Psychiatric morbidity is related to parental age: a national cohort study

BACKGROUND: The median age at first childbirth has increased dramatically in many high-income countries during the past decades. The psychiatric consequences of this demographic change are insufficiently described on a population level. This study aimed to investigate whether parental age at childbearing is related to psychiatric morbidity among Swedish youths. METHOD: This was a cohort study based on Swedish national registers. A national cohort of 292129 children born to primiparas women during 1973-1979 was followed prospectively from 1987 to 2002 in registers. Multivariate Cox analyses of proportional hazards were used to estimate the relative risk of hospital admission for schizophrenia, alcohol and illicit drug abuse, suicide attempts and deaths. RESULTS: Youths born of teenage mothers had a high risk for suicide death [relative risk (RR) 1.9, 95% confidence interval (CI) 1.3-2.7] and hospital admissions because of suicide attempt (RR 2.0, 95% CI 1.7-2.3) and substance abuse (alcohol: RR 1.6, 95% CI 1.4-1.8; illicit drug: RR 2.2, 95% CI 1.9-2.5) after adjustments for major sociodemographic confounders, compared with children of mothers aged 25-29 years. Offspring of older parents (>34 years) had the highest risk for schizophrenia (RR 1.8, 95% CI 1.0-3.0). CONCLUSIONS: Parental age is related to psychiatric morbidity.     

Prevalence of and risk factors for penile infection by high‐risk human papillomavirus among men infected with HIV

This study aimed to determine the prevalence of and risk factors for high‐risk human papillomavirus (HPV) genital infection and precursor lesions of penile cancer among patients infected with human immunodeficiency virus (HIV). In total, 276 men with a mean age of 34.6 years were included. All participants were subjected to peniscopic examination under magnification, collection of genital exfoliated cells for detecting HPV types using Hybrid Capture, and biopsy surgery of clinically observable lesions and aceto‐white areas for histopathological studies. The prevalence of high‐risk HPV types was 43%. Peniscopicy showed clinically visible lesions or aceto‐white areas in 75/276 participants (27%), of which genital warts were the most common (22/75; 29%). HIV‐positive (HIV⁺) men with CD4⁺ T‐cell counts <200 cells/mm³ showed a higher prevalence of penile lesions. Multivariate logistic regression was applied to identify independent risk factors for high‐risk HPV types. The results showed that high‐risk HPV was associated with lower education level (OR = 1.89, 95% CI: 1.15–3.13), illicit drug use (OR = 1.80, 95% CI: 1.03–3.14), mulatto ethnicity (OR = 2.51, 95% CI: 1.38–4.54), heterosexual orientation (OR = 2.12, 95% CI: 1.30–3.47) symptomatic AIDS (OR = 2.80, 95% CI: 1.65–4.77), AIDS‐associated opportunistic infections (OR = 2.92, 95% CI: 1.78–4.78), on HAART (OR = 2.91, 95% CI: 1.78–4.77), and CD4⁺ T‐cell count <200 cells/mm³ (OR = 3.31, 95% CI: 1.84–5.96). Immunocompromised men were more susceptible to developing penile lesions associated with high‐risk HPV types. J. Med. Virol. 85:413–418, 2013. © 2013 Wiley Periodicals, Inc.     

Case-control study of risk factors for incident HIV infection in rural Uganda

OBJECTIVE: To identify risk factors associated with HIV incidence in a rural Ugandan population. DESIGN: Case-control study. METHODS: Men and women who seroconverted between 1990 and 1997 (cases) and seronegative subjects (controls) were drawn from a general population cohort of approximately 5000 adults in rural, southwestern Uganda. Information on risk factors was ascertained through a detailed interview and physical examination by clinicians who were blind to the study subjects' HIV status. All patients were interviewed within 2 years of their estimated date of seroconversion. RESULTS: Data were available on 130 men (37 cases, 93 controls) and 133 women (46 cases, 87 controls). There was a significantly higher risk of infection in men (odds ratio [OR], 6.51; 95% confidence interval [CI], 1.06-39.84) and women (OR, 4.75; 95% CI, 1.26-17.9) who were unmarried and in a steady relationship, and in men who were divorced, separated, or widowed (OR, 4.33; 95% CI, 1.32-14.25) compared with those who were married. There was a significantly higher risk of HIV infection in men (OR, 3.78; 95% CI, 1.20-11.93) and women (OR, 20.78; 95% CI, 2.94-141.2) who reported > or =5 lifetime sexual partners compared with those who reported at most 1 partner. For men, there was an increased risk of infection associated with receiving increasing numbers of injections in the 6 months prior to interview (p < .001 for trend). Women reporting sex against their will in the year prior to interview were at higher risk of infection (OR, 7.84; 95% CI, 1.29-47.86; p = .020). CONCLUSIONS: The strongest risk factor for HIV incidence in this rural Ugandan population is lifetime sexual partners. The increased risks found for women reporting coercive sex and men reporting injections require further investigation.     

