Health insurance and household income associated with mammography utilization among American women, 2000–2008

Background  National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States (US) since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women.

Methods  Data were from the database of Behavioral Risk Factor Surveillance System (BRFSS) of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year.

Results  From 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006.

Conclusions  Health insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.

     

HIV and syphilis infections among street-based female sex workers in China, 2010–2012

Background Female sex workers （FSW） were high-risk population for HIV and other sexually transmitted diseases （STD） earlier,and now are an important driver of the HIV/AIDS epidemic in China.Sentinel surveillance for FSW was set up to monitor the trend of HIV prevalence and risk behavior-related HIV infection.This study collected the data on street-based FSW from HIV sentinel surveillance system to understand HIV and syphilis infections,risk behaviors,and intervention in China from 2010 to 2012.Methods The study population was the street-based FSW who were recruited for the national HIV integrated biological and behavioral surveillance between 2010 and 2012.Demographic information,HIV-related risk behaviors,and HIV and syphilis testing results were described and trend analysis was performed.Results Between 2010 and 2012,the number of street-based FSW surveyed was 3725,3425,and 3335,respectively.HIV knowledge awareness rate significantly increased from 74.6% in 2010 to 76.8% in 2011 and 82.2% in 2012 （P 〈0.01）.More FSW consistently used condom in the last month （49.0% in 2010; 51.0% in 2011; and 59.0% in 2012） and in the last commercial sex （72.0% in 2010; 78.5% in 2011; and 80.0% in 2012） over time.The proportions of individuals who received HIV testing in the last year were 31.2% （2010）,37.0% （2011）,and 36.9% （2012） （P-trend 〈0.01）.HIV prevalence rate changed from 1.5% in 2010 to 1.4% in 2011 and 2.3% in 2012 （P-trend=0.01）.Syphilis prevalence rate was 6.9%,7.2%,and 7.1% in the same period.The top three provinces with the highest average HIV prevalence rates over the 3 years were Guangxi （5.9%）,Yunnan （4.2%）,and Sichuan （1.2%）.Conclusions Street-based FSW are at high risk of HIV and syphilis infections.Intervention efforts need to target streetbased FSW who are of old age and minority,who use illicit drugs and have syphilis infection.     

HIV or HIV-Therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV

Objectives

Among people with HIV, we examined symptom attribution to HIV or HIV-therapy, awareness of potential side effects and discontinuation of treatment, as well as sex/gender differences.

Methods

HIV-patients (N = 168, 46% female) completed a comprehensive symptom checklist (attributing each endorsed symptom to HIV, HIV-therapy, or other causes), reported reasons for treatment discontinuations and potential ART-related laboratory abnormalities.

Results

Main symptom areas were fatigue/sleep/energy, depression/mood, lipodystrophy, and gastrointestinal, dermatological, and neurological problems.Top HIV-attributed symptoms were lack of stamina/energy in both genders, night sweats, depression, mood swings in women; and fatigue, lethargy, difficulties concentrating in men. Women attributed symptoms less frequently to HIV than men, particularly fa-tigue(p < .01).Top treatment-attributed symptoms were lipodystrophy and gastrointestinal problems in both genders. Symptom attribution to HIV-therapy did not differ between genders.Over the past six months, 22% switched/interrupted ART due to side effects. In women, side effect-related treatment decisions were more complex, involving more side effects and substances. Remarkably, women took predominantly protease inhibitor-sparing regimens (p = .05).Both genders reported only 15% of potential ART-related laboratory abnormalities but more than 50% had laboratory abnormalities. Notably, women had fewer elevated renal parameters (p < .01).

Conclusions

Men may attribute symptoms more often to HIV and maintain a treatment-regimen despite side effects, whereas women may be more prudent in avoiding treatment side effects. Lacking awareness of laboratory abnormalities in both genders potentially indicates gaps in physician-patient communication. Gender differences in causal attributions of symptoms/side effects may influence treatment decisions.     

HIV prevalence and influencing factors analysis of sentinel surveillance among men who have sex with men in China, 2003–2011

Background  Men who have sex with men (MSM) have been impacted by HIV and now as an important driver of the HIV/AIDS epidemic in China. This study collected HIV sentinel surveillance system data on the MSM population to describe the characteristics and trends of the HIV epidemic among MSM in China from 2003 to 2011.

Methods  Data on HIV prevalence and risk behaviors from 2003 to 2011 were obtained from the national HIV sentinel surveillance database.

