Prevalence and associated factors to hepatitis C in hemodialysis patients in Brazil

OBJECTIVE: The prevalence of hepatitis C virus (HCV) is higher in patients on hemodialysis than in the general population, probably due to greater exposure to risk situations. The purposes of the study were to determine anti-HCV antibodies prevalence among hemodialysis patients and dialysis clinics and patients factors associated with HCV transmission. METHODS: A cross-sectional study was conducted in 752 hemodialysis patients in all 12 dialysis clinics of Fortaleza, Brazil, and were screened using third generation ELISA. Sociodemographic, clinical, and epidemiological data of 663 patients were collected through interviews. Nosocomial factors were assessed using a specific questionnaire tool. Statistical analysis was conducted using Student's t test, odds ratio and multivariate analysis. RESULTS: The prevalence of anti-HCV was 52% (390/746; ranged from 6% to 72%). The anti-HCV positivity was higher in patients who had previous peritoneal dialysis (OR=1.76; 95% CI 1.12-2.76) and blood transfusion (OR=2.75; 95% CI 1.25-6.03). Dialysis age has been associated with anti-HCV positivity (OR=1.47; 95% CI 1.35-1.61). Clinics practices associated with anti-HCV positivity were: previous preparing of heparin (OR=2.92; 95% CI 1.23-6.92), failure in gloves use or change (OR=5.73; 95% CI 1.75-18.72), unsatisfactory dialysis machine disinfection (OR=2.79; 95% CI 1.57-4.96), and patient isolation in dialysis room (OR=0.18; 95% CI 0.05-0.61). CONCLUSIONS: The results show high anti-HCV prevalence among hemodialysis patients and the association of nosocomial factors with new HCV infection cases.     

Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders in Massage Practitioners

INTRODUCTION: Massage practitioners are at high risk for work-related musculoskeletal disorders (WMSDs). We investigated the prevalence and risk factors. METHODS: We randomly selected 161 visually impaired practitioners. Demographics, musculoskeletal symptoms, and working postures were analyzed with multivariate logistic regression. RESULTS: Results indicated that about 71.4% had at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%; shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%; and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for finger or thumb 4.0-4.5 with 95% confidence interval (CI) 1.5-13.8, client contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3-8.1), and < or =7-kg pulp-pinch strength (adjusted OR for upper extremity = 2.9-3.2, 95% CI=1.2-8.3). Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3-7.8) and 3.6 (95% CI=1.4-9.6), respectively, for lack of neutral neck posture and for inappropriate working-table height. CONCLUSION: WMSDs were prevalent among massage practitioners.     

Risk of specific birth defects in relation to chlorination and the amount of natural organic matter in the water supply

To assess the effect of water chlorination by-products on specific birth defects, the authors conducted a nationwide cross-sectional study of 285,631 Norwegian births in 1993-1998. Risks of birth defects according to four chlorination by-product exposure categories were compared on the basis of chlorination (yes/no) and level of water color (mg Pt/liter), representing the amount of natural organic matter: high (chlorination, < or =20), medium (chlorination, 10-19.9), and low (chlorination, <10) exposure, with no chlorination and low color (<10) as the reference category. In logistic regression analysis, the risks of any birth defect (adjusted odds ratio (OR) = 1.13, 95% confidence interval (CI): 1.01, 1.25) and of cardiac (adjusted OR = 1.37, 95% CI: 1.00, 1.89), respiratory system (adjusted OR = 1.89, 95% CI: 1.00, 3.58), and urinary tract (adjusted OR = 1.46, 95% CI: 1.00, 2.13) defects were significantly associated with exposure (medium and high combined). Regarding risk of specific birth defects, only that for ventricular septal defects was significantly elevated, with an exposure-response pattern, yielding adjusted odds ratios of 1.63 (95% CI: 1.02, 2.58) for the medium and 1.81 (95% CI: 1.05, 3.09) for the high exposure categories. Furthermore, risk of neural tube defects was related to high color (adjusted OR = 2.60, 95% CI: 1.30, 5.26).     

