Relation of smoking and alcohol consumption to incident Alzheimer's disease.

The authors examined the effects of smoking and alcohol use in a prospective community-based study of incident Alzheimer's disease. Two in-home interviews of the total elderly population of East Boston, Massachusetts, conducted in 1982 and 1985 were used to sample individuals for clinical evaluation for Alzheimer's disease. A total of 513 persons underwent detailed clinical evaluation including neurologic, neuropsychologic, and psychiatric evaluation to diagnose Alzheimer's disease. In weighted logistic regression controlled for age, sex, and education, the estimated odds ratio of Alzheimer's disease was 0.7 (95% confidence interval 0.3-1.4) for ever smokers compared with never smokers. For 40 pack-years of smoking, the odds ratio of Alzheimer's disease was 0.8 (95% confidence interval 0.6-1.1). Consumption of 1 oz (30 ml) of alcohol per day was associated with an odds ratio of 1.1 (95% confidence interval 0.8-1.5). These results suggest that recent mild-to-moderate consumption of alcohol is not substantially related to incidence of Alzheimer's disease and that smoking does not increase risk of the disease.     

Occupation, industry, and fatal motor vehicle crashes in 20 states, 1986-1987.

BACKGROUND: Motor vehicles are a leading cause of injury on and off the job. METHODS: To describe the occurrence of fatal motor vehicle crashes in the working-age population, a case-control study was conducted among persons 15-64 years old who died in 1986 or 1987 in any of 20 states reporting death certificate occupational data to the National Center for Health Statistics. Cases were occupants of motor vehicles (excluding motorcycles) who died of injuries sustained in a crash (E810-E825, 9th revision International Classification of Diseases), and controls died of any other cause. RESULTS: Transportation-related occupations had more than the expected number of deaths for men (odds ratio = 1.6, 95% confidence interval = 1.4-1.9) and women (odds ratio = 2.1, 95% confidence interval = 1.0-4.5), as did managerial occupations (odds ratio = 1.3 and 1.7, 95% confidence interval = 1.1-1.5 and 1.3-2.2 for men and women, respectively). Men in mining and oil drilling occupations and the wholesale trade industry also had excess crash deaths. Among women, additional excesses were observed among professional specialists and in several groups with few deaths, including agriculture, construction, and the military, whereas homemakers had markedly fewer vehicle crash deaths than expected. CONCLUSIONS: These findings encourage further investigation of this important safety hazard, but also call attention to a need for more detailed studies and improved data.     

Evaluation of safety orientation and training programs for reducing injuries in the plumbing and pipefitting industry

Construction workers are at increased risk for fatal and non-fatal injuries. This study examined the effectiveness of employee orientation and training in reducing injuries among plumbers and pipefitters. We searched the Occupational Safety and Health Administration's "recordable" injury data and "documentable" safety and training records for six plumbing and pipefitting employers in northwestern Ohio. During the period 1996 to 1998, 133 injuries were recorded with the duration of 2,541,432 working hours. The most common types of injuries were cuts, lacerations, and abrasions. The majority of injuries resulted from workers being struck by objects. The injury rate was significantly higher for small companies and longer working hours. No difference was found between traveling and local workers. Seventy-five percent of workers received safety orientations on injury prevention. Among workers who received safety orientations, only 3.4% experienced injuries, compared with 11.1% of workers without orientations. Safety orientations were associated with a significant reduction in injuries (odds ratio, 0.23; 95% confidence interval, 0.15 to 0.35). Proper safety orientation and training could reduce the risks for occupational injuries in construction workers.     

The effect of wrist guard use on upper-extremity injuries in snowboarders

The objective of this investigation was to determine the effect of wrist guard use on all upper-extremity injuries in snowboarders. This matched case-control study was conducted at 19 ski areas in Quebec, Canada. Cases were 1,066 injured snowboarders who reported upper-extremity injuries to the ski patrol during the 2001-2002 season. Controls were 970 snowboarders with non-upper-extremity injuries who were matched to cases on ski area and the nearest date, age, and sex, in that order. The response rate was 71.8% (73.5% for cases and 70.1% for controls). Cases were compared with controls with regard to wrist guard use. The prevalence of wrist guard use among snowboarders with hand, wrist, or forearm injuries was 1.6%; for those with elbow, upper arm, or shoulder injuries, it was 6.3%; and for controls, it was 3.9%. Thus, wrist guard use reduced the risk of hand, wrist, or forearm injury by 85% (adjusted odds ratio = 0.15, 95% confidence interval: 0.05, 0.45). However, the adjusted odds ratio for elbow, upper arm, or shoulder injury was 2.35 (95% confidence interval: 0.70, 7.81). These results provide evidence that use of wrist guards reduces the risk of hand, wrist, and forearm injuries but may increase the risk of elbow, upper arm, and shoulder injuries.     

