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Background/purpose: Interleukin-6 (IL-6) and C-reactive protein (CRP) are inflammatory makers of potential interest in all-cause and cardiovascular death risk prediction, but their additive explanatory value to established risk factors is not well documented among nonwestern populations., Methods: We investigated the additive value of IL-6 and CRP to the Framingham risk score and lifestyle factors in predicting all-cause and cardiovascular mortality among a population-representative sample of 1023 adults aged 54 years and above in Taiwan., Results: A total of 351 deaths and 82 cardiovascular deaths were identified (median follow-up = 11.2 years). After adjustment for established risk factors, elevated IL-6 and CRP levels were associated with a higher risk of all-cause death: the hazard ratios for the highest risk quartile compared with the lowest quartile were 3.64 (95% confidence interval, 2.44-5.44) for IL-6 and 2.31 (95% confidence interval, 1.62-3.29) for CRP. IL-6 was also significantly associated with cardiovascular mortality. For both all-cause and cardiovascular mortality, IL-6 yielded a substantial and significant increase in the area under the receiver operator characteristic curve (change in the area under the receiver operator characteristic curve = 0.036 and 0.024, respectively), but CRP did not (change in the area under the receiver operator characteristic curve = 0.004 and 0.009, respectively)., Conclusion: Although both IL-6 and CRP were significantly associated with all-cause mortality, only IL-6 provided a substantial improvement in discrimination. Similarly, IL-6 demonstrated a notable prognostic value for predicting cardiovascular mortality, but not CRP. These findings provide further support for the role of inflammation in the deterioration of health at older ages among a nonwestern population., (Copyright © 2017. Published by Elsevier B.V.)

Objectives: This study assesses whether socioeconomic and demographic differences in reported mobility limitations are attributable to differential perceptions of mobility difficulty that result in the differential use of response categories., Methods: Data come from the Social Environment and Biomarkers of Aging Study and its parent study, the Taiwan Longitudinal Study of Aging. Ordered probit models with person-specific cut-points are used to test whether, after controlling for underlying mobility using objective performance measures, cut-points for reporting mobility limitations vary across groups defined by demographic and socioeconomic characteristics., Results: Age is the only characteristic that is consistently associated with the location of the cut-points for reporting mobility difficulty: At the same level of underlying mobility difficulty, older adults are more likely than younger adults are to report difficulty with all tasks except short walks. Other variables showed differences but only for one specific activity, for example, urban residents are more likely to report difficulty running than are rural residents with the same underlying level of mobility function., Discussion: For most mobility activities, there are no systematic differences in the perception of difficulty by individual characteristics. Thus, for older Taiwanese adults, differences in mobility limitations associated with socioeconomic status are more likely to reflect underlying differences in function than differences in how these groups report the same capacity. The usual loss of mobility with age, however, reflects both a decrease in capacity and a lowering of the threshold for reporting difficulty.

The theory of allostatic load describes how the cumulative experience of emotional challenges and stressful events over the life course may take a significant physiological toll on multiple interrelated systems of the body. Various summary measures of these effects have been proposed in the literature, but few studies focus on systematically evaluating them. We use data from a population-based sample of older Taiwanese to compare the explanatory power and cross-sectional predictive performance of several measures of allostatic load for diverse health outcomes. We find that choices regarding which biomarkers to include in a summary measure and how the measure is formed have modest effects across the basic prediction models we evaluate. Our findings suggest that count-based summary measures incorporating risk at both high and low tails and measures that preserve the continuous properties of the biological variables are strategies that may yield stronger predictions of a wider array of health outcomes than other measures. These fundamental insights are useful for researchers in search of empirical formulations of allostatic load and for those who are focused on the development of improved measurement strategies.

Despite the increasing evidence linking aspects of the social environment to a range of health outcomes, important questions remain concerning the precise mechanisms or pathways through which social circumstances exert their influence. Biological pathways are one important area of current research interest. Using data from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, we examined relationships between social environment characteristics and an index of cumulative biological dysregulation ("allostatic load," AL) in near elderly (NE) (aged 54-70) and elderly Taiwanese (aged 71+). Longitudinal data on levels of social integration and extent of social support were used to predict cumulative AL at the final survey year. Linear regression analyses revealed that among the NE, presence of a spouse between 1996 and 2000 was associated with lower AL in 2000 among men, but not women. Among the elderly, ties with close friends and/or neighbors were found to be significantly related to lower AL for both men and women. Perceived qualities of these social relationships did not show consistent associations with AL. This relatively modest set of significant relationships stands in contrast to somewhat stronger patterns of findings from studies in Western societies. Cross-cultural differences between Western societies and an East Asian society such as Taiwan raise the intriguing possibility that contextual, normative influences on social experience affect the patterns of association between features of these social worlds and the physiological substrates of health.

