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1.
BackgroundAlthough young adults exhibit a high rate of psychiatric disorders, their rate of access to mental health care is low compared with older age groups. Our study examined the relationship between socio-demographic factors and the use of health care services for psychological reasons.MethodsWe studied a community sample of 1103 French 22 to 35-year-old (TEMPO cohort study) who were surveyed by mailed questionnaire in 2009. Data were collected regarding participants’ health (internalizing and externalizing psychological symptoms in 1991 and 2009), health care use (access to health professionals and psychotropic medications in case of psychological difficulties), and socio-demographic factors (sex, age, employment status, marital situation, social support). Parental history of depression was ascertained based on TEMPO participants’ and their parents’ reports (in the GAZEL cohort study).ResultsIn the 12 months preceding the study, 16.7% of study participants saw a health professional and 12.8% took a psychotropic medication for psychological reasons. In multivariate regression, models adjusted for all socio-demographic and psychological characteristics, access to health professionals was associated with being unemployed/out of the labor force (OR = 1.93; 95% CI = 1.11–3.30), family situation (OR in participants living with a partner with no children: 2.16; 95% CI 1.26–3.72; OR in participants not living with a partner: 2.29; 95% CI = 1.34–3.90), and having low social support (OR = 1.75; 95% CI = 1.21–2.54). The use of psychotropic medications was associated with female gender (OR = 2.70; 95% CI = 1.60–4.55), being unemployed/out of the labor force (OR = 3.85; 95% CI = 2.14–6.95), not living with a partner (OR = 2.04; 95% CI = 1.09–3.80) and having low social support (OR = 1.65; 95% CI = 1.05–2.59). Additionally, use of health services was associated with participants’ and their parents’ psychological difficulties.  相似文献   

2.
ObjectiveScant evidence exists pertaining to objectively measured sedentary time and dietary quality among adults. Therefore, we examined the relationships between sedentary time, physical activity, and dietary quality.MethodsCross-sectional analyses of a 4,910 US adults from two cycles (2003–2006) of the National Health and Nutrition Examination Survey. The primary independent variables were sedentary time and physical activity (continuous and categorical), while the outcomes were overall dietary quality (Healthy Eating Index (HEI) 2010), fruit and vegetable scores, and empty caloric intake (kcal).ResultsMultivariable analyses revealed that a 1 min increase in daily sedentary behavior was associated with a 0.2 kcal decrease in empty calories (− 0.18, 95% CI =  0.34, − 0.03); however, sedentary time was not significantly related to overall dietary quality (HEI) and fruit and vegetable intake. In comparison, a 1 min increase in daily moderate-to-vigorous intensity physical activity was related to a 0.1 higher HEI score (0.08, 95% CI = 0.04, 0.11), a 0.01 higher fruit score (0.01, 95% CI = 0.01, 0.02), and conversely a 1.3 kcal decrease in empty calories (− 1.35, 95% CI =  2.01, − 0.69). In addition, meeting physical activity guidelines was associated with a 2.8 point higher HEI score (2.82, 95% CI = 1.40, 4.25), a 0.5 point higher fruit score (0.51, 95% CI = 0.31–0.71), and 37.4 fewer empty calories (− 37.43, 95% CI =  64.86, − 9.10).ConclusionsPhysical activity is significantly related to better overall dietary quality, while sedentary behavior is not. Findings suggest the need to promote physical activity and encourage adherence to dietary guidelines jointly, whereas sedentary behavior and overall dietary quality might need to be targeted independently.  相似文献   

3.
ObjectiveTo assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics.Study Design and SettingScreening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression.ResultsHaving one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.15–1.19; ≥2 vs. 0: OR = 1.43, 95% CI = 1.40–1.47) and lower specificity (1 vs. 0: OR = 0.86 [95% CI = 0.84–0.88]; ≥2 vs. 0: OR = 0.70 [95% CI = 0.68–0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95% CI = 0.99–1.19]; ≥2 vs. 0: OR = 1.12 [95% CI = 0.99–1.26]). There was no indication that influence of risk factors varied by radiologist characteristics.ConclusionWomen with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.  相似文献   

