Tuberculosis in Bissau: incidence and risk factors in an urban community in sub-Saharan Africa

BACKGROUND: Despite the long history of tuberculosis (TB) research, population-based studies from developing countries are rare. METHODS: In a prospective community study in Bissau, the capital of Guinea-Bissau, we assessed the impact of demographic, socioeconomic and cultural risk factors on active TB. A surveillance system in four districts of the capital identified 247 adult (>or=15 years) cases of intrathoracic TB between May 1996 and June 1998. Risk factors were evaluated comparing cases with the 25,189 adults living in the area in May 1997. RESULTS: The incidence of intrathoracic TB in the adult population was 471 per 100 000 person-years. Significant risk factors in a multivariate analysis were increasing age (P < 0.0001), male sex (odds ratio [OR] = 2.58, 95% CI: 1.85, 3.60), ethnic group other than the largest group (Pepel) (OR = 1.64, 95% CI: 1.20, 2.22), adult crowding (OR = 1.68, 95% CI: 1.18, 2.39 for >2 adults in household), and poor quality of housing (OR = 1.66, 95% CI: 1.24, 2.22). Household type was important; adults living alone or with adults of their own sex only, had a higher risk of developing TB than households with husband and wife present, the adjusted OR being 1.76 (95% CI: 1.11, 2.78) for male households and 3.80 (95% CI: 1.69, 8.56) for female households. In a multivariate analysis excluding household type, child crowding was a protective factor, the OR being 0.68 (95% CI: 0.51, 0.90) for households with >2 children per household. CONCLUSIONS: Bissau has a very high incidence of intrathoracic TB. Human immunodeficiency virus (HIV), increasing age, male sex, ethnicity, adult crowding, family structure, and poor housing conditions were independent risk factors for TB. Apart from HIV prevention, TB control programmes need to emphasize risk factors such as socioeconomic inequality, ethnic differences, crowding, and gender.     

成年人肺结核病的非生物危险因素病例对照研究

目的　探讨影响成年人患肺结核病的非生物危险因素。方法　采用 1∶2配比病例对照研究 ,选取 15 8例 2 5～ 6 0岁的涂阳肺结核病患者作为病例组 ,每个病例选取 2名与其住所相邻、同性别、同年龄组的正常人作为对照 ;制定统一的调查表进行入户调查 ;采用单因素和多因素条件logistic回归进行统计分析。结果　单因素分析有统计学意义 (P <0 .0 5 )的变量有婚姻状况、文化程度、个体经营、吸烟、外出打工史、家庭年收入、家庭收入在社区的水平、家庭财产 ;多因素分析进入模型的有统计学意义 (P <0 .0 5 )的变量为婚姻状况、个体经营、吸烟、家庭财产、外出打工史 ,其OR值分别为2 .82 6、2 .35 0、1.5 36、0 .70 7、2 .0 96。结论　单身、吸烟、个体经营、有外出打工史是肺结核病的危险因素 ,家庭经济条件好是肺结核病的保护因素 ;在结核病控制工作实践中 ,采取相应的针对性措施有助于结核病的疫情控制。     

林州食管癌发病因素病例对照研究

目的 探讨林州居民食管癌发病的相关因素及其特征。方法 在全市１９９５、１９９６两年新发生的食管癌病人中,选取３５２例现症病人;另选取同性别、同年龄（上下不超过３岁）的邻居为对照,进行１：１配对,采用统一调查表,进行回顾性入户问卷调查,资料编码量化后录入微机,应用ＳＡＳ软件,计算单因素和多因素的比值比,对相对危险进行估计。结果 显示农民家庭经济条件差,住地周围环境污染,室内油烟污染,体质指数低,常吃     

