RESUMEN
BACKGROUND: The relationships between environmental correlates of adolescent obesity are complex and not yet well defined by current research, especially when considering age and gender. OBJECTIVE: The purpose of this study was to test a model of proximal (home) and distal (neighbourhood) environmental correlates of obesity for adolescent age and gender groups. METHODS: This was a descriptive, cross-sectional study, using the 2007 National Survey of Children's Health of 39 542 children ages 11-17 years. RESULTS: The model fit the data well for early adolescents (ages 11-14 years) (root mean square standard error of approximation [RMSEA] 0.040, 90% confidence interval [CI]: 0.039-0.041; comparative fit index [CFI] 0.947; Tucker-Lewis index [TLI] 0.929) and middle adolescents (ages 15-17 years) (RMSEA 0.037, 90% CI: 0.036-0.038; CFI 0.052; TLI 0.937). The model also fit the data well for boy adolescents (RMSEA 0.038, 90% CI: 0.037-0.039; CFI 0.951; TLI 0.935) and girl adolescents (RMSEA 0.038, 90% CI: 0.037-0.040; CFI 0.949; TLI 0.932). CONCLUSIONS: All models provide loadings of the environmental correlates of adolescent obesity for specific age and gender groups that can be used for early identification of risks and targeted interventions.
Asunto(s)
Conducta del Adolescente/psicología , Obesidad Infantil/prevención & control , Adolescente , Factores de Edad , Niño , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Obesidad Infantil/etiología , Obesidad Infantil/psicología , Características de la Residencia , Factores de Riesgo , Conducta Sedentaria , Factores Sexuales , Medio Social , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Statins represent the largest selling class of cardiovascular drug in the world. Previous randomized trials (RCTs) have demonstrated important clinical benefits with statin therapy. AIM: We combined evidence from all RCTs comparing a statin with placebo or usual care among patients with and without prior coronary heart disease (CHD) to determine clinical outcomes. DESIGN: We searched independently, in duplicate, 12 electronic databases (from inception to August 2010), including full text journal content databases, to identify all statin versus inert control RCTs. We included RCTs of any statin versus any non-drug control in any populations. We abstracted data in duplicate on reported major clinical events and adverse events. We performed a random-effects meta-analysis and meta-regression. We performed a mixed treatment comparison using Bayesian methods. RESULTS: We included a total of 76 RCTs involving 170,255 participants. There were a total of 14,878 deaths. Statin therapy reduced all-cause mortality, Relative Risk (RR) 0.90 [95% confidence interval (CI) 0.86-0.94, P ≤ 0.0001, I(2)=17%]; cardiovascular disease (CVD) mortality (RR 0.80, 95% CI 0.74-0.87, P<0.0001, I(2)=27%); fatal myocardial infarction (MI) (RR 0.82, 95% CI 0.75-0.91, P<0.0001, I(2)=21%); non-fatal MI (RR 0.74, 95% CI 0.67-0.81, P ≤ 0.001, I(2)=45%); revascularization (RR 0.76, 95% CI 0.70-0.81, P ≤ 0.0001); and a composite of fatal and non-fatal strokes (0.86, 95% CI 0.78-0.95, P=0.004, I(2)=41%). Adverse events were generally mild, but 17 RCTs reported on increased risk of development of incident diabetes [Odds Ratio (OR) 1.09; 95% CI 1.02-1.17, P=0.001, I(2)=11%]. Studies did not yield important differences across populations. We did not find any differing treatment effects between statins. DISCUSSION: Statin therapies offer clear benefits across broad populations. As generic formulations become more available efforts to expand access should be a priority.