4.
BackgroundEvidence of the influence of the school food environment on adolescent diet is still little explored in low- and middle-income countries. We aimed to evaluate the association between food environment in schools and the immediate vicinity and the regular consumption of unhealthy food among adolescents.MethodsWe used cross-sectional data collected by the Brazilian National Survey of School Health (PeNSE) from a representative sample of adolescents attending 9th grade public and private schools in Brazil, in 2012. We estimated students' regular consumption (> 5 days/week) of unhealthy food (soft drinks, bagged salty snacks, deep fried salty snacks and sweets) and school availability, in the cafeteria or an alternative outlet, of the same food plus some healthy options (fruit and natural fruit juice). We performed multilevel logistic regression models.ResultsHaving a cafeteria inside school selling soft drinks (private schools OR = 1.23; 95% CI = 1.14–1.33; public schools OR = 1.13; 95% CI = 1.06–1.20) and deep fried salty snacks (private schools OR = 1.41 95% CI = 1.26–1.57; public schools OR = 1.16 95% CI = 1.08–1.24) was associated with a higher consumption of these unhealthy foods of among students. In private schools, cafeteria selling fruit and natural fruit juice was associated with lower student consumption of bagged salty snacks (OR = 0.86; 95% CI 0.77–0.96) and soft drinks (OR = 0.85; 95% CI = 0.76–0.94). In addition, eating meals from the Brazilian School Food Program in public schools was associated with a lower consumption of unhealthy foods.ConclusionsFoods available in the school food environment are associated with the consumption of unhealthy food among adolescents in Brazil.  相似文献   

5.
ObjectivesTo identify the correlates between risk perceptions and cervical cancer screening among urban Malaysian women.MethodA cross-sectional household survey was conducted among 231 women in Petaling Jaya city in 2007. The association of risk perceptions of cervical cancer and screening practice was analyzed using Poisson regression.Results56% of the respondents ever had a Pap smear test. Knowledge of signs and symptoms (aPR = 1.11, 95% CI = 1.03–1.19), age (aPR = 1.02, 95% CI = 1.01–1.03), number of pregnancies (aPR = 1.06, 95% CI = 1.01–1.11), marital status, education level and religion were found to be significant correlates of Pap smear screening. Respondents who were never married were less likely to have had a Pap smear. Those who had no education or primary education were less likely to have had a Pap smear compared to those with degree qualification. The prevalence of screening was significantly higher among Christians and others (aPR = 1.35; 95% CI = 1.01–1.81) and Buddhists (aPR = 1.38; 95% CI = 1.03–1.84), compared to Muslims.ConclusionEliminating anecdotal beliefs as risks via targeted knowledge on established risk factors and culturally sensitive screening processes are strategic for increasing and sustaining uptake of Pap smear screening versus current opportunistic screening practices.  相似文献   

