Demenz, Depressionen und Aktivit?ten des t?glichen Lebens als Risikofaktoren von Stürzen bei Betagten

OBJECTIVES: Falls among elderly are a well-recognised public health problem. The purpose of the present study was to explore the relation between dementia, number of depressive symptoms, activities of daily living, setting, and risk of falling. METHODS: Data for the analysis came from a cross-sectional study about dementia, depression, and disabilities, carried out 1995/96 in Zurich and Geneva. The random sample stratified, by age and gender consisted of 921 subjects aged 65 and more. The interview was conducted by means of the Canberra interview for the Elderly, extended by short questionnaire. The subject was classified as a faller if the subject and/or the informant had reported a fall within the last 12 months prior to the interview. Logistic-regression analysis was used to determine the independent impact of dementia, depressive symptoms, and ADL-score on risk of falling. RESULTS: The stepwise logistic regression analysis has revealed a statistically significant association between dementia (OR 2.14, 95% CI 1.15-3.96), two resp. three depressive symptoms (OR 1.64, 95% CI 1.04-2.60) as well as four or more depressive symptoms (OR 2.64, 95% CI 1.39-5.02) and the risk of falling. There was no statistically significant relationship between studied risk factors and the risk of being one-time faller. However, we found a strong positive association between dementia (OR 3.92, 95% CI 1.75-8.79), four or more depressive symptoms (OR 3.90, 95% CI 1.55-9.83) and the risk of being recurrent faller. Moreover, residents of nursing homes (OR 8.50, 95% CI 2.18-33.22) and elderly aged 85 or more (OR 2.29, 95% CI 1.08-4.87) were under statistically significant higher risk of sustaining recurrent falls. CONCLUSIONS: The results of the present study confirm that dementia and depression substantially increase the risk of falling.     

Psychotropic drug use among persons with mental distress symptoms: a population-based study in Norway

AIMS: To explore psychotropic drug use in the general population and in particular among non-institutionalized persons with mental distress symptoms. METHODS: A total of 14,139 women and 11,665 men participating in the Oslo Health Study or the Oppland/Hedmark Study 2000-2001 submitted a self-administered questionnaire on health status and drug use, lifestyle, and socioeconomic factors. Respondents using antidepressants, hypnotics, and/or anxiolytics during the last four weeks were defined as users. A high Hopkins Symptoms Checklist-10 score indicated mental distress. The 15% with the highest score in each gender and age group (adults: 30/40/45 years; elderly: 60 years) were studied. RESULTS: The prevalence of antidepressant use among those with mental distress was, for women: adults 21%; elderly 30%; and for men, adults 15%; elderly 15%. These figures were nearly four times higher than in the general population. Not participating in the labour market was the main factor associated with use of antidepressants for subjects with mental distress: adult women (odds ratio (OR) 3.5; 95% confidence interval (CI) 2.5-5.0); elderly women (OR 5.2; CI 2.7-10.2); adult men (OR 4.7; CI 3.0-7.3); and elderly men (OR 2.9; CI 1.4-6.0). Use of analgesics was the main factor associated with use of anxiolytics/hypnotics: adult women (OR 2.4; CI 1.7-3.4); elderly women (OR 2.3; CI 1.4-3.8); adult men (OR 2.1; CI 1.3-3.3); and elderly men (OR 3.4; CI 1.9-6.0). CONCLUSIONS: Among individuals with mental distress, not participating in the labour market and regular use of analgesics were the main factors associated with use of psychotropics in both genders regardless of age.     

Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis

Objective:

to determine the incidence of falls in elderly residents of long-stay institutions of the Federal District, to identify the aspects involved in the falls, in terms of risk factors, from the application of scales and the Taxonomy II of NANDA-I, and to define the level of accuracy with its sensitivity and specificity for application in the clinical nursing practice.

Method:

this was a cohort study with the evaluation of 271 elderly people. Cognition, functionality, mobility and other intrinsic factors were evaluated. After six months, the elderly people who fell were identified, with significance analysis then performed to define the risk factors.