Prognostic factors of severe asthma in Puerto Rico

Asthma in Puerto Rico is a serious Public Health Problem. This study extends our cross-sectional self-reported asthma prevalence survey of 3,000 volunteers. The purpose of the present study was to analyze the importance of known prognostic factors of asthma severity among 486 self-reported participants. Patients with more than one visit to the emergency room in the previous 12 months due to asthma exacerbations were classified as cases of "severe asthma", and those asthmatic patients who did not visit emergency rooms were classified as "non-severe asthmatic subjects". Severe cases and non-severe asthmatic subjects were compared regarding age, sex, family history of asthma, presence of household pets, and in the previous 12 months: history of hospitalization due to asthma, respiratory infections, tobacco smoking, exposure to passive smoking, and avoidance of passive smoking. Crude and logistic regression adjusted odds ratio was used as a measure of association between each prognostic factor, and the outcome namely severe asthma, while adjusting for all confounders simultaneously. The results clearly showed that previous hospitalizations due to asthma (OR = 7.3, p < 0.0001) and frequent of respiratory infection (OR = 2.5, p = 0.0003) were prognostic factors associated with increased asthma severity. A statistically significant, two percent less likelihood to have severe asthma for each year of age was found. Weak associations were found between asthma severity and male gender, family history of asthma, passive smoking, and presence of household pets. Avoidance of environmental tobacco exposure (passive smoking) was found to be an important and statistically significant protective factor associated with a 47% less likelihood for severe asthma. In conclusion, appropriate management of patients with history of hospitalization due to asthma is very important. The correct management of respiratory infection in asthmatic patients may result in a reduction of up to 60 percent of the odds of having asthma severe enough to require emergency treatment, and may reduced by 86.3 percent hospitalizations.     

Tuberculosis transmission attributable to close contacts and HIV status, Malawi

We conducted the first molecular study of tuberculosis (TB) to estimate the role of household contact and transmission from HIV-positive putative source contacts (PSCs) in a high HIV-prevalence area. TB patients in a long-term population-based study in Malawi were asked about past contact with TB. DNA fingerprinting was used to define clusters of cases with identical strains. Among 143 epidemiologically defined PSC-case pairs, fingerprinting confirmed transmission for 44% of household and family contacts and 18% of other contacts. Transmission was less likely to be confirmed if the PSC were HIV positive than if he or she was HIV negative (odds ratio 0.32, 95% confidence interval [CI] 0.14-0.74). Overall, epidemiologic links were found for 11% of 754 fingerprint-clustered cases. We estimate that 9%-13% of TB cases were attributable to recent transmission from identifiable close contacts and that nearly half of the TB cases arising from recent infection had acquired the infection from HIV-positive patients.     

Is it exposure to cigarette smoke or to smokers which increases the risk of meningococcal disease in teenagers?

BACKGROUND: Passive smoking appears to increase the risk of meningococcal disease (MD) in adolescents. Whether this effect is attributable to exposure to cigarette smoke or contact with smokers is unknown. METHODS: We conducted a prospective population-based case-control study with age, sex matched-controls in 1:1 matching. Participants were 15-19 year old with MD recruited at hospital admission in six regions (65% of the population of England) from January 1999 through June 2000, and their matched controls. Data on potential risk factors were gathered by confidential interview, including seven passive smoking variables. Factor analysis was performed to assess the dimensionality of the passive smoking exposure variables. The data were analysed with univariate and multivariate conditional logistic regression. RESULTS: 144 case-control pairs were recruited (51% male; median age 17.6). Factor analysis identified two independent factors representing passive smoking (P < 0.01), one associated with 'exposure to smoke', the other with 'smoker contact'. Only smoker contact was a significant risk factor for MD (OR = 1.8; 95% CI 1.0-3.3; P = 0.05). In multivariate analysis this factor was still associated with MD independently of potential confounders such as active smoker status and household crowding. CONCLUSION: Contact with smokers is associated with increased risk of MD in adolescents. This is more likely to be due to higher carriage rates in smokers than to exposure to smoke and emphasizes the importance of public health measures to stop smoking. In epidemiological studies that assess risk from passive smoking, exposure to smoke should be differentiated where possible from contact with smokers.     