6.
BackgroundPolymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene can affect disease progression in HBV infection. However, the results from different reports are inconsistent. The aim of this study was to investigate the association between the MTHFR C677T polymorphism and the outcome of HBV infection in a Tianjin Han population.MethodsTaqMan SNP genotyping was employed to determine the alleles and genotypes of MTHFR C677T in 2511 subjects from various stages of HBV infection and 549 healthy controls.ResultsOf the 3060 subjects, the genotypic frequencies were CT 48.9%, TT 29.3% and CC 21.8%; the allelic frequencies were T 53.8% and C 46.2%. There was no significant difference in genotypic or allelic distribution among the different disease groups. When either healthy subjects or self-limited subjects were used as controls, the TT genotype and the T allele conferred protective effects against hepatocellular carcinoma (HCC) (HCC vs healthy subjects: OR = 0.588, 95% CI = 0.413–0.836, P = 0.003; OR = 0.768, 95% CI = 0.645–0.915, P = 0.003, respectively. HCC vs self-limited subjects: OR = 0.598, 95% CI = 0.404–0.886, P = 0.010; OR = 0.772, 95% CI = 0.635–0.940, P = 0.010, respectively). After sub-stratification by gender, the prevalence of the TT genotype or T allele was the lowest in the male HCC group (TT 23.5%, T 49.8%). The protective effects of the TT genotype and the T allele were observed in male HCC and cirrhotic subjects (HCC vs self-limited subjects: OR = 0.470, 95% CI = 0.288–0.766, P = 0.002; OR = 0.681, 95% CI = 0.535–0.866, P = 0.002, respectively. Liver cirrhosis vs self-limited subjects: OR = 0.624, 95% CI = 0.392–0.992, P = 0.046; OR = 0.791, 95% CI = 0.627–0.998, P = 0.048, respectively), but not in female. When the subjects were stratified according to the clinical features, no statistically significant difference in the genotypic distribution was observed (P > 0.05).ConclusionsThe TT genotype and T allele of MTHFR C677T may confer a protective effect on disease progression to HCC in HBV-infected individuals, especially among male patients, in a population with a high prevalence of this genetic marker.  相似文献   

7.
ObjectiveTo determine the association between standing time and all-cause mortality.MethodsProspective questionnaire data from 221,240 individuals from the 45 and Up Study were linked to mortality data from the New South Wales Registry of Deaths (Australia) from February 1, 2006 to June 17, 2012. Hazard ratios for all-cause mortality according to standing time at baseline were estimated in 2013 using Cox regression modelling, adjusted for sex, age, education, urban/rural residence, physical activity, sitting time, body mass index, smoking status, self-rated health and disability.ResultsDuring 937,411 person years (mean follow-up = 4.2 yr) 8009 deaths occurred. All-cause mortality hazard ratios were 0.90 (95% CI 0.85–0.95), 0.85 (95% CI 0.80–0.95), and 0.76 (95% CI 0.69–0.95) for standing 2–≤ 5 h/d, 5   8 h/d, or > 8 h/d respectively, compared to standing two or less hours per day. Further analyses revealed no significant interactions between standing and sex (p = 0.93), the presence/absence of cardiovascular disease or diabetes (p = 0.22), BMI (p = 0.78), physical activity (p = 0.16) and sitting time (p = 0.22).ConclusionThis study showed a dose–response association between standing time and all-cause mortality in Australian adults aged 45 years and older. Increasing standing may hold promise for alleviating the health risks of prolonged sitting.  相似文献   

8.
ObjectiveWe assessed differential misclassification in self-reported family history of varicose veins by comparing consistency of subject's own varicose vein status and the consistency of information on varicose veins in family members.Study Design and SettingA population-based cohort study of 4,903 middle-aged residents of the city of Tampere, Finland. A questionnaire was used at entry and at the end of the 5-year follow-up.ResultsThe estimated prevalence of positive family history of varicose veins varied depending on subject's own varicose veins from odds ratio (OR) 0.14 (95% confidence interval [CI] = 0.01–0.58), in those with varicose veins reported in the first but not the second survey to OR 6.0 (95% CI = 2.0–47.8), in those with varicose veins reported in the second survey but not in the first. The incidence of varicose veins varied from 0.4 (95% CI = 0.1–1.4) to 4.1 (95% CI = 2.1–7.1) (per 100 person-years) depending how the proband memorized the family history.ConclusionResults on the effect of family history on varicose veins are subject to bias, which reduces the credibility of the reports proposing a strong hereditary component of varicose veins.  相似文献   

