Asthma in schoolchildren. Demographic associations and peak expiratory flow rates compared in children with bronchitis.

The frequency of asthma in 10 971 school-children between the ages of 5 and 14 years was reported by their parents to be 3-8%. Of these, 20-7% were said to have had bronchitis, 5-9% pneumonia, and 4-7% eczema. Asthma was reported more commonly in boys than girls and was greatest in children of social classes I and II. One-third of the children were reported to have their first attack before the age of 2 years. Few (18%) first attacks started after the age of 5 years. There was no evidence that bronchitis predisposed to the later development of asthma, or vice versa. Within each age-sex group children with a history of asthma had lower peak expiratory flow rates than children who gave no such history. These diffences in PEFR were greater than for children with a history of bronchitis.     

Self-reported racial discrimination and substance use in the Coronary Artery Risk Development in Adults Study

The authors investigated whether substance use and self-reported racial discrimination were associated in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Smoking status, alcohol consumption, and lifetime use of marijuana, amphetamines, and opiates were ascertained in 2000-2001, 15 years after baseline (1985-1986). Most of the 1,507 African Americans reported having experienced racial discrimination, 79.5% at year 7 and 74.6% at year 15, compared with 29.7% and 23.7% among the 1,813 Whites. Compared with African Americans experiencing no discrimination, African Americans reporting any discrimination had more education and income, while the opposite was true for Whites (all p < 0.001). African Americans experiencing racial discrimination in at least three of seven domains in both years had 1.87 (95% confidence interval (CI): 1.18, 2.96) and 2.12 (95% CI: 1.42, 3.17) higher odds of reporting current tobacco use and having any alcohol in the past year than did their counterparts experiencing no discrimination. With control for income and education, African Americans reporting discrimination in three or more domains in both years had 3.31 (95% CI: 1.90, 5.74) higher odds of using marijuana 100 or more times in their lifetime, relative to African Americans reporting no discrimination. These associations were similarly positive in Whites but not significant. Substance use may be an unhealthy coping response to perceived unfair treatment for some individuals, regardless of their race/ethnicity.     

Situational analysis of antenatal care practices in rural Punjab

In India, interviews with 104 mothers living in 16 villages of Ludhiana district were conducted to determine prenatal care practices among women of low and middle socioeconomic classes. Just 4 women (5.4%), who were of the middle socioeconomic group, had their pregnancy medically confirmed. Most women (64.9%) knew that they were pregnant because of amenorrhea. Middle class women believed there was no need to visit a physician during pregnancy, while poverty and no need were reasons for no prenatal care among the low income group. Middle class women were more likely to report medical/health problems and use home remedies to treat those problems throughout pregnancy than did low income women (e.g., 21 vs. 2 women and 6 women vs. 0 women). Low income women were more likely to seek treatments for illness from a physician, especially for complaints of pain in the lower abdomen (33.9% vs. 23%). Perhaps a tendency among the low income mothers to ignore symptoms until they became serious enough to require a doctor accounted for this difference. Even though middle class women were more likely to deliver at a hospital or maternity home (47.9% vs. 13.1%), low income women were more likely to have trained assistance during home deliveries than middle class women (83.9% vs. 20.8%; home deliveries without trained assistance 0 vs. 31.3%). None of the women improved their nutrition intake during pregnancy. The reason for any incidental intakes of special foods among low income and middle income women was strong liking for these foods. Poverty and ignorance contributed to the reason for not consuming enough good quality food during pregnancy among the low income women. Among the middle class group, ignorance was instrumental. These findings will be used to plan a parent and community education program in child care and development in rural areas.     

Intrathecal narcotics are associated with prolonged second-stage labor and increased oxytocin use