Prevention of childhood injuries: evaluation of the Statewide Childhood Injury Prevention Program (SCIPP).

We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of burns, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings.     

A case-control study of injuries arising from the earthquake in Armenia, 1988.

The study attempts to identify predictors of injuries among persons who were hospitalized following the Armenian earthquake of 7 December 1988. A total of 189 such individuals were identified through neighbourhood polyclinics in the city of Leninakan and 159 noninjured controls were selected from the same neighbourhoods. A standardized interview questionnaire was used. Cases and controls shared many social and demographic characteristics; however, 98% of persons who were hospitalized with injuries were inside a building at the time of the earthquake, compared with 83% of the controls (odds ratio = 12.20, 95% confidence interval (CI) = 3.62-63.79). The odds ratio of injuries for individuals who were in a building that had five or more floors, compared with those in lower buildings, was 3.65 (95% CI = 2.12-6.33). Leaving buildings after the first shock of the earthquake was a protective behaviour. The odds ratio for those staying indoors compared with those who ran out was 4.40 (95% CI = 2.24-8.71).     

The WHO safe community program for injury prevention: evaluation of the impact on injury severity

Despite the fact that injuries consume a considerable amount of health care resources world-wide, 3.5 million people die from unintentional injuries each year. To handle this central public health problem, WHO has introduced the Safe Community accreditation for injury prevention programs. This study was to investigate the impact from a Safe Community program with regard to injury severity. Data were collected in Motala municipality (population = 41 000), Östergötland county, Sweden, during one year before and one year after program intervention, from two sources: registration of trivial (AIS 1) and non-trivial (AIS 2–6) unintentional injuries from all acute care episodes in the area and recollection of hospital bed days from discharge registers. The incidence of non-trivial injuries treated in health care was found to have decreased by 41% (95% confidence interval, 37–45%), while the trivial injuries increased by 16% (9–22%). The larger decrease of non-trivial injuries was observed in all ages and injury event environments. The total number of bed days at emergency hospitals due to injuries decreased by 39% (37–41%) from 1983–84 to 1989, while the hospital bed utilization for other reasons decreased by 9% (8–9%). The study showed that implementation of a WHO Safe Community program led to the harm from unintentional injuries within the community being considerably more reduced than that of the injury incidence. In future assessments of injury prevention programs, classification of injury severity should be included to increase the validity of inter-program comparisons.     

Occurrence of hospital infection among interned elderly in a university hospital

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

Gesundheitskompetenztraining für Menschen in Langzeitarbeitslosigkeit

Among the long-term unemployed ill health is often a hindrance to successful reintegration in the job market. In a quasi-experimental controlled study we examined the effects of a health promotion intervention program tailored to the specific needs of the long-term unemployed combining individual sessions based on motivational interviewing and participatory group sessions including physical activity. Over a period of 3 months the participants of the intervention group (n?=?179) showed more improvement compared to the control group (n?=?108) in terms of motivation for lifestyle changes towards more physical activity and healthier nutrition. Participants of the intervention group developed an intention to act significantly more often (active lifestyle: odds ratio 4.44; 95% CI: 2.00-9.83; healthy nutrition: odds ratio 3.94; 95% CI: 1.55-10.00) and actually implemented a behavior change significantly more often (active lifestyle: odds ratio 2.77; 95% CI: 1.35-5.71; healthy nutrition: odds ratio 4.34; 95% CI: 1.92-9.78). In terms of smoking and alcohol consumption no significant intervention effects were detected. The results of the study show the effectiveness of the described health promotion program regarding a lifestyle change towards more healthy nutrition and more physical activity.     