Cancer and mental disorders in a national community sample: findings from the national comorbidity survey

OBJECTIVE: To determine the association between cancer (past 12 months) and mental disorders (past 12 months) among community-dwelling adults. METHODS: Data were drawn from the National Comorbidity Survey (n = 5,877), a representative household sample of adults aged 15-54 years in the United States. Multiple logistic regression analyses were used to determine the association between cancer and mental disorders, adjusting for differences in sociodemographic characteristics. RESULTS: Cancer was significantly associated with increased rates of major depression [odds ratio (OR) = 3.6, 95% confidence interval (CI) = 1.4-8.8], drug dependence (OR = 3.6, 95% CI = 1.3-9.8), simple phobia (OR = 2.5, 95% CI = 1.0-6.2) and agoraphobia (OR = 3.3, 95% CI = 1.0-10.4). These associations persisted after adjusting for major sociodemographic factors, and sex plays a significant role in the association between cancer diagnosis and mental disorder, with cancer diagnosis having a stronger influence on major depression and drug dependence in men than in women. CONCLUSIONS: Clinicians and community health workers working with cancer survivors need to be not only alert for signs of clinical depression but also of co-occurring drug dependence and certain anxiety disorders so that appropriate referrals to mental health professionals can be made.     

Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients

STUDY OBJECTIVE: To explore gender differences in morbidity and total health care utilization 5 years prior to diagnosis of obstructive sleep apnea (OSA). DESIGN: Case-control study; patients were recruited between January 2001 and April 2003. SETTING: Two university-affiliated sleep laboratories. PATIENTS: 289 women (22-81 years) with OSA were matched with 289 men with OSA for age, body mass index (BMI), and apnea-hypopnea index (AHI). All OSA patients were matched 1:1 with healthy controls by age, geographic area, and primary physician. MEASUREMENTS AND RESULTS: Women with OSA compared to men with OSA have lower perceived health status and Functional Outcomes of Sleep Questionnaire score (54.5% vs. 28.4%, P <0.05 and 67.5+/-21.4 vs. 76+/-20.1, P <0.05, respectively). Compared to men with OSA, women with OSA have higher risk of hypothyroidism (OR 4.7; 95% CI, 2.3-10) and arthropathy (OR 1.6, 95% CI, 1.1-2.2) and lower risk for CVD (OR 0.7; 95% CI, 0.5-0.91). Compared to controls, both women and men with OSA had 1.8 times higher 5-year total costs (P <0.0001). Compared to men with OSA, expenditures for women with OSA are 1.3 times higher (P <0.0001). The multiple logistic regression (adjusting for BMI, AHI) revealed that age (OR 1.04; 95% CI, 1.01-1.07), antipsychotic and anxiolytic drugs (OR 2.3; 95% CI, 1.2-4.4), and asthma (OR 2.4; 95% CI, 1.1-5.6) are independent determinants for "most costly" OSA women. CONCLUSION: Compared to men with similar OSA severity, women are heavier users of health care resources. Low FOSQ score and poor perceived health status in addition to overuse of psychoactive drugs are associated with high health care utilization among women with OSA.     

Coeliac disease and risk of mood disorders--a general population-based cohort study

