BACKGROUND & AIMS: BACKGROUND:In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. METHODS:The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. RESULTS:Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). CONCLUSIONS:Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The aim of this study was to ascertain the equivalence between WHO caries diagnosis criteria and the ICDAS II caries classification scale for comparisons in epidemiological studies. MATERIALS AND METHODS:Two intraoral examinations, one using the ICDAS II caries codes and the other the WHO caries assessment method, were performed in a random sample of 101 children (29 aged 5-6 years, 32 aged 12 and 40 aged 15). Both examinations were performed not more than one month apart by two calibrated examiners (one for ICDAS II criteria, Kappa=0.86, and the other for WHO criteria, Kappa=0.91). The DMFT/dft, DMFS/dfs and caries prevalence (DMFT or dfs>0) indices were obtained in accordance with WHO assessment criteria and by applying 5 cut-off points on the ICDAS II scale. The differences between means were analysed with the Wilcoxon test and those between proportions with the McNemar test. Agreement was determined by the intraclass correlation index and the Kappa statistic. RESULTS:The least differences between the WHO and ICDAS 11 criteria were found at cut-off point 3 (ICDAS 11 codes 3 to 6). The greatest agreement was found at the same cut-off point. CONCLUSION:While the equivalence between both methods used in epidemiological studies does not appear to be clear, possible errors could be reduced by locating this equivalence at cut-off point 3 and not at cut-off point 4.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk. METHODS:From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences. RESULTS:Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes. CONCLUSION:Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:A national Publicly Funded Health Insurance (PFHI) scheme called Pradhan Mantri Jan Arogaya Yojana (PMJAY) was launched by government of India in 2018. PMJAY seeks to cover 500 million persons with an annual cover of around 7000 USD per household. PMJAY claims to be the largest government funded health scheme globally and has attracted an international debate as a policy for Universal Health Coverage. India's decade-long experience of the earlier national and state-specific PFHI schemes had shown poor effectiveness in financial protection. Most states in India have completed a year of implementation of PMJAY but no evaluations are available of this important scheme. METHODS:The study was designed to find out the effect of enrolment under PMJAY in improving utilisation of hospital services and financial protection in Chhattisgarh which has been a leading state in implementing PFHI in terms of enrolment and claims. The study analyses three repeated cross-sections. Two of the cross-sections are from National Sample Survey (NSS) health rounds - year 2004 when there was no PFHI and 2014 when the older PFHI scheme was in operation. Primary data was collected in 2019-end to cover the first year of PMJAY implementation and it formed the third cross-section. Multivariate analysis was carried out. In addition, Propensity Score Matching and Instrumental Variable method were applied to address the selection problem in insurance. RESULTS:Enrollment under PMJAY or other PFHI schemes did not increase utilisation of hospital-care in Chhattisgarh. Out of Pocket Expenditure (OOPE) and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PMJAY or other PFHI schemes. The size of OOPE was significantly greater for utilisation in private sector, irrespective of enrollment under PMJAY. CONCLUSION:PMJAY provided substantially larger vertical cover than earlier PFHI schemes in India but it has not been able to improve access or financial protection so far in the state. Though PMJAY is a relatively new scheme, the persistent failure of PFHI schemes over a decade raises doubts about suitability of publicly funded purchasing from private providers in the Indian context. Further research is recommended on such policies in LMIC contexts.

背景与目标：

BACKGROUND & AIMS: :This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.

背景与目标： : 本文报告了用于口腔健康调查的正畸治疗需求指数 (IOTN) 修改版的可靠性研究结果。使用持续约1.5小时的标准化教学方案，对十二名非专业牙科检查员进行了使用改良IOTN的培训。在进行基于学校的校准练习之后，发现几乎所有的考官都达到了良好或出色的一致性 (平均Kappa = 0.74)。平均敏感性和特异性评分分别为0.90和0.84。改良的IOTN似乎克服了非专业人员在口腔健康调查中经常使用正畸指标的培训和可靠性问题。