Risk factors for work-related injury among male farmers in Iowa: a prospective cohort study.

Agriculture is one of the most hazardous occupations in the United States. We examined the work-related injury rate and risk factors among 290 Iowa male principal farm operators using a population-based, prospective study. Baseline data were collected between 1991 and 1994, and injury events were surveyed in the fall of 1995. Cumulative incidence of farmwork-related injury during the previous year was 10.5%. We found that depressive symptoms (odds ratio, 3.22; 95% confidence interval, 1.04 to 9.99) and the number of hours working with animals (odds ratio, 2.14; 95% confidence interval, 1.04 to 4.44) were associated with the incidence of farmwork-related injuries.     

Seasonal Influenza Vaccination among Homebound Elderly Receiving Home-Based Primary Care in New York City

Seasonal influenza vaccination is recommended for all persons aged ≥50 years to reduce influenza related morbidity and mortality, but vaccination coverage among community-dwelling elderly remains low. Homebound elderly receiving home-based primary care (HBPC) have fewer barriers to vaccination than other community-dwelling elderly. The Mount Sinai Visiting Doctors (MSVD) program provides HBPC to homebound elderly in New York City. This study assessed seasonal influenza vaccination coverage within an urban HBPC program and identified factors associated with vaccine refusal. A cross-sectional analysis of data from the 2008–2009 influenza season was completed and influenza vaccination coverage was assessed. The association between social, demographic and health-related characteristics and vaccine refusal was evaluated using bivariate analysis and multivariable logistic regression. Of 689 people aged >65 eligible for influenza vaccination, 578 (84%) accepted and 111 (16%) refused vaccination. In multivariable analysis, vaccine refusal was positively associated with female gender (adjusted odds ratio [AOR] = 1.85, 95% confidence interval [CI] 1.02, 3.35), black race (AOR = 2.04, 95% CI 1.28, 3.25), and living alone (AOR = 1.71, 95% CI 1.10, 2.67), and negatively associated with dementia (AOR = 0.59, 95% CI 0.37, 0.91). Seasonal influenza vaccine coverage in the MSVD program was high compared to nursing home and community-dwelling elderly. Offering patients vaccination at home without additional expense will likely improve vaccine coverage among urban homebound elderly. Understanding why vaccine refusal rates are higher among females, black patients, and those living alone should guide interventions to increase vaccine acceptance among this population.     

Community-based injury prevention: effects on health care utilization.

BACKGROUND: Worldwide, an estimated 78 million people are disabled each year because of unintentional injuries and about 3 million die. The WHO Safe Community model is a framework for community-based injury prevention programmes. The aim of this study is to evaluate the outcome on health care utilization of a Safe Community programme. METHODS: The incidence of injuries treated at health care facilities in an intervention municipality (pop. 41,000) was compared to the injury incidence in a control municipality (pop. 26,000). The incidence was recorded immediately before and one year after programme implementation from registrations made during all first-contact health care visits and from examination of hospital discharge registers. RESULTS: The incidence of health care treated injuries in the intervention area had decreased by 13% (95% CI: 9-16%) from 119 (95% CI: 115-122) per 1000 population-years to 104 (95% CI: 101-107). In the control area, the corresponding injury incidences were 104 (95% CI: 100-108) and 106 (95% CI: 102-109). The hospital-treated injuries in the intervention area decreased by 15% (95% CI: 7-24%) from 19 (95% CI: 17-20) per 1000 population-years to 16 (95% CI: 15-17), while in the control area, the incidences remained at 13 (95% CI: 11-14) per 1000 population-years. Utilization of acute care in the intervention area for reasons other than injuries increased by 8% (95% CI: 6-10%), while in the control area, the number of visits did not show significant change. CONCLUSION: This first controlled evaluation showed that an injury prevention programme based on local action groups can significantly reduce injuries requiring health care in a community. Local prevention can provide a complement to national level campaigns.     