Results  MSM sentinel surveillance data for 2011 showed that proportions of MSM who consistently used condoms during anal sex in the last six months and at last anal sex encounter were 43.3% and 74.1%, respectively. Between 2005 and 2011 there were no significant changes in the proportion of consistent condom use. The proportion of MSM who had multiple male sex partners in the last six months increased. Overall HIV prevalence over the years showed a rising trend from 0.9% in 2003 to 6.3% in 2011. The syphilis antibody positive rate was 7.8% in 2011. In addition, the proportion of MSM in heterosexual marriages was rising, AIDS awareness was also increasing, and the proportion of MSM who had taken an HIV test in the last year and was aware of the results rose. The proportion who had received intervention services in the last year stabilized.

Conclusions  HIV prevalence in MSM populations is rapidly and widely distributed. MSM who are in heterosexual marriages may be a bridge group transmitting HIV to their heterosexual partners. The risky sexual behavior among MSM will remain a serious and important driver of China’s AIDS epidemic over the next period of time. Intervention need to be strengthened, as does the effective implementation of measures to control AIDS and prevent it from spreading further.

     

HIV/AIDS Knowledge, Attitudes and Behaviors among Undergraduate Students in China

Objective To assess students＇ knowledge, practices on HIV/AIDS, to see what their attitudes are towards the pandemic of HIV/AIDS and to identify the differences of their knowledge, attitudes, and practices regarding HIV/AIDS by gender, major, monthly expenditure. Methods 259 undergraduates from different faculties were randomly selected through stratified cluster sampling. A self-designed questionnaire was utilized to collect data of this study. Results Our findings suggested that the majority of undergraduates had a moderate level of HIV/AIDS knowledge, and tolerant attitudes towards people with HIV/AIDS. Boys held more tolerant and positive attitudes towards people with HIV/AIDS than girls. Students majoring in Medicine performed better （more knowledgeable and tolerant） than non-medical students. Differences between students with various monthly expenditures were found. Students with monthly expenditures of 300-599 Yuan were shown to know more about HIV/AIDS, practiced safer behavior regarding HIV/AIDS and held more positive attitudes towards HIV/AIDS people than students whose expenditures were above 600 Yuan. Conclusion Based on the results of our study, we are convinced that there is still room for improvement： students＇ knowledge about HIV/AIDS was uneven, and their knowledge was not correlated with safer sexual behavior. Therefore, developing and maintaining safer sexual behavior will be emphasized as well as spreading information with regard to HIV/AIDS and its prevention.     

A study on the serum pregnancy zone protein levels in pregnant women and patients with gynecological tumors.

In this study, the serum levels of the pregnancy zone protein (PZP) were determined by PZP-single radial immunodiffusion in 708 cases of normal pregnancy, 207 with abormal pregnancy and 188 with gynecological tumors. The results indicated that serum PZP levels in the normal pregnancy was detectable 5 weeks after gestation. It increased with the advance of gestational weeks, and reached a peak level in week 40. The serum PZP levels in 81.7% of patients with threatened abortion but not aborted were within the normal range, and also mostly in those with pregnancy-nduced hypertension, intrauterine growth retardation (IUGR), anencepbalus and ectopic pregnancy; the serum PZP levels in 51.6% of patients with invasive moles and 80.0% with choriocarcinoma, respectively, were lower than in normal controls. In gynaecological tumors, the serum PZP levels were significantly higher in patients with ovarian carcinomas than in those with other ovarian tumors (P<0.01), and in those with endometrial or cervical carcinoma     

Utilization of statins and aspirin among patients with diabetes and hyperlipidemia: Taiwan, 1998–2006

BackgroundThe proper use of statins and aspirin decrease the risk of coronary heart disease (CHD) among patients with diabetes (DM) and hyperlipidemia. The purpose of this study was to analyze the time trends and determinants of prescribing statins and aspirin among patients with DM and hyperlipidemia in medical practice in Taiwan.MethodsA cohort of 21,667 patients with DM and hyperlipidemia during the period from 1998 to 2006 was identified by using data of ambulatory care claims from Taiwan's National Health Insurance Database. The dataset was categorized into two equal calendar periods: Period 1 (September 1998–June 2002) and Period 2 (July 2002–April 2006). Multivariate logistic regression analyses were used to determine the independent determinants associated with receipt of lipid-lowering agents and aspirin among these patients.ResultsThere were significant increases in the prescribing of statins (OR 1.78; 95% CI 1.66?1.91) and aspirin (OR 1.47, 95% CI 1.50?1.59) in Period 2 as compared with Period 1. Nevertheless, 30% of patients with coexisting CHD neither received statins nor aspirin. Only 15% to 25% of DM patients with hyperlipidemia and CHD received the combined treatment with aspirin and statin. In multivariate logistic regression, we found that women received aspirin less frequently than men. Old patients (>45 years) with concomitant CHD were more likely to receive statins and aspirin.ConclusionDespite the increasing trend in the use of statins and aspirin in DM patients with hyperlipidemia in Taiwan, the improvements were at best modest, particularly for secondary prevention. Our data indicate the need for continued efforts to improve the utilization of these drugs in daily practice.     