BACKGROUND & AIMS: :A total of 479 stool specimens were collected from rural communities of Ubon Ratchathani Province, Thailand and examined by two techniques: the modified Kato thick smear and the direct smear. The prevalence of Opisthorchis viverrini (14.8%), hookworm (10.2%), Sarcocystis spp (4.6%), Taenia spp (2.9%), Strongyloides stercoralis (2.1%), Giardia lamblia (1.2%), Echinostoma spp (0.6%), Ascaris lumbricoides (0.4%), Entamoeba histolytica (0.2%), Chilomastix mesnili (0.2%) and Endolimax nana (0.2%) were determined. The morphology of the Sarcocystis spp sporocysts examined by both procedures looked similar and was found to be easily recognizable. Among these specimens, 22 cases (4.6%) were positive for Sarcocystis infection detected by the modified Kato technique, whereas only one case (0.2%) was detected by both techniques. These differences were found to be statistically significant (p < 0.05), indicating that the modified Kato technique was decidedly more sensitive than the direct smear procedure in identifying Sarcocystis infection. An epidemiological survey was conducted in Khon Kaen Province involving 1124 stool samples using the modified Kato technique. The greatest frequency was Opisthorchis viverrini at 32.0% while the second highest was Sarcocystis spp at 8.0%. The prevalences of hookworm, Echinostoma spp, Taenia spp, Trichuris trichiura and Enterobius vermicularis were 2.7, 2.1, 1.0, 0.2 and 0.2%, respectively. Other than opisthorchiasis, northeastern Thailand may be an endemic area for sarcocystosis. This is the first report of the applicability and potential usefulness of the Kato thick smear technique for the diagnosis of Sarcocystis infection in a field survey.

背景与目标： : 从泰国乌汶府的农村社区收集了总共479个粪便标本，并通过两种技术进行了检查: 改良的加藤厚涂片和直接涂片。viverrini (14.8%)，钩虫 (10.2%)，Sarcocystis spp (4.6%)，带绦虫 (2.9%)，stercoral圆线虫 (2.1%)，贾第鞭毛虫 (1.2%)，棘突虫 (0.6%)，a虫 (0.4%)，溶组织内阿米巴 (0.2%)，测定了Chilomastix mesnili (0.2%) 和Endolimax nana (0.2%)。通过两种程序检查的Sarcocystis spp孢子囊的形态看起来相似，并且易于识别。在这些标本中，通过改良的Kato技术检测到22例 (4.6%) 的肉囊虫感染呈阳性，而通过两种技术仅检测到1例 (0.2%)。发现这些差异具有统计学意义 (p <0.05)，表明改良的Kato技术在鉴定肉囊虫感染方面明显比直接涂片程序更敏感。使用改良的Kato技术在孔敬省进行了流行病学调查，涉及1124个粪便样本。最高的频率是32.0% 的Opisthorchis viverrini，第二高的频率是8.0% 的Sarcocystis spp。钩虫，棘口虫，带绦虫，毛头虫和肠线虫的患病率分别为2.7，2.1，1.0，0.2和0.2%。除opisthorchiasis外，泰国东北部可能是sarcocystosis的流行地区。这是加藤厚涂片技术在现场调查中诊断肉囊虫感染的适用性和潜在实用性的第一份报告。

BACKGROUND & AIMS: OBJECTIVES:This study compares trends in socioeconomic inequalities related to key cardiovascular risk factors in neighbouring countries Northern Ireland (NI) and the Republic of Ireland (RoI). DESIGN:Repeated cross-sectional studies. SETTING:Population based. PARTICIPANTS:3500-4000 in national surveys in NI and 5000-9000 in RoI, aged 20-69 years. MEASURES:Educational attainment was used as a socioeconomic indicator by which the magnitude and direction of trends in inequalities for smoking, diabetes, obesity and physical inactivity in NI and RoI were examined between 1997/1998 and 2007/2011. Gender-specific relative and absolute inequalities were calculated using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) for both countries. RESULTS:In both countries, the prevalence of diabetes and obesity increased whereas levels of smoking and physical inactivity decreased over time. In NI relative inequalities increased for obesity (RII 1.1 in males and 2.1 in females in 2010/2011) and smoking (RII 4.5 in males and 4.2 in females in 2010/2011) for both genders and absolute inequalities increased for all risk factors in men and increased for diabetes and obesity in women. In RoI greater inequality was observed in women, particularly for smoking (RII 2.8 in 2007) and obesity (RII 8.2 in 2002) and in men for diabetes (RII 3.2 in 2002). CONCLUSIONS:Interventions to reduce inequalities in risk factors, particularly smoking, obesity and diabetes are encouraged across both countries.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The purpose of this study was to characterize response rates for mail surveys published in medical journals; to determine how the response rate among subjects who are typical targets of mail surveys varies; and to evaluate the contribution of several techniques used by investigators to enhance response rates.