BACKGROUND: Safe and effective labor analgesia is an important part of obstetric care. Intrathecally injected narcotics (ITN) are an effective alternative to epidural anesthesia, and are perceived less likely to interfere with the course and outcome of labor. Data on their effects, however, are sparse and contradictory. METHODS: Our retrospective study compared labor length, oxytocin use, delivery type, maternal side effects, and neonatal outcomes among women who received ITN (n=100) and a group who received intravenous narcotics or no analgesia during labor (n=100). We randomly sampled medical records with stratification for parity and collected data through systematic chart review. RESULTS: Women receiving ITN were more likely to be white. They experienced longer second-stage labors (73 minutes vs 40 minutes, P=.000) and used oxytocin twice as often. These differences remained significant after controlling for potential confounding factors. ITN use was also associated with a trend toward more cesarean sections (7% vs 1%, P=.06). More of the women receiving ITN required urinary catheterization (25% vs 5%, P=.000) and experienced significant pruritus (10% vs 0%, P=.001). Neonatal outcomes were similar for both groups. CONCLUSIONS: In our retrospective study, ITN use was associated with a significant prolongation of second-stage labor, which may be clinically relevant for women having their first child. ITN were also associated with increased oxytocin use and a trend toward more cesarean births. Whether these relationships are causal or a proxy for more difficult labors is a question for future prospective studies.     

Multilevel Influences on Patient-Oncologist Communication about Genomic Test Results: Oncologist Perspectives

Thousands of women with early-stage breast cancer receive gene-expression profile (GEP) tests to guide chemotherapy decisions. However, many patients report a poor understanding of how their test results inform treatment decision-making. We applied models of patient-centered communication and informed decision-making to assess which variables oncologists’ perceive as most influential to effective communication with their patients about GEP results and intervention modalities and approaches that could support more effective conversations about treatment decisions in routine clinical care. Medical oncologists who were part of a practice group in the mid-Atlantic US completed an online, cross-sectional survey in 2016. These data were merged with de-identified electronic patient and practice data. Of the 83 oncologists contacted, 29 completed the survey (35% response rate, representing 52% of the test-eligible patients in the practice network). There were no significant differences between survey responders and nonresponders. Oncologists reported patient-related variables as most influential, including performance status (65.5%), pretesting preferences for chemotherapy (55.2%), and comprehension of complex test results (55.2%). Oncologists endorsed their experience with testing (58.6%) and their own confidence in using the test results (48.3%) as influential as well. They indicated that a clinical decision support tool incorporating patient comorbidities, age, and potential benefits from chemotherapy would support their own practice and that they could share these results and other means of communication support using print materials (79.3%) with their patients in clinic (72.4%). These preferred intervention characteristics could be integrated into routine care, ultimately facilitating more effective communication about genomic testing (such as GEP) and its role in treatment selection.     

Relationship of AIDS-related attitudes to sexual behavior changes in adolescents.

The impact of the acquired immunodeficiency syndrome (AIDS) epidemic on a group of adolescents was investigated by surveying 197 sexually active, predominantly African-American, urban high school students. Reported sexual behavior changes were evaluated in relation to AIDS-related knowledge and attitudes. Over 50% of the students decreased their frequency of sexual activity, increased their condom use, and/or decreased their number of partners. These students had significantly higher scores on a measure of worry about vulnerability to human immunodeficiency virus (HIV) infection than those whose behavior had not changed. AIDS knowledge, AIDS beliefs, and AIDS-related anxiety interacted with gender to affect sexual behavior change. Male students reporting decreased frequency of sexual activity, for example, had more accurate beliefs about AIDS than males reporting no decrease. Among female students, however, those reporting decreased frequency had less accurate beliefs than those reporting no decrease. These results highlight the importance of considering gender and specific sexual behaviors when designing AIDS education interventions.     

Sexually Assaulted Males: 115 Men Consulting a Counseling Service

The nature of sexual assault on men and their help seeking following the assault was investigated. All men were seen at least once for face-to-face counseling at SURVIVORS, a counseling service for male victims. Data on 115 men were analyzed: 69 were assaulted while under age 16. Mean time from assault to contact with SURVIVORS was 16.4 years. 51 men (44%) were assaulted more than once. The assailant was known to the victim in all but 16 cases. 100 men (87%) were assaulted by at least one man, 7 (6%) by a man and a woman, and 8 (7%) by women. Forced anal penetration took place in 88. 27 men (23%) feared for their lives during the assault. 88 men (79%) sought no help and only 17 men (15%) reported to police. For victims assaulted under the age of 16, the assault was more likely to be their first sexual experience and they were more likely to delay contact with SURVIVORS for more than 17 years. They were also less likely to report to police. Victims assaulted by more than one person were more likely to have been assaulted by strangers, by women, and to have suffered physical harm. They were less likely to have experienced the assault as their first sexual experience.     

