Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis

Objective:

to determine the incidence of falls in elderly residents of long-stay institutions of the Federal District, to identify the aspects involved in the falls, in terms of risk factors, from the application of scales and the Taxonomy II of NANDA-I, and to define the level of accuracy with its sensitivity and specificity for application in the clinical nursing practice.

Method:

this was a cohort study with the evaluation of 271 elderly people. Cognition, functionality, mobility and other intrinsic factors were evaluated. After six months, the elderly people who fell were identified, with significance analysis then performed to define the risk factors.

Results:

the results showed an incidence of 41%. Of the 271 patients included, 69 suffered 111 episodes of falls during the monitoring period. Risk factors were the presence of stroke with its sequelae (OR: 1.82, 95% CI 1.01 - 3.28, p=.045), presenting more than five chronic diseases (OR: 2.82, 95% CI 1.43 - 5.56, p=.0028), foot problem (OR: 2.45, 95% CI 1.35 - 4.44, p=.0033) and motion (OR: 2.04, 95% CI 1.15 - 3.61, p=.0145).

Conclusion:

the taxonomy has high validity regarding the detection of elderly people at risk of falling and should be applied consistently in the clinical nursing practice.     

Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

OBJECTIVE:

to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status.

METHOD:

cross-sectional study with a populational sample (n=934), conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more) was measured using a numerical scale (0-10) and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor). For the statistical analysis, the absolute frequency and percentage, CI (95%), Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%.

RESULTS:

The prevalence of chronic pain was 52.8% [CI (95%):49.4-56.1]; most frequently located in the lower limbs (34.5%) and lumbar region (29.5%); with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001) a worse self-perception of health (OR=4.2:2.5-7.0), a greater number of chronic diseases (OR=1.8:1.2-2.7), joint disease (OR=3.5:2.4-5.1) and the female gender (OR=2.3:1.7-3.0). A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001).

CONCLUSION:

the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.     

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

Objectives

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

Data sources

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

Data extraction

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

Data synthesis

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

Conclusions

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

Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery

OBJECTIVES:

to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain.

METHOD:

observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student''s t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis.

RESULTS:

the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72%) and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83). Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01).

CONCLUSION:

preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery.     

Comparative Effectiveness of Standard versus Patient‐Centered Collaborative Care Interventions for Depression among African Americans in Primary Care Settings: The BRIDGE Study

Objective

To compare the effectiveness of standard and patient-centered, culturally tailored collaborative care (CC) interventions for African American patients with major depressive disorder (MDD) over 12 months of follow-up.

Data Sources/Study Setting

Twenty-seven primary care clinicians and 132 African American patients with MDD in urban community-based practices in Maryland and Delaware.

Study Design

Cluster randomized trial with patient-level, intent-to-treat analyses.

Data Collection/Extraction Methods

Patients completed screener and baseline, 6-, 12-, and 18-month interviews to assess depression severity, mental health functioning, health service utilization, and patient ratings of care.

Principal Findings

Patients in both interventions showed statistically significant improvements over 12 months. Compared with standard, patient-centered CC patients had similar reductions in depression symptom levels (−2.41 points; 95 percent confidence interval (CI), −7.7, 2.9), improvement in mental health functioning scores (+3.0 points; 95 percent CI, −2.2, 8.3), and odds of rating their clinician as participatory (OR, 1.48, 95 percent CI, 0.53, 4.17). Treatment rates increased among standard (OR = 1.8, 95 percent CI 1.0, 3.2), but not patient-centered (OR = 1.0, 95 percent CI 0.6, 1.8) CC patients. However, patient-centered CC patients rated their care manager as more helpful at identifying their concerns (OR, 3.00; 95 percent CI, 1.23, 7.30) and helping them adhere to treatment (OR, 2.60; 95 percent CI, 1.11, 6.08).

Conclusions

Patient-centered and standard CC approaches to depression care showed similar improvements in clinical outcomes for African Americans with depression; standard CC resulted in higher rates of treatment, and patient-centered CC resulted in better ratings of care.     