BACKGROUND: Earlier research has indicated a positive association between coeliac disease (CD) and some mental disorders. Studies on CD and depression have inconsistent findings and we know of no study of CD and the risk of bipolar disorder (BD). METHODS: We used Cox regression to investigate the risk of subsequent mood disorders (MD); depression and BD in 13,776 individuals with CD and 66,815 age- and sex-matched reference individuals in a general population-based cohort study in Sweden. We also studied the association between prior MD and CD through conditional logistic regression. RESULTS: CD was associated with an increased risk of subsequent depression (Hazard ratio (HR)=1.8; 95% CI=1.6-2.2; p<0.001, based on 181 positive events in individuals with CD and 529 positive events in reference individuals). CD was not associated with subsequent BD (HR=1.1; 95% CI=0.7-1.7; p=0.779, based on 22 and 99 positive events). Individuals with prior depression (OR=2.3; 95% CI=2.0-2.8; p<0.001) or prior BD (OR=1.7; 95% CI=1.2-2.3; p=0.001) were at increased risk of a subsequent diagnosis of CD. LIMITATIONS: Study participants with CD and MD may have more severe disease than the average patient with these disorders since they were identified through a hospital-based register. CONCLUSIONS: CD is positively associated with subsequent depression. The risk increase for CD in individuals with prior depression and BD may be due to screening for CD among those with MD.     

Sex differences in young adulthood metabolic syndrome and physical activity: the Fels longitudinal study.

OBJECTIVE: To evaluate the effects of habitual physical activity (PA) on the metabolic syndrome (MS) in young adult men and women. RESEARCH METHODS AND PROCEDURES: Cross-sectional PA data were utilized from 249 women and 237 men, aged 18-40 years in the Fels Longitudinal Study. MS components--abdominal circumference (AC), triglycerides (TG), HDL, blood pressure (BP), and fasting glucose (FG)--were dichotomized according to the National Cholesterol Education Program's Adult Treatment Panel III revised criteria. Leisure, sport, work, and total PA scores were calculated using the Baecke Questionnaire of Habitual Physical Activity. Multiple logistic regression modeling assessed the effects of PA, age, smoking, and BMI on MS status. RESULTS: 26.9% of men and 19.3% of women had MS. For men, MS risk was reduced with increases in both total PA [OR = 0.65 (95% CI: 0.47, 0.90)] and sport PA [OR = 0.40 (95% CI: 0.23, 0.70)]. AC, TG, and HDL values also improved with total and sport PA. Among women, the risk for MS was marginally reduced by total PA [OR = 0.72 (95% CI: 0.50, 1.02)] and HDL levels were increased by both total PA [OR = 0.79 (95% CI: 0.63, 0.98)] and sport PA [OR = 0.54 (95% CI: 0.35, 0.84)]. DISCUSSION: Increased total and sport PA reduces risk for the MS in young men, though not as clearly in young women.     

Deletion polymorphism in the gene for angiotensin-converting enzyme is associated with essential hypertension in men born during the Pacific War

Age is a strong risk factor for hypertension in relation to vascular aging. Additional etiological factors include: lifestyle, genetic factors, and their interactions. The aim of this study is to examine whether an insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene is associated with essential hypertension in Korean born during the Pacific War. A total of 13,914 healthy subjects (8261 men, 5653 women) aged 20-79 years were examined. Subjects with abnormal renal, thyroid dysfunction, or electrolyte levels were excluded. Logistic regression analysis showed increased risk (OR=1.15; 95% CI, 1.01-1.31) in men, but not in women (OR, 1.06; 95% CI, 0.89-1.26). However, after adjustment for age, obesity, cholesterol, alcohol consumption, and diabetes mellitus, increased risk in men was not significant (OR, 1.13; 95% CI, 0.98-1.42). Analyzed according to birth-year, DD genotype showed increased risk for hypertension in only a subgroup of men (adjusted OR, 1.56; 95% CI, 1.16-2.09; p = 0.001), born during the Pacific War (1941-1945 year). Findings suggest that the ACE DD genotype plays a role in the pathogenesis of essential hypertension, in conjunction with adverse environmental conditions in early life, with sex-related difference.     

Early Onset Cannabis Use and Progression to other Drug Use in a Sample of Dutch Twins

One possible explanation of the commonly reported associations between early onset cannabis use and elevated risks of other illicit drug use is that early onset cannabis use increases access and availability to other drugs. It was this argument that in part motivated policy changes in the Netherlands that led to the de facto legalization of cannabis there. This study examines, using a co-twin control design, whether previously observed associations between early onset cannabis use and elevated lifetime rates of other illicit drug use would also be observed in a sample of 219 same sex Dutch twin pairs discordant for cannabis use before age 18. After adjustment for covariates, rates of lifetime party drug use (OR=7.4, 95% CI=2.3–23.4), hard drug use (OR=16.5, 95% CI=2.4–111.3), but not regular cannabis use (OR=1.3, 95% CI=0.3–5.1) were significantly elevated in individuals who reported early onset cannabis use, relative to their co-twin who had not used cannabis by age 18. The elevated odds of subsequent illicit drug use in early cannabis users relative to their non early using co-twins suggests that this association could not be explained by common familial risk factors, either genetic or environmental, for which our co-twin methodology provided rigorous control.     