Does gravidity influence smoking behaviour in pregnancy? A comparison of multigravid and primigravid women

This study used the data from a retrospective cross-sectional survey to describe the prevalence of smoking in pregnancy in a large UK sample, over more than 20 years of pregnancies. The main objective was to determine whether women in their second or subsequent pregnancy are more or less likely than primigravidae to change their smoking behaviour. The participants were 7506 ever-pregnant women, from 7702 who answered the second stage of a survey of reproductive history in 2001-02, sent to 10 828 women, aged 18-55 years on the UK electoral register. These women gave detailed information on their last pregnancy. The main outcome measure was self-reported cigarette consumption in the first trimester of pregnancy. Nineteen per cent (1417/7506) of women in this sample smoked in the first trimester of the reported pregnancy. The data showed that there had been a decrease over the last 20 years in smoking prevalence, but this trend was not statistically significant after adjustment for confounding (P(trend) = 0.07). There was evidence that multigravidae were more likely to smoke in their pregnancies than were primigravidae (adjusted OR = 1.24, [95% CI 1.01, 1.53]), with a highly significant trend with increasing pregnancy order (P(trend) < 0.0001). Over time, women who reported smoking before pregnancy (n = 1926), showed a decreasing trend in continuing to smoke the same amount after recognising their pregnancies (P(trend) < 0.0001). After adjustment, multigravid smokers were almost 75% more likely than primigravid smokers to continue to smoke with no change in consumption (adjusted OR = 1.74, [95% CI 1.32, 2.28]), with a clear trend found with increasing pregnancy order (P(trend) = 0.001). In this UK population-based study, multigravidae were more likely to smoke in pregnancy than women pregnant for the first time. If already a smoker, they were much less likely to cut down their smoking once they found out they were pregnant, regardless of age. This suggests that a great deal of the burden of morbidity associated with smoking in pregnancy is in the multigravid group.     

HLA and Down syndrome (DS): parents at the origin of the nondisjunction share no more HLA-A and -B antigens with their DS child than controls

Fifty couples and their children with Down syndrome (D.S.) were typed for HLA-A and HLA-B antigens and compared to 50 control families and 464 blood donors. The parental origin of the extra chromosome 21 was determined by cytogenetic methods. All individuals were caucasians and there was no history of consanguinity. No excessive HLA sharing was present in D.S. parents. The mothers of D.S. shared no more HLA antigens with their D.S. children than the control mothers with their normal children (14% vs. 18%). Thirteen of the fifty pairs (26%) (parent in whom the nondisjunction occurred and D.S. child) shared three HLA antigens at the A and/or B locus. This was not significantly higher than the proportion in the control group (12/50 or 24%). These data suggest that it is not the sharing of HLA-A and HLA-B antigens between the parents or between the parent who was the origin of the nondisjunction and the D.S. child that is related either to the occurrence of trisomy 21 zygotes or to prenatal survival of affected embryos and fetuses.     

Experiences and attitudes about faith healing among family physicians.

BACKGROUND. Recent media attention has focused on patients who use faith healers to care for their medical problems. Many people who use faith healers also consult physicians. This study was done to learn more about how often physicians see patients who are involved in faith healing, and to learn more about physicians' attitudes about, and experiences with, faith healing. METHODS. A 1-page questionnaire was mailed to 1025 family physicians in seven states; 594 participated, for a response rate of 59%. RESULTS. Approximately one half (52%) of the physicians were aware of at least one patient in their practice who had had a faith-healing experience. Most physicians came in contact with such patients no more frequently than once a year. Fifty-five percent agreed and 20% disagreed that reliance on faith healers often leads to serious medical problems. However, 44% thought that physicians and faith healers can work together to cure some patients, and 23% believed that faith healers divinely heal some people whom physicians cannot help. CONCLUSIONS. These results suggest that family physicians are infrequently aware of faith-healing beliefs and experiences among their patients. Family physicians were divided in their views about faith healing, with a majority expressing skepticism about faith healing and a sizeable minority favorable toward it.     

