text:
Former Rosanero midfielder Corini is the third man to take charge at the Stadio Renzo Barbera this season, with Davide Ballardini having been sacked after just two games while De Zerbi was given his marching orders following the Coppa Italia penalty shoot-out defeat to Serie B side Spezia on Wednesday.
That loss extended Palermo's losing run to eight matches in all competitions while they have lost all seven of their home matches in Serie A this season, leaving them at the foot of the table.
Corini looks like he has a tough job on his hands, as he takes charge of his fifth different club, but he does have experience of surviving relegation against the odds after guiding Chievo to safety in 2013.
"I'm happy and excited, I'm aware that hard work is waiting for me but I'm used to carrying out such an arduous task," said Corini, who made over 100 appearance for Palermo during his five years with the club as a player.
"I gladly accepted President Zamparini's invitation for me to return to Palermo, but I still haven't met him. With desire, commitment and strength, but above all togetherness, I'm convinced that we can stay up."


text:
- sort by:
53 properties in Stockport (Greater Manchester)Did you mean?
- Check you have entered the location correctly.
- Alternatively enter another alternative location or adjust your search criteria.
- If 'no results' continues to show, we may not have any properties for sale in your desired location.
4 Bedroom Detached House For Sale
Chester Road, Hazel Grove, Stockport, SK7
A spacious four bedroom detached family home. This well cared for home is in move in condition and is a credit to the current house proud owner. This home offers flexible living accommodation throughout and has potential to convert the garage to create a superb open...
4 Bedroom Detached House For Sale
Glenside Drive, Woodley, Stockport, SK6
This beautiful family home has been much improved by the current house proud owners and represents an ideal purchase for a family looking for a ready to move into home. The property has four good sized bedroom, large living room, recently fitted kitchen diner, two...
3 Bedroom Detached House For Sale
Lisburne Lane, Stockport, Greater Manchester, SK2
A truly stunning spacious period detached home. This fantastic home is in move in condition yet does require some updating. The home has been well cared for by the current house proud owner and will surely appeal to someone looking to put their own stamp on things...
3 Bedroom Detached House For Sale
Little Falls Lodge, The Crescent, Davenport, SK3
Offered chain free and situated on a large plot this detached three bedroom property offers a superb option for a growing family or people looking to downsize. The accommodation comprises large lounge diner, shower room and stunning kitchen diner downstairs whilst...
3 Bedroom Semi Detached House For Sale
Hartington Drive, Hazel Grove, Stockport, SK7
A superb three bedroom semi detached home. This home has undergone a full refurbishment to a very high standard by the current house proud owner. The home has a spacious fitted kitchen which opens through to a fantastic size living dining area. There is also a...
4 Bedroom Semi Detached House For Sale
Emlyn Grove, Cheadle, Greater Manchester, SK8
An immaculate, heavily extended four bedroom semi-detached family house sitting within one of the areas most popular and sought after residential estates. Currently undergoing an extensive refurbishment programme accommodation comprises:- living room, large modern...
3 Bedroom Semi Detached House For Sale
Crossmoor Crescent, Romiley, Stockport, SK6
Extended three bedroom semi-detached situated in a highly desirable area of Romiley. The well presented accommodation consists of entrance hall, lounge/diner, study/ hobby room, kitchen/ breakfast room, three bedrooms, bathroom and Wc. There is an additional loft room...
3 Bedroom Detached House For Sale
Conway Drive, Hazel Grove, Stockport, SK7
A spacious detached home in a prime location with outstanding schools within walking distance. This fantastic home could not be better located for ease of life with excellent local amenities on your doorstep and excellent schools close by. The home has recently been re
3 Bedroom Semi Detached House For Sale
Sunningdale Drive, Bramhall, Stockport, SK7
A well proportioned three bedroom semi detached property situated within a popular and convenient location offering excellent living space throughout with part UPVC double glazing and gas fired central heating. In brief the layout comprises: entrance porch, lounge...
3 Bedroom Detached House For Sale
Sandpiper Drive, Stockport, Greater Manchester, SK3
An impeccable and modern three double bedroom detached family home, situated at the head of a quiet cul-de-sac offering contemporary accommodation. Upgraded to a very high standard by its current owner, this home must be viewed to appreciate the quality on offer. With...
- sort by:
- Single Property
- Multiple Properties

subset: commoncrawl


text:
Each month, Rated People connects over 50,000 homeowners with quality tradesmen - simply enter your job details in the form above to get started.
We'll match your job to the relevant tradesmen in your area - those interested will pay to see your contact details and call you to quote.
As each tradesman expresses interest in quoting on your job, we'll send you their profile and ratings to help you choose the right one for you.
After the work is complete, return to the site and rate your tradesman based on their quality of work, reliability and value for money.
Painter / Decorator
Added 23/02/2017
Services required: wallpapering - unpatterned 1 x bedroom I require someone to hang wallpaper...
Painter / Decorator
Added 17/05/2016
Services required: painting 1 x bedroom A small job but needs doing urgently for a house...
Painter / Decorator
Added 16/05/2016
Painting the outside of a small house including Windows
Painter / Decorator
Added 28/07/2015
My husband and I live in a 1930's bay fronted house in Eldon Road. We would like the exterior...
Painter / Decorator
Added 15/07/2015
Services required: wallpapering - unpatterned 1 x dining room Wallpaper on one wall approx...
Painter / Decorator
Added 02/07/2015
Paint exterior of a large semi detached house in Cheltenham. 7m to eaves, can full scaffolding...
Very tidy . Came when promised. Very satisfied with work done. Would recommend to others.
Victor and his boys were wonderful. He made sure that he knew exactly what we wanted before beginning the work. He was also very knowledgeable and was able to advise us of all available options and their pros and cons. The standard of work done was excellent and his team were polite and courteous. We would not hesitate to recommend Victor to anyone, we were delighted with the work he did for us.
Would highly recommend, they were extremely punctual, friendly and reliable. We booked the job with quite short notice but Natasha and her team where extremely flexible and worked all hours to make sure the work was completed on time. We needed our flat to be painted within a day and they arrived at 7.30am and stayed working until at least 11pm to make sure it was done. Good value and very easy to work with! Will 100% be using again for future jobs
Very professional service
Great team, work completed on time, as requested and for the price agreed. Thanks
Very courteous and helpful, punctual and reliable. I would recommend them to my friends
Managing your job is easier with the Rated People Homes App, download it today.


text:
smooth sailing to east med: Celebrity Reflection Cruise Review by finemusic
Overall Member Rating
smooth sailing to east med
Destination: Europe - Eastern Mediterranean
Embarkation: Other
The next day we took the regional train to the port. It was an hour's ride. The train was very crowded with lots of cruisers. From the train station it was a nice 10 minutes walk to the port gate. There is the shuttle bus that take you to the ship.
Check in was a breeze. We were in our cabin after 30 minutes. The layout of the ship is the same as the Solstice which we took 2 years ago. One let down is the sky lounge. It is half the size of the Solstice because of some additional cabins they added on the port side Instead of 180 degree view we have now only 90 degree, but it is still very beautiful.
We think the food was very good. We had breakfast mainly in the Lido. It was quite busy during sea days, but we had no problem in finding a seat. We dined in the More MDR every night and the service was top notch.
Entertainment was on the weak side. Only dancers and singers except one night the string fever which I think is quite different.
We arranged our own shore excursions in 4 ports which is much cheaper than the ship's. We DIY in Istanbul and Mykonos. They are all beautiful and easy to navigate. In Istanbul you can just follow the tram line and see all the main attraction.
One major complaint was the crew members in guest relation were indifferent. I don't think they were very helpful.
All in all it was still a nice trip even though we enjoyed the Solstice more. Less
Published 08/14/13
Cabin review:
Read Cruise Critic's Celebrity Reflection Review >>
Overall Good
Okay ship but definitely not t...
Lovely luxury!
Enjoyable 1st time with Celebr...
Wonderful Wonderful
Loved everything!
Enjoyable 1st time with Celebr...
Wonderful Wonderful
Pleasantly Surprised with Alas...
Sponsored Links


text:
May 23– June 2
The Annual Community Arts and Crafts Exhibit will be on display from May 23 to June 2 during the Library's regular hours. This is a great opportunity for West Boylston residents and library patrons of all ages to show off their talents. We welcome all kinds of works: sculpture, paintings, handicrafts, quilting, woodcarving, needlework, photography, and more. All entries must be ready for display and submitted before May 19th at 5 p.m. Pictures must be framed and ready to hang, with hooks or string on the back. There is no entry fee, judging, or sale of artwork; there is a maximum limit of three entries per artist.