Contraceptive and reproductive risk factors for cervical intraepithelial neoplasia in American Indian women

OBJECTIVES: To evaluate contraceptive and reproductive risk factors for cervical intraepithelial neoplasia (CIN) in southwestern American Indian women. METHODS: We conducted a clinic-based case-control study. Cases were American Indian women with biopsy-proven CIN I, CIN II or CIN III. Controls were from the same clinics and had normal cervical epithelium. All subjects underwent structured interviews focused on contraceptive and reproductive factors. Laboratory assays included polymerase chain reaction (PCR)-based tests for cervical human papillomavirus (HPV) infection. RESULTS: We enrolled 628 women in the study. The strongest risk factors for CIN II/III included HPV infection (adjusted odds ratio [OR] = 7.9, 95% CI : 4.7-13.2), and low income (OR = 3.1, 95% CI : 1.7-5.7). The use of an intrauterine device (IUD) ever (OR = 3.0, 95% CI : 1.4-6.1) and currently (OR = 4.1, 95% CI : 1.1-14.6), and > or = 3 vaginal deliveries (OR = 5.2, 95% CI : 2.4-11.1) were associated with CIN II/III. History of infertility was also associated with CIN II/III (OR = 2.1, 95% CI : 1.0-4.2). CONCLUSIONS: The data suggest that history of infertility, IUD use and vaginal deliveries were associated with CIN among American Indian women.     

Influence of diabetes mellitus type 2 and prolonged estrogen exposure on risk of breast cancer among women in Armenia

Diabetes mellitus type 2 (DM2) and breast cancer (BrCa) are prevalent in Armenia. We investigated DM2, reproductive factors, and BrCa in a case control study of 302 women. Multiple logistic regression analyses revealed DM2 increased adjusted odds of BrCa by 5.53 (95% CI 1.34-22.81). Any birth was protective (adjusted OR=0.36, 95% CI 0.20-0.66). Each year delay in first pregnancy increased risk (adjusted OR=1.13, 95% CI 1.01-1.27) as did induced abortions (adjusted OR=2.86, 95% CI 1.02-8.04). Odds ratios were adjusted for age and body mass index (BMI), which confounded associations between DM2 and BrCa. We suggest our findings imply the need for further investigation in Armenian and in other populations with similar characteristics.     

Pregnancy outcome among offspring of airline pilots and cabin attendants

OBJECTIVES: This study assessed the occurrence of perinatal death, low birthweight, preterm birth, and birth defects (total, major, neural tube defects, total cleft, cleft palate, hypospadias, and Down syndrome) in the offspring of airline pilots and cabin attendants. METHODS: A cohort of offspring of airline pilots and cabin attendants was established and characterized in terms of parental exposure to cosmic radiation the year before birth or ever. Pregnancy outcome was derived from the Medical Birth Register of Norway. The reference group comprised offspring of parents without occupational exposure to cosmic radiation. RESULTS: No deviant risks were observed for the offspring of male pilots, either for the year preceding birth (N=2,111) or ever (N=2,356). Specific birth outcomes were fewer for the pilots than for the referents (N=1,621,186), except for Down syndrome, which was more frequent [odds ratio (OR) 1.41, 95% confidence interval (95% CI) 0.53-3.76]. For exposure the year preceding birth (N=2,512), the risk of low birthweight was lower for the female cabin attendants than for the referents (adjusted OR 0.83, 95% CI 0.69-1.00), while Down syndrome was more frequent (OR 1.44, 95% CI 0.60-3.47). For exposure ever (N=3346), the risk of low birthweight was lower (OR 0.82, 95% CI 0.70-0.96) for the cabin attendants, while hypospadias (OR 1.18, 95% CI 0.61-3.04) and Down syndrome (OR 1.79, 95% CI 0.03-3.45) were more frequent CONCLUSIONS: In general, offspring of air pilots and cabin attendants do not seem to be at increased risk of adverse pregnancy outcome.     