Douching beliefs and practices among black and white women

To ascertain beliefs about douching, douching practices, and their motivational antecedents among adult women living in the southeastern United States, we conducted a telephone survey of a random sample of 535 adult women. Douching was deemed a good hygienic practice by 65% of women, half of whom believed that douching was necessary for good hygiene. These beliefs were more common among black than white women. Older women and less educated women were more likely to believe that douching prevented infections and pregnancies. Physicians were the only discouraging influence regarding douching reported by a substantial proportion of the women. Healthcare providers' advice not to douche is correlated with not douching. Encouragement by mother (OR = 4.7, 95% CI 1.9-11.4), being black (OR = 2.8, 95% CI 1.1-6.9), and having no more than a high school education (OR = 2.2, 95% CI 1.2-4.2) were independently associated with ever (vs. never) douching. A substantial proportion of adult women living in the southeastern United States believe that douching is necessary for good hygiene. Our findings suggest that advice from healthcare providers to discourage the practice may have a salutary effect.     

Mice with low metabolic rates are not susceptible to weight gain when fed a high-fat diet

OBJECTIVE: Mice divergently selected for high or low food intake (FI) at constant body mass differ in their resting metabolic rates (RMRs). Low-intake individuals (ML) have significantly lower RMR (by 30%) compared with those from the high-intake line (MH). We hypothesized that MLs might, therefore, be more likely to increase their body and fat mass when exposed to a high-fat diet (HFD). RESEARCH METHODS AND PROCEDURES: We exposed both lines to a diet with 44.9% calories from fat for 3 weeks while measuring FI, fecal production, and body mass and then returned the mice to standard chow. RESULTS: When exposed to the HFD, both lines significantly decreased their FI (MH, 40% to 45%; ML, 31% to 35%). This decrease occurred simultaneously with a significant increase in apparent energy absorption efficiency (AEAE). When returned to chow, FI and AEAE returned to the levels observed prior to HFD exposure. Because of the adjustments in FI, the absorbed energy was maintained in the MLs and, thus, body mass remained constant. The MH individuals overcompensated for the elevated energy content and AEAE on the HFD and, therefore, absorbed lower energy than when feeding on chow. These mice also did not significantly change their body mass when on the HFD and must have made adjustments in their energy expenditures. Both lines and both sexes increased in fat content on the HFD, but these effects were not different between lines or sexes. DISCUSSION: We found no support for the hypothesis that mice with low RMRs were more susceptible to weight gain when fed the HFD.     

A randomized comparison of A-CASI and phone interviews to assess STD/HIV-related risk behaviors in teens.

PURPOSE: To compare response bias associated with a telephone survey of sexually transmitted disease/human immunodeficiency virus (STD/HIV)-related risk behaviors and an in-home self-administered audio computer assisted self interview (A-CASI). METHODS: We randomly assigned an urban household sample of 223 African-American adolescents to a telephone interview or an A-CASI in their home. The sample was previously recruited by telephone for an earlier study regarding STDs and sexual behavior. We queried participants about their STD/HIV-related risk behaviors. We also assessed their perceived comfort, honesty, and accuracy in answering questions in the different modes through a telephone computer-assisted self-interview (T-CASI). RESULTS: There were no significant differences by mode in percentages of participants reporting STD/HIV-related risk behaviors, except more A-CASI participants reported having engaged in sexual intercourse in past 3 months (43.8% vs. 33.3%). There were no differences in perceived comfort, honesty, and accuracy in answering questions in the different modes. These results also did not change after we adjusted for age, household structure, and current school enrollment. CONCLUSIONS: Telephone interviews, a more economical mode, can be employed without much risk of increasing the response bias in the data assessing crude measures of risk.     

Breast cancer incidence in women with abnormal cytology in nipple aspirates of breast fluid.