农村地区高血压危险因素的病例对照研究

对四川省农村地区218例原发性高血压(其中包括109例临界高血压)进行配对(1:2)病例对照研究。资料分析采用了条件Logistic回归分析方法。研究结果提示心率、高血压家族史、环境噪声、体重指数(QI)等综合因素与临界高血压和确诊高血压均有显著的联系。心率、体重指数(QI)以及高血压家族史是原发性高血压较稳定的影响因素,心率可作为研究血压的必测指标。环境因素对原发性高血压的影响不可忽视。原发性高血压是遗传因素、环境因素等综合作用的结果。     

Unplanned pregnancy in Southern Brazil: prevalence and associated factors

The purpose of this study was to investigate factors associated with unplanned pregnancies in Rio Grande, Rio Grande do Sul State, Brazil. A standardized questionnaire was applied in 2007 to all pregnant women in the city, including demographic characteristics, childbearing history, socioeconomic status, and prenatal and childbirth care. The study used Poisson multivariate regression analysis with robust adjustment of variance. Among the 2,557 women included in the study, 65% had not planned the current pregnancy. After adjusting for confounders, the following variables were significantly associated with unplanned pregnancy: black or mixed race, age < 20 years, single marital status, low family income, household crowding, smoking, and multiparity. Previous abortion was a protective factor against unplanned pregnancy. The high unplanned pregnancy rate, especially among women with increased risk of complications during pregnancy and childbirth, highlights the need to target healthcare programs for this group.     

HIV合并结核感染的流行病学特征和相关影响因素

目的研究人类免疫缺陷病毒（humam immunodenciency virus,HIV）感染者中合并结核（tuberculosis,TB）感染的流行病学特征和相关影响因素。方法对1139例HIV感染者或艾滋病（AIDS）病人,用统一的调查表了解其流行病学一般情况,行痰涂片、X光胸片检查、PPD皮试、TB抗体以及血沉等检测,部分病人做了痰培养或病理检查。对1023例结核病人进行HIV抗体检测,用SPSS软件对不同因素对HIV合并TB感染或TB合并HIV感染的影响情况进行相关性分析。结果本组HIV合并TB的感染率为25．20％;静脉吸毒传播的HIV感染者合并的TB发病率明显高于性传播的HIV感染者（33．62％vs18．61％,）（χ2=31．63,P〈0．01）,CD4^＋T细胞计数≤200个／μl的AIDS病人其TB发病率明显高于其它组（35．93％VS23．55％,χ2=11．42,P〈0．01;35．93％vs21．80％,χ2=42．37,P〈0．01）。住院TB患者中HIV抗体的检出率为1．56％。不同年龄组和不同职业的结核患者其抗HIV检出率差异无统计学意义（P〉0．05）;有吸烟史或其它慢性肺部疾病史的结核患者中HIV的检出率比无该类病史的患者更高。结论本组HIV合并TB感染率25．20％,静脉吸毒传播者和CD4^＋T细胞〈200个／μl的HIV—AIDS合并结核感染的发病率较高。有吸烟史或肺部感染史的结核患者,HIV抗体的检出率较高。     

北京地区子宫颈癌发病相关因素分析——1∶3病例-对照流行病学调查

目的:了解近年北京地区宫颈癌流行病学情况,探讨现阶段宫颈癌的预防措施。方法:2004年6～12月采用1∶3病例-对照研究方法,对北京地区经病理确诊的286例宫颈癌患者和858例按年龄和地区匹配的健康对照进行一般情况、饮食与生活方式、月经婚育史、激素使用、既往病史及家族史和妇女病普查知识等因素的调查。结果:宫颈癌患者年龄最小24岁,最大87岁,中位发病年龄45岁。多因素分析显示采用避孕措施是宫颈癌的保护因素,子宫颈癌家族史、子宫癌家族史、既往滴虫性阴道炎和吸烟为宫颈癌的高危因素。结论:提倡使用安全套、戒烟、便前便后洗手、积极防治生殖道炎症,对子宫恶性肿瘤家族史、早婚等高危人群加强监测,将有助于降低宫颈癌的发病率。     