Does High Emotional Demand with Low Job Control Relate to Suicidal Ideation among Service and Sales Workers in Korea?

We examined the relationship of high emotional demands and low job control to suicidal ideation among service and sales workers in Korea. A total of 1,995 service and sales workers participated in this study. Suicidal ideation and level of emotional demand and job control were assessed by self-reported questionnaire in 4th Korean National Health and Nutrition Examination Survey. Gender-specific odds ratio (OR) and 95% confidence intervals (95% CI) for suicidal ideation were calculated using logistic regression analysis. The results show that workers who suffered from high emotional demands (OR, 2.07; 95% CI, 1.24-3.45 in men, OR, 1.97; 95% CI, 1.42-2.75 in women) or low job control (OR, 1.96; 95% CI, 1.42-2.75 in men, OR, 1.33; 95% CI, 0.91-1.93 in women) were more likely to experience suicidal ideation after controlling for age, household income, and employment characteristics. The interaction model of emotional demands and job control revealed that workers with high emotional demands and high job control (OR, 1.93; 95% CI, 1.08-3.45 in men, OR, 1.60; 95% CI,1.06-2.42 in women) and high emotional demands and low job control (OR; 4.60, 95% CI;1.88-11.29 in men, OR; 2.78, 95% CI;1.64-4.44 in women) had a higher risk for suicidal ideation compared to those with low emotional demands and high job control after controlling for age, household income, employment characteristics, smoking, alcohol drinking and physical activity habit. These results suggest that high emotional demands in both genders and low job control in men might play a crucial role in developing suicidal ideation among sales and service workers in Korea.     

Aggressive behaviour at first contact with services: findings from the AESOP First Episode Psychosis Study

BACKGROUND: Aggressive behaviour is increased among those with schizophrenia but less is known about those with affective psychoses. Similarly, little is known about aggressive behaviour occurring at the onset of illness. METHOD: The main reasons for presentation to services were examined among those recruited to a UK-based first episode psychosis study. The proportion of individuals presenting with aggressive behaviour was determined and these individuals were compared to those who were not aggressive on a range of variables including sociodemographic, clinical, criminal history, service contact, and symptom characteristics. Among the aggressive group, those who were physically violent were distinguished from those who were not violent but who were still perceived to present a risk of violence to others. RESULTS: Almost 40% (n=194) of the sample were aggressive at first contact with services; approximately half of these were physically violent (n=103). Younger age, African-Caribbean ethnicity and a history of previous violent offending were independently associated with aggression. Aggressive behaviour was associated with a diagnosis of mania and individual manic symptoms were also associated with aggression both for the whole sample and for those with schizophrenia. Factors differentiating violent from non-violent aggressive patients included male gender, lower social class and past violent offending. CONCLUSIONS: Aggressive behaviour is not an uncommon feature in those presenting with first episode psychosis. Sociodemographic and past offending factors are associated with aggression and further differentiate those presenting with more serious violence. A diagnosis of mania and the presence of manic symptoms are associated with aggression.     

Life events and psychosocial factors in elderly suicides--a case-control study.

BACKGROUND: Stressful life events, such as family conflicts, separation, bereavement, somatic illness and financial problems are common antecedents of suicide. Studies on suicide among younger persons dominate the literature, despite the fact that a large proportion of suicides occur among elderly persons. METHODS: The occurrence of stressful life events was investigated among elderly suicide cases and population controls. The study was conducted in the southwestern part of Sweden and included 85 persons (46 males and 39 females) 65 years and above who had committed suicide from January 1994 to May 1996. Population controls (84 males and 69 females) were randomly selected. Interviews were carried out with the controls and with informants for the suicide cases. Questions on sociodemographic background, mental and somatic health status, and life events (0-6, 7-12 and 13-24 months preceding suicide/interview) were included in the interviews. RESULTS: Somatic illness, family discord and financial trouble were significant risk factors during all three time periods. Other risk factors were mental disorder, lower education, feelings of loneliness and previous suicide in the family. Factors associated with a decreased risk included active participation in organizations and having a hobby. Variables that remained in the multivariate logistic regression model were mental disorder (men, odds ratio (OR) = 62.4, 95% CI 17.9-217.5; women, OR = 55.9, 95% CI 14.1-222.3) and family discord (men, OR = 10.0. 95% CI 1.7-59.8; women, OR = 9.2, 95% CI 1.9-44.8). CONCLUSIONS: Mental disorder and family discord were the two major risk factors for suicide among elderly men and women.     