Results:

the results showed an incidence of 41%. Of the 271 patients included, 69 suffered 111 episodes of falls during the monitoring period. Risk factors were the presence of stroke with its sequelae (OR: 1.82, 95% CI 1.01 - 3.28, p=.045), presenting more than five chronic diseases (OR: 2.82, 95% CI 1.43 - 5.56, p=.0028), foot problem (OR: 2.45, 95% CI 1.35 - 4.44, p=.0033) and motion (OR: 2.04, 95% CI 1.15 - 3.61, p=.0145).

Conclusion:

the taxonomy has high validity regarding the detection of elderly people at risk of falling and should be applied consistently in the clinical nursing practice.     

Fall-related factors in a cohort of elderly community residents

OBJECTIVE: To identify factors associated to fall and recurrent fall episodes among elderly living in a community, and to determine the relative risk of each factor as a fall predictor. METHODS: A two-year follow-up study with two segments of multi-dimensional household surveys (1991-1992 and 1994-1995) was carried out in a cohort of 1,667 elderly, aged 65 or older, living in a community in the city of S?o Paulo, Brazil. The instrument used for data collection was the BOMFAQ, the Brazilian version of the Multidimensional Functional Assessment Questionnaire (OARS). A stepwise logistic regression analysis was conducted with p<0.05 and 95% CI. RESULTS: About 31% of the elderly referred a fall episode and around 11% referred two or more fall episodes in the previous year of the first survey. After follow-up, 53.4% didn't refer any fall episodes, 32.7% referred a fall episode either in the first survey or in the second one and almost 14% referred fall episodes in both surveys. The predictive model of recurrent falls was composed by the following variables: absence of a spouse (OR=1.59 95% CI 1.00-2.52), not having a reading habit (OR= 1.56 95% CI 1.03-2.37), history of fractures (OR=4.6 95% CI 2.23-9.69 difficulty to perform one to three activities of daily life (OR=2.37 95% CI 1.49-3.78), difficulty to perform four or more activities of daily life (OR=3.31 95%CI 1.58-6.93) and among those whose sight is most impaired (OR=1.53 95%CI 1.00-2.34). CONCLUSIONS: Population ageing and increase in life expectancy demand preventive and rehabilitation actions in order to reduce risk factors for falls, such as impaired functional capacity, impaired eye sight and lack of cognitive stimulation.     

2018年中国因跌倒/坠落就诊患者损伤严重程度及影响因素

  目的  了解中国因跌倒/坠落就诊病例流行特征和影响损伤严重程度的因素,为制定跌倒/坠落防控措施、政策提供依据。  方法  通过提取2018年中国伤害监测系统（national injury surveillance system,NISS）中跌倒/坠落病例数据,描述其流行特征,采用多因素Logistic回归分析模型分析损伤严重程度影响因素。  结果  共收集跌倒/坠落病例500 621例。损伤严重程度以轻度为主（76.00%）,中、重度损伤所占比例为24.00%。单因素分析显示,性别、年龄、城乡、发生季节、发生时段、发生地点、发生时活动、发生前饮酒情况的跌倒/坠落病例损伤严重程度差异具有统计学意义（均有P＜0.001）。多因素分析显示,男性（OR=1.056,95% CI:1.041~1.071）;年龄为5~岁（OR=1.412,95% CI:1.366~1.460）、15~岁（OR=1.382,95% CI:1.337~1.427）、30~岁（OR=1.844,95% CI:1.787~1.903）、45~岁（OR=2.746,95% CI:2.666~2.829）、≥65岁（OR=4.524,95% CI:4.390~4.663）;夏季（OR=1.097,95% CI:1.077~1.118）、秋季（OR=1.110,95% CI:1.089~1.131）、冬季（OR=1.137,95% CI:1.116~1.159）;地点为家中（OR=1.169,95% CI:1.143~1.196）、学校与公共场所（OR=1.102,95% CI:1.069~1.136）、体育和运动场所（OR=1.066,95% CI:1.016~1.119）、工业和建筑场所（OR=1.800,95% CI:1.727~1.877）、农场/农田（OR=1.257,95% CI:1.196~1.320）;活动为步行（OR=1.084,95% CI:1.045~1.126）;发生前饮酒（OR=1.318,95% CI:1.257~1.381）是中重度损伤的危险因素。  结论  中国因跌倒/坠落就诊患者中重度损伤占一定比例,且影响因素较多,相关部门应开展针对性的防控工作。     