上海市宝山区肺癌危险因素的病例对照研究

[目的]探讨室内装修及其他生活危险因素与肺癌的关系。[方法]采用1：1配对的病例对照研究方法,以2007年确诊的163例肺癌患者为病例组,选择在年龄、性别、住址方面相匹配的非肿瘤患者为对照组,进行条件Logistic回归分析。[结果]多因素分析结果存在统计学意义的因素包括肿瘤家族史（OR=4.090,P=0.001）、被动吸烟（OR=2.528,P=0.009）、住房10年内有过装修（OR=2.074,P=0.039）、室内经常通风（OR=0.160,P=0.028）、室内种植绿色植物（OR=0.483,P=0.027）和使用实木地板（OR=0.487,P=0.045）。[结论]有肿瘤家族史、被动吸烟和曾室内装修是肺癌的危险因素,室内经常通风、种植绿色植物、使用实木地板是肺癌的保护性因素。     

云浮市城区儿童哮喘危险因素1∶1病例对照分析

目的探讨云浮市城区儿童哮喘的危险因素。方法应用1∶1配对病例-对照研究方法 ,对城区152例哮喘儿童(病例组)和152例非哮喘儿童(对照组)的哮喘危险因素进行调查,并进行单因素和多因素条件Logistic回归分析。结果儿童过敏史、家族哮喘史、急性呼吸道感染史、被动吸烟及接触粉尘和有害气体是本城区儿童哮喘的危险因素。结论儿童哮喘是遗传和环境双重因素共同作用导致的一种复杂疾病,但可通过预防呼吸道感染、减少过敏原接触等方面来进行儿童哮喘防治。     

Prevalence of obesity and associated risk factors in a Turkish population (trabzon city, Turkey)

OBJECTIVE: To estimate the prevalence of overweight and obesity (general and central) in the Trabzon Region and its associations with demographic factors (age, sex, marital status, reproductive history in women, and level of education), socioeconomic factors (household income and occupation), family history of selected medical conditions (diabetes, hypertension, and obesity), lifestyle factors (smoking habits, physical activity, and alcohol consumption), and hypertension in the adult population. RESEARCH METHODS AND PROCEDURES: A sample of households was systematically selected from the central province of Trabzon and its five towns, namely, Sürmene, Vakfikebir, Ma?ka, Hayrat, and Tonya. A total of 5016 subjects (2728 women and 2288 men) were included in the study. Individuals more than 20 years old were selected from their family health cards. Demographic factors, socioeconomic factors, family history of selected medical conditions, and lifestyle factors were obtained for all participants. Systolic blood pressure and diastolic blood pressure levels were measured for all subjects. Study procedures were carried out in the local health centers in each town over an 8-month period. Obesity was defined as BMI > or = 30 kg/m2 and overweight as BMI = 25.0 to 29.9 kg/m2. RESULTS: The prevalence of obesity was 23.5%: 29.4% in women and 16.5% in men. The combined prevalence of both overweight and obesity was 60.3%. The prevalence of abdominal obesity was 29.4%: 38.9% among women and 18.1% among men. The prevalence of obesity increased with age, being highest in the 60- to 69-year-old age group (40.8%) but lower again in the 70+ age group. Obesity was associated positively with marital status, parity, cessation of cigarette smoking, alcohol consumption, and household income and inversely with level of education, cigarette use, and physical activity. Also, obesity was associated positively with hypertension. DISCUSSION: In the Trabzon Region, 60.3% of the adult population presents with some excess weight. Obesity is a major public health problem that requires generalized interventions to prevent it among the adult population.     

上海市徐汇区女性肺癌病例对照调查

All the 57 female lung cancer patients in Xu-Hui District, Shanghai discovered during 1985 were used as subjects of this study, each was matched with 2 of her near neighbours of same sex and within 5 years of age difference. Smoking, chronic bronchitis, pulmonary tuberculosis and family history of tumour were found to be related with lung cancer in single variable analysis. Upon stratification, smoking and pulmonary tuberculosis were still found related to lung cancer and considered as risk factors with OR and its 95% confidence interval 6.996, 3.23-15.14 and 4.82, 1.37-19.97 respectively. But chronic bronchitis failed to relate with lung cancer and was considered as a confounding factor. Of all the female lung cancer cases only 49.1% and 19.3% were smokers and TB patients respectively, hence smoking and TB could be responsible only for a small portion. In cancer cytology, squamous-cell carcinoma appeared to show association with smoking while adenocarcinoma did not. Among female lung cancer cases the proportion of adenocarcinoma exceeded that of squamous-cell carcinoma, and appeared unrelated with smoking. More family members of the lung cancer cases seem to have had malignant histories, suggesting that a hereditary factor of cancer susceptibility might be involved.     