text: U.S. Supreme Court Delaware Lawmakers to Ensure Abortion Stays Legal By Don Rush • May 9, 2017 creative commons Some Delaware lawmakers are moving to make sure that abortion will still be legal in the state even if the U.S. Supreme Court were to overturn Roe V. Wade that made it a right. Still on the books is a Delaware law that would bar abortion except in a few instances but was made moot by the 1973 court decision. With the possibility that President Trump may appoint enough justices to overturn that ruling State Senator Bryan Townsend says it's time to make sure that a right to an abortion is legal in the First State. Senator Tim Kaine to Filibuster Supreme Court Nominee By Don Rush • Mar 29, 2017 official photo WASHINGTON (AP) - Sen. Tim Kaine is joining with most of his Democratic colleagues and says he will vote to filibuster President Donald Trump's choice of Judge Neil Gorsuch to serve on the Supreme Court. The Virginia Democrat and vice presidential running mate last year for Hillary Clinton cited Gorsuch's opinion that employers have the right to deny government-mandated contraception coverage for their workers in explaining his opposition. Kaine said such rulings "do not demonstrate a philosophy that belongs on the Supreme Court." Supreme Court Turns Down Appeal by Virginia Death Row Inmate By Don Rush • Nov 8, 2016 creative commons WASHINGTON (AP) - The U.S. Supreme Court has again declined to hear the death row case of a man who was convicted of killing a Richmond family of four. The high court denied Ricky Gray's petition for a rehearing Monday after declining last month to hear his appeal. Death Row Inmate to Ask VA Governor for Clemency By Don Rush • Oct 4, 2016 creative commons WASHINGTON (AP) - A Virginia death row inmate convicted of hiring another man to kill his ex-girlfriend is planning to ask Gov. Terry McAuliffe to halt his execution. The U.S. Supreme Court refused Monday to hear Ivan Teleguz's appeal. Attorney Michael Williams said in an email that Teleguz will now ask the Democratic governor for clemency. Williams said McAuliffe will decide "whether to prevent the Commonwealth from executing an innocent man." A McAuliffe spokesman didn't immediately respond to a request for comment. Delaware Judge Reviews Death Penalty Case By Don Rush • Aug 30, 2016 New Castle County Police WILMINGTON, Del. (AP) - A judge is holding a status conference with attorneys regarding a murder suspect whose case led to Delaware's death penalty being overturned by the state Supreme Court. Tuesday's court conference involves Benjamin Rauf, charged with first-degree murder in last year's drug-related killing of 27-year-old Shazim Uppal of Hockessin, a fellow Temple University law school graduate. Prosecutors said they would seek the death penalty. High Court Asked to Weigh In on Virginia Transgender Bathroom Case By Don Rush • Aug 30, 2016 creative commons RICHMOND, Va. (AP) - A Virginia school board is urging the U.S. Supreme Court to weigh in on whether a transgender male must be allowed to use the boys' bathroom at his high school. The Gloucester County School Board formally asked the high court on Monday to overturn an appeals court ruling that said the board's policy barring Gavin Grimm from the boys' restroom violates federal law. Delaware AG Declines Appeal of Death Penalty Decision By Don Rush • Aug 16, 2016 amnestyusa.org DOVER, Del. (AP) - Delaware's attorney general says he will not appeal a state Supreme Court decision declaring the state's death penalty law unconstitutional, but that he believes the ruling cannot be applied retroactively to the 13 men currently on death row. In a statement Monday, Democratic Attorney General Matt Denn's office said he has decided not to appeal the Aug. 2 decision to the U.S. Supreme Court. Supreme Court Blocks Transgender from Boys Restroom By Don Rush • Aug 4, 2016 creative commons RICHMOND, Va. (AP) - The U.S. Supreme Court says a Virginia school board can block a transgender male from using the boy's bathroom at his school until it decides whether to intervene in his case. The high court agreed Wednesday to allow the Gloucester County School board to bar Gavin Grimm from the bathroom that matches his gender identity until the justices decide whether to review an appeals court ruling in his case. Supreme Court Asked to Allow Transgender Teen to Use Boys Restroom By Don Rush • Jul 27, 2016 creative commons RICHMOND, Va. (AP) - An attorney for a transgender teen in Virginia is urging the U.S. Supreme Court not to bar him from using the boys restroom when he returns to school this fall. In a brief filed Tuesday in the high court, Josh Block of the American Civil Liberties Union says the Gloucester County School Board has failed to show that it will be irreparably harmed by allowing Gavin Grimm to use the restroom that corresponds with his gender identity while his case plays out in lower courts. Delay Asked in McDonnell Public Corruption Case By Don Rush • Jul 22, 2016 official photo RICHMOND, Va. (AP) - Prosecutors have asked a federal appeals court to delay action for 30 days on a U.S. Supreme Court ruling in former Virginia Gov. Bob McDonnell's corruption case - to allow both sides time to analyze it. The Richmond Times-Dispatch reports the U.S. Attorney's Office said the motion filed jointly Thursday proposes that parties file a briefing schedule or update the 4th Circuit Court of Appeals on discussions after 30 days. Judicial Panel Hears Challenge to MD Congressional District Maps By Don Rush • Jul 12, 2016 Don Rush BALTIMORE (AP) - A special three-judge panel is hearing arguments in a lawsuit challenging Maryland's congressional districts map. The case being heard Tuesday was filed in June 2015 and argues that Maryland's map violates the U.S. Constitution. The lawsuit seeks to have the maps, which were redrawn in 2011, declared unconstitutional. The hearing in federal court in Baltimore is a result of a U.S. Supreme Court case decided late last year. The case said that certain cases can't be thrown out by a single judge but must first be heard by a three-judge panel. Supreme Court Rejects Challenge to Delaware Campaign Finance Law By Don Rush • Jun 28, 2016 creative commons WASHINGTON (AP) - The Supreme Court is rejecting a conservative group's challenge to a Delaware campaign finance law. The justices on Tuesday left in place a lower court ruling allowing the 2012 law to be enforced. The measure requires third-party groups working independently of candidates to influence elections to disclose the source of donations. Delaware Strong Families challenged the disclosure requirements. Justices Samuel Alito and Clarence Thomas said they would have heard the group's appeal. The case is Delaware Strong Families v. Denn, 15-1234. High Court Asked to Take Ricky Gray Death Row Case By Don Rush • Jun 24, 2016 creative commons RICHMOND, Va. (AP) - The American Bar Association is asking the U.S. Supreme Court to consider a Virginia death row inmate's appeal. The Richmond Times-Dispatch reports that the group says it filed a brief urging the high court to hear Ricky Gray's case because the state court didn't hold an evidentiary hearing before dismissing allegations that his death sentence was imposed in violation of his constitutional rights. High Court Ruling on Race Aids UD Minority Outreach By Don Rush • Jun 24, 2016 creative commons The U.S. Supreme Court ruling that allows race to be considered in college admissions will allow Delaware University campuses to continue their efforts to expand minority representation in a mostly white student body. The Wilmington News Journal reports that in the fall of 2015 75% of the undergraduates were white. That stands in contrast to state's population that is 64 percent white. The News Journal reports that earlier this year among the efforts to expand minority representation the University made SAT scores optional. Pennsylvania Asks Supreme Court to Take Delaware Money Order Suit By Don Rush • Jun 15, 2016 creative commons WILMINGTON, Del. (AP) - Pennsylvania officials have asked a judge to move their federal lawsuit against Delaware to the U.S. Supreme Court. The Wilmington News Journal reports that Pennsylvania is accusing Delaware of wrongfully seizing more than $10 million in unclaimed money orders. Death Row Inmate Asks High Court Review of Ineffective Counsel Argument By Don Rush • Jun 1, 2016 law enforcement RICHMOND, Va. (AP) - A Virginia death row inmate convicted of hiring a man to kill his ex-girlfriend is urging the U.S. Supreme Court to review his case. Ivan Teleguz claims in a petition recently filed with the Supreme Court that he hasn't had a fair opportunity to show that his defense attorneys provided ineffective counsel during his 2006 trial. Teleguz, who's from Ukraine, was set to be executed on April 13. But the Fourth Circuit Court of Appeals temporarily halted Ivan Teleguz's execution in March, pending review of his petition by the nation's highest court. Federal Appellate Court Rejects Overturning Transgender Bathroom Decision By Don Rush • Jun 1, 2016 creative commons RICHMOND, Va. (AP) - A federal appeals court won't reconsider a three-judge panel's ruling that a transgender teen must be allowed to use the boys' restroom at school. The 4th U.S. Circuit Court of Appeals denied the Gloucester County School Board's appeal on Tuesday. The school board had asked for a full-court review after a three-judge panel said schools are bound by Department of Education guidelines, which say students must be allowed to use restrooms corresponding to their gender identity. Virginia Death Row Inmate Takes Case to U.S. Supreme Court By Don Rush • Apr 7, 2016 amnestyusa.org RICHMOND, Va. (AP) - A Virginia death row inmate is taking his case to the U.S. Supreme Court after his execution was stayed by a federal appeals court. The Fourth Circuit Court of Appeals has temporarily halted Ivan Teleguz's execution, pending review of his petition by the nation's highest court. Teleguz was set to be executed on April 13. Teleguz was convicted in 2006 of hiring another man to kill his former girlfriend. Since then, two key prosecution witnesses have recanted. Supreme Court Challenge to Delaware Campaign Finance Law By Don Rush • Apr 5, 2016 Delaware Strong website DOVER, Del. (AP) - A conservative group is taking its fight against a Delaware campaign finance law to the U.S. Supreme Court. Attorneys for Delaware Strong Families filed a petition last week asking the court to hear the case. The group is challenging a 2012 law regarding third-party entities working independently of political candidates to influence elections. Prosecutors Urge DE High Court to Uphold Death Penalty Law By Don Rush • Apr 1, 2016 amnestyusa.org WILMINGTON, Del. (AP) - Prosecutors are arguing to the Delaware Supreme Court that the state's capital punishment process is constitutional, despite two recent U.S. Supreme Court rulings that raise questions about the state's law. Attorneys from the Delaware Department of Justice earlier this week filed a 44-page brief refuting arguments made by public defenders that Delaware's statute is unconstitutional because judges, not juries, have the final say in imposing a death sentence. Delaware High Court Streaming Arguments Live By Don Rush • Mar 9, 2016 Delaware Supreme Court website Starting today you will able to see the Delaware Supreme Court in action in real time. The high court begins live video streaming of non-confidential oral arguments today. In 2004, it began providing audio posts of its recordings of oral arguments. In a press release the court said that live video streaming was the next logical step. The U.S. Supreme Court has provided audio recordings of its proceedings. McDonnell Team Files Brief With High Court in Bribery Case By Don Rush • Mar 1, 2016 official photo RICHMOND, Va. (AP) - Former Virginia Gov. Bob McDonnell's legal team has filed its opening brief with the U.S. Supreme Court, arguing McDonnell was unfairly convicted on an overly broad definition of bribery. McDonnell's legal team said Monday it filed its first brief with the high court. In it, his lawyers say the federal government has interpreted bribery law in a way that allows prosecutors "to investigate and indict essentially any official they choose." Delaware Democrat Says Senate Should Act on High Court Nomination By Don Rush • Feb 24, 2016 official website Senator Chris Coons says that the White House should nominate someone to the U.S. Supreme Court who is confirmable. The Wilmington News Journal reports that the Delaware Democrat told reporters that the Senate should move forward with an appointment by President Obama to replace Justice Antonin Scalia who died earlier this month. Even as Coons was responding to questions by reporters Senate Majority Leader Mitch McConnell was on the floor telling his colleagues that no nominee should be considered until after the presidential election in November. More Plaintiffs in Maryland Redistricting Case By Don Rush • Feb 17, 2016 official map WASHINGTON (AP) - Maryland residents challenging their state's 2011 redrawing of its congressional districts are adding more plaintiffs to their case. A motion submitted in the case Tuesday adds six new plaintiffs to the original three. The case was initially thrown out, but the U.S. Supreme Court ruled in December that was premature. Judge Halts Death Penalty Cases in Delaware By Don Rush • Feb 2, 2016 creative commons DOVER, Del. (AP) - A Superior Court judge has halted all trials and penalty hearings in capital murder cases while Delaware's Supreme Court mulls the constitutionality of the state's death penalty law. The order was issued Monday President Judge Jan Jurden, head of the Superior Court system. Last week, the Supreme Court accepted several questions submitted by a Superior Court judge regarding the roles of judges and juries in Delaware death penalty cases. Exemption for Virginia Clerks on Same Sex Marriage License Pushed By Don Rush • Jan 12, 2016 equality virginia website RICHMOND, Va. (AP) - A Republican lawmaker in Virginia is pushing legislation that would allow clerks to refuse to issue licenses for marriages they object to on moral or religious grounds. Republican Sen. Charles Carrico of Galax said many of his constituents were concerned about what happened to Kim Davis, the Kentucky clerk who spent five days in jail last year for denying licenses to same-sex couples. Federal Judicial Panel Settles on VA Congressional Map By Don Rush • Jan 8, 2016 creative commons RICHMOND, Va. (AP) - A federal court has picked a new congressional map for Virginia that could be in place for this year's election. A three-judge panel on Thursday ordered the state to implement a new redistricting plan suggested by a special expert. Last year the panel concluded for a second time that legislators in 2012 illegally packed black voters into one district in order to make adjacent districts safer for Republican incumbents. Judge Offers Fix for Virginia Congressional District Case By Don Rush • Dec 15, 2015 wikipedia RICHMOND, Va. (AP) - A federal judge has suggested a conditional fix for redrawing Virginia's congressional map. The Richmond Times-Dispatch reports that U.S. District Judge Robert E. Payne made the suggestion during a hearing on Monday. Payne is a member of a three-judge panel that twice ruled legislators in 2012 illegally packed voters into the 3rd congressional district in order to make adjacent districts safer for Republican incumbents. U.S. Supreme Court Revives Challenge to MD Redistricting By Don Rush • Dec 8, 2015 creative commons WASHINGTON (AP) - The Supreme Court has unanimously sided with Maryland residents who say a judge prematurely threw out their challenge to the state's 2011 redrawing of its congressional districts The court ruled Tuesday that federal law requires that the Maryland case be heard by a panel of three judges, not the lone judge who dismissed the challenge. Justice Antonin Scalia said the law "could not be clearer." Supreme Court Hears Challenge to MD Congressional Districts By Don Rush • Nov 5, 2015 official map WASHINGTON (AP) - Maryland residents arguing that their lawsuit over the state's 2011 redrawing of its congressional districts was thrown out prematurely seemed to find some sympathy with justices at the U.S. Supreme Court. During oral arguments Wednesday, the residents' lawyer asked the Supreme Court to agree that that the lawsuit should have been forwarded to a three-judge panel, not dismissed by a single judge. Pages1 2 next › last »


