Mental Health Distress and Related Factors Among Prefectural Public Servants Seven Months After the Great East Japan Earthquake

Background

To develop an empirically informed support measure for workers, we examined mental health distress and its risk factors among prefectural public servants who were affected by the Great East Japan Earthquake and faced a demanding workload in the midterm of the disaster.

Methods

We conducted a self-administered health survey of all public servants in the Miyagi prefectural government two and seven months after the Great East Japan Earthquake (3743 workers, 70.6% of all employees). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for mental distress (defined as K6 score ≥10) in the domain of disaster-work-related stressors, work-related stressors, and disaster-related stressors.

Results

Among those with better levels of workplace communication, the only factor that increased the risk of mental distress was not taking a non-work day each week (adjusted OR 2.55, 95% CI 1.27–5.14). Among those with poorer levels of workplace communication, in addition to not taking a non-work day each week (adjusted OR 3.93, 95% CI 3.00–5.15), handling residents’ complaints (adjusted OR 1.55, 95% CI 1.00–2.42), having dead or missing family members (adjusted OR 2.87, 95% CI 1.53–5.38), and living in a shelter more than two months after the disaster (adjusted OR 2.80, 95% CI 1.32–5.95) increased the risk of mental distress.

Conclusions

All workers should be encouraged to take a non-work day each week. Among workers with poor workplace communication, special attention should be given to those who handle residents’ complaints, have lost a family member(s), and are living in a shelter for a prolonged period of time.Key words: mental health, disaster, worker, cross-sectional study, risk factors     

Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study

Objective

To assess whether having a subsequent child had an effect on the mental health of Chinese mothers who lost a child during an earthquake.

Methods

A cross-sectional survey of bereaved mothers was conducted 30 to 34 months after the 2008 Sichuan earthquake using individual structured interviews to assess sociodemographic characteristics, post-disaster experiences and mental health. The interviews incorporated standardized psychometric measures of anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief (CG). Social support was also assessed. An adjusted model taking potential confounders into account was used to explore any association between psychological symptoms and the birth of a subsequent child.

Findings

The prevalence of psychological symptoms was higher in mothers who did not have a child after losing the first one. In an adjusted model, symptoms of anxiety (odds ratio, OR: 3.37; 95% confidence interval, CI: 1.51–7.50), depression (OR: 9.47; 95% CI: 2.58–34.80), PTSD (OR: 5.11; 95% CI: 2.31–11.34) and CG (OR: 10.73; 95% CI: 1.88–61.39) were significantly higher among the 116 women without a subsequent child than among the 110 mothers who had another child after bereavement. More than two thirds of the mothers with new infants had clinically important psychological symptoms.

Conclusion

Women who have lost an only child in a natural disaster are especially vulnerable to long-term psychological problems, especially if they have reached an age when conception is difficult. Research should focus on developing and evaluating interventions designed to provide women with psychosocial support and reproductive services.     

A Systematic Review and Meta-analysis of Childhood Leukemia and Parental Occupational Pesticide Exposure

Objectives

We conducted a systematic review and meta-analysis of childhood leukemia and parental occupational pesticide exposure.

Data sources

Searches of MEDLINE (1950–2009) and other electronic databases yielded 31 included studies.

Data extraction

Two authors independently abstracted data and assessed the quality of each study.

Data synthesis

Random effects models were used to obtain summary odds ratios (ORs) and 95% confidence intervals (CIs). There was no overall association between childhood leukemia and any paternal occupational pesticide exposure (OR = 1.09; 95% CI, 0.88–1.34); there were slightly elevated risks in subgroups of studies with low total-quality scores (OR = 1.39; 95% CI, 0.99–1.95), ill-defined exposure time windows (OR = 1.36; 95% CI, 1.00–1.85), and exposure information collected after offspring leukemia diagnosis (OR = 1.34; 95% CI, 1.05–1.70). Childhood leukemia was associated with prenatal maternal occupational pesticide exposure (OR = 2.09; 95% CI, 1.51–2.88); this association was slightly stronger for studies with high exposure-measurement-quality scores (OR = 2.45; 95% CI, 1.68–3.58), higher confounder control scores (OR = 2.38; 95% CI, 1.56–3.62), and farm-related exposures (OR = 2.44; 95% CI, 1.53–3.89). Childhood leukemia risk was also elevated for prenatal maternal occupational exposure to insecticides (OR = 2.72; 95% CI, 1.47–5.04) and herbicides (OR = 3.62; 95% CI, 1.28–10.3).