Estrogen receptor alpha gene polymorphism associated with type 2 diabetes mellitus and the serum lipid concentration in Chinese women in Guangzhou

Background Estrogen might play an important role in type 2 diabetes mellitus pathogenesis. A number of polymorphisms have been reported in the estrogen receptor alpha （ERα） gene （also named ESR1）, including the XbaⅠ and PvuⅡ restriction enzyme polymorphisms of ESR1, which may be involved in disease pathogenesis. The aim of this study was to determine whether ER0t gene polymorphisms are associated with type 2 diabetes mellitus and serum lipid level. Methods Two hundred and ninety-nine patients with type 2 diabetes mellitus were compared with three hundred and forty-one health controls of Guangzhou in China, both were male and postmenopausal female residents at 51--70 years. ESR1 genotyping was performed using polymerase chain reaction （PCR） and PvulI and XbaI restriction fragment length polymorphism （PCR-RFLP） analysis. Results ESR1 allelic frequencies of P, p and X, x alleles were 0.408, 0.592; 0.360, 0.640 in the type 2 diabetes mellitus group and 0.318, 0.682; 0.328, 0.672 in the control group, respectively. In case-control study, there was significant difference in PvuⅡ, but not XbaⅠ, allele frequency between the type 2 diabetes mellitus and control groups （P=0.001 and P=0.122）. When the group was separated into men and women, the difference was significant in women （P〈0.001） but not in men （P=0.854） with the PvulI genotype, and the effect of PvulI variant on the development of type 2 diabetes mellitus was improved with aging. In addition, PvulI genotype was associated with blood glucose [fasting blood glucose （FBG）, postprandial blood glucose （PBG）] and serum lipid [total cholesterol （TC） and low density lipoprotein （LDL）-c] concentration in healthy women. Conclusions PvuII polymorphism of ESRI increases susceptibifity to type 2 diabetes mellitus in Chinese Guangzhou women. ESR1 variants may also impact serum lipid metabolism, which might provide a mechanism connecting ESR1 to type 2 diabetes.     

Cohort Study of HIV Infection among Drug Users in Ruili,Longchuan and Luxi of Yunnan Province,China

In March 1992,KAP investigation and HIV blood test were carried out for 860 drug users and 82 spouses in Ruili,Luxi,Longchuan of Yunnan Province,China.The results showed that there were 285 injecting drug users(IDUs)(33.1%)among 860 drug users.Among 282 blood samples of IDUs,the HIV infection rate was 49.0%,highest in Ruili(81.8%,63/77),then Longchuan(44.6%,74/166),lowest in Luxi county(5.1%,2/39).Twelve new HIV( )were found from 75 persons,who had been tested as HIV(-)in recent two years.Sixty-two blood samples were collected among 82 spouses of IDUs with HIV( ),and 6 were HIV( )(9.8%),with an increase of 6.7% compared with results of the investigation two years ago(3.1%,2/64).     

Tobacco consumption and its association with education among women residing in a rural area of Maharashtra: A?cross-sectional study

Background

Tobacco use is increasing among women and girls across the globe as well as in all parts of India. In India, 8 to 10 lakh people die due to tobacco related diseases every year. This tobacco epidemic among women needs to be prevented.

Objectives

Study was conducted to find the prevalence and pattern of tobacco consumption and it''s association with education among females (15–49 years) in a rural village of Pune, Maharashtra, India.

Material and Methods

A cross-sectional study was carried out among 313 females (15–49 years) in a rural field practice area of a Medical College in Pune during Feb 11 to May 11. Pre-tested questionnaire was used for collecting data by interview after obtaining informed consent. Statistical analysis was performed (Epinfo software version 3.5.3.).

Results

Out of 313 female studied, 14.05% (44) and 0.96% (03) were found to be current and former tobacco user respectively while 84.98% (266) never used any form of tobacco in their lifetime. Mishri consumption (45%) was commonest form of smokeless tobacco use followed by quid use (36%). Majority of the tobacco users (54.55%) were illiterate. There was significant association between tobacco consumption and education level (p = 0.0295). Tobacco consumption was more with increasing age.