METHODS:One hundred seventy-eight manuscripts published in 1991, representing 321 distinct mail surveys, were abstracted to determine response rates and survey techniques. In a follow-up mail survey, 113 authors of these manuscripts provided supplementary information.

RESULTS:The mean response rate among mail surveys published in medical journals is approximately 60%. However, response rates vary according to subject studied and techniques used. Published surveys of physicians have a mean response rate of only 54%, and those of non-physicians have a mean response rate of 68%. In addition, multivariable models suggest that written reminders provided with a copy of the instrument and telephone reminders are each associated with response rates about 13% higher than surveys that do not use these techniques. Other techniques, such as anonymity and financial incentives, are not associated with higher response rates.

CONCLUSIONS:Although several mail survey techniques are associated with higher response rates, response rates to published mail surveys tend to be moderate. However, a survey's response rate is at best an indirect indication of the extent of non-respondent bias. Investigators, journal editors, and readers should devote more attention to assessments of bias, and less to specific response rate thresholds.

背景与目标： 目标 : 本研究的目的是描述医学期刊上发表的邮件调查的回复率; 确定作为邮件调查典型目标的受试者的回复率如何变化; 并评估研究人员用于提高响应率的几种技术的贡献。
方法 : 提取了1991年发表的代表321份不同邮件调查的78份手稿，以确定响应率和调查技术。在后续的邮件调查中，这些手稿的113作者提供了补充信息。
结果 : 医学期刊上发表的邮件调查的平均回复率约为60%。但是，响应率根据所研究的主题和所使用的技术而有所不同。已发表的医师调查的平均缓解率仅为54%，非医师的平均缓解率为68%。此外，多变量模型表明，随仪器副本和电话提醒一起提供的书面提醒与响应率相关，比不使用这些技术的调查高出约13%。其他技术，例如匿名性和财务激励措施，与较高的响应率无关。
结论 : 尽管几种邮件调查技术与较高的响应率相关，但对已发布邮件调查的响应率往往适中。但是，调查的回复率充其量是对非受访者偏见程度的间接指示。研究人员，期刊编辑和读者应将更多的注意力放在偏见的评估上，而应减少对特定响应率阈值的关注。

BACKGROUND & AIMS: BACKGROUND:Although primary headache is the most frequent neurological disorder and there is some evidence that the prevalence rates have increased in recent years, no long-term data on the annual prevalence of headache are available for Germany. The objective of the study was therefore to obtain long-term data on the period prevalence of headache in the general population in Germany by means of population-based cross-sectional annual surveys (1995-2005 and 2009). METHODS:These surveys were conducted as face-to-face paper-and-pencil interviews from 1995 through 2004, and from 2005 onwards as computer-aided personal interviews. The reported headaches were self-diagnosed by the interviewees. Per year, approximately 640 trained interviewers interviewed between 10,898 and 12,538 German-speaking individuals aged 14 and older and living in private households in the whole of Germany (response rate: 67.4% and 73.1%, gross samples: 16,026 to 18,176 subjects). A total of more than 146,000 face-to-face interviews were analyzed. RESULTS:The one-year headache prevalence remained stable over the entry period, with 58.9% (95%CI 57.7-60.1) to 62.5% (95%CI 61.3-63.7) (p=0.07). Women showed consistently higher prevalence rates than men (females: 67.3 (95%CI 65.7-68.9) to 70.7% (95%CI 69.1-72.3), males: 48.4% (95%CI 46.5-50.3) to 54.3% (95%CI 52.4-56.2)), and both sexes showed a bell-shaped age dependence with peaks in the 30-39 age group. A stable slightly higher prevalence was observed in urban versus rural areas (p<0.0001), and there was also a significant trend towards higher prevalence rates in groups with a monthly household income larger than 3,500 € (p=0.03). CONCLUSION:The overall headache prevalence remained stable in Germany in the last 15 years.