A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study

The object of this article was to determine the predictive value of risk factors for recurrent falls and the construction of a fall risk model as a contribution to a mobility assessment for the identification of community-dwelling elderly at risk for recurrent falling in general practice. The design was a prospective cohort study (n = 311). There were four primary health care centers. A sample stratified on previous falls, age, and gender of community-dwelling elderly persons aged 70 years or over (n = 311) was taken from the respondents to a mail questionnaire (n = 1660). They were visited at home to assess physical and mental health, balance and gait, mobility and strength. A 36-week follow-up with telephone calls every 6 weeks was conducted. Falls and fall injuries were measured. During follow-up 197 falls were reported by 33% of the participants: one fall by 17% and two or more falls by 16%. Injury due to a fall was reported by 45% of the fallers: 2% hip fractures, 4% other fractures, and 39% minor injuries. A fall risk model for the prediction of recurrent falls with an area under the curve (AUC) of 0.79, based on logistic regression analysis, showed that the main determinants for recurrent falls were: an abnormal postural sway (OR 3.9; 95% Cl 1.3-12.1), two or more falls in the previous year (OR 3.1; 95% Cl 1.5-6.7), low scores for hand grip strength (OR 3.1; 95% Cl 1.5-6.6), and a depressive state of mind (OR 2.2; 95% CI 1.1-4.5). To facilitate the use of the model for clinical practice, the model was converted to a "desk model" with three risk categories: low risk (0-1 predictor), moderate risk (two predictors), and high risk (> or =3 predictors). A fall risk model converted to a "desk model," consisting of the predictors postural sway, fall history, hand dynamometry, and depression, provides added value in the identification of community-dwelling elderly at risk for recurrent falling and facilitates the prediction of recurrent falls.     

Occurrence of hospital infection among interned elderly in a university hospital

OBJECTIVE: Hospital infection is an important cause of morbidity and mortality in the elderly population. The objective of this study was to evaluate the occurrence of hospital infection and risk factors associated with it. METHODS: This is a prospective study of a sample of 332 elderly people, 60 years and older, interned in a university hospital, between September 1999 and February 2000. Sample size was calculated according to the Fisher and Belle formula, with a confidence interval of 0.95%, from a total of 760 elderly patients interned, in proportion to the number of patients present in each in-patient unit, in the 1997. Criteria for defining hospital infection were those established by the Center for Diseases and Prevention Control. Odds ratio and logistic regression were utilized for statistical analysis of the data. RESULTS: The rate of hospital infection was 23.6%. The prevalent topographies of infection were respiratory infections (27.6%), urinary tract infections (26.4%) and surgical wound infections (23.6%). The period of hospitalization of patients who did have hospital infections was 6.9 days, while those who had hospital infections were hospitalized for 15.9 days (p<0.05). Mortality rate among hospitalized patients was 9.6% and the rate of lethality among patients with hospital infection was 22.9% (p<0.05). Risk factors found for hospital infection were cholangiography (odds ratio (OR) =46.4, confidence interval 95% (CI95%) =4.4-485); diabetes mellitus (OR=9.9, CI 95% =4.4-22.3); chronic obstructive pulmonary disease (OR=8.3, CI 95% =2.9-23.7); urinary catheters (OR=5, CI 95% =2.7-11.8); hospitalization with community infection (OR=3.9, CI 95% =1.7-8.9) and mechanic ventilation (OR=3.8, CI 95% =1.9-6.3). CONCLUSIONS: Hospital infection presented elevated incidence and lethality and it increased the period of hospitalization among the elderly studied.     

Contaminated drinking water in one town manifesting as an outbreak of cryptosporidiosis in another

In early 1992 we identified an outbreak of cryptosporidiosis in Oregon and sought to identify and control its source. We used a series of studies to identify risk factors for illness: (i) a case-control study among employees of a long-term-care facility (LTCF); (ii) a matched case-control study of the general community; (iii) a cohort study of wedding attendees; and (iv) a cross-sectional survey of the general community. Drinking Talent water was associated with illness in the LTCF (OR = 22.7, 95 % CI = 2.7-1009.0), and in the community (matched OR = 9.5, 95% CI 2.3-84.1). Drinking Talent water was associated with illness only among non-Talent residents who attended the wedding (P < 0.001) and in the community (RR = 6.5, 95 % CI 3.3-12.9). The outbreak was caused by contaminated municipal water from Talent in the absence of a discernible outbreak among Talent residents, suggesting persons exposed to contaminated water may develop immunity to cryptosporidiosis.     