Conclusions

Childhood leukemia was associated with prenatal maternal occupational pesticide exposure in analyses of all studies combined and in several subgroups. Associations with paternal occupational pesticide exposure were weaker and less consistent. Research needs include improved pesticide exposure indices, continued follow-up of existing cohorts, genetic susceptibility assessment, and basic research on childhood leukemia initiation and progression.     

Quality-of-care audits and perinatal mortality in South Africa

Problem

Suboptimal care contributes to perinatal mortality rates. Quality-of-care audits can be used to identify and change suboptimal care, but it is not known if such audits have reduced perinatal mortality in South Africa.

Approach

We investigated perinatal mortality trends in health facilities that had completed at least five years of quality-of-care audits. In a subset of facilities that began audits from 2006, we analysed modifiable factors that may have contributed to perinatal deaths.

Local setting

Since the 1990s, the perinatal problem identification programme has performed quality-of-care audits in South Africa to record perinatal deaths, identify modifiable factors and motivate change.

Relevant changes

Five years of continuous audits were available for 163 facilities. Perinatal mortality rates decreased in 48 facilities (29%) and increased in 52 (32%). Among the subset of facilities that began audits in 2006, there was a decrease in perinatal mortality of 30% (16/54) but an increase in 35% (19/54). Facilities with increasing perinatal mortality were more likely to identify the following contributing factors: patient delay in seeking help when a baby was ill (odds ratio, OR: 4.67; 95% confidence interval, CI: 1.99–10.97); lack of use of antenatal steroids (OR: 9.57; 95% CI: 2.97–30.81); lack of nursing personnel (OR: 2.67; 95% CI: 1.34–5.33); fetal distress not detected antepartum when the fetus is monitored (OR: 2.92; 95% CI: 1.47–5.8) and poor progress in labour with incorrect interpretation of the partogram (OR: 2.77; 95% CI: 1.43–5.34).

Lessons learnt

Quality-of-care audits were not shown to improve perinatal mortality in this study.     

Factors Associated With Health Service Utilization in Ulaanbaatar,Mongolia: A Population-Based Survey

Background

Understanding patterns of health service utilization can improve health care and increase use of health services. We examined patterns of health service utilization among residents of Ulaanbaatar, Mongolia.

Methods

A total of 500 adults were surveyed using paper-based questionnaires. The χ² test and multiple logistic regression were used to identify associations between factors.

Results

44.1% of respondents had visited a physician during the previous 12 months. After controlling for determinants, the significant predictors of utilization of health service were attention to health examinations (OR = 3.6, CI: 1.93–6.76), being married (OR = 2.7, CI: 1.50–4.72), being satisfied with the overall cleanliness of the hospital (OR = 2.4, CI: 1.12–5.19), being a nonsmoker (OR = 2.2, CI: 1.21–3.98), having periodic physical examinations (OR = 2.2, CI: 1.25–3.71), not being a hospital patient during the previous 3 years (OR = 2.1, CI: 1.22–3.73), having proper documentation (OR = 1.9, CI: 1.10–3.43), having medical insurance (OR = 1.9, CI: 1.96–3.28), not wanting to receive information on food and nutrition (OR = 0.6, CI: 0.36–0.96), having more than 5 household members (OR = 0.5, CI: 0.50–0.85), low income (OR = 0.5, CI: 0.30–0.85), lack of concern for food and nutrition (OR = 0.5, CI: 0.28–0.84), self-medication during the past 12 months (OR = 0.4, CI: 0.24–0.69), and desire for treatment abroad (OR = 0.4, CI: 0.20–0.60).