背景与目标：

BACKGROUND & AIMS: :Cells in the umbilical cord stroma have gained attention in recent years; however, differentiation to certain lineages in humans has been demonstrated in few studies. Unlike bone marrow MSCs, human umbilical cord stroma cells (HUCSCs) are far from being well characterized. This study attempts to describe proliferation, structural, and differentiation properties of these cells to account for their exceptional nature in many aspects. Cellular dynamics, cellular structure, and the degree of transformations during expansion and differentiation into mesenchymal and neuronal lineages were examined in vitro over a 10-month period. Comparisons with human bone marrow MSCs regarding differentiation were performed. HUCSCs in culture revealed two distinct cell populations, type 1 and type 2 cells, that possessed differential vimentin and cytokeratin filaments. Corresponding cells were encountered in cord sections displaying region-specific localization. alpha-Smooth muscle actin and desmin filaments, which were evident in cord sections, diminished through passages. No difference was noted regarding type 1 and type 2 cells in differentiation to chondrogenic, adipogenic, and osteogenic lineages, whereas a preferential differentiation was noted in neuronal lineage. Relative success was achieved by production of chondrocytic spheres and osteogenic monolayers, whereas adipocytes were immature compared with bone marrow MSCs. The presence of neuronal markers suggests that they transform into a certain state of maturity under neurogenic induction. Conclusively, HUCSCs retain their original phenotype in culture without spontaneous differentiation, have a limited lifespan, and bear multipotent stem cell characteristics. Given these characteristics, they may be generally considered progenitor cells if manipulated under appropriate conditions and deserve further study to be potentially used in cell-based therapies.

背景与目标： : 近年来，脐带基质中的细胞受到关注; 然而，在很少的研究中已经证明了对人类某些谱系的分化。与骨髓间充质干细胞不同，人脐带基质细胞 (hucsc) 远未得到很好的表征。本研究试图描述这些细胞的增殖，结构和分化特性，以说明它们在许多方面的特殊性质。在10个月的时间内，在体外检查了细胞动力学，细胞结构以及在向间充质和神经元谱系扩展和分化过程中的转化程度。与人骨髓间充质干细胞进行了分化比较。培养中的hucsc揭示了两个不同的细胞群体，即1型和2型细胞，它们具有不同的波形蛋白和细胞角蛋白细丝。在显示特定区域定位的脐带部分中遇到相应的单元。在脐带切片中明显的 α-平滑肌肌动蛋白和结蛋白细丝通过通道减少。对于1型和2型细胞，在向软骨，成脂和成骨谱系的分化方面没有发现差异，而在神经元谱系中发现了优先分化。通过产生软骨球和成骨单层获得了相对的成功，而与骨髓间充质干细胞相比，脂肪细胞不成熟。神经元标记的存在表明它们在神经源性诱导下转变为某种成熟状态。最终，hucsc在培养中保留了其原始表型，而没有自发分化，寿命有限，并具有多能干细胞特征。鉴于这些特征，如果在适当的条件下进行操作，通常可以将它们视为祖细胞，并且值得进一步研究以潜在地用于基于细胞的疗法。

BACKGROUND & AIMS: :This article addresses the use of photographic comparison as a complementary visual appraisal method in an outdoor thermal perception survey. This survey was carried out during a Ph.D. research exploring how materials and vegetation influence thermal comfort in outdoor public spaces. Objective and subjective thermal perception parameters were combined and quantitative and qualitative research methods were used. The quantitative methods included microclimatic measurements, whilst the qualitative methods comprised observations and spatially localised interviews based on a questionnaire and the photographic comparison. This article explores how such visual research method allowed triangulating findings of this field survey. Three non-edited photographs of outdoor public spaces, under similar summer meteorological conditions but with contrasting spatial features, were shown to respondents to the questionnaire. The photographs depicted undisclosed locations for preventing biased emotional appreciations. Respondents were asked to select the potentially most comfortable and uncomfortable environments depicted. The choice of photographs matched the previous answers on the thermal sensation and evaluation judgement scales. Hence, we discuss the way the visual interpretations by respondents allowed the triangulation of in situ thermal perception data. The extent to which thermal comfort can be interpreted from thermal environments depicted in photographs containing clear visual signs is further discussed. The article concludes on how such a visual appraisal method can be valuable for enriching future qualitative outdoor thermal perception surveys with subjective interpretation of visual data.