9.
ObjectiveToll-like receptor 4 (TLR4) plays a vital role in immunity to tubercle bacillus and its gene polymorphisms are supposed to affect tuberculosis susceptibility in some rather than all studies. Then, we integrated published data and performed a comprehensive meta-analysis to get more reliable estimations for the strength of associations between TLR4 gene polymorphisms and the risk of tuberculosis.MethodsWe systematically searched the electronic PubMed database for research articles about TLR4 gene polymorphisms and tuberculosis up to February 2012. Revman 5.0 software was adopted to conduct the meta-analysis. Crude odds ratio (ORs) and 95% confidence intervals (95% CIs) were calculated by either fixed-effects model or random-effects model.ResultsFinally, six case-control studies were identified, involving 1587 controls and 2110 patients. Overall, no significant associations were found between TLR4 gene Asp299Gly polymorphism and tuberculosis in the codominant models (GG vs AA: OR = 1.56, 95% CI = 0.76–3.21, P = 0.23; GA vs AA: OR = 1.01, 95% CI = 0.84–1.23, P = 0.89), the dominant model (GG + GA vs AA: OR = 1.04, 95% CI = 0.80–1.35, P = 0.75), the recessive model (GG vs GA + AA: OR = 1.55, 95% CI = 0.75–3.19, P = 0.24) and the allele model (G vs A: OR = 1.06, 95% CI = 0.81–1.40, P = 0.66). Similarly, no significant associations between TLR4 gene Thr399Ile and tuberculosis were observed (all P > 0.05).ConclusionsThe present meta-analysis suggests that TLR4 gene Asp299Gly and Thr399Ile polymorphisms are not associated with the susceptibility of tuberculosis.  相似文献   

10.
《Vaccine》2017,35(6):897-902
BackgroundAlthough the incidence of HPV-attributable cancers in males is rapidly increasing, HPV vaccine uptake in males remains poor. While quadrivalent human papillomavirus vaccine (4vHPV) series initiation in males increased following the Advisory Committee Immunization Practices (ACIP) male routine use recommendation, its impact on 4vHPV series completion in males at ACIP-recommended intervals has not been evaluated in large male cohorts. We examined trends and correlates of 4vHPV completion since licensure in males in a large cohort of insured boys before and after the ACIP routine use recommendation.MethodsWe grouped data from electronic medical records of males aged 9–17 years from Kaiser Permanente Southern California health plan who initiated 4vHPV into 3 cohorts by 4vHPV initiation date: licensure and ACIP permissive use: 2009–2010; addition of anal cancer indication: 2010–2011; ACIP routine use: 2011–2013. We estimated adjusted hazard ratios (AHRs) between patient and provider characteristics and vaccination using Marginal Cox proportional hazards models.ResultsOf 80,800 boys initiating 4vHPV, 24.3% completed the series within 12 months with minimal differences across cohorts. Completion decreased with increasing age at initiation (13–17 vs. 11–12 year olds: AHR = 0.85; 95% confidence interval [CI] = 0.80, 0.89) and was greater among patients with a primary care provider (AHR = 1.28, 95%CI = 1.17, 1.41), influenza vaccine recipients (AHR = 1.50, 95% CI = 1.43, 1.57), and Asian/Pacific Islanders (AHR = 1.07, 95% CI = 1.00, 1.15), and lower among non-Hispanic Blacks (AHR = 0.72, 95% CI = 0.65, 0.80) and Hispanics (AHR = 0.86, 95% CI = 0.81, 0.90) compared to non-Hispanic Whites.ConclusionsDespite the ACIP routine use recommendation in males, 4vHPV series completion remained low. 4vHPV initiation at 11–12 years and identification of a provider responsible for the adolescents’ health care may increase 4vHPV series completion. Given the rapidly increasing incidence of HPV-related cancers in males, it is important to identify measures to increase HPV vaccine series completion, particularly among non-Hispanic Black and Hispanic males.  相似文献   