Conclusions

A number of health-related behaviors and sociodemographic factors were important predictors of health service utilization.Key words: health service utilization, equity, Mongolia     

Non–Dioxin-Like Polychlorinated Biphenyls and Risk of Endometriosis

Background

Endometriosis, a gynecologic disorder affecting 8–10% of reproductive-age women in the United States, is defined as the presence of endometrial tissue outside the uterus and is linked to pelvic pain and infertility. Environmental contaminants, including polychlorinated biphenyls (PCBs), are hypothesized to contribute to endometriosis risk through effects on steroid hormones.

Objective

We evaluated serum concentrations of certain noncoplanar PCBs, which have no or only weak dioxin-like properties, as risk factors for endometriosis.

Methods

In a case–control study of Group Health enrollees in western Washington State, 20 PCB congeners were measured in serum from surgically confirmed endometriosis cases that were newly diagnosed between 1996 and 2001 (n = 251) and from female controls matched for age and reference year (n = 538).

Results

Summed and estrogenic PCB concentrations were not associated with endometriosis risk [summed: odds ratio (OR) = 1.3; 95% confidence interval (CI), 0.8–2.2; estrogenic: OR = 1.1; 95% CI, 0.8–1.4]. Although several congener-specific ORs were statistically above or below the null (PCB 170: third quartile vs. lowest: OR = 0.5; 95% CI, 0.3–0.9; PCB 196: third quartile vs. lowest: OR = 0.4; 95% CI, 0.2–0.7; PCB 201: second vs. lowest: OR = 0.5; 95% CI, 0.3–0.8; third quartile vs. lowest: OR = 0.4; 95% CI, 0.2–0.7), there were no overall consistent patterns of endometriosis risk.

Conclusions

Taken in context with other North American studies, our findings suggest that noncoplanar PCB concentrations consistent within the range of exposure currently observed in western Washington State do not contribute meaningfully to endometriosis risk.     

Willingness to Exchange Health Information via Mobile Devices: Findings From a Population-Based Survey

PURPOSE

The rapid proliferation of mobile devices offers unprecedented opportunities for patients and health care professionals to exchange health information electronically, but little is known about patients’ willingness to exchange various types of health information using these devices. We examined willingness to exchange different types of health information via mobile devices, and assessed whether sociodemographic characteristics and trust in clinicians were associated with willingness in a nationally representative sample.

METHODS

We analyzed data for 3,165 patients captured in the 2013 Health Information National Trends Survey. Multinomial logistic regression analysis was conducted to test differences in willingness. Ordinal logistic regression analysis assessed correlates of willingness to exchange 9 types of information separately.

RESULTS

Participants were very willing to exchange appointment reminders (odds ratio [OR] = 6.66; 95% CI, 5.68–7.81), general health tips (OR = 2.03; 95% CI, 1.74–2.38), medication reminders (OR = 2.73; 95% CI, 2.35–3.19), laboratory/test results (OR = 1.76; 95% CI, 1.62–1.92), vital signs (OR = 1.63; 95% CI, 1.48–1.80), lifestyle behaviors (OR = 1.40; 95% CI, 1.24–1.58), and symptoms (OR = 1.62; 95% CI, 1.46–1.79) as compared with diagnostic information. Older adults had lower odds of being more willing to exchange any type of information. Education, income, and trust in health care professional information correlated with willingness to exchange certain types of information.

CONCLUSIONS

Respondents were less willing to exchange via mobile devices information that may be considered sensitive or complex. Age, socioeconomic factors, and trust in professional information were associated with willingness to engage in mobile health information exchange. Both information type and demographic group should be considered when developing and tailoring mobile technologies for patient-clinician communication.     