背景与目标： : 本文介绍了在户外热感调查中使用摄影比较作为补充视觉评估方法的方法。这项调查是在博士学位期间进行的。研究探索材料和植被如何影响室外公共空间的热舒适性。结合客观和主观热感知参数，采用定量和定性研究方法。定量方法包括微气候测量，而定性方法包括基于问卷调查和摄影比较的观察和空间局部访谈。本文探讨了这种视觉研究方法如何允许对该野外调查的结果进行三角测量。向问卷调查的受访者展示了三张未经编辑的户外公共空间照片，这些照片在夏季气象条件相似但具有相反的空间特征。这些照片描绘了未公开的位置，以防止有偏见的情感欣赏。受访者被要求选择所描绘的潜在最舒适和不舒适的环境。照片的选择与热感觉和评估判断量表上的先前答案相匹配。因此，我们讨论了受访者的视觉解释允许对原位热感知数据进行三角测量的方式。进一步讨论了可以从包含清晰视觉标志的照片中描绘的热环境中解释热舒适性的程度。本文总结了这种视觉评估方法如何通过主观解释视觉数据来丰富未来的定性户外热感调查的价值。

BACKGROUND & AIMS: BACKGROUND:Asthma and allergic diseases have increased in the developed countries. It is important to determine whether the same trends are occurring in the developing countries in Africa. We aimed to determine the time trend in the prevalence of exercise-induced bronchospasm (EIB) and atopic sensitisation over a ten-year period in Ghanaian schoolchildren. METHODS AND FINDINGS:Two surveys conducted using the same methodology ten years apart (1993 and 2003) among schoolchildren aged 9-16 years attending urban rich (UR), urban poor (UP), and rural (R) schools. Exercise provocation consisted of free running for six minutes. Children were skin tested to mite, cat, and dog allergen. 1,095 children were exercised in 1993 and 1,848 in 2003; 916 were skin tested in 1993 and 1,861 in 2003. The prevalence of EIB increased from 3.1% (95% CI 2.2%-4.3%) to 5.2% (4.3%-6.3%); absolute percentage increase 2.1% (95% CI 0.6%-3.5%, p < 0.01); among UR, UP, and R children EIB had approximately doubled from 4.2%, 1.4%, and 2.2% to 8.3%, 3.0% and 3.9% respectively. The prevalence of sensitisation had also doubled from 10.6%, 4.7%, and 4.4% to 20.2%, 10.3%, and 9.9% (UR, UP, and R respectively). Mite sensitisation remained unchanged (5.6% versus 6.4%), but sensitisation to cat and dog increased considerably from 0.7% and 0.3% to 4.6% and 3.1%, respectively. In the multiple logistic regression analysis, sensitisation (odds ratio [OR] 1.77, 95% CI 1.12-2.81), age (OR 0.88, 95% CI 0.79-0.98), school (the risk being was significantly lower in UP and R schools: OR 0.40, 95% CI 0.23-0.68 and OR 0.54, 95% CI 0.34-0.86, respectively) and year of the study (OR 1.73, 95% CI 1.13-2.66) remained significant and independent associates of EIB. CONCLUSIONS:The prevalence of both EIB and sensitisation has approximately doubled over the ten-year period amongst 9- to 16-year-old Ghanaian children irrespective of location, with both EIB and atopy being more common among the UR than the UP and R children.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Understanding socioeconomic disparities in physical activity is important, given its contribution to overall population-wide health and to health disparities. Existing studies examining trends in these disparities have focused exclusively on physical activity during leisure-time and have not investigated the potential moderators of socioeconomic disparities in physical activity. Using self-reported data from the US National Health and Nutrition Examination Survey (NHANES) 2007 to 2016 for 29,039 adults aged 20 years and over we examined education-related disparities in overall (total) moderate-to-vigorous intensity physical activity, and in its sub-components, recreational (leisure-time) and non-recreational (active transportation and work) activity. We also examined if education-related disparities in physical activity were moderated by age, gender, and race/ethnicity. METHODS:Logistic regression models were used to evaluate disparities in physical activity according to education group and their moderation across age, gender, race/ethnicity, and time-period. RESULTS:Overall activity levels (% ≥150 min/week) were highest amongst highly educated adults, yet contrasting education-related disparities were found for recreational and non-recreational activities (active transportation and work), favoring the highest- and lowest-educated groups respectively. Within each domain of activity, associations were moderated by age and race/ethnicity, and by gender for work-based activity. The net result was that education-related disparities in total activity were substantially larger in older adults (P < 0.001) and amongst women (P < 0.001). For example, the estimated difference in the probability of being active in the highest versus the lowest educational groups was 23.1% (95% CI: 19.1, 27.2) amongst those aged ≥60 years, yet 10.8% (95% CI: 7.1, 14.6) amongst those aged 20-39. CONCLUSIONS:Education-related disparities in physical activity persisted from 2007 to 2016. Our results suggest that understanding and addressing these disparities requires assessment of their multiple domains, and identification of the demographic sub-groups for which the disparities are more or less pronounced.

