men. The influence of weight as a determinant of women's eating behaviors has seldom been studied, especially in Latin America. In this study, we analyzed the food choices of vulnerable women according to their weight status. We conducted photo-elicitation interviews with 31 women from low-income neighborhoods in Santiago, Chile. Weight and height were measured and participants were divided into normal weight (n = 9), overweight (n = 15), and obese groups (n = 7) according to World Health Organization (WHO) body mass index (BMI) categories (p < 0.001). Quantitative and qualitative approaches were used for the analysis. Women in overweight and obese groups described more about their families, temporality, financial issues, and food perception. When weight groups were analyzed separately, more factors explaining eating behaviors were found (mental and physical health, body dissatisfaction, gender role, and obstacles for eating healthy) in the obese group. Results suggest that women with obesity or overweight based their diets on more internal and external factors than did normal weight women. This study contributes to our understanding of why changing behaviors can be difficult in women with obesity. Health care providers should consider these factors in the implementation of programs to address the need for a healthy diet for overweight and obese women.

Geographic and Social Factors Associated With Chronic Disease Self-Management Program Participation: Going the "Extra-Mile" for Disease Prevention.

INTRODUCTION: We examined geographic and social factors associated with participation in the Chronic Disease Self-Management Program (CDSMP) and the Diabetes Self-Management Program (DSMP) implemented at 144 sites in Illinois. METHODS: Programs were delivered by trained facilitators, once per week, during 6 weeks to 1,638 participants aged 50 or older. Of the 1,638 participants, we included in our analysis 1,295 participants with complete geographic information and baseline data on demographic characteristics, health history, and health behaviors. We assessed the following program data: program type (CDSMP or DSMP), workshop location, class size, and number of sessions attended by participants. We geocoded each participant's home address, classified the home address as rural or urban, and calculated the distance traveled from the home address to a workshop. We used linear and logistic regression analyses to examine the associations between participant and program factors with number of sessions attended and odds of program completion by whether participants lived in an urban or rural county. RESULTS: Average program attendance was 4.2 sessions; 71.1% (1,106 of 1,556) completed 4 or more sessions. Most participants enrolled in CDSMP (59.6% [954 of 1,600]), but DSMP had greater completion rates. Less than 7% (85 of 1,295) of our sample lived in a rural county; these participants had better completion rates than those living in urban counties (89.4% [76 of 85] vs 75.6% [890 of 1,178]). Traveling shorter distances to attend a workshop was significantly associated with better attendance and program completion rates among urban but not rural participants. The number of sessions attended was significantly higher when class size exceeded 16 participants. Not having a high school diploma was significantly associated with lower levels of attendance and program completion. CONCLUSION: Participation in CDSMP and DSMP was associated with distance traveled, program type, class size, and education. Increasing participation in self-management programs is critical to ensure participants' goals are met.