Risk modifying effect of social capital on measures of heavy alcohol consumption, alcohol abuse, harms, and secondhand effects: national survey findings

STUDY OBJECTIVE: To examine associations between social capital and individual risk for alcohol abuse and harms and identify protective effect mechanisms. DESIGN: Multilevel multivariate analysis with individual level data from a national panel survey of drinking and a contextual measure of social capital reflecting college mean aggregate reports of student volunteerism. Outcomes include heavy episodic (binge) drinking, frequent drinking, frequent drunkenness, diagnosable alcohol abuse, intentional drunkenness, acquisition of binge drinking, harms, secondhand effects from others' drinking. SETTING: United States, 119 four year colleges. PARTICIPANTS: Representative samples of youth ages 18-24 surveyed in 1997 and 1999 using an anonymous mailed questionnaire (total n = 27 687). MAIN RESULTS: Students from colleges with higher levels of social capital reported reduced risks for binge drinking (adjusted OR 0.38, 95% CI 0.20 to 0.69, p = 0.002), frequent drunkenness (adjusted OR 0.58, 95% CI 0.34 to 0.98, p = 0.04), acquisition of binge drinking in college (adjusted OR 0.48, 95% CI 0.24 to 0.95, p = 0.03), and alcohol abuse (adjusted OR 0.55, 95% CI 0.34 to 0.91, p = 0.02) in multilevel multivariate analyses that controlled for individual volunteering, the measure on which social capital was based. Higher levels of social capital protected against multiple drinking related harms (adjusted OR 0.51, 95% CI 0.29 to 0.90, p = 0.02) and secondhand drinking effects (adjusted OR, 0.30, 95% CI 0.16 to 0.58, p = 0.0003). Significant cross level interactions exist between fraternity/sorority membership and social capital for measures of risky drinking. Harm reduction primarily reflects consumption modification. CONCLUSIONS: Social capital exerts strong protective effects on alcohol abuse and harm in college including among high risk students.     

Risk factors for cryptorchidism: a nested case-control study

Summary. .A nested case-control study of cryptorchidism (i.e. undescended testicles) was undertaken as part of a hospital-based cohort study of 6699 singleton male neonates in New York City. Since some of the cryptorchid infants experienced spontaneous descent of their testes, separate analysis was performed for this third group of late descenders' ( n = 140). Cases ( n = 63) represented infants whose testes remained undescended at the one year assessment. Controls ( n =219) represented the next male infant who was delivered immediately after an infant who was cryptorchid at birth. The only independent risk factors for cryptorchidism were Asian ethnic group (adjusted odds ratio (OR) = 3.90,95% confidence interval (CI) = 1.22-12.41), swollen legs or feet during pregnancy (adjusted OR=2.16, 95% CI = 1.15-4.04), a family history of cryptorchidism (adjusted OR=4.32, 95% CI = 1.91-9.80), low birthweight (adjusted OR = 4.10, 95% CI = 1.39-12.08), and use of analgesics during pregnancy (adjusted OR = 1.93/95% CI = 1.03-3.62). Multiple logistic regression analysis was also performed to identify those factors that were associated with late testicular descent. In this analysis the independent risk factors were black or Hispanic ethnicity (adjusted OR = 2.05, 95% CI = 1.09-3.83), a family history of cryptorchidism (adjusted OR = 4.25,95% CI = 1.84-9.78), consumption of cola-containing drinks during the pregnancy (adjusted OR = 2.09, 95% CI = 1.10-3.99), a low birthweight delivery (adjusted OR = 9.78, 95% CI = 3.39-28.20), and preterm birth (adjusted OR = 4.01, 95% CI = 1.66-9.70).     