Reducing radiation exposure using commonly available objects

Objectives

One and a half years have passed since the Fukushima Daiichi nuclear power plant disaster. The environmental radiation dose rate was not critical, but an existing exposure situation has been identified in a large part of Fukushima Prefecture. Although people continue to live and work in the contaminated area, they are not provided with sufficient information to reduce their exposure to radiation by themselves. In this study, we attempt to evaluate the efficiency of radiation shielding by using everyday items widely available to people.

Methods

NaI scintillation and Geiger–Müller survey meters were used to measure the radiation dose of (1) contaminated soil and (2) soil covered with commonly available items.

Results

In the soil at a depth of 10 cm from the surface, the radiation dose rate decreased from 3.36 to 0.65 μSv/h, and the count rate decreased from 3,120 to 352 cpm. Both the radiation dose rate and count rate reduced when the soil was covered with everyday items, such as a magazine more than 20 mm thick, a polystyrene foam board, and a wooden board of the same thickness.

Conclusions

To protect residents from unnecessary radiation exposure in the existing exposure situation, covering contaminated soil with a wooden board or a magazine, either of them 20 mm thick, is useful to reduce the radiation dose.     

Physical Functionality and Self-Rated Health Status of Adult Patients With Knee Osteoarthritis Presenting in a Primary Care Clinic

Background

Knee osteoarthritis is a chronic medical condition of public health importance in Nigeria which causes disability and impacts daily activities in the sufferers. This study aimed to describe the physical functionality and self-rated health status of adult patients with clinical knee osteoarthritis presenting at the Family Medicine Department, University College Hospital, Ibadan, Nigeria.

Methods

This was a cross-sectional study of 400 respondents. Knee osteoarthritis was diagnosed clinically using the criteria of the American College of Rheumatology. Morbidities, self-rated health status and physical functionality of the respondents were also assessed.

Results

Knee osteoarthritis was diagnosed in 46(11.5%) respondents. Respondents with knee osteoarthritis significantly rated their health worse than those without knee osteoarthritis (p <0.0001). Experience of pain, stiffness and performance of daily activities were significantly worse among respondents with knee osteoarthritis. Those who had knee osteoarthritis had significantly higher waist (p <0.0001), hip (p <0.0001) and knee circumferences (p <0.0001) respectively. Logistic regression analysis showed increasing age (OR=1.103; 95% CI=1.022 – 1.191), self-rated health worse than six months ago (OR=12.562; 95% CI=1.178–125.243), experience of stiffness after waking up in the morning (OR=12.758; 95% CI=3.572–45.569), stiffness after sitting/lying down/resting (OR=21.517; 95% CI=2.213–209.220) and waist circumference (OR=1.225;95% CI=1.017–1.477) to be the most significantly associated with knee osteoarthritis.

Conclusion

Knee osteoarthritis significantly impairs the health and daily activities of adult patients in Ibadan, Nigeria. Healthcare workers need to screen adult patients routinely at first-contact to detect knee osteoarthritis clinically early and manage appropriately.     

Pesticide Use and Cutaneous Melanoma in Pesticide Applicators in the Agricultural Heath Study

Background

Melanoma rates continue to increase; however, few risk factors other than sun sensitivity and ultraviolet radiation (including sun exposure) have been identified. Although studies of farmers have shown an excess risk of melanoma and other skin cancers, it is unclear how much of this is related to sun exposure compared with other agricultural exposures.

Methods

We examined dose–response relationships for 50 agricultural pesticides and cutaneous melanoma incidence in the Agricultural Health Study cohort of licensed pesticide applicators, along with ever use of older pesticides that contain arsenic. Logistic regression was used to examine odds ratios (ORs) and 95% confidence intervals (CIs) associated with pesticide exposure adjusted for age, sex, and other potential confounders.