Knowledge about Obstetric Danger Signs among Pregnant Women in Aleta Wondo District, Sidama Zone, Southern Ethiopia

Background

Raising awareness of women on danger signs of pregnancy, childbirth and the postpartum period is crucial for safe motherhood. In Ethiopia, a country where maternal morbidity and mortality is high little is known about knowledge level of pregnant women on obstetric danger signs. The objective of this study was to assess pregnant women''s knowledge about obstetric danger signs in Aleta Wondo district, Sidama Zone, South Ethiopia.

Methods

A community based cross-sectional study was conducted from January 18 – February 20, 2007, on a sample of 812 pregnant women selected from, 8 rural and 2 urban Kebeles. A structured pre-tested questionnaire was used to collect quantitative data on socio-demographic characteristics, obstetric history, and knowledge about danger signs of pregnancy, childbirth and post partum period. Qualitative data was collected through focus group discussion with pregnant women and in-depth interview with traditional birth attendants. The collected data were analyzed using SPSS for Windows version 12.0.1.

Results

Seven hundred forty three pregnant women participated in the study making a response rate of 92%. Out of the 743 pregnant women who participated in this study 226 (30.4%), 305(41.3%) and 279(37.7%) knew at least two danger signs during pregnancy, childbirth and postpartum period, respectively. Being urban resident was consistently found to be strongly associated with mentioning at least two danger signs of pregnancy (OR=4.1; 95% CI: 2.4, 7.0), child birth (OR=3.3; 95% CI: 1.8, 6.1), and postpartum period (OR=8.4; 95% CI: 4.5, 15.4).

Conclusion

This study indicated that the knowledge level of pregnant women about obstetric danger signs (during pregnancy, childbirth and postpartum period) was low and affected by residential area. Therefore, the identified deficiencies in awareness should be addressed through maternal and child health services by designing an appropriate strategies including provision of targeted information, education and communication.     

Prevalence and factors associated with sedentary behavior in adolescents

OBJECTIVE

To analyze the prevalence of sedentary behavior and associated factors in adolescents.

METHODS

A cross-sectional study with adolescents aged 10 to 17 years, of both sexes, belonging to a 1994-1999 birth cohort in the city of Cuiabá, MT, Central Western Brazil. Data were collected using a questionnaire containing sociodemographic, economic, lifestyle and anthropometric variables. Sedentary behavior was determined as using television and/or computer/video games for a time greater than or equal to 4 hours/day. Associations with sedentary behavior were evaluated using body mass index in childhood and adolescence and sociodemographic and behavioral variables using hierarchical logistic regression.

RESULTS

The overall prevalence of sedentary behavior was 58.1%. Of the 1,716 adolescents evaluated, 50.7% (n = 870) were male. In multivariate analysis, after adjustment for confounding factors, the variables that remained associated with sedentary behavior were: age (14 and over) (OR = 3.51, 95%CI 2.19;5.60); higher socioeconomic class (OR = 3.83, 95%CI 2.10;7.01), higher level of maternal education (OR = 1.81, 95%CI 1.09;3.01); living in the country (OR = 0.49, 95%CI 0.30;0.81); insufficient physical activity (OR = 1.25, 95%CI 1.02;1.53); experimentation with alcoholic beverages (OR = 1.34, 95%CI 1.08;1.66) and being overweight in adolescence (OR = 1.33, 95%CI 1.06;1.68).

CONCLUSIONS

The high proportion of adolescents in sedentary activities and the lack of association with being overweight in childhood, indicates the need for educational initiatives to reduce multiple risk behaviors. Encouraging physical activity in young people as a way of reducing sedentary behavior and, consequently, being overweight is fundamental.     

Non–Dioxin-Like Polychlorinated Biphenyls and Risk of Endometriosis

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Residential Pesticides and Childhood Leukemia: A Systematic Review and Meta-Analysis

Objective

We conducted a systematic review and meta-analysis of previous observational epidemiologic studies examining the relationship between residential pesticide exposures during critical exposure time windows (preconception, pregnancy, and childhood) and childhood leukemia.