Mental disorders in medical inpatients and the association to severity of illness, self-rated physical disability, and health perception

In a study of 294 consecutive medical inpatients, the authors assessed a subsample of 157 patients for psychiatric diagnoses using an extensive semistructured interview, Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Patients rated their health and physical functioning, and medical consultants assessed them for chronic and life-threatening diseases. A life-threatening condition increased odds for having a psychiatric diagnosis by 3.1 times (95% Confidence Interval (CI): 1.03-9.1), while a chronic medical disease had no such impact (OR=1.1; 95% CI: 0.5-2.3). In women, mental disorders were strongly associated with self-rated disability (OR=6.7; 95% CI: 1.6-27.8) and self-rated health (OR=9.4; 95% CI: 2.7-32.4). This association was absent in men (OR(disability)=0.7; 95% CI: 0.2-2.7; OR(health)=1.6; 95% CI: 0.6-4.7). Analyses included adjustment for age and gender.     

Injection drug use is an independent risk factor for iron deficiency and iron deficiency anemia among HIV-seropositive and HIV-seronegative women

The risk factors for iron deficiency and iron deficiency anemia among female injection drug users are not well characterized. We measured hemoglobin and plasma ferritin and obtained demographic information and injection drug use history in the last 6 months in a cross-sectional study of 200 female injection drug users (134 HIV-positive and 66 HIV-negative). The women were participants in a natural history study, the AIDS Linked to Intravenous Experiences study in Baltimore, Maryland. In multivariate analyses adjusting for age, hepatitis C virus status, and HIV status, injection drug use within the last 6 months was associated with iron deficiency (odds ratio [OR] = 2.61, 95% confidence interval [CI]: 1.33 to 5.09) and iron deficiency anemia (OR = 6.65, 95% CI: 2.33 to 18.9). Among 134 HIV-positive women, injection drug use in the last 6 months was associated with iron deficiency (OR = 2.43, 95% CI: 1.08 to 5.48) and iron deficiency anemia (OR = 6.05, 95% CI: 1.82 to 20.1) in multivariate analyses adjusting for hepatitis C virus status and CD4 lymphocyte count. Injection drug use seems to be associated with iron deficiency and iron deficiency anemia. Further longitudinal studies are needed to gain insight into the nature of this association.     

High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India

OBJECTIVE: To estimate HIV and sexually transmitted disease (STD) prevalence and behavioral risk characteristics of men who have sex with men (MSM) in Chennai, India. METHODS: A cross-sectional population-based random sample survey was conducted in 2001. Randomly selected residents of 30 slums in Chennai were interviewed for behavioral risk factors through face-to-face interviews. Sera and urine were examined for syphilis, HIV-1, gonorrhea, and chlamydia. Logistic regression analyses were used to assess associations between MSM status and HIV infection and to identify risk characteristics of MSM. RESULTS: Of 774 men, 46 reported (5.9%) sex with other men. MSM were more likely to be seropositive for HIV (odds ratio [OR] = 8.57; 95% confidence interval [CI]: 1.83, 40.23) and were more likely to have a history of STD (OR = 2.66; 95% CI: 1.18, 6.02) than non-MSM. Men who used illicit drugs in past 3 months (adjusted odds ratio [AOR] = 4.01; 95% CI: 1.92, 8.41), ever exchanged money for sex (AOR = 3.93; 95% CI: 1.97, 7.84), or were ever tested for HIV (AOR = 3.72; 95% CI: 1.34, 10.34) were significantly more likely to report sex with men. CONCLUSIONS: MSM in Chennai slums are at high risk for HIV. HIV prevention strategies aimed at changing unsafe drug and sexual practices should target the general population of men, with specific attention to areas with high rates of MSM.     