Influence of Diabetes Mellitus Type 2 and Prolonged Estrogen Exposure on Risk of Breast Cancer Among Women in Armenia

Diabetes mellitus type 2 (DM2) and breast cancer (BrCa) are prevalent in Armenia. We investigated DM2, reproductive factors, and BrCa in a case control study of 302 women. Multiple logistic regression analyses revealed DM2 increased adjusted odds of BrCa by 5.53 (95% CI 1.34–22.81). Any birth was protective (adjusted OR = 0.36, 95% CI 0.20–0.66). Each year delay in first pregnancy increased risk (adjusted OR = 1.13, 95% CI 1.01–1.27) as did induced abortions (adjusted OR = 2.86, 95% CI 1.02–8.04). Odds ratios were adjusted for age and body mass index (BMI), which confounded associations between DM2 and BrCa. We suggest our findings imply the need for further investigation in Armenian and in other populations with similar characteristics.     

Black tea consumption and risk of rectal cancer in Moscow population

PURPOSE: This population-based case-control study (663 cases and 323 controls) examined the effect of black tea intake on the risk of rectal cancer in Moscow residents. The Moscow population was selected for its wide range of black tea consumption. METHODS: This study used three measures of tea consumption: the volume of beverage (l/month), zavarka (tea concentrate, l/month), and dry tea (g/month). We calculated the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for these three parameters of tea intake using logistic regression. RESULTS: Greater use of dry tea was associated with lower risk of rectal cancer in women (high vs. low: OR = 0.40; 95% CI, 0.23-0.70) and in men (high vs. low: OR = 0.77; 95% CI, 0.42-1.43). The observed effect was weaker when tea was measured as zavarka (high vs. low in women: OR = 0.47; 95% CI, 0.26-0.83; in men: OR = 0.99; 95% CI, 0.52-1.96) and as beverage volume (high vs. low in women: OR = 0.68; 95% CI, 0.39-1.19; in men: OR = 1.03; 95% CI, 0.53-2.09). CONCLUSIONS: These findings support the hypothesis that black tea consumption reduces the risk of rectal cancer. The attenuation of the effect across the three measures of tea intake can be explained by an increasing degree of exposure misclassification from dry tea to zavarka and beverage volume.     

Gender differences in adolescent smoking: mediator and moderator effects of self-generated expected smoking outcomes

PURPOSE: To examine relations among gender, self-generated smoking-outcome expectancies, and smoking in adolescents. METHODS: Students from one all-girls' (n=350; 53%) and one all-boys' (n=315; 47%) Catholic high school participated. Analyses included binary and ordinal logistic regression. RESULTS: For boys, smoking behavior was associated with buzz (odds radio [OR] = 1.92, 95% confidence interval [CI]: 1.31-2.83, p < .001), pleasure (OR = 1.47, 95% CI: 1.01-2.16, p = .044), taste/smell (OR = 2.17, 95% CI: 1.12-4.19, p = .022), stimulation (OR = 3.69, 95% CI: 1.32-10.28, p = .013), and exercise/sport impairment (OR = 2.84, 95% CI: 1.68-4.81, p < .001). Among girls, weight control (OR = 0.22, 95% CI: 0.13-0.36, p < .001), negative aesthetics (OR = 0.42, 95% CI: 0.28-0.64, p < .001), addiction (OR = 0.39, 95% CI: 0.28-0.55, p < .001), and negative mood (OR = 0.44, 95% CI 0.20-0.97, p = .041) predicted smoking. Buzz (beta = 2.88, p = .004) mediated the gender-smoking relationship. Moderators included negative social (beta = -0.45, p = .021) and enhance self-esteem (beta = -1.07, p = .024). CONCLUSION: Interventions might benefit from tailoring on gender differences in smoking-outcome expectancies.     

Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore

Between 1 and 22 March 2003, a nosocomial outbreak of Severe Acute Respiratory Syndrome (SARS) occurred at the Communicable Disease Centre in Tan Tock Seng Hospital, Singapore, the national treatment and isolation facility for patients with SARS. A case-control study with 36 cases and 50 controls was conducted of factors associated with the transmission of SARS within the hospital. In univariate analysis, contact with respiratory secretions elevated the odds ratio to 6.9 (95 % CI 1.4-34.6, P= 0.02). Protection was conferred by hand washing (OR 0.06, 95% CI 0.007-0.5, P=0.03) and wearing of N95 masks (OR 0.1, 95% CI 0.03-0.4, P=0.001). Use of gloves and gowns had no effect. Multivariate analysis confirmed the strong role of contact with respiratory secretions (adjusted OR 21.8, 95 % CI 1.7 274.8, P=0.017). Both hand washing (adjusted OR 0.07, 95 % CI 0.008-0.66, P=0.02) and wearing of N95 masks (adjusted OR 0.1, 95% CI 0.02-0.86, P=0.04) remained strongly protective but gowns and gloves had no effect.     

HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention

OBJECTIVES: This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. METHODS: We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. RESULTS: HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. CONCLUSIONS: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.     

Dietary factors are associated with coronary heart disease risk factors in college students

It is hypothesized that healthy dietary and physical activity choices will be inversely associated with coronary heart disease (CHD) risk factors. Results from a cross-sectional study of 294 first-year University of Rhode Island students were used for the analyses. The presence of CHD risk factors was defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines. Diet was assessed by three 24-hour food recalls, and physical activity was assessed by the International Physical Activity Questionnaire. Logistic regression models adjusted for sex estimated the odds of having CHD risk factors. A higher percent of kilocalories from alcohol was associated with a 9.9% increased risk for elevated triacylglycerol (odds ratio [OR], 1.099; 95% confidence interval [CI], 1.000-1.207). Sugar intake (OR, 1.015; 95% CI, 1.004-1.026), saccharin intake (OR, 1.047; 95% CI, 1.015-1.080), and body mass index (BMI; OR, 1.139; 95% CI, 1.037-1.252) were associated with an increased risk of low high-density lipoprotein cholesterol; dietary fiber intake (OR, 0.934; 95% CI, 0.873-1.000) was associated with a decreased risk of low high-density lipoprotein cholesterol. Participants with a higher BMI were 9.4% more likely to have elevated fasting glucose (OR, 1.094; 95% CI, 1.004-1.192) and 193.6% more likely to have a larger waist circumference (OR, 2.936; 95% CI, 1.543-5.586). Dietary factors and BMI are better indicators of CHD risk than physical activity is in this population.     

Patient-physician colorectal cancer screening discussions and screening use

BACKGROUND: Little is known about patient-physician colorectal cancer (CRC) screening discussions or how discussion content affects screening use. Analyses conducted in 2004-2005 of patient-physician CRC screening discussion content and its association with screening use are described. METHODS: A mailed survey and retrospective claims data were used to compile information on insured, primary care patients aged 50 to 70 years (n = 4966). The survey collected information on patient-physician CRC screening discussion content (including the 5A's: assess, advise, agree, assist, and arrange). Survey responses were linked with 5-year retrospective claims data (ending December 31, 2003) on CRC screening use. Among patients reporting screening discussions, generalized estimating equation approaches were used to estimate the association of discussion content with screening use. RESULTS: Among those reporting discussion information (n = 2463), 80% reported discussing CRC screening with their physician. The content of these discussions varied, and only 54% used CRC screening. Multivariable model results indicated that the likelihood of screening was greater among patients reporting help scheduling an appointment (assist) (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.95-3.72) and those reporting a discussion of results or follow-up (arrange) (OR = 1.63, 95% CI = 1.18-2.24), and lower among patients offered a choice among screening modalities (agree) (OR = 0.57, 95% CI = 0.37-0.86) as well as among those who wanted more screening information (OR = 0.65, 95% CI = 0.43-0.97). CONCLUSIONS: Not all patient-physician CRC screening discussions result in CRC screening use. It is important to understand which aspects of shared decision making and discussion content are likely to increase informed and value-concordant decisions to participate in recommended evidence-based CRC screening.     