Data sources

Searches of MEDLINE and other electronic databases were performed (1950–2009). Reports were included if they were original epidemiologic studies of childhood leukemia, followed a case–control or cohort design, and assessed at least one index of residential/household pesticide exposure/use. No language criteria were applied.

Data extraction

Study selection, data abstraction, and quality assessment were performed by two independent reviewers. Random effects models were used to obtain summary odds ratios (ORs) and 95% confidence intervals (CIs).

Data synthesis

Of the 17 identified studies, 15 were included in the meta-analysis. Exposures during pregnancy to unspecified residential pesticides (summary OR = 1.54; 95% CI, 1.13–2.11; I² = 66%), insecticides (OR = 2.05; 95% CI, 1.80–2.32; I² = 0%), and herbicides (OR = 1.61; 95% CI, 1.20–2.16; I² = 0%) were positively associated with childhood leukemia. Exposures during childhood to unspecified residential pesticides (OR = 1.38; 95% CI, 1.12–1.70; I² = 4%) and insecticides (OR = 1.61; 95% CI, 1.33–1.95; I² = 0%) were also positively associated with childhood leukemia, but there was no association with herbicides.

Conclusions

Positive associations were observed between childhood leukemia and residential pesticide exposures. Further work is needed to confirm previous findings based on self-report, to examine potential exposure–response relationships, and to assess specific pesticides and toxicologically related subgroups of pesticides in more detail.     

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Risk Factors of Active Tuberculosis in People Living with HIV/AIDS in Southwest Ethiopia: A Case Control Study

Background

Determinants of active tuberculosis among People Living with HIV/AIDS (PLHA) are not well elucidated in countries with limited resources. The objective of this study was to assess distal and proximate determinants of active tuberculosis among people living with HIV/AIDS in southwest Ethiopia.

Methods

A case-control study was conducted from January to March, 2009 in South West Ethiopia. The study population consisted of 162 cases and 647 controls. Cases were adult people living with HIV/AIDS who developed active pulmonary tuberculosis and controls were people living with HIV/AIDS without active tuberculosis. An interviewer administered structured questionnaire was used to collect information on potential risk factors.

Results

After adjustment for potential confounders, male gender (OR=1.7; 95%CI: 1.1, 2.7), a low level of education (OR=2.8; 95% CI: 1.1, 7.1), a body mass index less than 18.5 kg/m2 (OR=4.1; 95% CI: 2.3, 7.4), hemoglobin level less than 10.0 g/dl (OR=2.8; 95%CI: 1.5, 5.2), a CD4 lymphocyte count less than 200 cells/µL (OR=9.8‘95% CI: 5.5, 17.5), a WHO clinical stage IV (OR=4.3; 95% CI: 2.6, 6.8), not taking antiretroviral treatment (OR=3.1; 95%CI: 1.9,4.9), an infection with helminthes (OR=2.2; 95% CI: 1.4, 3.4), a history of contact with a tuberculosis patient in the family (OR=2.0; 95% CI: 1.2, 3.3), and living in a house made of mud wall (OR=3.7; 95% CI: 1.5, 7.5) were independently associated with the development of active tuberculosis in people living with HIV/AIDS.

Conclusion

All people living with HIV/AIDS should be screened for tuberculosis but in the presence of the risk factors mentioned above, intensified screening is recommended.     

Subsequent Risk of Metabolic Syndrome in Women With a History of Preeclampsia: Data From the Health Examinees Study

Background

To investigate whether preeclampsia is independently associated with risk of future metabolic syndrome and whether any such primary associations are modified by different ages at first pregnancy.

Methods

Based on the Health Examinees Study, a cross-sectional analysis was conducted. Data of women (n = 49 780) who had experienced at least 1 pregnancy during their lifetime and had never been diagnosed with any metabolic disorder before their pregnancy were analyzed using multiple logistic regression models. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated after adjusting for age, lifestyle characteristics, and reproductive factors. A stratified analysis was also conducted to estimate the extent of the primary association between preeclampsia and future metabolic syndrome by age at first pregnancy.