Comparison of an ESAT-6/CFP-10 peptide-based enzyme-linked immunospot assay to a tuberculin skin test for screening of a population at moderate risk of contracting tuberculosis

Screening for latent tuberculosis infection (LTBI) with the Mantoux tuberculin skin test (TST) has many limitations including false-positive results due to Mycobacterium bovis bacillus Calmette-Guérin (BCG) vaccination. Three hundred ninety adult inmates with normal screening chest radiographs in a county jail were evaluated for LTBI using TST and an ESAT-6/CFP-10 peptide-based enzyme-linked immunospot assay (T-SPOT.TB). LTBI prevalence rates were 19.0% and 8.5% by T-SPOT.TB and TST, respectively. Overall agreement between test results was 82.8% (kappa = 0.29). Positive T-SPOT.TB results were significantly associated with increased age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.06) and intravenous drug use history (OR, 2.92; 95% CI, 1.36 to 6.27). Positive TST results were significantly associated with increased age (OR, 1.06; 95% CI, 1.02 to 1.09) and foreign birth (OR, 6.61; 95% CI, 1.98 to 22.01). Discordant covariates between the assay results included increased age (OR, 0.96; 95% CI, 0.94 to 0.99) and intravenous drug use history (OR, 0.41; 95% CI, 0.19 to 0.88). T-SPOT.TB reactivity is unaffected by prior BCG vaccination. T-SPOT.TB may be more sensitive than TST in diagnosing LTBI among a moderate risk population of inmates, particularly those with intravenous drug use history. Longitudinal studies are needed to assess the positive predictive value of T-SPOT.TB in identifying those most likely to convert to active disease in general populations as well as in high-risk subpopulations.     

Risk factors for human herpesvirus 8 seropositivity in the AIDS Cancer Cohort Study.

BACKGROUND: Cigarette smoking has been associated with a decreased risk for AIDS-related and classical KS, but whether it is associated with decreased risk of human herpesvirus 8 (HHV-8) infection is unknown. STUDY DESIGN: We evaluated factors associated with HHV-8 seropositivity in 2795 participants (132 with KS) in the National Cancer Institute AIDS Cancer Cohort, including 1621 men who have sex with men (MSM), 660 heterosexual men and 514 women. Odds ratios (OR) and 95% confidence intervals were estimated using logistic regression models. RESULTS: Among non-KS subjects, HHV-8 seropositivity was 6%, 13% and 29% among women, heterosexual men and MSM, respectively. HHV-8 seropositivity was decreased in heavier (> or =1/2 pack/day) compared to lighter smokers among women (5% versus 8%; adjusted OR (aOR) 0.4; 95% CI 0.2-0.8) and MSM (27% versus 32%; aOR 0.7; 95% CI 0.6-1.0), but not among heterosexual men (12% versus 16%; aOR 0.7; 95% CI 0.4-1.2). HHV-8 seroprevalence was increased in heavier (> or =1 drink/day) compared to lighter consumers of alcohol among women (16% versus 4%; adjusted OR 5.2; 95% CI 2.3-12), but not among MSM (33% versus 28%; aOR 1.2; 95% CI 0.9-1.6) or heterosexual men (13% versus 13%; aOR 1.1; 95% CI 0.6-2.0). In analyses adjusted for smoking and drinking, HHV-8 seropositivity was positively associated with chlamydia infection (OR=4.3; 95% CI 1.2-13) and with marital status among women p(heterogeneity)=0.03, and with hepatitis (OR=1.6; 95% CI 1.2-2.1), gonorrhea (OR=1.5; 95% CI 1.1-1.9), genital warts (OR=1.5; 95% CI 1.1-2.0) and nitrate inhalant use (OR=1.7; 95% CI 1.3-2.3) among MSM. CONCLUSIONS: Inverse association of HHV-8 seropositivity with cigarette smoking may indicate protective effect of tobacco smoke on HHV-8 infection, whereas positive associations with alcohol may reflect either behavioral factors or biological effects modulating susceptibility. Smoking and drinking may influence KS risk, at least in part, by altering the natural history of HHV-8 infection.     