This is a prospective study of breast cancer risk in relation to nipple aspirate fluid cytology in 2,701 volunteer white women from the San Francisco Bay Area first enrolled between 1973 and 1980. The women were not pregnant or lactating and were free of breast cancer within 6 months of entry into the study. The breast cancer status of this cohort was determined between June 1988 and April 1991. Follow-up was complete for 87% (n = 2,343) of the cohort, representing 29,961 person-years and an average of 12.7 years of follow-up. The overall breast cancer incidence was 4.4% (104 of 2,343) and rose with fluid cytology findings as follows: no fluid obtained, 2.6% (9 of 352); unsatisfactory specimen, 4.8% (15 of 315); normal cytology, 4.3% (56 of 1,291); epithelial hyperplasia, 5.5% (18 of 327); and atypical hyperplasia, 10.3% (6 of 58). Relative risks for breast cancer and their 95% confidence intervals were estimated by Cox regression, adjusting for age and year of entry. Compared with the relative risk for women who yielded no fluid, relative risks were: unsatisfactory specimen, relative risk (RR) = 1.4 (95% confidence interval (CI) 0.6-3.3); normal cytology, RR = 1.8 (95% CI 0.9-3.6); epithelial hyperplasia, RR = 2.5 (95% CI 1.1-5.5); and atypical hyperplasia, RR = 4.9 (95% CI 1.7-13.9). These findings were strongest for and were mainly confined to women aged 25-54 years. Women with atypical hyperplasia and a first-degree family history of breast cancer were six times more likely to develop breast cancer than were women with atypical hyperplasia but without a family history of breast cancer (95% CI 1.0-30.2). These findings provide strong support for our hypothesis that hyperplasia and atypical hyperplasia diagnosed in nipple aspirates of breast fluid are associated with an increased risk of breast cancer.     

Men, women and friends — are there differences in relation to mental well-being?

This is a study on associations between the number of close friends and mental well-being in a nationwide sample of the Finnish general population (n = 1603). Mental well-being was assessed by means of the 12-item General Health Questionnaire. A total of 3% of the sample had no close friends and another 3% had only one. Over half of the sample (52%) reported having five or more friends. The overall prevalence of mental distress was 15% in men and 21% in women. According to multivariate analyses the risk of mental distress was increased in men among those with no friends (odds ratio [OR]: 2.70) and among those who had one (OR: 4.32) or two to four friends (OR: 1.75), as compared with those who had more friends. In women, having only one friend (OR: 2.30), insufficient family support (OR: 1.63) and insufficient support from relatives (OR: 1.77) associated with the risk of mental distress. These results suggest that mental well-being might be promoted if mentally distressed men seeking professional help were supported in building up and maintaining social networks and mentally distressed women were supported in harmonizing their family life. This revised version was published online in June 2006 with corrections to the Cover Date.     

Does breast feeding protect against breast cancer? An epidemiological study]

The association between breastfeeding and the risk of breast cancer was studied as part of a Dutch population-based epidemiological study of the aetiology of female breast cancer. A total of 484 breast cancer patients and 484 controls (matched for age; age range: 20-54 years) were compared with regard to their breastfeeding habits. There was no clear association between breastfeeding and breast cancer risk. After adjustment for confounders women who had ever breastfed had no lower risk of breast cancer than women who never had given breastfeeding. Women who had breastfed for prolonged periods (total lifetime nursing of 44 weeks or more) had, after adjustment for confounders, a 29% lower risk of breast cancer compared to women who had never breastfed, but this risk reduction was not statistically significant. These results do not support the hypothesis that (short) periods of breastfeeding reduce the risk of breast cancer in young women. A possible protective effect of longer periods of breastfeeding, which is suggested more strongly in the literature, could not be investigated in this study because the women breastfed their children for relatively short periods.     

Age differences between sexual partners in the United States.

CONTEXT: Researchers have examined the age of partners of young women at first intercourse and of young women who have given birth, but little is known about the age of partners of young women in current sexual relationships or young women who have had an abortion. METHODS: Data from the 1995 National Survey of Family Growth (NSFG) were used to examine age differences between women and their current partner and women's use of contraceptives at last intercourse, by marital status and by the age difference between women and their partner. Data from the NSFG and the 1994-1995 Alan Guttmacher Institute Abortion Patient Survey, with supplemental information from other sources, were used to estimate 1994 pregnancy rates for women by their age and marital status, according to the age difference between the women and their partner. RESULTS: Among all sexually active women aged 15-44, 10% had a partner who was three or more years younger, 52% a partner who was within two years of their age, 20% a partner who was 3-5 years older, and 18% a partner who was six or more years older. In contrast, 64% of sexually active women aged 15-17 had a partner within two years of their age, 29% a partner who was 3-5 years older, and 7% a partner who was six or more years older. Among women younger than 18, the pregnancy rate among those with a partner who was six or more years older was 3.7 times as high as the rate among those whose partner was no more than two years older. Among women younger than 18 who became pregnant, those with a partner who was six or more years older were less likely to have an unintended pregnancy (70%) or to terminate an unintended pregnancy (21%) than were those whose partner was no more than two years older (82% and 49%, respectively). Among women younger than 18 who were at risk of unintended pregnancy, 66% of those who had a partner who was six or more years older had practiced contraception at last sex, compared with 78% of those with a partner within two years of their own age. Young women who were Catholic and those who had first had sex with their partner within a relatively committed relationship were less likely to be involved with a man who was six or more years older than were young women who were Protestants and those who first had sex with their partner when they were dating, friends or had just met. Young women who had ever been forced to have sex were twice as likely as those who had not to have a partner who was 3-5 years older. CONCLUSION: Although the proportion of 15-17-year-old women who have a much older partner is small, these adolescents are of concern because of their low rate of contraceptive use and their relatively high rates of pregnancy and birth. Research is needed to determine why some young women have relationships with an older man, and how their partner's characteristics affect their reproductive behavior.     