text:
Breast and cervical cancer screening among women in metropolitan areas of the United States by county-level commuting time to work and use of public transportation, 2004 and 2006
Commuting times and behaviors have been associated with a variety of chronic disease outcomes and health behaviors. We examined the relationships between ecologic measures of commuting time and use of public transportation in relation to breast and cervical cancer screening among women in U.S. metropolitan areas who participated in the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys.
Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas (MSAs). Only BRFSS respondents who resided in the 39 MSAs with a population of ≥ 1.5 million in 2007--representing a total of 337 counties--were included in this analysis. A total of 76,453 women aged ≥ 40 years were included in analyses on mammography. Analyses on Pap testing were limited to women aged ≥18 years with no history of hysterectomy (n = 80,959). Area-based measures of socio-economic status (SES) were obtained by utilizing county-level information from the 2000 U.S. Census.
With adjustment for age, no important associations were observed between receipt of a recent mammogram and either a county-level measure of commute time or residence in an area where more residents had access to a car. Similarly, women living in counties where at least four percent of the residents used public transportation were as likely to have had a recent mammogram or Pap test compared with women in areas where less than four percent of residents used public transportation. However, women living in counties where < 2% of residents had no access to a car were somewhat more likely to have had a Pap test in the past 3 years than women in areas where ≥ 3% of the residents had no access to a car (87.3% versus 84.5%; p-value for test for trend < 0.01). In multivariate analysis, living in a county with a median commute time of at least 30 minutes was not significantly associated with having had a Pap test in the past 3 years (adjusted odds ratio (OR) = 1.1, 95% CI 0.9-1.2, p = .50), or with having had a mammogram in the past 2 years (adjusted OR = 0.9, 95% CI 0.9-1.1, p = .28). A weak positive association was observed between residence in a county with less use of public transportation and having had a Pap test in the past 3 years, which was of borderline significance (adjusted OR 1.2, 95% CI 1.0-1.4, p = .05).
In large U.S. metropolitan areas, transportation issues may play a role in whether a woman obtains cancer screening along with other factors (e.g., Hispanic ethnicity, low income, and no physician visit in the past year). In this contextual analysis, a longer commute time was not associated with breast and cervical cancer screening.
Screening mammography is currently the most effective method of detecting breast cancer early and reducing mortality from the disease. Routine use of the Papanicoloau (Pap) test has been associated with reduced incidence of cervical cancer. A number of studies have identified socio-demographic and health systems-related characteristics that are barriers or facilitators of breast and cervical cancer screening
Studies have examined cancer screening and treatment outcomes in relation to the distance that women have to travel to get to screening mammography or treatment facilities
Commuting times and behaviors have been associated with a variety of chronic disease outcomes and health behaviors including obesity
The objective of this study was to examine the relationships between ecologic measures of commuting time, use of public transportation, and access to an automobile in relation to breast and cervical cancer screening, among women in U.S. metropolitan areas who participated in the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Although ecological measures of commuting time and use of public transportation were primarily used as surrogates of individual-level measures of commuting time and use of public transportation, we also considered the possibility that ecologic measures of commuting time, use of public transportation, and access to an automobile might also be associated with other unmeasured characteristics of metropolitan areas. We hypothesized a priori that women who live in metropolitan areas with longer commuting times would be less likely to adhere with guidelines for breast and cervical cancer screening, since more of their daily routine is spent commuting and we thought it plausible that they may spend more of their financial resources on commuting costs. However, in view of the sparse literature on this topic, we considered this to be a two-sided hypothesis (i.e., we did not have an a priori opinion about the direction of the association).
The data used in the current study were obtained from the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS), a state-based system of telephone health surveys. Data from 2004 and 2006 were combined in order to increase the sample available for analysis. The BRFSS uses a random-digit dialing technique and multistage cluster sampling in each participating state in order to sample non-institutionalized adults living in a residence that had a telephone
The current study sample was drawn from women aged 18 years or older who responded to BRFSS surveys in 50 states and the District of Columbia. All eligible women were included regardless of their self-identified race and Hispanic ethnicity. For the study outcome of having had a Pap test within the previous three years, the eligible sample consisted of women who reported a known Pap test screening status, were aged 18 years or older, and who reported no history of a hysterectomy (n = 80,959). For the study outcome of having had a mammogram within the previous two years, the eligible sample consisted of women who reported a known mammography screening status and were aged 40 years or older (n = 76,453).
Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas using Office of Management and Budget (OMB) definitions, revised in November 2007. All counties within the metropolitan areas were included regardless of state boundaries. In order to ensure there were sufficient numbers of respondents in each metropolitan area, only BRFSS respondents who resided in Metropolitan Statistical Areas (MSAs) with a population of at least 1.5 million in 2007 were included in this analysis (Additional file
Additional file 1
Excel file containing figure 1.
Click here for file
These account for about 27% of female BRFSS respondents during this time period. The 39 MSAs included ranged in population size from 18,815,988 to 1,521,437 persons.
County-level measures of commuting time within Metropolitan Statistical Areas (MSAs) (< 30 minutes vs. ≥ 30 minutes), use of public transportation (<4% vs. ≥ to 4%, where public transportation included use of a bus or trolley bus, streetcar or trolley car, subway or elevated railway, railroad, ferryboat, or taxicab), and automobile access (≤ 1%, 2%, or 3%+ with no access to car) were obtained from 2000 Census data, summary file 3
Other county-level socio-economic status indicators used were sex-specific educational attainment for the population 25+ years (table P37), sex-specific employment status for the population 16+ years (table P43), and poverty status in 1999 by age (table P87).
To account for the complex sample design of the BRFSS, all cancer screening percentages were weighted and standard errors calculated using SUDAAN statistical software
In addition, except for age group-specific estimates, percentages were age-adjusted to the July 1, 2000 female population using United States Census estimates. Self-reported Pap test and mammography rates were estimated by various demographic, socioeconomic, or health-related individual-level covariates, and by county-level measures of commuting time, use of public transportation, automobile access, and employment status. The Cochran-Mantel-Haenszel test of association was used to assess the overall statistical significance of each potential factor, such as the association of health insurance status with cancer screening test use, after adjusting for age. A multivariate analysis of correlates of screening test use was conducted using logistic regression techniques and SUDAAN, to take the weighting and complex sampling into account, and to further adjust for covariates found to be related to cancer screening rates, according to ecologic measures of commuting times and traffic congestion. Marital status was omitted from the multivariate models because of the weak associations with cancer screening. Adjusted Wald F tests were used to determine the significance of the model and for selection of variables.
The data used in this analysis are anonymous and included no personally identifying information. This analysis of existing data from an anonymous survey (BRFSS) combined with US Census Data at the county level was determined to be exempt from institutional review board review according to Centers for Disease Control and Prevention guidelines.
Characteristics of the 81,820 women who were at least 18 years of age at time of the survey administration and reported no history of hysterectomy are shown in Additional file
Additional file 2
Excel file containing table 1, table 2a and 2b, and table 3.
Click here for file
Over 10 percent of the women had less than a high school education. About 10 percent had a household income of less than $15,000 per year. Almost 15 percent had no health insurance. About 37 percent of the women lived in counties where at least 13 percent of residents lived below the poverty level. Over half of the women lived in counties where at least four percent of residents used public transportation.
Rates of self-reported mammogram in the past two years are shown in Additional file
Rates of Pap testing in the past three years are shown in Additional file
In multivariate analysis (Additional file
The findings of this study contribute to the growing literature on socioeconomic and demographic characteristics of the neighborhoods in which women live that are associated with use of breast and cervical cancer screening
We cannot rule out the possibility that the weak association observed in multivariate analysis between residence in a county with less use of public transportation and having had a Pap test in the past 3 years may be accounted for by uncontrolled confounding by unmeasured individual-level variables or county-level characteristics. For example, BRFSS data do not included information about health literacy, knowledge about cancer, or attitudes toward routine cancer screening.
Penchansky and Thomas
The ability of this study to identify specific pathways influencing screening utilization was limited by the variables included in the analytic data set, by the smallest geographic area of residence available for analysis (county), and by the ecological nature of the study. A further issue is that the effects of transportation variables on breast or cervical cancer screening may vary across large metropolitan areas. In the U.S., transportation infrastructure, facilities, and utilization patterns vary across major metropolitan areas. For example, not all cities have low-cost subway systems or trolley cars. In Census 2000, public transportation use was concentrated in the Northeast, and carpooling was concentrated in the South and the West
By way of summary, in this contextual analysis, select commuting variables were not significantly associated with higher breast and cervical cancer screening. Living in a county with less use of public transportation was weakly associated with cervical cancer screening but the association was of borderline significance. In large metropolitan areas, transportation issues play a role in whether a woman obtains cancer screening along with other factors (for example, Hispanic ethnicity, low income, and no physician visit in the past year). Future contextual analyses of the utilization of cancer screening services within specific metropolitan areas could include additional transportation and commuting variables and examine neighborhood characteristics in greater detail at the census tract level or block group level.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
Both authors made substantial contributions to the conception and design of the study and interpretation of the data. SC drafted the manuscript. JK analyzed the data and reviewed the manuscript and tables for accuracy. Both authors read and approved the final manuscript.
The authors thank Thomas Richards and Lucy Peipins for their helpful comments during the early stages of this study. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Cervical cancer screening among women in metropolitan areas of the United States by individual-level and area-based measures of socioeconomic status, 2000 to 2002
Factors associated with continued participation in mammography screening
Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey
Mammography-facility-based patient reminders and repeat mammograms for Medicare in New York State
The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial
Predictors of varying levels of nonadherence to mammography screening in older wome
Correlates of mammography among women with low and high socioeconomic resources
Targeting the underserved for breast and cervical cancer screening: the utility of ecological analysis using the National Health Interview Survey
County characteristics and racial and ethnic disparities in the use of preventive services
Contexual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002
Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery
Travel distance and season of diagnosis affect treatment choices for women with early-stage breast cancer in a predominantly rural population (United States)
Impact of geographic barriers on the utilization of mammograms by older rural women
Effect of distance and social disadvantage on the response to invitations to attend mammography screening
Relationship between travel distance and utilization of breast cancer treatment in rural northern Michigan
Relationship of distance from a radiography facility and initial breast cancer treatment
Spatial equity in facilities providing low- or no-fee screening mammography in Chicago neighborhood
The relationship between destination proximity, destination mix and physical activity behaviors
The benefit of public transportation: physical activity to reduce obesity and ecological footprint
The relationship between destination proximity, destination mix and physical activity behaviors
Active commuting and cardiovascular risk: a meta-analytic review
Census 2000 Brief. Journey to Work: 2000
Commuting in America III. The Third National Report on Commuting Patterns and Trends
BRFSS summary data quality control reports
Census 2000 Summary File 3 (SF 3) - United States
SUDAAN User's Manual: Software for Analysis of Correlated Data, Release 6.40
The concept of access: definition and relationship to consumer satisfaction
Spatial accessibility of primary care: concepts, methods and challenges
Car travel time and accessibility by bus to general practitioner services: a study using patient registers and GIS
Impact of women's experiences during mammography on adherence to rescreening (United States)
A comparative study of re-attenders and non-re-attenders for second triennial National Breast Screening Programme appointments
The connection between public transport and employment: the cases of Portland and Atlanta
U.S. screening mammography services with mobile units: results from the National Survey of Mammography Facilities
Concordance of self-reported data and medical record audit for six cancer screening procedures
Validity of Pap smear and mammogram self-reports in a low-income Hispanic population
Pre-publication history
The pre-publication history for this paper can be accessed here:


text:
Studio appartment in Poljana (Ugljan) capacity 2+0
House 8249 in the town of Poljana, Ugljan - North Dalmatia has accommodation units of type Studio flat (4) and is 40 m away from the sea. A beach is nearby (concrete slabs). As the house is divided into several accommodation units, other guests will most likely be present during your stay. The hosts will be in residence during your holiday. The house owner is under no obligation to accept additional persons and pets that were not stated in the reservation request and it is necessary to report them in advance.
Studio flat can accommodate 2 guests. Beds are situated in 1 sleeping rooms, within 20m2. Guests can enjoy a sea view from the private balcony. Food can be prepared using barbecue which is shared with other guests too.
INCLUDED IN THE PRICE: tourist tax, final cleaning, air-conditioning, parking, internet.
OBLIGATORY ADDITIONAL COSTS: short stay surcharge.
OPTIONAL ADDITIONAL COSTS: boat mooring (€10.00 per night).
The availability of additional services for your chosen dates of stay, as well as their prices (if none are listed) must be checked ahead of time. Any additional services not shown in the price calculation are payable directly to the property owner and only if used by the visitor.
Dining room (4 m2)
Bedroom (10 m2): Double bed (2)
Kitchen (3 m2): Kitchenette: Refrigerator, Sink, Additional equipment: Stove, On request: Coffee machine
Bathroom (3 m2): Shower
Balcony (5 m2): Sea view, Sun protection, Access from: Dining room, Bedroom
Infield (Well-equipped), Courtyard (500m2, Sitting area), Parking lot (Number of parking spaces: 4, Distance from the house: In the courtyard), Barbecue (shared), WiFi Internet, Boat mooring (Distance from the house: 300 m, Type of boat berth: shore)
The facility is not located near the road
There is no road between the property and the beach
Car access possible: Yes
The facility is situated in quiet surroundings
The property is surrounded by greenery
Sea: 40 m
Beach: 50 m
Supermarket: 300 m
Restaurant: 300 m
Emergency room: 10 km
Post office: 3 km
Disco: 8.3 km
Diving Centre: 8.8 km
Clinic: 2.8 km
Pharmacy: 2.8 km
Internet cafe: 8.4 km
Exchange office: 1.6 km
Tourist info: 1.6 km


text:
This 100-room city hotel is housed in a 7-storey building that combines the colonial style with new millennium technology. Guests are welcomed into a lobby with a 24-hour check-out service and currency exchange facilities, and there is a TV lounge, bar and restaurant on site. Room and laundry services are available at this hotel and wireless Internet is provided throughout public areas. Guests arriving by vehicle can make use of the car park.
This hotel is located in the financial and commercial district of Santa Cruz de la Sierra, just 100 m from the city's main square. Guests will find a range of dining options nearby and there are several nightlife venues approximately 2 km from the hotel. Shopping opportunities can be found at Las Siete Calles, a 5-minute walk away. Viru Viru Airport is located just 15 minutes from the accommodation.
The luxury rooms come equipped with double or king-size beds, a direct dial telephone, satellite/cable TV and Internet access. The en suite bathrooms have been fitted with a shower and bath, and all rooms feature air conditioning units as standard.
The hotel features a swimming pool with a children's swimming area, as well as a gym and sauna.
Room Facilities:
Direct dial telephone
Satellite cable TV
Internet access
Double bed
King size bed
Central airconditioned
Wheelchair accessible


text:
Tag: cuisine
What to Eat on St. Patrick's Day
read more No Comments
You know it's mid-March when Spring starts stirring under her snowy blanket and Green Cabbage goes on sale at Fairway. This Sunday is St. Patrick's Day, the annual beer-feast that's liable to get sloppy without the proper nourishment to accompany it. So what's it going to be?
Das Bierhaus in Burlington, VT
read more No Comments
A quote from Das Bierhaus' dinner menu: "We dedicate 100% of our draft lines to German biers." Alright, looks like my work here is done…see ya in Burlington.


text: Wow!Œæ This Mind Cure singles of the month series is going from strength to strength.Œæ Shifting gears a bit from the first two more metal leaning singles The GotoBeds (one word) new single is so insanely catchy and all around perfect.Œæ äóìIpso Factoäó? is the kind of song that makes it hard to flip the record over as it is so good you just play it again when it is over.Œæ When you finally do flip the record youäó»re treated to an excellent version of the KBD classic originally by Australiaäó»s Victims äóìTelevision Addictäó? and there you have it, another perfect 7äó? in this Mind Cure singles of the month series.Œæ Fun facts:Œæ The GotoBeds feature two guys who used to be in Kim PhucŒæ


text:
A Dweller refers to an inhabitant of the Dweller Camp in Mistpeak. They were the autonomous owners of the Mistpeak lands until Logan started exploiting the resources there, claiming the land and forcing the Dwellers to live in the coldest and most unhospitable areas. An extremely nomadic and strong people, the Dwellers are also very wary of outsiders, such as when they initially meet the Hero of Brightwall. Trying to recruit the Dwellers into their army, the Hero runs into opposition in the form of the Dweller King, Sabine, who sees no reason to trust Logan's sibling. Seeing an opportunity to improve the welfare of his people and get revenge on King Logan, Sabine tasks the Hero with three challenges: proving their worth as a Hero by retrieving the Music Box in the Reliquary, permanently ending the mercenary attacks by getting rid of their leader, Captain Saker, and getting them more food and supplies. Once the Hero accomplishes all these tasks, the Dwellers completely set aside their initial mistrust and pledge themselves to the revolution, serving as frontline soldiers during the Battle for Albion and installing the Hero as Monarch. Once he/she ascends to the monarchy, the Dwellers only ask one more boon of the Hero – a formal recognition of their ownership of Mistpeak and protection of their right to dwell within the mountains. However, like any promise, the decision is up to the Hero.
Fifty years after Fable III, the Dwellers still exist, appearing in a primary role in Fable: The Journey. Tribes of Dwellers roam the wild northern reaches of Albion and the Edgelands, and their passing helped to bolster the economies of the many small towns and villages that scattered the land. However, like many of the native inhabitants, the Dwellers have deemed the Edgelands too dangerous in recent times, fleeing over the Ironwash River back to Albion. Katlan's tribe, the one that Gabriel belongs to, is among them.
- "Dwell" is an Middle to Old English word meaning "To live or stay as a permanent resident".
- They are also like the Gypsies from Fable II, in that they live in caravans away from civilization. Griffith Smith of the Albion Historical Restoration Society also refers to the old Gypsy Camp in Millfields as the "old Dweller camp", hinting that the two groups are related.
- Gabriel, the protagonist of the title Fable: The Journey, is a dweller.
- Their design was also strongly influenced by Cossacks.