Occupation, pesticide exposure and risk of multiple myeloma

OBJECTIVES: This population-based case-control study examined the relationship between occupation, living or working on a farm, pesticide exposure, and the risk of multiple myeloma. METHODS: The study included 573 persons newly diagnosed with myeloma and 2131 controls. Information was obtained on sociodemographic factors, occupational history, and history of living and working on a farm. Occupational and industrial titles were coded by standardized classification systems. A job-exposure matrix was developed for occupational pesticide exposure. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression. RESULTS: Farmers and farm workers had odds ratios of 1.9 (95% CI 0.8-4.6) and 1.4 (95% CI 0.8-2.3), respectively. An odds ratio of 1.7 (95% CI 1.0-2.7) was observed for sheep farm residents or workers, whereas no increased risks were found for cattle, beef, pig, or chicken farm residents or workers. A modestly increased risk was observed for pesticides (OR 1.3, 95% CI 0.9-1.8). Significantly increased risks were found for pharmacists, dieticians and therapists (OR 6.1, 95% CI 1.7-22.5), service occupations (OR 1.3, 95% CI 1.02-1.7), roofers (OR 3.3, 95% CI 1.1-9.8), precision printing occupations (OR 10.1, 95% CI 1.03-99.8), heating equipment operators (OR 4.7, 95% CI 1.4-15.8), and hand molders and casters (OR 3.0, 95% CI 1.0-8.4). CONCLUSIONS: A modest increased risk of multiple myeloma is suggested for occupational pesticide exposure. The increased risk for sheep farm residents or workers indicates that certain animal viruses may be involved in myeloma risk.     

中国中老年人群和高个成年人中心型肥胖的腰围界值点验证

目的 探讨中国中老年人群和高个成年人的适宜腰围界值点及其对糖尿病患病危险的预测价值.方法 利用2002年中国居民营养与健康状况调查数据,分析≥45岁人群和身高在全人群第85百分位数(P85)以上成年人的腰围分布特征,分析不同的腰同界值点与体重指数(BMI:kg/m2)≥24的诊断一致性,采用多元logistic回归分析不同腰围水平的调查对象患糖尿病和空腹血糖受损的相对风险,并以ROC曲线最短距离确定上述人群的适宜腰围界值点.结果 中国中老年人腰围男性均值为80.8 cm,女性均值为79.4 cm;高个男性腰围均值为84.1 cm,女性为77.9 cm.中老年人腰围以男性85 cm、女性80 cm作为界值点,与BMI≥24的诊断一致性最好,预测糖尿病的ROC曲线距离最短.与腰围<85 cm组相比,85 cm～组、90 cm～组和95 cm～组的中老年男性患糖尿病[OR值分别为2.1(95%CI:1.6～2.8)、3.0(95%CI:2.3～4.0)和4.5(95%CI:3.4～5.8)]和空腹血糖受损[OR值分别为1.6(95%CI:1.2～2.2)、2.6(95%CI:1.9～3.5)和3.5(95%CI:2.6～4.6)]的相对风险明显增加.与腰围<80 cm组相比,80 cm～组、85 cm～组和90 cm～组中老年女性患糖尿病[OR值分别为1.9(95% CI:1.4-2.6)、3.2(95%CI:2.4～4.3)和4.8(95%CI:3.7～6.1)]和空腹血糖受损[OR值分别为2.5(95%CI:1.8～3.4)、3.2(95%CI:2.4～4.4)和4.2(95%CI:3.2～5.6)]的相对风险明显增高.高个成年人腰围以男性90 cm、女性85 cm作为界值点,预测糖尿病患病的ROC曲线距离最短.与腰围<85 cm组相比,95cm～组高个男性患糖尿病和空腹血糖受损的相对风险明显增高[OR值分别为3.6(95%CI:2.1～6.4)和5.5(95%CI:3.0～10.1)].与腰围<80cm组相比,85 cm～、90 cm～组高个女性患糖尿病的相对风险明显升高[OR值分别为5.0(95%CI:2.7～9.4)和8.0(95%CI:4.6～14.1)],90 cm～组患空腹血糖受损的相对风险OR=3.7(95%CI:2.0～6.9).结论 男性85 cm和女性80 cm是中老年人群的适宜腰围界值点;对于高个成年人,此腰围界值点对于空腹血糖受损有预测价值;人群中心型肥胖预防指标建议使用男性85 cm和女性80 cm作为腰围界值点.     