Effect of the fat/carbohydrate ratio in the diet on obesity and oral glucose tolerance in C57BL/6J mice

To study whether consumed dietary fat has a linear relationship or a threshold with glycemic controls, female C57BL/6J mice were fed different levels of a safflower oil (10, 20, 30, 40, 50, and 60% of total energy) diet ad libitum for 15 wk. Food intake, body weight, parametrial white adipose tissue (WAT) and liver weight were measured, and oral glucose tolerance tests were conducted. Although there was no significant difference in average energy intake, graded increments of safflower oil resulted in graded deterioration of glucose tolerance during 5 and 12-wk feeding, and deterioration of glucose tolerance was more manifested after 12-wk feeding as compared to 5-wk feeding. After 12-wk feeding, a significant deterioration of glucose tolerance was observed in diets of more than 40% fat. Graded increments of body weight and WAT weight were observed, and their weight increases were manifested in diets of more than 30% fat. These data indicated that the amount of dietary fat had an almost linear relationship with glucose tolerance, and significant differences were observed in mice fed diets more of than 40% fat.     

Do junior doctors feel they are prepared for hospital practice? A study of graduates from traditional and non-traditional medical schools

A valid and reliable questionnaire was developed which assesses eight subscales relating to key areas of medical hospital-based work. This was used to evaluate junior doctors' perceptions of the adequacy of their undergraduate medical training to prepare them for hospital practice. Data from 139 (60%) first-year doctors (interns) showed that graduates from the problem-based medical school rated their undergraduate preparation more highly than traditional medical school graduates in preparing them for practice in the areas of interpersonal skills, confidence, collaboration with other health care workers, preventive care, holistic care and self-directed learning. These findings persisted when ratings were adjusted for the effects of age and gender. There were no differences between the intern groups for patient management and understanding science. This research suggests that educational experiences in different undergraduate medical courses are important in preparing doctors for their early working life.     

Predicting Functional Resilience Among Young-Adult Children of Opiate-Dependent Parents

PurposeThis study describes the adversities experienced by a sample of children of opiate-dependent parents, examines criteria for young adulthood functional resilience, and tests parent, child, and school predictors of resilience.MethodsThe Focus on Families (FOF) project was a randomized trial of a family-focused intervention with opiate-dependent individuals in methadone treatment and their children. Analyses were conducted on data from the children in treatment and control families during the original study (1991–1995) and a long-term follow-up interview (2005–2006).ResultsAlthough all participants had an opiate-dependent parent, 70% experienced two or more additional types of childhood adversity and 20% experienced four or more types. A total of 24% met the following three criteria for functional resilience at the time of their young-adult interview: (1) working or being enrolled in school, (2) no history of substance abuse or dependence, and (3) no adult criminal charges in the prior 5 years. The FOF intervention did not significantly predict functional resilience. Girls were approximately four times more likely to exhibit resilience than boys. Experiencing a wider range of adversities in addition to having an opiate-dependent parent did not reduce the likelihood of functional resilience. Of the five child, family, and school predictors tested, only externalizing or internalizing problems in childhood were significantly associated with the likelihood of functional resilience (odds ratio = .30, p = .04) as a young adult.ConclusionsThese findings suggest that early intervention with families with opiate-dependent parents to prevent and reduce internalizing and externalizing problems in their children holds the most promise of supporting resilient adaptation in early adulthood.