Postmenopausal estrogen and progestogen therapy and the risk of uterine leiomyomas

OBJECTIVE: Leiomyomas are common benign neoplasms. Although hormone therapy is the most common and effective treatment for menopausal symptoms, little is known about its effect on leiomyomas. We examined the risk of a first diagnosis of leiomyomas in peri- and postmenopausal women associated with prior use of estrogen and progestogen therapy (EPT). DESIGN: A case-control study was conducted among enrollees from a nonprofit health plan. Cases had a first diagnosis of leiomyomas confirmed by surgery or ultrasound. Controls were women of the same age range without a diagnosis of leiomyomas selected at random from membership and outpatient files. Participants were interviewed regarding prior use of exogenous hormones, medical history, and reproductive history. This analysis was restricted to cases (n = 256) and controls (n = 276) who were peri- or postmenopausal and more than 40 years of age. Adjusted odds ratios (OR) and 95% CIs were estimated using logistic regression models. RESULTS: EPT use for more than 5 years was associated with a 1.7-fold increased risk of leiomyomas (95% CI, 0.9-3.3). Associations with EPT use were only present among women with a body mass index less than 24 kg/m; OR (ever-use), 2.3 (95% CI, 1.2-4.3); and OR (>or= 5 years use), 4.0 (95% CI, 1.6-10.3). CONCLUSION: Among peri- and postmenopausal women, prior EPT use was associated with an increased risk of a subsequent leiomyomas. This association seemed limited to the subset of women with low body mass index. Exogenous sources of estrogen and progestin in the setting of low adiposity may contribute to the development of leiomyomas.     

Maternal mortality in Dar es Salaam,Tanzania: Socio-economic,obstetric history and accessibility of health care factors

A community-based incident case-referent study was performed in Ilala district, Dar es Salaam, Tanzania to estimate the social, obstetric history and accessibility of health care factors for maternal death. From February 1991 to January 1993 all female deaths in the reproductive ages were identified through the existing administrative information system. For every maternal death three live mothers was selected as referents matched for age. In cases a relative to the deceased mother and in referents the live mother herself was interviewed using a pre-tested questionnaire. Socio-economic factors were strongly related to the risk of maternal death. Single and divorced women were at an increased risk (odds ratio (OR) equals5.1; 95% confidence interval (CI): 2.8-9.3 and OR equals28; 95% CI: 6.5- 118). Women with less than 3 years' education had a 3 fold higher risk than women with more than 7 years' schooling. Also women who were peasants and unskilled workers were at higher risk when compared with professionals and peasants and unskilled workers were at higher risk when compared with professionals and skilled workers (OR equals20, 95% CI:7.4-51 and OR equals6.2; 95% CI:2.5-15). An obstetric history with no previous live births (OR equals 36; 95% CI: 8.239), more than one induced abortion (OR=36; 95% CI; 9.7-132) or stillbirth (OR equals4.8; 95% CI:1.6-14) and unwanted pregnancy (OR equals4.0; 95% CI:2.2-7.3) were, as expected, statistically significant risk factors for maternal death. Factors reflecting living standards such as type of housing, access to tap- water and electricity, availability of a toilet and the living standard as estimated by the interviewer were all statistically significant for the risk of maternal death (OR equals7.2, 2.7, 2.1, 8.3 and 6.2, respectively). Increased distance in meters from the house to a road and increased time in minutes taken to reach the nearest transport, clinic and hospital in minutes increased the risk for a maternal death significantly. The preventive activities require efforts from the whole community. The health care system can contribute by early identification of risk cases. e.g. women with previous stillbirths and miscarriages in the antenatal care.     

Risk factors for spontaneous abortion: a case-control study in France.

A case-control study was conducted in seven maternity hospitals in the Paris area in 1988 to evaluate the role of several risk factors in spontaneous abortion. A total of 279 cases and 279 controls were compared for socio-demographic characteristics, reproductive history and for conditions of conception. Prior fetal losses [odds ratio (OR) = 2.30 for n greater than or equal to 2; 95% confidence interval (CI) = 1.17-4.61] and maternal age at pregnancy (greater than 30 years) appeared to be major and independent risk factors of spontaneous abortion. Other factors associated with an increased risk of fetal loss were: geographical or ethnic origin (OR = 2.85 for North African women; 95% CI = 1.58-5.10); psychological problems at the time of conception, either related to the outcome of the pregnancy (OR = 3.08; 95% CI = 0.92-10.25) or unrelated to this outcome (OR = 3.35; 95% CI = 1.41-8.00). The following factors were not associated with spontaneous abortion: gravidity, parity, prior induced abortion, prior sexually transmitted diseases and Chlamydia trachomatis serology, menstrual cycle abnormalities, induced conception cycle and in-vitro fertilization, cigarette smoking, current or past use of combined oestrogen/progestagen pill or intrauterine device. These findings confirm the importance of two risk factors for fetal loss: maternal age and number of prior spontaneous abortions. Two risk factors, ethnic origin and psychological problems at the time of conception are also identified, which require further study.