11.
ObjectiveTo examine the longitudinal relationship between psychological distress and body mass index (BMI) changes over a period of five and ten years.MethodData were used from the Dutch, prospective, population based Doetinchem Cohort study over the period 1995/1999 until 2005/2009 (N = 5504). Psychological distress was assessed using the Mental Health Inventory (MHI-5). BMI (kg/m2) was calculated from measured body height and body weight. GEE analyses were used to examine the relationship between psychological distress at baseline and BMI change, and the development of overweight over five years. Linear and logistic regression analyses were used to examine these relations over ten years.ResultsPsychological distress predicted an extra overall increase in BMI of 0.14 kg/m2 (95% CI 0.03–0.25) over five years and an increase of 0.18 kg/m2 (95% CI 0.01–0.35) over ten years, when comparing psychologically distressed participants to psychologically healthy participants. This was especially the case among persons with normal weight (five years; B = 0.26 kg/m2, 95% CI = 0.12–0.40/ten years; B = 0.32 kg/m2 95% CI = 0.11–0.53) and moderate overweight (five years: B = 0.18 kg/m2, 95% CI = 0.02–0.35) at baseline. Psychological distress did not predict the development of overweight five and ten years later.ConclusionThe results in this study indicated that psychological distress predicted an increased risk in gaining weight, but did not result in an increased risk for developing overweight.  相似文献   

12.
《Eating behaviors》2014,15(2):182-185
Menopausal transition has been associated with the emergence of metabolic abnormalities, which may increase risk for chronic medical conditions in women. This study compared metabolic function between premenopausal women (n = 152), postmenopausal women (n = 88), and men (n = 98) recruited for treatment studies for obesity co-occurring with binge eating disorder (BED), a high-risk population for developing metabolic syndrome (MetS). Postmenopausal women were more likely than premenopausal women to show elevated total cholesterol (OR = 2.75; 95% CI = 1.56–4.80) and poor glycemic control (OR = 2.92; 95% CI = 1.32–6.33) but were more likely to have lower HDL levels (OR = 0.36; 95% CI = 0.19–0.68). These became non-significant after adjusting for age. Both pre- and postmenopausal women were less likely than age-matched men to show elevated levels of triglycerides (OR = 0.27; 95% CI = 0.13–0.53 [postmenopausal], OR = 0.29; 95% CI = 0.16–0.53 [premenopausal]), blood pressure (OR = 0.48; 95% CI = 0.25–0.91 [postmenopausal], OR = 0.40; 95% CI = 0.23–0.69 [premenopausal]), and less likely to have MetS (OR = 0.41; 95% CI = 0.21–0.78 [postmenopausal], OR = 0.46; 95% CI = 0.27–0.79 [premenopausal]). Premenopausal women were also less likely to have elevated fasting glucose level (OR = 0.50; 95% CI = 0.26–0.97) than age-matched men. Among obese women with BED, aging may have a more profound impact on metabolic abnormalities than menopause, suggesting the importance of early intervention of obesity and symptoms of BED. The active monitoring of metabolic function in obese men with BED may also be critical.  相似文献   

13.
《Vaccine》2016,34(1):120-127
BackgroundThis study evaluated hospitalization and mortality in patients with chronic hepatitis B virus infection (HBV (+)) and matched comparison patients after stratifying the patients according to annual influenza vaccination (Vaccine (+)).MethodsData from Taiwan's National Health Insurance program from 2000 to 2009 were used to identify HBV(+)/vaccine(+) (n = 4434), HBV(+)/Vaccine(−) (n = 3646), HBV(−)/Vaccine(+) (n = 8868), and HBV(−)/Vaccine(−) (n = 8868) cohorts. The risk of pneumonia/influenza, respiratory failure, intensive care, hospitalization, and mortality in the four cohorts was evaluated.ResultsThe total hospitalization rate was significantly lower in patients with chronic HBV infection who received an annual influenza vaccination than in chronic HBV-infected patients who did not receive an influenza vaccination (16.29 vs. 24.02 per 100 person-years), contributing to an adjusted hazard ratio (HR) of 0.56 (95% confidence interval (CI) = 0.50–0.62). The HBV(+)/Vaccine(+) cohort also had lower risks than the HBV(+)/Vaccine(−) cohort for pneumonia and influenza (adjusted HR = 0.79, 95% CI = 0.67–0.92), intensive care unit admission (adjusted HR = 0.33, 95% CI = 0.25–0.43), and mortality (adjusted HR = 0.19, 95% CI = 0.15–0.24).ConclusionsOur results suggest that annual influenza vaccination can reduce the risk of hospitalization and mortality in patients with chronic HBV infection.  相似文献   