帕金森病的危险因素及其交互作用研究

目的 探讨帕金森病(PD)的危险因素、PD家族史与其他危险因素间的交互作用以及遗传因素对PD易患性的相对作用。方法 选取齐鲁医院就诊的157例PD患者及157例对照作1:1配对病例对照研究。结果 条件logistic回归分析结果显示:PD家族史、脑力劳动、杀虫剂、饮酒、抑郁史与PD有正关联,吸烟与PD有负关联。分析PD家族史与杀虫剂、饮酒、抑郁史之间的交互作用,其归因交互效应百分比AP(AB)依次为55.2％、34.0％和41.4％,超相对危险比RERI依次为8.96、3.31和7.85。PD患者一级亲属的遗传度为36.86％±5.76％,二级亲属的遗传度为20.66％±6.81％。结论 家族史与其他危险因素共存时对PD表现为正相加模型交互作用。遗传因素在PD发病中所起作用小于环境因素。     

Risk factors for acute respiratory disease hospitalization in children under one year of age

OBJECTIVE: To evaluate risk factors for acute respiratory disease hospitalizations in children under one year of age. METHODS: A case-control study was conducted in the city of Pelotas, Southern Brazil. Cases were children under one year of age who were hospitalized due to acute respiratory diseases from August 1997 to July 1998. Controls were same-age community children randomly selected without previous respiratory disease hospitalization. A questionnaire about risk factors exposure was applied to the mothers of cases and controls. Univariate, bivariate and multivariate analyses through logistic regression were carried out to evaluate risk factors for the outcome of interest. RESULTS: There were studied 777 children; 625 cases and 152 controls. In the crude analysis, the risk factors associated with the outcome were: being male, children under six months of age, household crowding, maternal education, family income, inadequate housing conditions, lack of breastfeeding, maternal smoking, use of pacifiers, and a previous history of hospitalization and respiratory symptoms. Maternal working was a protection factor associated with acute respiratory disease hospitalizations. In the multivariate analysis the following risk factors remained associated: maternal education (OR=12.5), previous history of wheezing (OR=7.7), lack of breastfeeding (OR=2.3), use of pacifiers (OR=1.9), maternal smoking (OR=1.7), children under six months of age (OR=1.7), and being male (OR=1.5). CONCLUSIONS: The study results show the importance of the family's social and behavioural aspects as well as previous respiratory disease as risk factors for acute respiratory disease hospitalizations in children under one year of age.     

History of urinary tract infection and risk of renal cell carcinoma

Limited data exist regarding whether a history of urinary tract infection (UTI) increases risk of developing renal cell carcinoma (RCC). Furthermore, it is unclear whether any association of RCC with a history of UTIs is modified by known risk factors for RCC (i.e., smoking, obesity). The authors report data from a 1986-1989 population-based case-control study in Iowa. RCC cases (233 males, 139 females) were identified through the Iowa Cancer Registry; controls (1,497 males, 751 females) were randomly selected from the general population, frequency matched on age and sex. Subjects provided detailed information on demographic, anthropometric, lifestyle, dietary, and medical history risk factors. In age-adjusted analysis, risk increased for subjects who self-reported a history of physician-diagnosed kidney or bladder infection (odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.5, 2.5) compared with those reporting no such history. Both sex and smoking status modified the risk of RCC associated with a history of UTI, with the strongest risk reported for males (OR = 2.7, 95% CI: 1.9, 3.8) and current smokers (OR = 4.3, 95% CI: 2.7, 6.7). The strongest risk was reported for male current smokers with a history of UTI (OR = 9.7, 95% CI: 5.0, 18.1). Multivariate adjustment for anthropometric, lifestyle, and dietary factors did not alter these findings. Results suggest a positive association of UTI history with RCC development, with elevated risks most notable for males with a history of smoking.     