Balance and mobility performance as treatable risk factors for recurrent falling in older persons

BACKGROUND AND OBJECTIVES: The purpose of this study was to examine whether easily measurable measures for balance and muscle strength predicted recurrent falling as well as sophisticated measurements, and to examine which of the modifiable risk factors were strongest associated with recurrent falling. METHODS: The study was performed in a subsample (n=439, aged 69-92 years) of the Longitudinal Aging Study Amsterdam (LASA). Balance, muscle strength, physical activity, and performance tests were assessed. Falls were recorded during 1 year. The outcome measure was recurrent falls (>/=2 falls within 1 year). RESULTS: The area under the curve (AUC) of mediolateral sway (AUC=0.67; 95% CI:0.57-0.77), tandem stand (AUC=0.61; 95% CI:0.49-0.73), leg extension strength (AUC=0.58; 95% CI:0.51-0.64), and handgrip strength (AUC=0.57; 95% CI:0.51-0.64) for recurrent falling were not significantly different. In a multivariate model, mediolateral sway (OR=2.8; 95% CI:1.1-6.9), tandem stand (OR=2.1; 95% CI:1.1-3.8), and walking test (OR=2.2; 95% CI:1.1-4.1) were significantly associated with recurrent falling. CONCLUSIONS: The easily measurable tandem stand and handgrip strength predicted recurrent falling as well as the sophisticated measures. Mediolateral sway was strongest associated with recurrent falling.     

Access to pocket money and low educational performance predict tobacco use among adolescent boys in Kerala, India

BACKGROUND: Tobacco use is increasing among adolescents. We conducted this study to find prevalence and correlates of tobacco use among adolescent boys in Trivandrum city, Kerala. METHODS: Using a two-stage cluster sampling technique, 1323 boys (12-19 years) were selected from 14 schools. Information on tobacco use, academic performance, pocket money, and other variables was collected using a questionnaire. Multivariate analyses were done to find associations between current use of tobacco and other variables. RESULTS: Prevalence of current tobacco use was 11.3% (95% CI 9.6-13.0). Current tobacco use was 2.9 times higher among older boys compared to younger boys (OR 2.9, CI 1.6-5.3), 2 times higher among boys whose fathers used tobacco (OR 2.0, CI 1.3-3.1), 2.9 times higher among boys whose friends used tobacco (OR 2.9, CI 1.6-5.1) compared to their counterparts, 3 times higher among boys securing poor (<40% marks) grade compared to those securing excellent (>80% marks) grade (OR 3.0, CI 1.4-6.6), and 4 times higher among those who received pocket money compared to those who did not (OR 4.0, CI 2.2-7.4). CONCLUSIONS: Health programs to quit tobacco are suggested in schools with special emphasis on poor performers, those receiving pocket money, and those whose fathers and friends use tobacco.     

中国农村中老年人社会隔离的影响因素分析

目的 调查我国农村中老年人社会隔离的影响因素。方法 采用2015年中国健康与养老追踪数据,筛选出符合研究纳入标准的农村中老年人样本7 427例,根据Berkman社会网络指数判断是否存在社会隔离,采用多因素logistic逐步回归分析,对社会隔离的影响因素进行探讨。结果 中国农村中老年人社会隔离发生率为28.84%,其主要影响因素有:性别(OR = 1.55,95%CI:1.38～1.73)、年龄(OR = 1.69,95%CI:1.58～1.80)、地域(OR = 1.21,95%CI:1.13～1.29)、教育水平(OR = 0.83,95%CI:0.74～0.94)、金融机构存款金额(OR = 0.86,95%CI:0.80～0.93)、出入阶梯数(OR = 1.06,95%CI:1.01～1.13)、听力(OR = 1.25, 95%CI:1.11～1.41)、认知情况(OR = 0.91,95%CI:0.89～0.93)、生活满意度(OR = 1.07, 95%CI:1.01～1.15)、抑郁(OR = 1.17,95%CI:1.04～1.31)。结论 我国农村中老年人社会隔离发生率较高,应结合农村中老年人群体的特殊性,加强农村基础设施建设,重视中老年人身心健康管理,增加其社会网络和社会参与,以减少社会隔离的发生。     