14.
BackgroundDengue is a systemic viral infection that spreads to humans by the bite of infected Aedes mosquitoes. The secreted NS1 protein of dengue virus activates macrophages and human PBMCs via TLR4 and induce the release of pro-inflammatory cytokines which is responsible for the pathogenesis of disease. Mutations in TLR4 gene have been associated with the increased susceptibility to many viral, bacterial and parasitic diseases.ObjectiveTo study the impact of TLR4 Asp299Gly (rs4986790) and Thr399Ile (rs4986791) gene polymorphisms with susceptibility to dengue infection.MethodsA total of 120 dengue infected (57; DHF/DSS and 63; DF) and 200 healthy controls were included in the study. TLR4 Asp299Gly and Thr399Ile gene polymorphisms was studied by PCR-RFLP. Expression of TLR4 mRNA was evaluated by rRT-PCR.ResultsIndividuals with heterozygous genotype for TLR4 Asp299Gly and Thr399Ile polymorphisms had increased susceptibility to dengue infection (OR-1.70, 95% CI = 1.01–2.86 P = 0.042 and OR-2.17, 95% CI = 1.10–4.28, P = 0.024, respectively). The frequency of Gly and Ile alleles were higher in dengue patients as compared to controls (OR-1.67, 95% CI = 1.05–2.64, P = 0.029 and OR-2.20, 95% CI = 1.19–4.07, P = 0.011, respectively). IIe/Gly haplotype was associated with the risk of the disease when compared with controls (OR = 3.15, 95% CI = 1.09–9.09, P = 0.035). The mRNA expression was higher in DF when compared with DHF/DSS and controls (P = 0.040 and 0.009, respectively).ConclusionA higher expression of TLR4 mRNA was associated with DF. The TLR4 Asp299Gly and Thr399Ile gene polymorphisms were associated with the susceptibility of dengue infection probably by altering the immune response.  相似文献   

15.
IntroductionBullying involvement has been linked with substance use; however, less is known about its relationship with pre-initiation stages of adolescent cigarette smoking behavior. This study examined the association between bullying involvement and smoking susceptibility among never tried or experimented with cigarette smoking students. Susceptibility to cigarette smoking in adolescence is a strong predictor of subsequent smoking initiation.MethodsA cross-sectional data on Canadian adolescent and youth were drawn from the 2012/2013 Youth Smoking Survey (n = 28,843). Logistic regression analysis was used to examine the association between bullying and smoking susceptibility among never-smoking students.ResultsAbout 21% self-reported involvement in bullying (as a bully, victim or both). Middle school students (grades 6–8) reported more involvement in bullying (24%) than those in grades 9–12 (16%). The multivariable analyses showed that the association between bullying and smoking susceptibility was significantly different by grade level. Middle school students involved in bullying had higher odds of smoking susceptibility compared to uninvolved students (bully, adjusted odds ratio [AOR] = 2.54, 95% CI = 1.73–3.74; victim, AOR = 1.29, 95% CI = 1.11–1.48; bully–victim, AOR = 2.19, 95% CI = 1.75–2.74). There were no significant associations between all subgroups of bullying and smoking susceptibility for grades 9–12 students.ConclusionsStudents involved in bullying were more susceptible to smoking, although patterns of association varied by grade level. In particular, the findings highlight that non-smoking middle school students involved in bullying were susceptible to future smoking.  相似文献   