Results

We found significant associations between cutaneous melanoma and maneb/mancozeb (63 exposure days: OR = 2.4; 95% CI, 1.2–4.9; trend p = 0.006), parathion (≥ 56 exposure days: OR = 2.4; 95% CI, 1.3–4.4; trend p = 0.003), and carbaryl (≥ 56 exposure days: OR = 1.7; 95% CI, 1.1–2.5; trend p = 0.013). Other associations with benomyl and ever use of arsenical pesticides were also suggested.

Conclusions

Most previous melanoma literature has focused on host factors and sun exposure. Our research shows an association between several pesticides and melanoma, providing support for the hypotheses that agricultural chemicals may be another important source of melanoma risk.     

Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality

Objectives

To compare risks of hypernatraemia on admission to hospital in persons who were with those who were not identified as care home residents and evaluate the association of hypernatraemia with in-hospital mortality.

Design

Retrospective observational study.

Setting

A National Health Service Trust in London.

Participants

A total of 21,610 patients aged over 65 years whose first admission to the Trust was between 1 January 2011 and 31 December 2013.

Main outcome measures

Hypernatraemia on admission (plasma Na > 145 mmol/L) and in-hospital death.

Results

Patients admitted from care homes had 10-fold higher prevalence of hypernatraemia than those from their own homes (12.0% versus 1.3%, respectively; odds ratio [OR]: 10.5, 95% confidence interval [CI]: 8.43–13.0). Of those with hypernatraemia, nine in 10 cases were associated with nursing home ECOHOST residency (attributable fraction exposure: 90.5%), and the population attributable fraction of hypernatraemia on admission associated with care homes was 36.0%. After correcting for age, gender, mode of admission and dementia, care home residents were significantly more likely to be admitted with hypernatraemia than were own-home residents (adjusted odds ratio [AOR]: 5.32, 95% CI: 3.85–7.37). Compared with own-home residents, care home residents were also at about a two-fold higher risk of in-hospital mortality compared with non-care home residents (AOR: 1.97, 95% CI: 1.59–2.45). Consistent with evidence that hypernatraemia is implicated in higher mortality, the association of nursing homes with in-hospital mortality was attenuated after adjustment for it (AOR: 1.61, 95% CI: 1.26–2.06).

Conclusions

Patients admitted to hospital from care homes are commonly dehydrated on admission and, as a result, appear to experience significantly greater risks of in-hospital mortality.     

Household Exposure to Paint and Petroleum Solvents,Chromosomal Translocations,and the Risk of Childhood Leukemia

Background

Few studies have examined the association between home use of solvents and paint and the risk of childhood leukemia.

Objectives

In this case–control study, we examined whether the use of paint and petroleum solvents at home before birth and in early childhood influenced the risk of leukemia in children.

Methods

We based our analyses on 550 cases of acute lymphoblastic leukemia (ALL), 100 cases of acute myeloid leukemia (AML), and one or two controls per case individually matched for sex, age, Hispanic status, and race. We conducted further analyses by cytogenetic subtype. We used conditional logistic regression techniques to adjust for income.

Results

ALL risk was significantly associated with paint exposure [odds ratio (OR) = 1.65; 95% confidence interval (CI), 1.26–2.15], with a higher risk observed when paint was used postnatally, by a person other than the mother, or frequently. The association was restricted to leukemia with translocations between chromosomes 12 and 21 (OR = 4.16; 95% CI, 1.66–10.4). We found no significant association between solvent use and ALL risk overall (OR = 1.15; 95% CI, 0.87–1.51) or for various cytogenetic subtypes, but we observed a significant association in the 2.0- to 5.9-year age group (OR = 1.55; 95% CI, 1.07–2.25). In contrast, a significant increased risk for AML was associated with solvent (OR = 2.54; 95% CI, 1.19–5.42) but not with paint exposure (OR = 0.64; 95% CI, 0.32–1.25).

Conclusions

The association of ALL risk with paint exposure was strong, consistent with a causal relationship, but further studies are needed to confirm the association of ALL and AML risk with solvent exposure.     