text:
LGBT Rights
Same-sex marriage in Alaska has been legal since October 12, 2014, following a ruling of a federal judge for the United States District Court for the District of Alaska in the case Hamby v. Parnell. The court held that Alaska's statutory and constitutional bans on same-sex marriage violated the Due Process and Equal Protection clauses of the United States Constitution. The state sought to appeal the ruling to the United States Supreme Court, though on October 17, 2014, the court denied Alaska's request for a stay of the District Court ruling.[1]
Though Alaska is one a few states which enforces a three-day waiting period between requesting a marriage license and conducting a marriage ceremony, several same-sex couples had the waiting period waived in the immediate aftermath of the District Court's ruling.[2][3]
On May 12, 2014, five same-sex couples filed a lawsuit in federal district court in Anchorage challenging the state's same-sex marriage ban.[4] The suit named Governor Sean Parnell as the primary defendant.[5] The state's brief, filed on June 19, said that the questions the plaintiffs raised were political, not legal. It said that under the Tenth Amendment to the U.S. Constitution "Alaska has the right as a sovereign state to define and regulate marriage" and "Alaska voters had a fundamental right to decide the important public policy issue of whether to alter the traditional definition of marriage as between one man and one woman."[6] District Court Judge Timothy Burgess scheduled oral argument for October 10.[7]
On Sunday, October 12, 2014, less than a week after the U.S. Supreme Court declined to review similar cases from the Ninth Circuit Court Appeals, Latta v. Otter and Sevcik v. Sandoval, Judge Burgess ruled for the plaintiffs and declared Alaska's statutory and constitutional bans on same-sex marriage unconstitutional.[8] He issued an injunction effective immediately.[9] The same day, Governor Sean Parnell announced that he would appeal the ruling and "defend our constitution." The head of the state Bureau of Vital Statistics commented, "The license application begins the three-day waiting period before the license can be issued. All marriages in Alaska must have the marriage license issued before the ceremony is performed. We expect our office will be busy tomorrow [October 13] but we will make every effort to help customers as quickly as possible."[10] In Barrow, Alaska a same-sex marriage took place when Magistrate Mary Treiber waived the state's three-day waiting period and married Kristine Hilderbran and Sarah Ellis on October 13, 2014.[11] On October 13, the state asked the district court to issue a stay pending appeal, which was denied.[12]
On October 15, 2014, the Ninth Circuit Court of Appeals, which hears appeals from both Alaska and Idaho, denied a stay request by Idaho to prevent same sex couples from marrying there; however, the stay request was denied in a strongly worded opinion.[13] This denial serves as a precendent for the entire Ninth Circuit, which includes Idaho, Alaska, Montana, and Arizona. As such, the Ninth Circuit denied the states's request for a stay on October 15; however, in the same order it granted a temporary stay until 12:00 noon PDT on October 17[14] to allow Alaska to attempt to obtain a longer stay from the United States Supreme Court.[15] The Supreme Court denied a stay in a one-sentence statement.[16] Same-sex marriage ceremonies proceeded following dissolution of the Ninth Circuit's temporary stay.[17]
See also Edit
References Edit
- ↑ Text of the Supreme Court order denying stay
- ↑ North Carolina and Alaska issue same-sex marriage licenses
- ↑ Alaska governor promises appeal after judge strikes down gay marriage ban
- ↑ Couples Challenging Alaska Gay-Marriage Ban. ABC News (May 13, 2014). Retrieved on May 13, 2014.
- ↑ Couples file suit to overturn Alaska's ban on same-sex marriage. Anchorage Daily News (May 12, 2014). Retrieved on May 13, 2014.
- ↑ "Alaska's same-sex marriage ban doesn't violate couples' rights", Alaska Dispatch News, June 19, 2014. Retrieved on July 25, 2014.
- ↑ "Arguments Set in Challenge to Alaska's Gay Marriage Ban", Edge, New York, July 24, 2014. Retrieved on July 25, 2014.
- ↑ Hamby v. Parnell. U. S. District Court, District of Alaska. Retrieved on October 13, 2014.
- ↑ "Federal judge rules Alaska's same-sex marriage ban unconstitutional", Alaska Dispatch News, October 12, 2014. Retrieved on October 13, 2014.
- ↑ "State vows to appeal after Alaska's same-sex marriage ban struck down", Alaska Dispatch News. Retrieved on October 13, 2014.
- ↑ http://news.yahoo.com/alaska-judge-conducts-apparent-first-gay-marriage-203957791.html?utm_source=twitterfeed&utm_medium=twitter
- ↑ "Judge denies stay on rejection of Alaska's same-sex marriage ban". Retrieved on 15 October 2014.
- ↑ Order re:. United States Court of Appeals for the Ninth Circuit. Retrieved on 16 October 2014.
- ↑ 9th Circuit grants temporary stay of Alaska same-sex marriages. Retrieved on 16 October 2014.
- ↑ Stay Denied, Temporary Stay to allow for stay request to US Supreme Court. US Court of Appeals for the Ninth Circuit. Retrieved on 16 October 2014.
- ↑ http://www.adn.com/sites/default/files/10-17%20SCOTUS%20order.pdf
- ↑ Alaska Gay Couples Apply for Marriage Licenses (ABC News)
Same-sex unions in the United States
Alabama • Alaska • Arizona • Arkansas • California • Colorado • Connecticut • Delaware • District of Columbia • Florida • Georgia • Hawaii • Idaho • Illinois • Indiana • Iowa • Kansas • Kentucky • Louisiana • Maine • Maryland • Massachusetts • Michigan • Minnesota • Mississippi • Missouri • Montana • Nebraska • Nevada • New Hampshire • New Jersey • New Mexico • New York • North Carolina • North Dakota • Ohio • Oklahoma • Oregon • Pennsylvania • Rhode Island • South Carolina • South Dakota • Tennessee • Texas • Utah • Vermont • Virginia • Washington • West Virginia • Wisconsin • Wyoming
Civil union or Domestic partnerships also offered:
California • Colorado • District of Columbia • Hawaii • Illinois • Maine • Maryland • Nevada • New Jersey • Oregon • Rhode Island • Washington • Wisconsin


text: nutrition Call 800-423-8309 to Order More than 50 heat-free recipes packed with flavor and learning ESS S H E D BY R ED PR PUB LI LEAF (E-book #541952 $24.95) (E-book #542584 $19.95) S H E D BY ESS LI ED PR Cooking Is Cool #541587 $19.95 R Early Sprouts #326401 $24.95 The award-winning Early Sprouts program includes tips for planting a garden, suggestions for involving children's families, and recipes that children can help prepare. Age focus: 2–6. Softbound, 216 pgs. PUB A complete gardening and nutrition curriculum LEAF As children read recipes, measure ingredients, and taste each dish, they build math and literacy skills, practice science process skills, and explore different food groups. All of this hands-on learning is possible with these heat-free recipes—no oven, stove, or microwave needed. With your guidance, budding chefs can transform fresh, simple ingredients into tasty snacks, beverages, entrees. Age focus: 3–12. Softbound, 144 pgs. Strategies to resolve feeding issues Includes great recipes like Feeding Challenges in Young Children Book + #571219 $39.95 C D- ROM 50 activities to get children excited about health Chicken Fajitas S H E D BY ED PR ESS LI R The Early Sprouts Cookbook #540429 $29.95 PUB Broccoli Cheddar Soup Get research-based guidance to resolve a wide range of feeding issues and understand the entire process of feeding development. A CD-ROM with almost 50 pages of printable tools and handouts is included. Age focus: 0–5. Softbound, 318 pgs. LEAF (E-book #541969 $29.95) More than 70 delicious recipes anchored by wholesome ingredients Bell Pepper Veggie Burgers Promote healthy eating habits in young children and encourage their participation in preparing the food. Nutrition information, food safety procedures, tips for cooking with children, recipe variations, and colorful photographs are also included. Age focus: 3–6. Softbound, 200 pgs. Save almost $10 when you buy both books Includes Early Sprouts and The Early Sprouts Cookbook. Early Sprouts Set #326411 $44.95 5 Minute Nutrition Activities for Preschoolers #120007 $29.95 Introduce, reinforce, and review lessons on nutrition. Age focus: 3–6. Spiral, 54 pgs. 50 quick activities to learn about fruits and vegetables Help children think about healthy produce with these creative and fun five-minute activities. Age focus: 3–18. Spiral, 50 pgs. 5 Minute Fruit and Vegetable Activities #120014 $29.95 60 Pg60&61.All.WS14.indd 1 11/4/13 2:59 PM


text: Just wondering what other guys charge for a late fee. Im in michigan and i charge a $25.00 late fee, if the payment is not in my hands by the given date, was wondering if i am charging a high late fee. If everyone could share their late fee's that would be nice.