长春市成年居民一般心理健康状况及其影响因素分析

目的 了解长春市成年居民一般心理健康状况的分布特征及其影响因素。方法 采用一般健康问卷12项评价量表（12-item general health questionnaire,GHQ-12）对多阶段分层随机整群抽样选取的长春市成年居民进行心理健康状况调查,并利用Logistic回归分析其影响因素。结果 长春市成年居民GHQ-12平均分为2.13分,阳性检出率为21.1% ;其中男性阳性检出率16.6%,女性阳性检出率为25.6%,差异有统计学意义（χ2=72.078,P<0.001）;多因素分析结果显示,女性（OR=1.509,95% CI:1.248～1.824）、婚姻状况为丧偶（OR=1.483,95% CI:1.103～1.995）、睡眠时间为<7 h（OR=1.586,95% CI:1.334～1.885）或≥9 h（OR=1.322,95% CI:1.003～1.743）、职业类型为其他（OR=1.245,95% CI:1.002～1.547）、患有慢性病（OR=2.130,95% CI:1.760～2.578）为影响长春市居民心理健康状况的危险因素;年龄为35岁以上（OR=0.540,95% CI:0.361～0.808;OR=0.497,95% CI:0.328～0.752;OR=0.425,95% CI:0.276～0.656;OR=0.526,95% CI:0.325～0.852）、家庭人均月收入为500元及以上（OR=0.656,95% CI:0.519～0.829;OR=0.571,95% CI:0.445～0.732;OR=0.567,95% CI:0.432～0.761;OR=0.519,95% CI:0.366～0.737）、饮食规律（OR=0.584,95% CI:0.485～0.704）、进行锻炼（OR=0.583,95% CI:0.480～0.709;OR=0.789,95% CI:0.642～0.971）均为心理健康状况的保护因素。结论 长春市成年居民一般心理健康状况较差,相关部门应采取针对性的措施提高居民的基本生活质量,并结合宣讲等方式增加其保健意识。     

Predictors of short-term readmission of asthmetic children

BACKGROUND: Bronchial asthma admission rate has increased dramatically all over the world. Part of this increase in hospital admissions is due to patients' readmission. OBJECTIVE: Determining what risk factors are associated with short-term hospital readmission of pediatric patients with asthma within two months of the last hospital admission. METHODS AND SETTING: A retrospective case-control study using registration books of both admissions and discharges to identify patients groups. All hospital records were reviewed for patients admitted from August 1998 through December 2002 at Assir Central Hospital, southwestern of Saudi Arabia. Patients who were admitted at this period of study and they were readmitted to the hospital within two months constituted the study group (n = 28) and those patients who were admitted within the same period but not readmitted within two months constituted the control group (n = 45). Demographic variables, route of admission, patient previous medical history, clinical assessment, hospital treatment as well as discharge treatment were extracted from medical records. RESULTS: twenty eight patients were readmitted within two months of the discharge from hospital (17 boys and 11 girls), seventy percent of these were below four years of age. Significant predictors of readmission were; prior history of asthma admission (adjusted OR 1.81 (1.20-2.73), NICU graduate (adjusted OR 4.44 (1.67-6.34), chronic lung disease (adjusted OR 3.06, 95% CI 2.01-4.95), tracheosphageal fistula (Adjusted OR 3.19, 95% CI 1.08-8.74), recurrent aspiration (adjusted OR 3.14, 95% CI 1.90-4.27), duration of asthma symptoms more than four days (adjusted OR 0.23, CI 0.21-0.42), moderate to severe clinical assessment (adjusted OR 1.67-95% CI 1.15-3.04), intensive care admission (adjusted OR 2.96, 95% CI 1.09-8.63), intravenous steroids ( adjusted OR 2.21,95% CI 1.36-4.67), and chest x-ray findings (adjusted OR 0.39, 95% CI:0.20-0.64). CONCLUSION: Previous NICU admission, bronchopulmonary dyspalsia, and history of previous asthma admissions, tracheosophageal fistula, recurrent aspirations, intensive care admission, intubation and intravenous steroids were significant predictors of asthma short readmission.     