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BACKGROUND & AIMS: BACKGROUND:KwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support the initiation and sustaining of breastfeeding, implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in infant feeding practices in KZN over this time period. METHODS:Two cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N = 4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N = 900). All caregivers aged ≥15 years attending the clinic with infants aged 13- < 16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points. RESULTS:At KIBS1 (May2014- March2015), 4172 interviews were conducted with carers, of whom 3659 (87.6%) were mothers. At KIBS2 (January-August 2017), 929 interviews were conducted which included 788 (84.8%) mothers. Among all carers the proportion exclusively breastfeeding was 44.6 and 50.5% (p = 0.1) at KIBS1 and KIBS2 respectively, but greater improvements in EBF were shown among mothers (49.9 vs 59.1: p = 0.02). There were reductions in mixed breastfeeding among all infants (23.2% vs 16.3%; p = 0.016). Although there was no change in the proportion of carers who reported not breastfeeding (31.9% vs 32.8%; p = 0.2), the duration of breastfeeding among mothers who had stopped breastfeeding was longer at KIBS2 compared to KIBS1 (p = 0.0015). Mothers who had returned to work or school were less likely to be breastfeeding (adjusted odds ratio [AOR] 3.76; 95% CI 3.1-4.6), as were HIV positive mothers (AOR 2.1; 95% CI 1.7-2.6). CONCLUSION:Despite improvements to exclusive breastfeeding, failure to initiate and sustain breastfeeding is a challenge to achieving optimal breastfeeding practices. Interventions are required to address these challenges and support breastfeeding particularly among working mothers and HIV positive mothers.

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BACKGROUND & AIMS: OBJECTIVE:To review evidence of cultural differences in both biologic and nonbiologic factors as possible explanations for variation across cultures in self-reported vasomotor symptoms from surveys. DESIGN:Literature review and cross-sectional and longitudinal comparisons of ethnic groups with respect to patterns of symptom reporting from the Study of Women's Health Across the Nation (SWAN). RESULTS:The evidence to date indicates that cultural differences in vasomotor symptom reporting on surveys reflect both differences in the underlying biology, which ar likely to influence vasomotor symptom occurrence, and differences in nonbiologic sociocultural factors such as attitudes toward menopause, which are likely to be related to vasomotor symptom perception and reporting, CONCLUSIONS:It is important to consider interactions of culture and biology in studies of vasomotor symptoms. Recommendations for future studies include using both open- and closed-ended questions, including measurements of objective indicators such as reproductive hormone concentrations, measuring both culturally related biologic and nonbiologic factors related to vasomotor symptom occurrence or reporting, and using the same general study protocol for multiple cultural groups being compared.

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