Tuberculosis: associations with HIV and socioeconomic status in rural Malawi

Tuberculosis (TB) is associated with human immunodeficiency virus (HIV) infection, increasing age and male sex, but less is known about other risk factors in developing countries. As part of the Karonga Prevention Study in northern Malawi, we conducted a retrospective cohort study in the general population to assess risk factors for the development of TB. Individuals were identified in 1986-89 and TB cases diagnosed up to 1996 were included. TB was confirmed in 62/11,059 (0.56%) HIV negative individuals and 7/182 (3.9%) HIV positive individuals (relative risk 7.1, 95% confidence interval 3.2-15.7). This association was little altered by adjustment for age, sex or socioeconomic factors. The risk of TB was higher in those aged over 30 years than in younger individuals, in men than in women, in those engaged in occupations other than farming than in subsistence farmers, in those living in households with burnt brick dwellings than in those with less well built dwellings, and in those with some schooling than in those with none. These associations persisted after adjusting for age, sex, HIV status and population density. The absolute risks of TB were low in this study due to the passive follow-up and strict diagnostic criteria. The relative risk with HIV was of a similar magnitude to that measured elsewhere. Increased risks of TB with age and in men are expected. Associations with measures of higher socioeconomic status were unexpected. They may reflect a greater likelihood of diagnosis in this group.     

Factors associated with positive HIV serostatus among women who use drugs: continued evidence for expanding factors of influence

OBJECTIVE: To identify risk factors associated with positive HIV serostatus among African American women who smoke crack and/or inject drugs and who are not enrolled in drug treatment or another institutional setting. METHODS: Baseline interviews were conducted from June 1998 to June 2000 with 379 heterosexually active women (ages 18 to 59) who had been recruited for potential enrollment into an HIV intervention trial. RESULTS: Adjusted for age and drug using status, women who expressed more difficulty saying no to sex with male partners were more likely to be HIV-positive (adjusted odds ratio [aOR]=3.08, 95% confidence interval [CI] 2.02, 4.83). Similarly, those who indicated greater communication with casual sex partner(s) were less likely to test positive (aOR=0.29, 95% CI 0.10, 0.89). Lower HIV internal control and a history of cuts or burns on lips due to crack smoking were also associated with positive serostatus, and were important confounders in the final multivariate model. A higher level of internal control was associated with a decreased likelihood of positive serostatus, while a history of cuts or burns on the lips was associated with an increased likelihood of HIV antibodies, even after controlling for the amount of oral sex. CONCLUSIONS: A broad array of factors may promote or avert infection with HIV. The degree to which personal attributes and beliefs, and relationship characteristics contribute to the likelihood of infection must continue to be addressed. The importance of oral sex and presence of oral sores and their potential role in transmission was suggested.     

High prevalence of antibodies to Chlamydia pneumoniae; determinants of IgG and IgA seropositivity among Jerusalem residents.

The prevalence of antibodies to Chlamydia pneumoniae was examined in a stratified random sample of 581 Jerusalem adult residents between August 1987 and March 1989. IgG and IgA titres were measured by microimmunofluorescence, and associations with smoking and socio-demographic variables were assessed. IgG antibodies were found in 84.5% (95% confidence interval (CI): 80.4-87.9) of men and 68.7% (95% CI: 61.6-75.0) of women (P < 0.0001 for sex difference), indicating a very high rate of exposure in this population. IgA antibodies, postulated to represent persistent infection, were present in 45.1% (95% CI: 40.1-50.2) of men and 23% (95% CI: 17.4-29.7) of women (P < 0.0001 for sex difference). Factors associated with IgG seropositivity included family size, education and social class. On the other hand age (in men) and smoking were associated with IgA seropositivity. These findings support the hypothesis that low socioeconomic status and household crowding may be predictive of exposure to or infection with this organism (IgG seropositivity), whereas they do not explain persistence of the infection putatively expressed as IgA seropositivity.