The association between aluminum-containing products and Alzheimer's disease

The association between exposure to aluminum through the lifetime use of antiperspirants and antacids and Alzheimer's disease (AD) was explored in a case-control study of 130 matched pairs. Cases were clinically diagnosed between January 1980 and June 1985 at two geriatric psychiatric clinics in Seattle, Wash. Controls were friends or non-blood relatives of the case. Subjects were matched by age, sex, and the relationship between the case and his or her surrogate. For all antiperspirant/deodorant use, regardless of aluminum content, there was no association with AD (adjusted odds ratio (OR) = 1.2, 95% CI = 0.6-2.4). For aluminum-containing antiperspirants, the overall adjusted OR was 1.6 (95% CI = 1.04-2.4) with a trend toward a higher risk with increasing frequency of use (p for trend = 0.03), the adjusted OR in the highest tertile being 3.2. For antacids regardless of aluminum content, the overall adjusted OR was 3.1 (95% CI = 1.2-7.9). Here, a steep dose-response gradient was found (p for trend = 0.009), with an adjusted OR for the highest tertile of 11.7. However, when only aluminum-containing antacids were analyzed, the overall adjusted OR was only 0.7 (95% CI = 0.3-2.0) and there was no significant dose-response trend. These results are provocative but inconclusive due to methodologic problems relating to the necessary use of surrogate respondents and the long time period of potential exposure for this dementing disease.     

Physical and sexual violence during pregnancy and after delivery: a prospective multistate study of women with or at risk for HIV infection

OBJECTIVES: We sought to describe and compare prevalence rates of and risk factors for violence against women during pregnancy and postpartum. METHODS: Physical and sexual violence and violence risk factors were assessed during late pregnancy and 6 months postpartum in a prospective study of pregnant women with (n=336) and without (n=298) HIV in 4 US states. RESULTS: Overall, 10.6% of women reported having experienced violence, 8.9% during pregnancy and 4.9% after delivery. Of these women, 61.7% were abused only during their pregnancy, 21.7% were repeatedly abused, and 16.7% were abused only after their delivery. Sexual violence rarely occurred in the absence of physical violence. The strongest predictor of violence was engaging in bartered sex (adjusted odds ratio [OR]=5.54; 95% confidence interval [CI] =2.0, 15.4). Other predictors included frequent changes in residence (adjusted OR=1.57; 95% CI=1.1, 2.2), financial support from family or partners (adjusted OR=0.42; 95% CI=0.2, 0.8), and HIV diagnosis during current pregnancy (adjusted OR=0.30; 95% CI=0.1, 0.7). CONCLUSIONS: Women more commonly experienced violence during than after their pregnancy, but violence was best predicted by socioeconomic and behavioral indicators whose influence did not vary over time.     

Perinatal mortality associated factors in a general hospital of Chiapas, Mexico

OBJECTIVE: To identify socioeconomic, gynecological-obstetric and fetal factors associated with perinatal mortality. METHODS: A matched case-control study was carried out. Cases were newborns (born live or dead) that were born and died between 28 weeks gestation and 7 days of life. Controls were live newborns between 28 weeks gestation and 7 days of life. A total of 99 cases and 197 controls were studied. Data were obtained from the corresponding medical charts. Statistical analysis was performed using Stata 6.0 software. RESULTS: Mean maternal age was 24.82 years and mean newborn age was 37.78 weeks gestation with an average birth weight of 2,760 grams. Factors associated with perinatal mortality were: father's occupation as a farmer (adjusted odds ratio (OR)=3.31; 95% CI=1.26-8.66); high obstetric risk index (adjusted OR=10.57; 95% CI=2.82-39.66), cesarean birth (adjusted OR=2.75; 95% CI=1.37-5.51), five or more prenatal visits (adjusted OR=4.43; 95% CI=1.86-10.54) and preterm fetal maturity indices (PEG, APG, GEG) (adjusted OR=9.20; 95% CI=4.39-19.25). CONCLUSIONS: The risk factors associated with perinatal mortality found in the study are consistent with the findings reported in the international literature. These results show that prevention and control measures should be implemented to identify at risk pregnant women in order to lower perinatal mortality.