Objectives: This study examines the relatively low use of modern pregnancy-related care in Guatemala, especially among indigenous women, and explores the role of socioeconomic status, social and cultural variables, and access to biomedical health facilities in accounting for ethnic differences in care., Methods: The data for the analysis come from the Guatemalan Survey of Family Health--a population-based survey of rural women that contains detailed data on care received during pregnancy and delivery along with extensive background information. Binomial and multinomial logit models are used to identify the variables that affect the likelihood of receiving different types of care during pregnancy and delivering in a medical facility and the extent to which sociocultural factors and measures of access account for the observed ethnic differences., Results: The estimates not only confirm previous findings of a large ethnic difference in the use of modern pregnancy-related care, but also extend them by identifying a gradient within the indigenous population. The analysis demonstrates that, in general, sociocultural variables are more strongly associated with modern pregnancy-related care than are measures of access and that the former variables explain more of the ethnic variation in care than the latter. The results also demonstrate that pregnant women, especially indigenous women, are more likely to seek biomedical care in conjunction with traditional midwifery care rather than to rely solely on the former., Conclusion: The findings suggest that midwives are likely to continue to be key providers of pregnancy-related care in the future, even as access to modern health facilities improves. Current efforts directed toward the training and integration of midwives into the formal health system are likely to be much more effective at improving pregnancy-related care than the replacement of midwives with biomedical providers.

Context: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy., Methods: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use., Results: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age., Conclusions: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.

Context: The personal and social costs associated with teenage pregnancy in the United States concern many policymakers and researchers, yet the role of contraception in preventing these pregnancies has not been adequately quantified., Methods: Published estimates of contraceptive effectiveness were applied to 1995 National Survey of Family Growth data on sexual and contraceptive practices in order to estimate the number of pregnancies averted through the use of contraceptives by U.S. teenagers. Four scenarios of contraceptives access--from current levels of access to highly restricted access--and teenagers' sexual and contraceptive practices in response to such restrictions are used to project the potential impact on pregnancies among teenagers., Results: Current levels of contraceptive use averted an estimated 1.65 million pregnancies among 15-19-year-old women in the United States during 1995. If these young women had been denied access to both prescription and over-the-counter contraceptive methods, an estimated one million additional pregnancies (ranging from 750,000 to 1.25 million) would have occurred, assuming some decrease in sexual activity. These pregnancies would have led to 480,000 live births, 390,000 abortions, 120,000 miscarriages, 10,000 ectopic pregnancies and 37 maternal deaths., Conclusions: Contraceptive use by teenage women prevents pregnancies and negative pregnancy-related health consequences that can disrupt the lives of adolescent women and that have substantial societal costs. Continued and expanded access to contraceptives for adolescents is a critically important public health strategy.

Objective: To determine the association between parent-reported behavior problems and health care utilization, especially among physically healthy children., Design: Analysis of data from the 1988 National Health Interviews Survey--Child Health Supplement. The sample for analysis consisted of 11,840 children aged 5 to 17 years. The independent measure of primary interest are behavior problems as measured by the Behavior Problems Index. For the bivariate analysis, children in the lowest quartile, highest quartile and middle half were compared. For the multivariate analysis, children in the highest quartile with behavior problems were compared with all other children., Main Outcome Measures: The number of reported physician visits in the past year and the past 2 weeks, Two common behavior syndromes--antisocial and depressed or anxious--were analyzed separately to determine whether a specific type of behavior problem was associated with frequent health care utilization., Results: Eighteen percent of the children aged 5 to 17 years had four or more health visits during the past year, and 2% had two or more visits during the past 2 weeks. Children in the top quartile for parent-reported behavior problems were more likely to have four or more physician visits than children in the middle half and bottom quartile. Children reported to be in "excellent," "very good," or "good" health who were in the top quartile of behavior problems were more likely to report four or more physician visits during the past year, but no statistically significant differences were seen among children reported to be in "fair" or "poor" health. Controlling for confounding variables, children in the top quartile of the Behavior Problems Index are significantly more likely to report four or more visits during the past year and two or more visits during the past 2 weeks compared with other children. Anxious or depressed and antisocial subscales of the Behavior Problems Index showed independent and significant associations with four or more physician visits in the past year., Conclusion: Children with parent-reported behavior problems are likely to have more frequent physician visits compared with children without behavior problems, even when confounding sociodemographic and health status variables are controlled. The association is concentrated among physically healthy children.