Maternal, delivery, and perinatal characteristics associated with cryptorchidism: a population-based case-control study among births in Washington State

BACKGROUND: The etiology of cryptorchidism is largely unknown. To identify maternal, perinatal, and delivery characteristics associated with cryptorchidism at birth, we conducted a population-based case-control study using Washington State birth certificates linked to birth hospitalization records. METHODS: We identified 2,395 cases of cryptorchidism among male infants born in Washington State during 1986-1996, and, for comparison, we randomly selected four controls per case (N = 9,580), frequency-matched by year of birth. RESULTS: Infant characteristics associated with cryptorchidism included low birth weight (OR = 1.5; 95% CI = 1.3-1.8), small size for gestational age (OR = 1.9; 95% CI = 1.6-2.2), and breech presentation (OR = 1.7; 95% CI = 1.4-2.1). In addition to cryptorchidism, cases were more likely to have another type of congenital malformation (OR = 3.7; 95% CI = 3.2-4.2), particularly digestive (OR = 6.8; 95% CI = 3.7-12.7) or genitourinary (OR = 4.1; 95% CI = 3.0-5.6). Maternal and pregnancy characteristics associated with cryptorchidism included nulliparity (OR = 1.2; 95% CI = 1.1-1.3), maternal smoking during pregnancy (OR = 1.2; 95% CI = 1.1-1.4), and the following pregnancy complications: oligohydramnios (OR = 1.8; 95% CI = 1.3-2.6), placental abnormality (OR = 1.3; 95% CI = 1.0-1.8), and pregnancy-induced hypertension (OR = 1.6; 95% CI = 1.4-1.9). Odds ratios were similar when the analysis was restricted to term infants. CONCLUSIONS: These findings suggest that factors affecting fetal growth and development may increase the risk of cryptorchidism.     

Feeling the blues of infertility in a South Asian context: psychological well-being and associated factors among Sri Lankan women with primary infertility

Primary infertility may have a considerable impact on the psychological well-being of women. In the present study, the authors investigated the psychological well-being and its correlates among Sri Lankan women with primary infertility. A total of 177 women with primary infertility were compared with 177 fertile women matched for age and duration of marriage to identify differences in the psychological well-being between the two groups. They were recruited from a prevalence survey conducted in the district of Colombo, Sri Lanka from August 2005 to February 2006. The General Health Questionnaire-30 (GHQ-30) and Mental Health sub-components of the Short Form-36 (SF-36) were used to measure psychological well-being. In addition, infertile women with and without psychological distress were compared to identify the social, marital, treatment, and demographic factors independently associated with psychological distress. A significantly higher proportion of women with primary infertility (66.1%; 95% CI 58.6-73.0%) had psychological distress as compared to fertile women (18.6 %; 95% CI 13.2-25.2%; P < 0.001). After adjustment for confounding factors, infertile women who were psychologically distressed were significantly less educated (OR = 55.3; 95% CI 15.2-201.0), had poor marital communication (OR = 3.5; 95% CI 1.3-9.8), had a higher priority for having children (OR = 4.2; 95% CI 1.3-13.8), and had been previously (OR = 39.1; 95% CI 8.3-185.4) or currently (OR = 11.0; 95% CI 3.0-40.6) investigated/treated for infertility when compared with infertile women without distress. Women with primary infertility reported more distress as compared to fertile women. Psychological distress among infertile women was associated with poorer education, being previously/currently investigated/treated, placing higher importance on having children, and having poor marital communication. The need for psychological intervention targeting infertile women in clinics and community settings is highlighted.     