One- and two-year predictors of excess weight gain among elementary schoolchildren in multiethnic, low-income, inner-city neighborhoods

Longitudinal studies are needed to increase understanding of the causes of childhood obesity. To identify 1- and 2-year predictors of excess weight gain among preadolescents, the authors conducted a prospective cohort study of fourth- and fifth-grade students in 16 elementary schools located in multiethnic, low-income neighborhoods in Montreal, Quebec, Canada, that were participating in the evaluation of a school-based heart health promotion program. Subjects included 2,318 children aged 9-12 years with baseline and 1-year follow-up data and 633 children aged 9-11 years with baseline and 2-year follow-up data. One-year predictors of highest decile of change in body mass index (BMI) identified in logistic regression analyses included baseline BMI of 90th percentile or more (odds ratio (OR) = 2.66, 95% confidence interval: 1.80, 3.94) in boys and baseline BMI of 90th percentile or more (OR = 2.34, 95% confidence interval: 1.46, 3.76), no sports outside school (OR = 1.90, 95% confidence interval: 1.18, 3.06), and playing video games everyday (OR = 2.48, 95% confidence interval: 1.04, 5.92) in girls. Two-year predictors included baseline BMI of 90th percentile or more (OR = 3.26, 95% confidence interval: 1.52, 7.01), no sports outside school (OR = 2.14, 95% confidence interval: 0.96, 4.77), and least active (OR = 2.18, 95% confidence interval: 1.01, 4.71) in boys; only baseline BMI of 90th percentile or more (OR = 2.22, 95% confidence interval: 1.02, 4.81) was significant in girls. Results suggest the need for interventions to promote increased physical activity in children.     

Health problems presented to family practices in the Netherlands 1 year before and 1 year after a disaster.

BACKGROUND: Disasters often have negative health consequences. Studies of health problems presented in family practice before and after a disaster are rare. The present study analyzed health problems before and after a disaster and predictors of increased morbidity after the disaster as presented in family practice. METHODS: A matched cohort study design with measurements 1 year before the disaster and 1 year after the disaster. Victims (N = 9183) and matched controls (N = 7066) were surveyed in the electronic medical records of 30 family practices after the explosions of a fireworks depot in The Netherlands. All health problems were registered using the International Classification of Primary Care. RESULTS: Victims showed significantly higher prevalence rates for psychological problems after the disaster than before the disaster (422 vs133 per 1000 person-years; P < .001) and for problems of the musculoskeletal system (450 vs 401 per 1000 person-years; P < .05). Relocation because of the disaster (odds ratio, 10.65; 95% confidence interval, 8.15-13.94) and, to a lesser degree, psychological morbidity before the disaster (odds ratio, 2.31; 95% confidence interval, 1.42-3.76) were the strongest predictors of psychological problems after the disaster. CONCLUSION: The results suggested that forced relocation and a history of psychological problems were risk factors to post-disaster psychological problems of victims presenting to a family practice.     

Do peer educators make a difference? An evaluation of a youth-led HIV prevention model in Zambian Schools

Restless Development's youth-led model places trained Volunteer Peer Educators (VPEs), aged 18-25 years, in schools to teach HIV prevention and reproductive health (RH). VPEs also run youth centers, extracurricular and community-based activities. This evaluation assesses (i) program effects on students' HIV/RH knowledge, attitudes and behaviors using a non-randomized quasi-experimental design among 2133 eighth and ninth grade students in 13 intervention versus 13 matched comparison schools and (ii) program costs. Intervention students had significantly higher levels of knowledge related to HIV [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.18-2.19; P < 0.01] and RH (OR 1.71; 95% CI 1.21-2.49; P < 0.01), more positive attitudes toward people living with HIV and greater self-efficacy to refuse unwanted sex and access condoms. No evidence of differences in ever having had sex was found (28% in the intervention; 29% in the comparison schools). However, intervention students were more likely not to have had sex in the previous year (OR 1.26, 95% CI 1.03-1.56; P < 0.05) and to have had only one sex partner ever (OR 1.43, 95% CI 1.00-2.03; P < 0.05). The average annual cost of the program was US$21 per beneficiary. In conclusion, the youth-led model is associated with increased HIV and RH knowledge and self-efficacy and lowered levels of stigma and sexual risk-taking behaviors.     

Soccer Injuries in Female Youth Players

A cross-sectional survey of injuries among female youth soccer players found 44.6% (95% confidence interval 34.9%–54.8%) had ever been injured. The injury incidence rate for the current season was 2.2/1000 soccer exposure hours (95% CI 1.5–3.1). Future studies should evaluate modifiable risk factors in youth to identify injury prevention strategies.     