Prevalence and Socio-Demographic Determinants of Overweight and Obesity in a Nigerian Population

Objective

This survey explored prevalence of overweight and obesity and their associations with socio-demographic variables in a Nigerian population.

Methods

This cross-sectional survey involved 1521 adults in Nnewi. Age, sex, educational and occupational status, and BMI were recorded.

Results

Prevalence of overweight was higher in males (32.3%; 95% CI, 29.5%–35.2%) than in females (29.8%; 95% CI, 26.8%–33.0%); the reverse was the case for prevalence of obesity (19.6%; 95% CI, 17.3%–22.2% in males and 36.0%; 95% CI, 32.8%–39.4% in females). Higher odds ratios (ORs) for overweight and obesity were observed in participants aged 41–60 years (OR 2.03; 95% CI, 1.57–2.61 for overweight and OR 4.29; 95% CI, 3.25–5.67 for obesity) and those >60 years (OR 1.72; 95% CI, 1.21–2.43 for overweight and OR 4.21; 95% CI, 2.86–6.19 for obesity) compared to those aged 18–40 years. Female sex was associated with higher ORs for overweight (OR 1.20; 95% CI, 0.96–1.51) and obesity (OR 2.21; 95% CI, 1.73–2.83). Participants with secondary education had marginally higher ORs for overweight (OR 1.15; 95% CI, 0.88–1.51) and obesity (OR 1.17; 95% CI, 0.86–1.59) than those with tertiary education, and so were those with primary education for obesity (OR 1.19; 95% CI, 0.74–1.89) but higher OR for overweight (OR 1.44; 95% CI, 0.98–2.13). Unskilled participants had about the same OR for overweight and obesity as professionals, and while skilled participants had about the same OR for overweight as professionals, their OR for obesity (OR 1.27; 95% CI, 0.67–2.43) was fairly higher than that for professionals.

Conclusions

Prevalence of overweight is higher in males than in females, but the reverse is the case for prevalence of obesity. Older age and female sex are associated with increased risk of overweight and obesity, while working at a skilled occupation is associated with obesity, and tertiary educational attainment is associated with overweight.Key words: determinants, obesity, overweight, prevalence, developing country     

Associations of Protein,Fat, and Carbohydrate Intakes With Insomnia Symptoms Among Middle-aged Japanese Workers

Background

Diet is a modifiable factor that may affect sleep, but the associations of macronutrient intakes with insomnia are inconsistent. We investigated the associations of protein, fat, and carbohydrate intakes with insomnia symptoms.

Methods

In this cross-sectional analysis of 4435 non-shift workers, macronutrient intakes were assessed by the brief-type self-administered diet history questionnaire, which requires the recall of usual intakes of 58 foods during the preceding month. Presence of insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and poor quality of sleep (PQS) were self-reported. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% CIs adjusted for demographic, psychological, and behavioral factors, as well as medical histories.

Results

Low protein intake (<16% vs ≥16% of total energy) was associated with DIS (OR 1.24, 95% CI 0.99–1.56) and PQS (OR 1.24, 95% CI 1.04–1.48), while high protein intake (≥19% vs <19% of total energy) was associated with DMS (OR 1.40, 95% CI 1.12–1.76). Low carbohydrate intake (<50% vs ≥50% of total energy) was associated with DMS (OR 1.19, 95% CI 0.97–1.45).

Conclusions

Protein and carbohydrate intakes in the daily diet were associated with insomnia symptoms. The causality of these associations remains to be explained.Key words: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), poor quality of sleep (PQS), cross-sectional study     

Association between Local Traffic-Generated Air Pollution and Preeclampsia and Preterm Delivery in the South Coast Air Basin of California

Background

Preeclampsia is a major complication of pregnancy that can lead to substantial maternal and perinatal morbidity, mortality, and preterm birth. Increasing evidence suggests that air pollution adversely affects pregnancy outcomes. Yet few studies have examined how local traffic-generated emissions affect preeclampsia in addition to preterm birth.