Conclusion

Tobacco consumption was found to be prevalent in 14.05% of women. Almost all of them used smokeless tobacco, mainly mishri. Tobacco consumption was directly associated with age and inversely with educational level. Therefore increasing women''s literacy may bring down tobacco use among women.     

Relationship among bacterial colonization,airway inflam-mation, and bronchodilator response in patients with stable chronic obstructive pulmonary disease

Bronchodilator reversibility, a response of airway to bronchodilator, occurred in 64% of stablepatients with chronic obstructive pulmonary disease (COPD).1 In patients with COPD who have a significant response to bronchodilators, a clinical and functional response to inhaled corticosteroids is similar to that in asthmatics.2 A significant number of patients with stable COPD have lower airway bacterial colonization.3,4 Higher airway bacterial load is associated with greater airway inflamma…     

Prehospital road traffic injuries among the elderly in Beijing, China: data from the Beijing Emergency Medical Center, 2004–2010

Background Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing’s geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.

Methods In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using χ2 tests and Logistic regression analysis.

Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 (P <0.001). The mean age was (72.92±5.67) years, and 911 (53.40%) of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%). Our statistical analysis found three factors for injury severity: abdominal injuries (P <0.001), number of injury sites (P=0.027), and head injuries (P=0.034). The decline in traffic injuries is due to a decrease in victims aged 65–74 years and pedestrians; the severity of RTIs also decreased.

Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

     

Comparison of microalbuminuria among treatment na?ve HIV sero-positive and negative adult clients in Faith Alive Foundation Hospital,Jos

Background:

This study is to determine microalbuminuria in human immunodeficiency virus (HIV) infected patients before commencement of highly active anti-retroviral treatment (HAART).

Patients and Methods:

Consecutive patients with the HIV infection seen in the HIV counselling and testing (HCT) unit of the Faith Alive Foundation Hospital, Jos, and a similar group of healthy uninfected patients were evaluated for renal disease: Urinary albumin and urinary creatinine were analysed.

Results:

Of the 200 patients with HIV infection and 100 uninfected controls studied, increased urinary albumin excretion (UAE) was present in 39 (19.5%) of the subjects and 5.0 (5.0%) of controls. The difference between the mean values for the UAE for both subjects and controls [182.3 ± 54.3 and 163.9 ± 39.3 mg/l, respectively (P = 0.006)] was statistically significant. On the other hand the urinary creatinine for both the subjects and controls [11.7 ± 5.2 and 12.0 ± 4.8 mmol/L, respectively (P = 0.6)] was not statistically significant. The difference between the mean urinary albumin/creatinine ratio (UACR) for both subjects and controls [1.8 ± 1.2 mg/mmol and 1.4 ± 0.4 mg/mmol respectively (P = 0.001)] was statistically significant.

Conclusion/Recommendation:

Increase UAE is a common complication of HIV infection due to a number of factors other than HAART. Early screening for renal disease using microalbuminuria is very useful since the use of medications such as angiotensin converting enzyme inhibitors, which could help reverse progression to end-stage renal disease.     

Fatal hemorrhagic–necrotizing pancreatitis associated with pancreatic and hepatic lipidosis in an obese Asian palm civet (Paradoxurus hermaphroditus)

Asian palm civets (Paradoxurus hermaphroditus), or toddy cats, belong to the family Viverridae. Little is known about the pathology of these animals and few articles have been published, mainly concerning their important role as wild reservoir hosts for severe infectious diseases of domestic animals and human beings. A 4-year-old, female Asian palm civet was found dead by the owner. At necropsy, large amount of adipose tissue was found in the subcutis and in the peritoneal cavity. Most of the pancreas appeared red, translucent. Hepatomegaly, discoloration of the liver were evident, with multifocal areas of degeneration, characterized by white nodular lesions. Histologically, the pancreas showed severe interstitial and perilobular necrosis and extensive haemorrhages, with separation of the interstitium, mild reactive inflammation at the periphery of the pancreatic lobules. Liver showed multifocal foci of vacuolar degeneration, lipidic accumulation, sometimes associated to hepatocyte necrosis. A diagnosis of acute severe hemorrhagic-necrotizing pancreatitis (or acute pancreatic necrosis) associated with pancreatic and hepatic lipidosis was made. To the best of our knowledge, this represents the first case report of acute lethal pancreatitis in an Asian palm civet. Although the exact cause of the disease remains undetermined, a hypothesis of the cause and pathogenesis is discussed, pointing out dietary indiscretion and consequent overweight as possible important risk factors.