text:
Eisenberg says college athletes much less likely than other students to seek help with mental health conditions
Mitchell finds children who lose fathers suffer at cellular level
Seefeldt says hard work alone won't allow poor to reach middle-class status in America
Neal Krause wins GSA's Robert Kleemeier Award
U-M awarded $58 million to develop ideas for preventing and treating health problems
Bailey, Eisenberg , and Fomby promoted at PSC
Former PSC trainee Eric Chyn wins PAA's Dorothy S. Thomas Award for best paper
Pierotti, Rachael. 2013. "Increasing Rejection of Intimate Partner Violence: Evidence of Global Cultural Diffusion." American Sociological Review, 78(2): 240-265.
This study extends existing world society research on ideational diffusion by going beyond examinations of national policy change to investigate the spread of ideas among nonelite individuals. Specifically, I test whether recent trends in women's attitudes about intimate partner violence are converging toward global cultural scripts. Results suggest that global norms regarding violence against women are reaching citizens worldwide, including in some of the least privileged parts of the globe. During the first decade of the 2000s, women in 23 of the 26 countries studied became more likely to reject intimate partner violence. Structural socioeconomic or demographic changes, such as urbanization, rising educational attainment, increasing media access, and cohort replacement, fail to explain the majority of the observed trend. Rather, women of all ages and social locations became less likely to accept justifications for intimate partner violence. The near uniformity of the trend and speed of the change in attitudes about intimate partner violence suggest that global cultural diffusion has played an important role.
DOI:10.1177/0003122413480363 (Full Text)
Country of focus: Global.
Browse | Search : All Pubs | Next


text:
This is a superb place if you have business at the University of Cincinnati. A great location very close to UC, and still within walking distance of great restaurants and other amenities. The host, Nancy, has seen to every detail, including complimentary wines, soft drinks, home baked brownies, and even fresh coffee outside your door at 6 AM. Breakfast was substantial, and prepared by a chef-graduate of the University culinary school. Do not stay in a business hotel downtown when you can be close and stay in a place like home. Rooms are large, well appointed, and have the modern touches sometimes missing from B & Bs.
- Also Known As:
- Clifton House Cincinnati, Ohio


text:
Beaumont/Port Arthur
UPDATE: At 7:13 p.m., all eastbound and westbound traffic lanes of Interstate 10 have reopened following an earlier crash.
Lamar University has cancelled Monday, April 18 classes beginning after 11 a.m. due to flooding conditions. Classes will resume Tuesday, April 19, at regular times.
Highway 12 between Texas and Louisiana has been reopened after severe floods that caused major traffic disruptions have subsided, Texas Department of Transportation spokesperson Sarah Dupre said in a news release.
City offices, including Water Customer Service and all library branches, will be closed on Wednesday, November 11, 2015 in observance of Veteran's Day.
At approximately 9:45 p.m, on Tuesday, Octo
Effective Thursday, October 22, 2015, Forrest Street between Harrison Avenue and North Street will continue to be closed to traffic until Friday, October 23, 2015 at 5 p.m. This closure will allow the Streets & Drainage Department to finish making repairs to Forrest Street.
Motorists navigating the roadways around the intersection of Washington
Beaumont motorists might have to take a detour if they are driving through the South Park area in the next couple of months. A portion of Lavaca is closed for construction related to the city's South Park Drainage Improvement Project.
UPDATE (7:31 p.m. Jan. 24, 2014): The Beaumont Police Department issued the following update on Beaumont Traffic operations. All highways in Beaumont had reopened, including Interstate 10, the Eastex Freeway, Cardinal Drive, and MLK Parkway. The Purple Heart Memorial Bridge over the Neches River was open, as well.
While we harbor no disrespect for the Wall Street Journal who called us "that scrappy little paper from Southeast Texas," we prefer to think of ourselves as simple seekers of the truth. We're of the opinion that headlines and sound bites never tell the whole story. Our readers demand all the facts, facets and flavors of every story or event. And, they expect to be informed, educated and stirred to action.
For this week's New York Times crossword puzzle, pick up a copy of this week's The Examiner on newsstands now.


text:
Peep Show
American League
Boston Red Sox: Byung-Hyun Kim's starting days with the Red Sox are over -- at least for the time being. Kim got hammered by the Indians last night and found himself out of a starting job by the end of the fourth inning. "We're in a very competitive area in what we're trying to do," manager Terry Francona told Bob Hohler of the Boston Globe. "And right now it's just not working [with Kim] starting. I don't think it's fair to him or to us, so we're going to make a change for now." Kim's nightmare outing included a pitch on which he completely missed Jason Varitek's target, crossing up his catcher and allowing two runs to score. His rotation spot will be taken by Bronson Arroyo. Kim has the choice to report to the bullpen, Triple A Pawtucket, or the team's training and rehabilitation center in Fort Myers, Florida, writes Hohler.
To continue reading this article you must be an Insider
Become an insider and get access to all our articles and toolsView Insider Benefits »
Magazine subscribers: activate your Insider account.
- The Age Of Mike Trout
- The BBTN 100 counts down the top 25 players in baseball for 2015.
Rankings »
- MLB Confidential
- MLB players weigh in on baseball's best player, PEDs and what they really think about A-Rod's return.
MLB Confidential »
- Baseball's Top 50 Prospects
- Where does the recently-signed Yoan Moncada land on Keith Law's prospect rankings?
Top 50 update


text:
Toggle Navigation
I'm an employer
Find a Job
Explore Companies
Career Center
About Us
Log In
Sign up
Lead InterConnect Engineer - Poughkeepsie, NY or Austin, TX
Poughkeepsie , New York
May 13, 2017
IBM is hiring a Lead InterConnect Engineer to design, develop and document interconnect packaging for power, thermal and electronic components in high end computer systems from concept through market introduction, including ongoing product engineering and design support for production and field systems.
Specific responsibilities include lead technical architecture for interconnect defining connectors, cables, and other means of designing electrical components into compute, server, storage or similar devices , performing high level system interconnect design and architecture, performing early characterization and full functional testing and application verification for prototypes, participating in technical supplier selection and business awards, performing long term qualification testing for all components and system level quality as well as failure analysis and quality management.
Successful candidate will lead design teams and work primarily with a cross-functional team across system hardware development. This will include thermal, power, card and board design, processor and module level design, memory, interconnect, I/O, storage, Manufacturing, Service, Reliability, Availability, Serviceability, various compliance teams including shock and vibration, EMC, and acoustics. In addition, the person would interface with procurement, suppliers, supplier management and supplier quality teams as well as various executive management and program management contacts.
A little about us:
IBM is the world's largest information technology company with more than 360,000 employees serving clients in 170 countries.
Share this job
Know someone who would be interested in this job? Share it with your network.


text:
The quick and dirty:
Unbound O-Factor:
Soothe offers maximum lubrication for comfort and enjoyment for both partners. Blended with guava bark extract-a natural antibacterial agent, Soothe is a premium paraben-free water based lubricant specifically formulated for anal play. DEA free and pure vegan, Soothe is also made with certified organic extracts and is latex condom friendly and safe to ingest. For best results, use with Intimate Organics anal relaxing sprays Adventure and Daring.
Background Check:
Intimate Earth is a signature collection of arousal serums, glides & massage oils formulated with certified organic extracts & natural ingredients.


text:
|Sun 13 Mar 2016, 10:00am–4:00pm
Round 4 of The 2016 PSP New Zealand Jetsprint Championship.
The Riverside Jet racing track in Crownthorpe near Hastings, opened in 2008. Built in a spring fed lagoon, the natural waterway has been formed into an exciting series of islands which provides an ideal venue for Jetsprinting. With raised spectator banking on both sides of the challenging course, everyone will be able to get a close up view of the high speed V8 Jetsprint action.
The venue is 35km West from Hastings City. From Hastings take the Taihape Road turn off at Fernhill and drive 10km to a left turn into Matapiro Road, drive another 12km to the track entrance which is on your left.
Gates will open at 10am (runs till approx 4pm).
Before you go, would you like to subscribe to our free weekly newsletter with events happening in your area, competitions for free tickets and CD giveaways?
No thanks - I'm already an Eventfinda member (or I don't want to join)
Enter your email below, click on the Sign Up button and we'll send you on your way
Continuing confirms your acceptance of our terms of service.


text:
Gumrah (1963) - Chalo Ek Baar Phir Se MP3
Movie: Gumrah (1963) Song: Chalo Ek Baar Phir Se Vocals: Mahendra Kapoor.
Gumrah 1963)Hindi DVDRip XviD ~ Smeet MP3
cast: sunil dutt, mala sinha, ashok kumar Director: B.R. Chopra Lyrics: Sahir Ludhianvi lot of resemblances with the original love story of Sahir Ludhianvi.
Best Of Sridevi | Jukebox | Chandni O Meri Chandni | Sridevi Superhit Songs MP3
Jukebox compilation of hit songs of actress Sridevi. Sridevi was born to Ayyapan and Rajeswari on 13th August 1963 in Sivakasi, Tamilnadu .She belongs to the ...
Aap Aaye To Khayale Dil e Nuasad Aaya Gumrah 1963 MP3
Gumrah: Yeh Hawa Yeh Fiza Aa Bhi Jaa MP3
Movie: Gumrah (1963) Song: Yeh Hawa Yeh Fiza Actors: Sunit Dutt, Mala Sinha Singer: Mahendra Kapoor.
chalo ek bar fir se., gumrah 1963 mahendra kapoor MP3
Song : Chalo Ek Baar Phir se ajnabi ban jayen hamdono.. Movie : Gumrah(1963) Singer : Mahendra Kapoor, Mahendra Kapoor won the filmfare best male ...
GUMRAH - Tujhko Mera Pyar Pukare (Duet) MP3
Film: GUMRAH Year: 1963 Singer: Mahendra Kapoor & Asha Bhosle Music Director: Ravi Director: Chopra B R Producer: B R Films Lyrics: Sahir Ludhianvi.
GUMRAH - Aap Aaye MP3
Film: GUMRAH Year: 1963 Singer: Mahendra Kapoor Music Director: Ravi Director: Chopra B R Producer: B R Films Lyrics: Sahir Ludhianvi.
Yeh Wadiyan Yeh Fizaayein - Sunil Dutt - Nanda - Aaj Aur Kal - Bollywood Evergreen Songs - Ravi MP3
Music Director: Ravi Lyrics: Sahir Ludhianvi Singer: Mohammed Rafi Enjoy this super hit song from the 1963 movie Aaj Aur Kal starring Nanda, Sunil Dutt, Ashok ...
Best Of B R Chopra Film Songs - Audio Jukebox - Vol 1 - Old Hindi Songs MP3
Baldev Raj Chopra (B.R. Chopra) 22nd April 1914 -- 5th November 2008 was an Indian director and producer of Bollywood movies and television serials.
Woh Jab Yaad Aaye Bahut Yaad Aaye - Parasmani - Evergreen Hindi Romantic Songs MP3
Watch this soothing romantic song Woh Jab Yaad Aaye Bahut Yaad Aaye from the movie Parasmani. Film directed by Babubhai Mistri. Music composed by ...
Jail Break - Movie Scene - Gumrah - Sanjay Dutt, Sridevi, Anupam Kher MP3
Jaggu and Prakash hatch an ingenious plot to help Roshni break out of jail. Will they succeed or will their efforts go in vain? Watch this action-packed scene to ...
Woh Jab Yaad Aaye - Parasmani (1963) MP3
Movie: Parasmani (1963) Singers: Lata Mangeshkar, Mohammed Rafi Music: Laxmikant Pyarelal.
Insaan Bano Baiju Bawra 1952 Hindi Movie Bollywood Video Songs Wallpapers lyrics mp3 Download MP3
All the songs of Baiju Bawra were based on Hindustani Classical Music/Ragas and created a rage. Nausahd sahab said in an interview later that the ...
Yeh Rastey Hain Pyar Ke - Asha Bhosle, Yeh Rastey Hain Pyar Ke Song MP3
Song from old classic movie Yeh Rastey Hain Pyar Ke (1963) starring Sunil Dutt, Ashok Kumar, Leela Naidu, Rehman, Manmohan, Moti Lal, Shashikala, Farida, ...
Mein tera ashiq hoon - Gumraah MP3
Chalo Ek Baar Phir Se Ajnabi Ban jayan Hum dono MP3