Results

Women with a history of preeclampsia had significantly increased odds of developing metabolic syndrome (adjusted OR 1.23; 95% CI, 1.12–1.35), central obesity (adjusted OR 1.36; 95% CI, 1.25–1.47), elevated blood pressure (adjusted OR 1.53; 95% CI, 1.41–1.67), or elevated fasting glucose (adjusted OR 1.13; 95% CI, 1.03–1.25) in later life. In the stratified analysis, women who first became pregnant at ages >35 years and had preeclampsia were found to be at significantly increased likelihood of metabolic syndrome later in life (adjusted OR 4.38; 95% CI, 1.62–11.9).

Conclusions

Our findings suggest that preeclampsia increases the risk of metabolic syndrome in later life, and late age at first pregnancy can further exacerbate this risk.Key words: history of preeclampsia, metabolic syndrome, cohort, HEXA, Korea     

Rotenone, paraquat, and Parkinson's disease

Background

Mitochondrial dysfunction and oxidative stress are pathophysiologic mechanisms implicated in experimental models and genetic forms of Parkinson’s disease (PD). Certain pesticides may affect these mechanisms, but no pesticide has been definitively associated with PD in humans.

Objectives

Our goal was to determine whether pesticides that cause mitochondrial dysfunction or oxidative stress are associated with PD or clinical features of parkinsonism in humans.

Methods

We assessed lifetime use of pesticides selected by mechanism in a case–control study nested in the Agricultural Health Study (AHS). PD was diagnosed by movement disorders specialists. Controls were a stratified random sample of all AHS participants frequency-matched to cases by age, sex, and state at approximately three controls: one case.

Results

In 110 PD cases and 358 controls, PD was associated with use of a group of pesticides that inhibit mitochondrial complex I [odds ratio (OR) = 1.7; 95% confidence interval (CI), 1.0–2.8] including rotenone (OR = 2.5; 95% CI, 1.3–4.7) and with use of a group of pesticides that cause oxidative stress (OR = 2.0; 95% CI, 1.2–3.6), including paraquat (OR = 2.5; 95% CI, 1.4–4.7).

Conclusions

PD was positively associated with two groups of pesticides defined by mechanisms implicated experimentally—those that impair mitochondrial function and those that increase oxidative stress—supporting a role for these mechanisms in PD pathophysiology.     

Napping during the night shift and recovery after work among hospital nurses

OBJECTIVE:

To analyze the association between the length of napping during the night shift and the recovery after work among nurses.

METHOD:

Cross-sectional epidemiological study involving 1940 nurses from 18 public hospitals in the City of Rio de Janeiro. A multidimensional and self-applied questionnaire was used with information about health, sociodemographic and occupational characteristics, health-related behaviors and housework. Multiple logistic regression was applied to identify the association, adjusted for confounding variables.

RESULTS:

The gross analyses showed 44%, 127% and 66% higher chances of a high level of recovery after work for nurses who sleep up to two hours, between 2.1 and 3 hours and 3.1 hours or more, respectively, when compared to the nurses who do not sleep. After adjusting for confounding variables, the association only continues significant for the group that sleeps 2.1 to 3 hours during the night shift (OR=1.79; 95%CI=1.33-2.41).

CONCLUSION:

The association between the length of napping and the high level of recovery after work, confirmed in the present results, can be included in the studies that aim to support more appropriate policies aimed at improving the workers'' work, life and health conditions, not only in nursing, but night-shift workers in general.     

Family History of Hypertension and the Risk of Overweight in Japanese Children: Results From the Toyama Birth Cohort Study

Background

Family history can be a useful screening tool in the assessment and management of the risk for noncommunicable disease. However, no data have yet been reported on family history of hypertension and its effect on children’s overweight.

Methods

A total of 7249 Japanese children enrolled in the Toyama Birth Cohort Study were followed until 2002 (mean age: 12.3 years). Family history of hypertension was ascertained by asking children’s parents whether children’s biological parents or grandparents had doctor-diagnosed hypertension. Child overweight was defined according to international criteria for age- and sex-specific body mass index.