Possible relation of Tunisian pemphigus with traditional cosmetics: a multicenter case-control study

Pemphigus is a severe, autoimmune, blistering disorder with a high incidence among young women in rural Tunisia. The authors investigated explanatory environmental factors. A multicenter case-control study was conducted prospectively from 1992 to 1996 in Tunisia. Sixty-eight incident female cases of pemphigus and 166 controls matched on age, hospital, and geographic area were included. Data collected concerned socioeconomic status, medical history, drug intakes, lifestyle, and environment. Several factors were significantly associated with pemphigus in multivariate logistic regression analyses: traditional cosmetics (odds ratio (OR) = 4.0, 95% confidence interval (CI): 1.1, 14.8); Turkish baths (OR = 3.2, 95% CI: 1.4, 7.3); cutting up raw poultry (OR = 5.1, 95% CI: 1.3, 19.4); contact with ruminants (OR = 2.7, 95% CI: 1.3, 5.8); and wasp, bee, and spider stings (OR = 3.1, 95% CI: 1.5, 6.4). A dose-dependent relation was observed for traditional cosmetics. All risks except insect bites were higher when analysis was restricted to younger women, the demographic group with higher incidence. The strength of the associations, the dose-dependent relation for traditional cosmetics, and the increase of risk estimates for younger women support a causal relation. Traditional cosmetics widely used by Tunisian women could play a major role in excess of cases of pemphigus.     

Factors affecting the compliance of the antenatal hepatitis B screening programme in Italy

The effectiveness in the prevention of perinatally transmitted HBV infection was assessed in 11858 pregnant women consecutively recruited in public and private hospitals in six Italian regions during a 2 months period in 2001. Of them 10881 (91.8%) attended HBsAg antenatal screening. The overall HBsAg prevalence was 1.7% (CI 95%: 1.4-1.9); it was 1.4% (CI 95%: 1.2-1.7) in pregnant women born in Italy but 5.9% (CI 95%: 4.1-8.1) in those born in Asia, Africa, central and south America, and eastern Europe. Results of multiple logistic regression analysis indicate that birth in foreign countries (OR 2.0; CI 95%: 1.3-3.0), family size with more than 4 members in the household (OR 3.5; CI 95%:2.7-4.6), and birth in a private hospital (OR 1.9; CI 95%: 1.3-2.8) were all independent predictors of lack of adherence to HBsAg screening. Out of the 182 new-borns of HBsAg positive mothers 172 (95.0%) were given active plus passive immunisation; this figure was 100% in new-borns of foreign mothers. These findings evidence a good effectiveness in the prevention of perinatally transmitted HBV in Italy. More efforts should be addressed to improve the effectiveness of the programme among foreign pregnant women who have high rate of HBsAg and more likely escape HBsAg screening than Italian pregnant women.     

Occupational activity and prevalence of osteomuscular pain among dentists in Belo Horizonte, Minas Gerais State, Brazil: a contribution to the debate on work-related musculoskeletal disorders

The objective was to determine the prevalence of upper-limb and back pain among dentists (n = 358) and factors associated with these symptoms. Dentists were interviewed using a self-administered questionnaire containing data on sociodemographic, occupational, lifestyle, and psychosocial factors and presence, site, and characteristics of pain. Participation rate was 92.3%. 58% reported upper limb pain, with 22, 21, 20, and 17% for the arm, back, neck, and shoulder, respectively. 26% reported daily frequency and 40% classified pain as moderate or severe. In the multivariate analysis (multiple logistic regression), the factors associated with pain were: neck: anxiety/depression (OR = 2.3; CI95%: 1.2-4.5), compressor in the office (OR = 2.1; CI95%: 1.2-3.7), job satisfaction (OR = 0.3; CI95%: 0.1-0.9), and use of indirect vision (OR = 0.5; CI95%: 0.3-0.9); shoulder: income > 20 minimum wage (OR = 2.9; CI95%: 1.2-6.7), greater productivity (OR = 3.3; CI95%: 1.3-8.4), height > or = 160cm (OR = 0.3; CI95%: 0.2-0.7), and age 30-49 years (OR = 0.3; CI95%: 0.1-0.8); back: anxiety/depression (OR = 2.3; CI95%: 1.2-4.5), manual activity (OR = 0.4; CI95%: 0.2-0.9), and being married (OR = 0.5; CI95%: 0.3-0.9); arms: manual activity (OR = 1.8; CI95%: 1.0-3.2).