text:
Kategorie: Stereovorstufen
Ausstattungsliste: Bryston BP26
Ausstattung & technische Daten
|Input: 2x XLR balanced pairs, 5x RCA single ended pairs (4x with DAC, MM or MC phono), 2x SPDIF**, RCA single ended phono***, RCA single ended (tape loop)
|Output: XLR Balanced, 2x RCA single ended pairs
|Low noise floor
|Steel cabinet shielding to reduce EMI
|Gold plated switch, contacts, and connectors
|Outboard MPS-2 power supply required (see Power Supply in Other Products)*
|* The BP26 can be used without an additional power supply (if you currently own a MPS-2 power supply with one of our other products) by daisy chaining the existing product with the BP26.
|** Only available with optional DAC.
|*** Only available with optional MM or MC phono.
|Available with silver or black faceplate
|17" or 19" faceplate available (non-rack mountable)
|Optional BR2 remote control (see Accessories in Other Products)
|Optional internal DAC, MM phono, or MC phono (see Accessories in Other Products)


text:
Custom Faux Wooden Blinds in Shoreham NY 11786
Custom Faux Wooden Blinds in Shoreham NY 11786
Shoreham Window Treatments Nationwide - Serving Shoreham and surrounding areas. Highly trusted for over 15 years!Call Now! (855) 548-0845
Since the bathroom in Shoreham NY 11786 is one of the most used parts of the house, you always have to ensure that it is clean, well-ventilated, and bright. If your bathroom has no protection against cold or hot temperature, or does not filter light properly that you always have to turn on the light when in use, then it's about time to reconsider your bathroom window treatments.
The first thing to do is to come up with a window treatment checklist. What type of window blinds should you use? For sure, use of wooden blinds is a big no-no since wood is prone to warping and swelling and the bathroom is a place where high levels of moisture can occur. In Shoreham NY 11786 go for mini blinds made in vinyl or aluminum. These are materials that are resistant to humidity and cleaning them even with a damp cloth will not make them crack. If you want a touch of wood in your bathroom windows, go for the faux wood instead. You get them at a cheaper price than real wood minus the problems associated with true wood.
There are many colors and designs to choose from. In order to maximize the light filtering capabilities of your window blinds in Shoreham NY 11786, choose shades in pastel colors like yellow, lime, sky blue, and beige. You might also want to paint your walls in lighter tints so that during daytime, when natural light enters through the blind slats, there is no need for you to turn on the light. You save immensely on electricity and purchasing your shades will definitely be an advantage.
To eliminate unwanted odors in your bathroom in Shoreham NY 11786, you may opt to slightly open the blinds to let air properly circulate within the area. And to maintain privacy while inside the bathroom, just close the blinds and you are assured that your time alone in the bathroom is secure.
Optimize your bathroom experience with window blinds today.


text:
One-Day Membership
Enjoy first-class 50 over and T20 cricket.
Take your seat at Lancashire County Cricket Club as an official LCCC Member and watch explosive cricket at Emirates Old Trafford.
Access all Royal London One-Day Cup, NatWest T20 Blast AND Kia Women's Super League home LCCC fixtures in 2017, with plenty of additional benefits available as a Member.
Price Freeze
2017 Membership prices are currently frozen to 2016 standard price. The deadline to secure your early bird price is until Mon 31 Oct so hurry and buy yours online where you will save an additional £5.
Get priority access to 2017 international tickets at Emirates Old Trafford – with Members' receiving access to the first selection of tickets before they go on general sale on Mon 10 Oct.
*Lancashire County Cricket Club Voting Rights are only available to Members aged 18 and over as of Wednesday 1 February 2017.
†Members who join after the start of the season should note that, due to the timing of some of the benefits the full list of entitlements may not be available.
°Stand E seats for 2017 international fixtures will be on sale to Members until Monday 31 October, before going on general sale.
~Direct Debit payments are subject to a £3 banking charge per Membership.


