Background Walking or bicycling to school (ie, active commuting) has shown promise for improving physical activity and preventing obesity in youth. Our objectives were to examine, among US youth, whether active commuting was inversely associated with adiposity and positively associated with moderate-to-vigorous physical activity (MVPA). We also examined whether MVPA mediated the relationships between active commuting and adiposity. Methods Using data of participants aged 12 to 19 years from the US National Health and Nutrition Examination Survey 2003 to 2004 (n = 789 unweighted), we constructed multiple linear regression models that controlled for dietary energy intake and sociodemographics. The main exposure variable was active commuting. The outcomes were BMI z-score, waist circumference, skinfolds and objectively measured MVPA. The product-of-coefficients method was used to test for mediation. Results Active commuting was inversely associated with BMI z-score (β = −0.07, P = .046) and skinfolds (β = −0.06, P = .029), and positively associated with overall daily (β = 0.12, P = .024) and before- and after-school (β = 0.20, P < .001) MVPA. Greater before- and after-school MVPA explained part of the relationship between active commuting and waist circumference (Sobel z = −1.98, P = .048). Conclusions Active commuting was associated with greater MVPA and lower measures of adiposity among US youth. Before- and after-school MVPA mediated the relationships between active commuting and waist circumference.

Background: Thyroid cancer incidence is increasing, potentially due to enhanced diagnostic practices. However, access to healthcare may be dependent on socioeconomic status (SES) and race/ethnicity. Consequently, certain segments of the population may experience thyroid cancer overdiagnosis as a result of greater access to and use of enhanced diagnostic technology. The current study examined trends by SES in thyroid cancer incidence at the census tract level from 1995 to 2008 for the population of Texas, as well as by racial/ethnic subgroup. Methods: Joinpoint regressions were used to examine incidence trends over time by SES for the study population, and for the non-Hispanic white, non-Hispanic black, and Hispanic subgroups separately. Other race/ ethnicities were not adequately represented for subgroup analyses. Results: There were 22,390 incident thyroid cancer cases (65.0% white, 6.7% black, 24.3% Hispanic, 4.1% Asian/ other races; 85.9% papillary histology). The low SES group experienced a steady increase in incidence since 1995 (6.7% per year, p < 0.05), whereas incidence among the high SES group has increased at a rate of 8.6% per year since 1999 ( p < 0.05). The joinpoint projected incidence trends for the low and high SES groups were significantly different ( p = 0.047). Whites experienced a steady increase in incidence over time among both high and low SES groups (7.6% per year p < 0.05), whereas blacks and Hispanics of higher SES had a much more pronounced increase in incidence over time relative to their lower SES counterparts (blacks = 12.8% vs. 4.1%; Hispanics = 11.2% vs. 8.3%, p < 0.05). For blacks and Hispanics, joinpoint projected incidence trends for the low and high SES groups were significantly different from one another ( p < 0.001-0.004). Conclusions: These results identify groups experiencing the greatest problem of increasing thyroid cancer incidence, and raise concern that greater access to healthcare may be accompanied by thyroid cancer overdiagnosis. A dual focus on delineating and preventing disease-related causal factors and focusing clinical attention on avoiding overdiagnosis among certain populations (e.g., high SES) may be advisable to address thyroid cancer in Texas. Clinicians are encouraged to adhere to ATA/NCCN guidelines when choosing patients for thyroid ultrasound, selecting which nodules to examine, and deciding which patients should proceed to biopsy.

No abstract

The β5 subunit of the proteasome has been shown in worms and in human cell lines to be regulatory. In these models, β5 overexpression results in upregulation of the entire proteasome complex which is sufficient to increase proteotoxic stress resistance, improve metabolic parameters, and increase longevity. However, fundamental questions remain unanswered, including the temporal requirements for β5 overexpression and whether β5 overexpression can extend lifespan in other species. To determine if adult-only overexpression of the β5 subunit can increase proteasome activity in a different model, we characterized phenotypes associated with β5 overexpression in Drosophila melanogaster adults. We find that adult-only overexpression of the β5 subunit does not result in transcriptional upregulation of the other subunits of the proteasome as they do in nematodes and human cell culture. Despite this lack of a regulatory role, boosting β5 expression increases the chymotrypsin-like activity associated with the proteasome, reduces both the size and number of ubiquitinated protein aggregates in aged flies, and increases longevity. Surprisingly, these phenotypes were not associated with increased resistance to acute proteotoxic insults or improved metabolic parameters.

Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.

Hereditary haemochromatosis, one of the most common genetic disorders in the United States, can produce systemic iron deposition leading to end-organ failure and death if untreated. The diagnosis of this condition can be challenging as elevated serum ferritin may be seen in a variety of conditions, including acute and chronic liver disease, a range of systemic inflammatory states, and both primary and secondary iron overload syndromes. Appropriate and timely diagnosis of haemochromatosis is paramount as simple interventions, such as phlebotomy, can prevent or reverse organ damage from iron overload. The recognition of other aetiologies of elevated ferritin is also vital to ensure that appropriate intervention is provided and phlebotomy only utilized in patients who require it. In this review, we summarize the existing data on the work up and management of hereditary haemochromatosis and present a practical algorithm for the diagnosis and management of this disease.

Objectives To explore associations between subjective social status (SSS) and smoking level among 2274 adult current smokers. Methods Associations were investigated using a covariate-adjusted proportional odds cumulative logit model. Moderation (via race/ethnicity or sex) and mediation (via depressive symptoms, social/emotional support, or life satisfaction) were explored in additional models. Results Higher SSS was associated with greater likelihood of nondaily versus light daily or moderate/ heavy daily smoking (p = .017). Life satisfaction partially mediated the association of SSS and smoking level (p = .003). Conclusions Higher SSS was associated with greater likelihood of nondaily relative to light daily or moderate to heavy smoking, potentially via greater life satisfaction. Additional studies are needed to confirm these findings.

The efficacy of tobacco treatment delivered by state quitlines in diverse populations is well-supported, yet little is known about associations between treatment dose and cessation outcomes following the implementation of Ask-Advise-Connect (AAC), an electronic health record-based systematic referral process that generates a high volume of proactive calls from the state quitline to smokers. The current study is a secondary analysis of a 34-month implementation trial evaluating ACC in 13 safety-net clinics in Houston, TX. Treatment was delivered by a quitline and comprised up to five proactive, telephone-delivered multi-component cognitive-behavioral treatment sessions. Associations between treatment dose and abstinence were examined. Abstinence was assessed by phone six months after treatment enrollment, and biochemically confirmed via mailed saliva cotinine. Among smokers who enrolled in treatment and agreed to follow-up (n = 3704), 29.2% completed no treatment sessions, 35.5% completed one session, 16.4% completed two sessions, and 19.0% completed ≥three sessions. Those who completed one (vs. no) sessions were no more likely to report abstinence (OR: 0.98). Those who completed two (vs. no) sessions were nearly twice as likely to report abstinence (OR: 1.83). Those who completed ≥three (vs. no) sessions were nearly four times as likely to report abstinence (OR: 3.70). Biochemically-confirmed cessation outcomes were similar. Most smokers received minimal or no treatment, and treatment dose had a large impact on abstinence. Results highlight the importance of improving engagement in evidence-based treatment protocols following enrollment. Given that motivation to quit fluctuates, systematically offering enrollment to all smokers at all visits is important.