Objectives

We examined effects of residential exposure to local traffic-generated air pollution on preeclampsia and preterm delivery (PTD).

Methods

We identified 81,186 singleton birth records from four hospitals (1997–2006) in Los Angeles and Orange Counties, California (USA). We used a line-source dispersion model (CALINE4) to estimate individual exposure to local traffic-generated nitrogen oxides (NO_x) and particulate matter < 2.5 μm in aerodynamic diameter (PM_2.5) across the entire pregnancy. We used logistic regression to estimate effects of air pollution exposures on preeclampsia, PTD (gestational age < 37 weeks), moderate PTD (MPTD; gestational age < 35 weeks), and very PTD (VPTD; gestational age < 30 weeks).

Results

We observed elevated risks for preeclampsia and preterm birth from maternal exposure to local traffic-generated NO_x and PM_2.5. The risk of preeclampsia increased 33% [odds ratio (OR) = 1.33; 95% confidence interval (CI), 1.18–1.49] and 42% (OR = 1.42; 95% CI, 1.26–1.59) for the highest NO_x and PM_2.5 exposure quartiles, respectively. The risk of VPTD increased 128% (OR = 2.28; 95% CI, 2.15–2.42) and 81% (OR = 1.81; 95% CI, 1.71–1.92) for women in the highest NO_x and PM_2.5 exposure quartiles, respectively.

Conclusion

Exposure to local traffic-generated air pollution during pregnancy increases the risk of preeclampsia and preterm birth in Southern California women. These results provide further evidence that air pollution is associated with adverse reproductive outcomes.     

Lung Cancer in Chinese Women: Evidence for an Interaction between Tobacco Smoking and Exposure to Inhalants in the Indoor Environment

Background

Epidemiologic data suggest that Chinese women have a high incidence of lung cancer in relation to their smoking prevalence. In addition to active tobacco smoke exposure, other sources of fumes and airborne particles in the indoor environment, such as cooking and burning of incense and mosquito coils, have been considered potential risk factors for lung cancer.

Objectives

We used a case–control study to explore effects of inhalants from combustion sources common in the domestic environment on lung cancer and their modification by active tobacco smoking.

Methods

We analyzed 703 primary lung cancer cases and 1,578 controls. Data on demographic background and relevant exposures were obtained by face-to-face interviews in the hospital.

Results

We observed a positive relationship with daily exposure to incense or mosquito coils and to cooking fumes only among smokers, and no association among lifetime nonsmokers. Interactions between smoking and frequency of cooking, or exposure to incense or mosquito coils were statistically significant and consistent with synergistic effects on lung cancer. The odds ratio (OR) comparing smokers without daily incense or mosquito coil exposure with nonsmokers without daily exposure was 2.80 [95% confidence interval (CI), 1.86–4.21], whereas the OR comparing smokers with daily exposure to the same referent group was 4.61 (95% CI, 3.41–6.24). In contrast, daily exposure to incense or mosquito coils was not associated with lung cancer among nonsmokers (OR = 0.91; 95% CI, 0.72–1.16). We observed the same pattern of associations for smokers without (OR = 2.31; 95% CI, 1.52–3.51) and with (OR = 4.50; 95% CI, 3.21–6.30) daily cooking exposure compared with nonsmokers, with no evidence of an association with daily cooking exposure among nonsmokers.

Conclusion

Our results suggest that active tobacco smoking not only is an important risk factor for development of lung cancer, but also may cause smokers to be more susceptible to the risk-enhancing effects of other inhalants.     

Factors Influencing Family Physicians’ Contribution to the Child Health Care Workforce

PURPOSE

We wanted to explore demographic and geographic factors associated with family physicians’ provision of care to children.

METHODS

We analyzed the proportion of family physicians providing care to children using survey data collected by the American Board of Family Medicine from 2006 to 2009. Using a cross-sectional study design and logistic regression analysis, we examined the association of various physician demographic and geographic factors and providing care of children.