Women's knowledge about cervical cancer, Pap smear and human papillomavirus and its relation to screening in Argentina

The purpose of this study was to evaluate women's knowledge about cervical cancer, Pap smears, and human papilloma virus in relation to their cervical cancer screening behavior. This hospital-based study was conducted with a sample of 200 women: 100 women screened in the last three years and 100 non-screened women who attended a hospital located in the metropolitan area of Buenos Aires, between September 2008 and February 2009. Women at the hospital were surveyed using a structured questionnaire. Multiple logistic regression models were used to evaluate the relation of women's knowledge about Pap smears to screening behavior, controlling for socio-demographic characteristics. Of the women who had been screened, 49% compared to 73% of those not screened had inadequate knowledge about Pap smears (P = 0.001), and 47% of screened and 30% of non-screened women reported that they had ever heard about human papilloma virus (P = 0.013). In multivariate analysis, having adequate knowledge about Pap smears (odds ratio: 2.6 or 95%, confidence interval: 1.4-4.8) having health insurance (odds ratio: 2.6 or 95%, confidence interval: 1.1-6.4) and being married (odds ratio: 1.8 or 95%, confidence interval: 1.1-3.4) were the factors related to being screened in the previous three years. Knowledge was related to screening. Comprehensive educational approaches may enhance screening for cervical cancer prevention.     

Waterborne toxoplasmosis, northeastern Brazil

Two waterborne outbreaks of toxoplasmosis have been described recently in southern Brazil. We present data from a community-based study of pregnant women in northeastern Brazil. Consumption of homemade ice was the only variable associated with seropositivity (adjusted odds ratio, 3.1, 95% confidence interval, 1.53-6.24). Our results suggest that water is a source of infection with Toxoplasma gondii.     

Smoking and the occurrence of Alzheimer's disease: cross-sectional and longitudinal data in a population-based study

The authors tested the hypothesis that smoking exerts a protective effect on Alzheimer's disease or dementia in a population-based cohort of 668 people aged 75-101 years (Sweden). Smoking was negatively associated with prevalent Alzheimer's disease (adjusted odds ratio = 0.6, 95% confidence interval 0.4-1.1) and dementia (adjusted odds ratio = 0.6, 95% confidence interval 0.4-1.0). Over 3-year follow-up (1989-1992), the hazard ratios of incident Alzheimer's disease and dementia due to smoking were 1.1 (95% confidence interval 0.5-2.4) and 1.4 (95% confidence interval 0.8-2.7). Mortality over 5-year follow-up was greater among smokers in demented (hazard ratio = 3.4) than nondemented (hazard ratio = 0.8) subjects. Smoking does not seem protective against Alzheimer's disease or dementia, and the cross-sectional association might be due to differential mortality.     

Violence and psychiatric morbidity in a national household population--a report from the British Household Survey

This study measured the prevalence of self-reported violence and associations with psychiatric morbidity in a national household population, based on a cross-sectional survey in 2000 of 8,397 respondents in Great Britain. Diagnoses were derived from computer-assisted interviews, with self-reported violent behavior over the previous 5 years. The 5-year prevalence of nonlethal violence in Britain was 12% (95% confidence interval: 11, 13). The risk of violence was substantially increased by alcohol dependence (odds ratio=2.72, 95% confidence interval: 1.85, 3.98), drug dependence (odds ratio=2.63, 95% confidence interval: 1.45, 4.74), and antisocial personality disorder (odds ratio=6.12, 95% confidence interval: 3.87, 9.66). Low prevalences of these conditions (7%, 4%, and 4%, respectively) contrasted with their relatively high proportions of attributed risk of violence (23%, 15%, and 15%). Hazardous drinking was associated with 56% of all reported violent incidents. Screening positive for psychosis did not independently increase risk (odds ratio=3.20, 95% confidence interval: 0.35, 29.6). The study concluded that psychiatric morbidity makes a significant public health impact on violence exerted primarily by persons with any personality disorder, substance dependence, and hazardous drinking. Population interventions for violent behavior are appropriate for hazardous drinking as are targeted interventions for substance dependence and antisocial personality disorder. Despite public concern, the risks of violence from persons with severe mental illness were very low.