Occupational exposure to PBDEs and lead occurred in recyclers. Environmental exposure to arsenic, lead, and mercury occurred in both cohorts. Occupational and environmental remediation are recommended.
ImportanceThe Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy.ObjectiveTo (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference’s association with geographic and temporal factors.Design, Setting, and ParticipantsThis cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022.ExposureCase report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals.Main Outcomes and MeasuresDescriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year.ResultsA total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P < .001) or other screening tests (46 [1.0%] P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25).Conclusions and RelevanceIn this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.
The purpose of this study was to analyze type 2 diabetes (T2D) among adult female Jamaican Maroons, comparing those with and without type 2 diabetes (T2D). A health survey was conducted with a self-selected sample of female heads of household (n=116). Comparisons used analysis of variance/ covariance (ANOVA/ANCOVA), cross tabulations, and logistic regression and resampling with listwise deletion of missing values (n=86). T2D women were significantly older than non-T2D women (71.7 years vs. 57.0 years, p < 0.01). Hip circumference (cm), BMI, fat mass (FM) (kg), and percent body fat were significantly lower in T2D women compared to non-T2D women. Obesity was significantly more frequent in non-T2D women (OR = 0.16, p < 0.05). Notably, waist:hip ratio was higher among T2D women compared to non-T2D individuals (0.95 vs. 0.88, p < 0.04). Mean systolic blood pressure among T2D women (152.8 mmHg) was significantly (p < 0.04) higher than non-T2D females (134.7 mmHg). The estimated prevalence of T2D among Maroon females (16/116) was 13.79% (95% CI: 8.67% -21.24%), which is similar to non-Maroon Jamaican populations. Stepwise multivariate logistic regression showed that women self-reporting T2D tended to have: a higher waist circumference (OR=1.22, p < 0.01), decreased FM(OR=0.71, p < 0.001), higher systolic pressure (OR=1.06, p < 0.007), lower diastolic pressure (OR=0.90, p < 0.02), and a first-degree relative with T2D (OR = 9.11, p < 0.03). This is the first report on T2D in Jamaican Maroons. Abdominal (central) obesity, body composition, and systolic hypertension were associated with T2D. Central fat distribution predicted T2D rather than overweight or obesity per se. The prevalence of T2D in this small sample of women from a genetic isolate in the Blue Mountains of Jamaica was significantly lower compared to admixed urban Jamaicans.
ObjectiveTo analyze variation in the growth status of indigenous children and youth attending bilingual schools, escuelas albergues, for the indigenous population in México.Materials and methodsThe children and youth attended escuelas albergues in 1,009 localities in 21 Mexican states in 2012. Heights and weights of 31,448 boys and 27,306 girls 6–18 years of age were measured by trained staff at each school; the BMI was calculated. The students were divided into five geographic regions for analysis: North, Central, South‐Gulf, South‐Pacific, and South‐Southeast. Growth status was compared to United States reference percentiles (P).ResultsMean heights of children and youth from the five regions varied between P10 and P5 of the reference until about 13 years (girls) and 14 years (boys); subsequently, heights were ≤P5. Mean weights in both sexes were at P25 of the reference between 6 and 12 years, and then varied between P25 and P10 in boys and were ≥P25 in girls. Given the elevated weights relative to heights compared to the reference, mean BMIs of indigenous boys and girls were at or above the reference medians. Children and youth in the North and Central regions were, on average, taller than those in the South‐Pacific and South‐Southeast regions, while heights of those in the South‐Gulf region were generally intermediate. In contrast, mean weights and BMIs differed negligibly among the regions.ConclusionsThe geographic gradient in heights of indigenous children and youth was consistent with a north‐to‐south pattern noted among indigenous adults in studies spanning 1898 through 2013. Variation in height among children and youth likely reflected ethnic‐specific and geographic variation interacting with economic and nutritional factors.
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