RESULTS

Younger age, female sex, and rural location are positive predictors of family physicians providing care to children: odds ratio (OR) = 0.97 (95% CI, 0.97–0.98), 1.19 (1.12–1.25), and 1.50 (1.39–1.62), respectively. Family physicians practicing in a partnership are more likely to provide care to children than those in group practice: OR = 1.53 (95% CI, 1.40–1.68). Family physicians practicing in areas with higher density of children are more likely to provide care to children: OR = 1.04 (95% CI, 1.03–1.05), while those in high-poverty areas are less likely 0.10 (95% CI, 0.10–0.10). Family physicians located in areas with no pediatricians are more likely to provide care to children than those in areas with higher pediatrician density: OR = 1.80 (95% CI, 1.59–2.01).

CONCLUSIONS

Various demographic and geographic factors influence the likelihood of family physicians providing care to children, findings that have important implications to policy efforts aimed at ensuring access to care for children.     

A follow-up of cancer incidence among former Finnish dump site residents: 1999–2011

Background:

In an analysis of the years 1976–1998, a 50% excess in cancer incidence was observed among residents in twelve blockhouses in Helsinki, Finland on a former dump area containing industrial and household waste.

Objective:

To assess cancer risk over a 13-year period 1999–2011 among residents formerly living in houses built on a dump area.

Methods:

All 1879 persons who ever lived in the former dump area were identified and the number of cancer cases in this population was obtained from the Finnish Cancer Registry.

Results:

After 5 years of residence at the dump site, the standardized incidence ratio of cancer (all sites combined) was 1.32 (95% CI: 0.94–1.79) in men and 0.53 (95% CI: 0.33–0.82) for women, in comparison with the general Helsinki population (1999–2011). No significant excess cancer risks were found.

Conclusions:

Residing on a former dump area was not found to result in an increased risk of cancer.     

Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa

Objective

To assess medical and nursing students’ intentions to migrate abroad or practice in rural areas.

Methods

We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students’ intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models.

Findings

Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25–2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21–6.29) and rural (OR: 4.84; 95% CI: 3.52–6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19–1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50–0.96).

Conclusion

A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.     

Depression and Pesticide Exposures among Private Pesticide Applicators Enrolled in the Agricultural Health Study

Background

We evaluated the relationship between diagnosed depression and pesticide exposure using information from private pesticide applicators enrolled in the Agricultural Health Study between 1993 and 1997 in Iowa and North Carolina.

Methods

There were 534 cases who self-reported a physician-diagnosed depression and 17,051 controls who reported never having been diagnosed with depression and did not feel depressed more than once a week in the past year. Lifetime pesticide exposure was categorized in three mutually exclusive groups: low (< 226 days, the reference group), intermediate (226–752 days), and high (> 752 days). Two additional measures represented acute high-intensity pesticide exposures: an unusually high pesticide exposure event (HPEE) and physician-diagnosed pesticide poisoning. Logistic regression analyses were performed relating pesticide exposure to depression.

Results

After adjusting for state, age, education, marital status, doctor visits, alcohol use, smoking, solvent exposure, not currently having crops or animals, and ever working a job off the farm, pesticide poisoning was more strongly associated with depression [odds ratio (OR) = 2.57; 95% confidence interval (CI), 1.74–3.79] than intermediate (OR = 1.07; 95% CI, 0.87–1.31) or high (OR = 1.11; 95% CI, 0.87–1.42) cumulative exposure or an HPEE (OR = 1.65; 95% CI, 1.33–2.05). In analysis of a subgroup without a history of acute poisoning, high cumulative exposure was significantly associated with depression (OR = 1.54; 95% CI, 1.16–2.04).

Conclusion

These findings suggest that both acute high-intensity and cumulative pesticide exposure may contribute to depression in pesticide applicators. Our study is unique in reporting that depression is also associated with chronic pesticide exposure in the absence of a physician-diagnosed poisoning.