Background: Cardiovascular health disparities across subpopulations and geographies have been well-documented in urban areas. Evidence suggests that racial minorities and low-socioeconomic groups have high risks of developing cardiovascular diseases (CVD). Residents of the Appalachia also exhibit high rates of CVD, but little is known about the relationships between cardiovascular risk factors, spatial disadvantage, and cardiovascular health outcomes in this region. Thus, this study aimed to examine the independent association between neighborhood factors and subclinical atherosclerosis in an asymptomatic population from central Appalachia. Methods: Community-dwelling asymptomatic individuals (n=210) were screened for Coronary Artery Calcium (CAC), a subclinical marker for coronary atherosclerosis, from January 2010 to January 2014. Based on the standard Agatston Scale, participants were grouped into 4 CAC scores: zero (CAC = 0), mild (CAC = 1-99), moderate (CAC = 100-399) and severe (CAC ≥ 400) to determine the severity of coronary artery disease (CAD). Demographic information (e.g., age, gender, race, and marital status), cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, obesity, smoking, and family history of CAD), and neighborhood level characteristics (racial and socioeconomic characteristics of the population) were used in ordinal logistic regression analyses performed in Stata 14.1. Results: Of the 210 participants, over three-fourths (79%) had a CAC score greater than 1. While 67% of the participants were hypertensive, 80% had hypercholesterolemia, 75% were overweight or obese, 52% had a history of smoking, and 55% had a family history of CAD. There were significant differences in the socioeconomic environment of these residents. Specifically, zip-code median household income was higher for individuals with zero CAC score. Additionally, the zip-code household poverty percentage was higher for those with CAC scores ≥ 1. Although all the neighborhood factors increased the odds of having higher CAC score, none of them were statistically significant. Conclusion: The positive, albeit statistically non-significant, association of adverse neighborhood factors with higher CAC scores suggests the need for larger studies for further understanding of this association. Finally, achieving the Healthy People 2020 goal of reducing or eliminating disparities requires risk factor screening and control in high prevalent areas such as central Appalachia, and understanding the neighborhood level dynamics for CVD.

Objectives: No nationwide paediatric reference standards for bone mineral density (BMD) are available in China. We aimed to provide sex-specific BMD reference values for Chinese children and adolescents (3-18 years). Methods: Data (10 818 participants aged 3-18 years) were obtained from cross-sectional surveys of the China Child and Adolescent Cardiovascular Health in 2015, which included four municipality cities and three provinces. BMD was measured using Hologic Discovery Dual Energy X-ray Absorptiometry (DXA) scanner. The DXA measures were modelled against age, with height as an independent variable. The LMS statistical method using a curve fitting procedure was used to construct reference smooth cross-sectional centile curves for dependent versus independent variables. Results: Children residing in Northeast China had the highest total body less head (TBLH) BMD while children residing in Shandong Province had the lowest values. Among children, TBLH BMD was higher for boys as compared with girls; but, it increased with age and height in both sexes. Furthermore, TBLH BMD was higher among US children as compared with Chinese children. There was a large difference in BMD for height among children from these two countries. US children had a much higher BMD at each percentile (P) than Chinese children; the largest observed difference was at P50 and P3 and the smallest difference was at P97. Conclusions: This is the first study to present a sex-specific reference dataset for Chinese children aged 3-18 years. The data can help clinicians improve interpretation, assessment and monitoring of densitometry results.

The objective of this study was to examine weight status among southern Appalachian adolescents and to identify risk factors for obesity. We analyzed baseline data from the Team Up for Healthy Living study in 2012. Overall, 19.8% of the sample was overweight, and 26.6% was obese. Boys had higher rates of overweight/ obesity than girls (50.5% vs 42.3%). Being male (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.39-2.29), having a mother with a high school education or less (OR = 1.39; 95% CI, 1.05-1.83), or having a father with a high school education or less (OR = 1.57; 95% CI, 1.17-2.09) was associated with a higher prevalence of obesity and a higher body mass index z score (β = 0.131, 0.160, and 0.043, respectively, P < .05). Parental education could be used to identify adolescents with a higher likelihood of obesity.

Background: Health literacy has become an important public health concern. However, a limited number of studies have investigated health literacy in Jiangsu Province of China. Methods: A total of 12,450 residents aged 15-69 years in Jiangsu Province were interviewed face-by-face through multi-stage cluster random sampling. The 2009 questionnaire of health literacy designed by the Ministry of Health of China was used to measure health literacy. The subjects were divided into low grade group (the comprehensive health literacy grade <34 points) and high grade group (the comprehensive health literacy grade ≥ 34 points). Multiple logistic regression was used for the analysis. Results: The knowledge rates about science concept of health, literacy of preventing acute infectious disease, literacy of preventing non-communicable chronic disease, safety and first aid, obtaining and making use of basic medical care, and comprehensive literacy knowledge were 60.02%, 66.80%, 51.85%, 66.84%, 55.27% and 52.46%, respectively. Multiple logistic regression showed that living in rural area, more numbers of household, increased age, less education, agricultural or rural migrant occupation workers, and lower family income were all risk factors for poor status of health literacy (all p values <0.01). Conclusion: The general health literacy level of the residents in Jiangsu Province was low. At least 40% of residents in Jiangsu Province were deficient in health literacy. Health education and promotion intervention may be targeted in this high risk population to improve health literacy.

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Abstract available through American Journal of Epidemiology.

Diabetes is a highly prevalent chronic disease among US adults, and its prevalence among US veterans is even higher. This study aimed to examine the prevalence of and trends in diabetes in US veterans by using data from the US National Health and Nutrition Examination Survey from 2005 through 2014. The overall prevalence of diabetes and undiagnosed diabetes was 20.5% and 3.4%, respectively, and increased from 15.5% in 2005–2006 to 20.5% in 2013–2014 (P = .04). Effective prevention and intervention approaches are needed to lower diabetes prevalence among US veterans and ultimately improve their health status.

In 2008, The American College of Cardiology/American Heart Association/Heart Rhythm Society issued revised guidelines for automatic implantable cardioverter-defibrillators (AICD). We hypothesized that these guidelines have influenced AICD implantation rates.

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