Results

The prevalence of child overweight at age 12 was 21.7% for males and 15.9% for females. After adjusting for family structure, parental employment status, and lifestyle factors, we found that a maternal family history of hypertension was positively associated with the risk of child overweight at age 12 (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 1.04–1.39). The adjusted OR increased from 1.16 (95% CI 0.99–1.35) to 1.42 (95% CI 1.04–1.92) to 4.75 (95% CI 1.35–16.69) as the number of family members with hypertension increased from 1 to 2 to 3, respectively. There was no significant difference in the prevalence of overweight between children with a paternal family history of hypertension and those without.

Conclusions

A maternal family history of hypertension was positively associated with the risk of overweight in children at age 12.Key words: family history, hypertension, overweight, the Toyama study     

Interventions to Improve Influenza and Pneumococcal Vaccination Rates Among Community-Dwelling Adults: A Systematic Review and Meta-Analysis

PURPOSE

Influenza and pneumococcal vaccination rates remain below national targets. We systematically reviewed the effectiveness of quality improvement interventions for increasing the rates of influenza and pneumococcal vaccinations among community-dwelling adults.

METHODS

We included randomized and nonrandomized studies with a concurrent control group. We estimated pooled odds ratios using random effects models, and used the Downs and Black tool to assess the quality of included studies.

RESULTS

Most studies involved elderly primary care patients. Interventions were associated with improvements in the rates of any vaccination (111 comparisons in 77 studies, pooled odds ratio [OR] = 1.61, 95% CI, 1.49-1.75), and influenza (93 comparisons, 65 studies, OR = 1.46, 95% CI, 1.35-1.57) and pneumococcal (58 comparisons, 35 studies, OR = 2.01, 95% CI, 1.72-2.3) vaccinations. Interventions that appeared effective were patient financial incentives (influenza only), audit and feedback (influenza only), clinician reminders, clinician financial incentives (influenza only), team change, patient outreach, delivery site changes (influenza only), clinician education (pneumococcus only), and case management (pneumococcus only). Patient outreach was more effective if personal contact was involved. Team changes were more effective where nurses administered influenza vaccinations independently. Heterogeneity in some pooled odds ratios was high, however, and funnel plots showed signs of potential publication bias. Study quality varied but was not associated with outcomes.

CONCLUSIONS

Quality improvement interventions, especially those that assign vaccination responsibilities to nonphysician personnel or that activate patients through personal contact, can modestly improve vaccination rates in community-dwelling adults. To meet national policy targets, more-potent interventions should be developed and evaluated.Key words: vaccination, influenza, Streptococcus pneumoniae, quality improvement, primary health care     

HLA-A Alleles and the Risk of Cervical Squamous Cell Carcinoma in Japanese Women

Background

We conducted a case-control study to examine the relationship between human leukocyte antigen-A (HLA-A) allele polymorphism and the pathogenesis of cervical neoplasia among Japanese women.

Methods

A total of 119 patients with invasive cervical squamous cell carcinoma were compared to 119 age- and menopausal status-matched non-cancer controls. Blood samples were taken from all cases and controls and lifestyle information was collected by means of a self-administered questionnaire. The estimated impact of HLA-A alleles on cervical cancer risk was evaluated by unconditional logistic regression models.

Results

The frequency of HLA-A*0206 among cases was significantly lower than among controls (P = 0.006). There was an inverse association between A*0206 and cervical cancer risk (odds ratio [OR] = 0.31, 95% confidence interval [95% CI] = 0.15 to 0.65, P = 0.002), and a positive association for HLA-A*2402 (OR = 1.76, 95% CI = 1.00 to 3.09, P = 0.048). After correction for multiple comparisons, A*0206 was significantly associated with reduced cervical cancer risk (corrected P = 0.036). Furthermore, the inverse association between A*0206 and cervical cancer risk was independent of smoking status (never smoker: OR = 0.37, 95% CI = 0.15 to 0.90; ever smoker: OR = 0.23, 95% CI = 0.06 to 0.89).

Conclusions

There was an inverse association between HLA-A*0206 and cervical cancer risk among Japanese women, which suggests that HLA-A polymorphism influences cervical cancer risk. Further investigation in other populations is thus warranted.Key words: cervical cancer, human leukocyte antigen, case-control study