text:
|Home | About | Journals | Submit | Contact Us | Français
Regular physical activity can improve people's overall health and contribute to both primary and secondary prevention of many chronic diseases and conditions including diabetes. The aim of this study was to examine the association between levels of physical activity and optimal self-rated health (SRH) of U.S. adults with and without diabetes in all 50 states and territories of the Unites States.
We estimated the prevalence of optimal SRH by diabetes status of 430,912 adults aged 18 years and older who participated in the 2007 state-based survey of the Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using levels of physical activity as a predictor and status of optimal SRH as an outcome variable while controlling for sociodemographic and behavioral health risk factors.
The prevalence of reporting optimal SRH was 53.3%, 52.2%, and 86.2% for adults with type 1 diabetes, type 2 diabetes, and without diabetes, respectively. Also in the aforementioned order, adults who reported being active had an increased likelihood of 81%, 32%, and 18% for reporting optimal SRH, when compared with adults who reported being inactive.
Regular physical activity of adults, particularly adults with diabetes, is associated with optimal SRH. The findings of this study underscore the importance of advising and motivating adults with diabetes so that physical activity can be integrated into their lifestyle for diabetes care. Additionally, a population-based effort to promote physical activity in communities may benefit adults in general by improving their overall health and well-being.
Regular physical activity can improve people's overall health and reduce various risks for morbidity and mortality due to a sedentary lifestyle [1,2]. Accumulating evidence from observational and experimental studies shows that routine physical activity exerts enormous benefits for both primary and secondary prevention of diabetes mellitus, cardiovascular disease, obesity, cancer, musculoskeletal diseases, and depression [3-8]. For most health outcomes, the report of 2008 Physical Activity Guidelines for Americans (2008 Guidelines) recommends a combination of active time equivalent to at least 150 minutes of moderate activity a week. These health benefits can occur in healthy people and in individuals who currently have or are at risk of developing chronic diseases and conditions [1,3,9]. In particular, regular physical activity may improve glucose homeostasis and insulin sensitivity thereby preventing, delaying or reversing the development of type 2 diabetes [3,4,7,10].
Self-rated health (SRH) is a powerful indicator of a population's overall well-being because its lower ratings (i.e., fair or poor) are strongly predictive of future morbidity, mortality, functional decline, and health care utilization [11-16]. For instance, individuals with ''poor'' SRH had a two-fold higher mortality risk than those with ''excellent'' SRH [14]. In addition, the lower ratings of diabetic patients have been linked to diabetes-related complications such as lower extremity amputation, blindness, kidney failure, and cardiovascular diseases (e.g., heart disease and stroke) [17]. Not surprisingly, maintaining and improving health-related quality of life of people with diabetes is a public health goal, whereas assisting patients to achieve optimal SRH is a quality indicator in primary care [17-19].
Despite substantial practical interest to consumers, researchers, and practitioners, much remains unknown regarding levels of physical activity in relation to optimal SRH pertaining to diabetes in adults in the general population. The aim of this study was to examine the association between levels of physical activity and optimal SRH of adults with and without diabetes in the United States by using the data from the 2007 state-based survey of the Behavioral Risk Factor Surveillance System (BRFSS).
The Behavioral Risk Factor Surveillance System (BRFSS) is the world's largest, ongoing, state-based, random-digit-dialed telephone survey that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury, and is considered to be exempt from review by the Centers for Disease Control and Prevention's Institutional Review Board [20]. Details about its purpose, sampling methods, data collection, and reporting are available elsewhere [20]. Survey information from non-institutionalized adults aged 18 years and older has been used to track health conditions and risk behaviors for improving the health of the American people. With a survey median cooperation rate of 72.1% in 2007, a total of 430,912 individuals from all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands participated in the survey [20]. Based on the history of diabetes collected (Table (Table1),1), participants were considered to have type 1 diabetes if their age at diagnosis was less than 30 years and they were currently using insulin. Participants were considered to have type 2 diabetes if their age at diagnosis was at least 30 years or if their age at diagnosis was less than 30 years and they were currently not using insulin [21-23].
To assess participation in moderate and vigorous activities, participants were asked a series of questions listed in Table Table1.1. According to the 2008 Guidelines, one minute of vigorous-intensity activity was considered equivalent to 2 minutes of moderate-intensity activity [1]. Thus, participants were classified as being active if they reported at least 150 minutes per week of moderate activity, or at least 75 minutes per week of vigorous activity, or a combination of moderate and vigorous activity totaling at least 150 minutes per week. Participants were classified as insufficiently active if they reported moderate or vigorous activity in episodes of at least 10 minutes, but did not accrue a combination of time equivalent to 150 minutes of moderate activity per week. Participants were classified as being inactive if they reported no moderate or vigorous activity in episodes of at least 10 minutes per episode.
SRH is a brief but valid proxy measure for overall health status [11,13,14]. As part of the health-related quality of life questions, the BRFSS survey asked the participants to rate their overall health (Table (Table1).1). We dichotomized these responses into the categories of optimal (i.e., excellent, very good, or good) and suboptimal (i.e., fair or poor) for this analysis.
In addition to the sociodemographic variables such as age, sex, race/ethnicity, education, marital status, and employment, information about behavioral health risk factors also was collected and defined for the analysis. For instance, based on the responses to the questions "Have you smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day, some days, or not at all?", current smokers were defined as those who had smoked 100 cigarettes or more during their lifetime and who currently smoked every day or some days. Similarly, participants who responded affirmatively to the question "During the past 30 days, have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?" were considered current drinkers. Participants who responded affirmatively to the questions about arthritis or disability were considered to have arthritis or disability (Table (Table1).1). Additionally, participants who responded affirmatively to any of the three questions about cardiovascular diseases (CVDs) were considered to have a history of CVDs (Table (Table1).1). Participants who responded affirmatively to the question "Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?" were considered to have health care access. Additionally, body mass index (BMI), the self-reported weight (kilograms) divided by the square of height (meters), was categorized as (1) neither overweight nor obese (< 25 kg/m2), (2) overweight (25 - < 30 kg/m2), and (3) obese (≥ 30 kg/m2). To assess diabetes education among participants with diabetes, the responses to the question "Have you ever taken a course or class in how to manage your diabetes yourself?" were evaluated.
We estimated the prevalence of optimal SRH among participants with and without diabetes and subgroups with regard to age, sex, race/ethnicity, education, employment, marital status, smoking, drinking, leisure time physical activity, history of cardiovascular diseases and arthritis, disability, BMI, health care access, and levels of physical activity [24]. Because optimal SRH is a common health outcome in the study population, logistic regression models may not produce an accurate approximation [25,26]. Therefore, to examine the association between levels of physical activity and optimal SRH, prevalence ratios (PR) and 95% confidence intervals were generated with multivariate Cox regression analyses for complex samples with constant time using levels of physical activity as a predictor and status of optimal SRH as an outcome variable. Cox regression models have shown PR similar to those of using Log-binomial regression models [25,26]. We present one unadjusted and two adjusted models controlling for sociodemographic characteristics such as age, sex, race/ethnicity, education, employment, and marital status (model 1), as well as additional covariates such as smoking, drinking, health care access, disability, leisure time physical activity, BMI, history of cardiovascular diseases and arthritis (model 2). For participants who reported being active with optimal SRH, we calculated the number of days per week they had engaged in moderate or vigorous activity or a combination of both types of physical activity. Moreover, the estimated proportion for levels of physical activity of adults with diabetes was calculated according to their status of ever having taken a course or class for managing diabetes.
We performed the analysis using SPSS 17 Complex Samples for Survey Analysis (SPSS Inc., Chicago, IL, 2008) to account for multiple stages of sampling, stratification, and clustering [27]. To obtain appropriate statistics, all analyses in this study were weighted according to the standard procedures for analyzing sample survey data [28]. Variance estimates were approximated based on Taylor series linearization [27].
The unadjusted prevalence of reporting optimal SRH was 53.3%, 52.2%, and 86.2%, among participants with type 1 diabetes, type 2 diabetes, and without diabetes, respectively (Table (Table2).2). Regardless of status of diabetes, the subgroup analysis showed that a greater prevalence of optimal SRH was found in participants who were currently employed, who had no history of cardiovascular diseases or arthritis, who had no disability, or who were neither overweight nor obese, when compared with their respective counterparts (p < 0.001 for χ2 test). In addition, a higher prevalence of optimal SRH was found in participants who were aged 18-44 years with type 1 diabetes or without diabetes, participants with type 2 diabetes or without diabetes who were male, who were non-Hispanic White, who had a college education, who were married, or who were not current smokers, who were current drinkers, or who had access to health care, as compared with their respective counterparts (p < 0.001 for χ2 test).
With an increased level of physical activity associated with a greater prevalence of reporting optimal SRH, participants who reported being active or insufficiently active had a higher prevalence of optimal SRH than adults who reported being inactive, regardless of diabetes status (Table (Table3).3). Upon controlling for covariates such as age, sex, race/ethnicity, education, employment, marital status, smoking, drinking, BMI, health care access, disability, history of cardiovascular diseases and arthritis in Cox regression models, participants who reported being active or insufficiently active were more likely to indicate optimal SRH (i.e., PR = 1.81-1.86 for type 1 diabetes; or PR = 1.24-1.32 for type 2 diabetes; PR = 1.13-1.18 for without diabetes), when compared with adults who reported being inactive (Table (Table33).
Of the participants who reported being active with optimal SRH, about 90% reported engaging in moderate or vigorous activity or a combination of both types of physical activity for at least 5 days a week, regardless of status of diabetes (Table (Table4).4). Additionally, adults with diabetes who had ever taken a course or class (55.4%) for managing diabetes had a higher proportion of being active than diabetic patients without taking such a class (p < 0.001 for χ2 test) (Figure (Figure11).
SRH is an indicator of chronic disease that cuts across the Healthy People 2010 objectives; it is also a well-established quality of life measure for public health research and practice [19,29]. The two overarching goals of Healthy People 2010 are (1) to help people of all ages increase life expectancy and improve their quality of life, and (2) to eliminate health disparities among different segments of the population [19,29]. Attaining these goals is especially challenging for individuals with diabetes because of disease severity, complications, and comorbid conditions. Health care providers are influential in helping people with diabetes to feel overall healthy as the quality of life of such individuals is often greatly impaired.
Although SRH ratings are generated by individuals through a subjective and contextual process [13], research shows that biological, physiological, and psychological factors are major determinants of SRH [13,30-32]. To date, there is overwhelming evidence that regular physical activity affects nearly all systems in the body and leads to many favorable chronic adaptations and acute changes [3]. Physical activity can bring about numerous health benefits which may include but are not limited to improving cardio-respiratory functions, body composition, lipid lipoprotein profiles, glycemic control, as well as reducing blood pressure, systemic inflammation, stress, anxiety and depression [3,7].
Our findings provide evidence that regular physical activity is associated with better SRH among adults. Although the prevalence of optimal SRH was substantially lower for adults with diabetes than for adults without diabetes, adults with either type 1 or type 2 diabetes who engaged in regular physical activity were even more likely to report optimal SRH than adults without diabetes. Indeed, research demonstrates that regular physical activity may reduce the risk of developing diabetes in individuals who are at an increased risk of developing this condition [3,33-35]. However, when compared with adults who reported being inactive, adults with type 1 diabetes, type 2 diabetes, or without diabetes were more likely to report optimal SRH. Given that adults with diabetes are less likely to participate in physical activity at the recommended levels than adults without diabetes [36], diabetic adults who are currently inactive are strongly advised to engage in a level of physical activity as their abilities and conditions allow, even if this initial level does not meet the 2008 Guidelines.
Available evidence has shown that physical activity is safe when adults with chronic diseases perform according to their abilities [1]. Currently, the American Diabetes Association (ADA) recommends not omitting aerobic physical activity for more than 2 consecutive days, as the effect of a single instance of aerobic activity on insulin sensitivity lasts no more than 72 hours [37]. Our study indicated that a majority of adults who were active and who had optimal health status engaged in moderate or vigorous activity or a combination of both types of physical activity with a frequency of at least 5 days a week, regardless of their diabetes status. In addition, the ADA suggests that all levels of physical activity can be performed by people with type 1 diabetes who do not have complications and who have optimal blood glucose control [33,37]. A growing body of evidence has demonstrated the effectiveness of counseling in motivating and promoting physical activity in people with Type 2 diabetes [34]. However, adults with diabetes should consult with their health care providers to design a physical activity program specific to their needs [10,38,39]. Although regular physical activity is recognized as a cornerstone in diabetes care, it is often underused in health care practice [34]. In this study, a higher percentage of adults with diabetes who had ever taken a course or class for managing diabetes was physically active than adults who did not take such lessons. Hence, diabetes educators, as well as physicians and exercise therapists, are in a unique and influential position to advise and motivate adults with diabetes so that physical activity can be integrated into their lives thus optimizing their health and well-being.
The findings of our study are generally consistent with the 2008 Guidelines and several previous studies that demonstrated a graded relationship between levels of physical activity and SRH [40-44]. That is, an increased level of physical activity is associated with a greater likelihood of reporting optimal SRH. To our knowledge, such an analysis specific to diabetes has not been reported in the past. Although the BRFSS data have been found to provide valid and reliable estimates as compared with the national household surveys [45,46], our study has several limitations. For example, cross-sectional surveys such as BRFSS are not designed to determine a causal relationship. It was difficult to distinguish cause and effect for adults with diabetes, because physical activity could be a marker of well-being rather than the cause of healthier life. Without a doubt, there are many long-term complications of diabetes such as peripheral neuropathy, CVDs, blindness, peripheral vascular disease, and amputations that could interfere with the capacity for physical activity. Also, BRFSS is a landline survey, so people with no telephone or with cell phone only were excluded, possibly resulting in sampling bias. In addition, the survey used for this study was based on self-reported data. Studies have shown that self-reported data, particularly of less socially desirable behaviors, are subject to limitations of underreporting and recall bias [47]. For instance, self-reported physical activity is a subjective method of assessment; it may yield higher estimates of activity than the objective measurements obtain with an accelerometer and may not accurately reflect total energy expenditure of participants [48,49]. However, the BRFSS uses questions similar to the National Health Interview Survey for a number of measures. Measures for behaviors (e.g., physical activity), medical conditions, and health status are known to have moderate to high reliability and validity. The overall differences between these surveys ranged from 0.4 to 3.0 percentage points [45,46]. Moreover, our efforts at controlling potential confounders were limited by the availability of appropriate variables in the survey. As such, we were unable to control for behavioral health factors such as diabetes management including diet and medication, co-morbid disorders, as well as disease severity, or for diabetes-related physical and psychological barriers.
Compelling evidence from past research and from this study indicates that regular physical activity is a key strategy in the prevention of diabetes and is an essential component of diabetes care. Intervention from the health professionals involved in diabetes care is an important part of the solution to the societal problem of inactivity. To increase physical activity of all adults, the Guide to Community Preventive Services has identified several evidence-based approaches that can effectively increase physical activity at the community level [50], including campaigns and informational, behavioral and social, as well as environmental and policy approaches [50].
Regular physical activity of adults, particularly adults with diabetes, is associated with optimal SRH. The findings of this study support the need to advise and motivate adults with diabetes so that physical activity can be integrated into their lifestyle for diabetes care. Additionally, a population-based effort to promote physical activity in communities may benefit adults in general by improving their overall health and well-being.
The authors declare that they have no competing interests.
JT and EF conceived of the study. All authors participated in the design of the study and data statistical analysis, and helped to draft the manuscript. All authors read and approved the final manuscript.
The pre-publication history for this paper can be accessed here:
The authors of this study sincerely thank BRFSS coordinators for all participating states and territories, the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, for making data available.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.