16.
BackgroundThis article presents the mortality data compiled among a cohort of workers at risk of internal uranium exposure and discusses the extent to which this exposure might differentiate them from other nuclear workers.MethodsThe cohort consisted of 2897 Areva-NC-Pierrelatte plant workers, followed from 1st January 1968 through 31st December 2006 (79,892 person-years). Mortality was compared with that of the French population, by calculating Standardized Mortality Ratios (SMR) and 95 % confidence intervals (CI95 %). External radiation exposure was reconstructed using external dosimetry archives. Internal uranium exposure was assessed using a plant-specific job-exposure-matrix, considering six types of uranium compounds according to their nature (natural and reprocessed uranium [RPU] and solubility [fast-F, moderate-M, and slow-S]). Exposure-effect analyses were performed for causes of death known to be related to external radiation exposure (all cancers and circulatory system diseases) and cancer of uranium target-organs (lung and hematopoietic and lymphatic tissues, HLT).ResultsA significant deficit of mortality from all causes (SMR = 0.58; CI95 % [0.53–0.63]), all cancers (SMR = 0.72; CI95 % [0.63–0.82]) and smoking related cancers was observed. Non-significant 30 %-higher increase of mortality was observed for cancer of pleura (SMR = 2.32; CI95 % [0.75–5.41]), rectum and HLT, notably non-Hodgkin's lymphoma (SMR = 1.38; CI95 % [0.63–2.61]) and chronic lymphoid leukemia (SMR = 2.36; CI95 % [0.64–6.03]). No exposure-effect relationship was found with external radiation cumulative dose. A significant exposure-effect relationship was observed for slowly soluble uranium, particularly RPU, which was associated with an increase in mortality risk reaching 8 to 16 % per unit of cumulative exposure score and 10 to 15 % per year of exposure duration.ConclusionThe Areva-NC-Pierrelatte workers cohort presents a non-significant over-mortality from HLT cancers, notably of lymphoid origin, unrelated to external radiation exposure. The pilot study suggests an association between mortality from the HLT and lung cancers and exposure to slowly soluble RPU compounds. The results of this study should be investigated further in more powerful studies, with a dose-response analysis based on individual assessment of uranium absorbed dose to uranium-target organs.  相似文献   

17.
《Vaccine》2015,33(25):2897-2902
BackgroundPneumococcal infection is a serious cause of mortality and morbidity in the elderly. A nationwide pneumococcal polysaccharide vaccine (PPV) program for elderly adults aged 75 years and older was conducted in Taiwan in 2008. The efficacy of the PPV in this very elderly population was evaluated.MethodsThe data were analyzed using the Taiwan National Health Insurance Research Database (NHIRD), the cause-of-death registration database and the invasive pneumococcal disease (IPD) notification database of Taiwan's Ministry of Health and Welfare. The efficacy of PPV administration in this very elderly population was evaluated using multivariate logistic regression after propensity score matching (PSM). The rates of IPD, death from IPD, pneumonia hospitalization, death from pneumonia, and all-cause mortality were compared for those who did and did not receive the PPV.ResultsAmong the 1078,955 eligible people, 318,257 (29.5%) received the PPV, and 760,698 (70.5%) were not vaccinated. Using PSM to adjust for confounding factors, including age, gender, influenza vaccination status, associated chronic diseases and health care utilization, those who received the PPV had significantly lower odds ratios (ORs) for IPD (OR = 0.24, 95% CI = 0.123–0.461, p < 0.001), death from IPD (OR = 0.09, 95% CI = 0.011–0.704, p < 0.022, p < 0.001), pneumonia hospitalization (OR = 0.40, 95% CI = 0.395–0.415, p < 0.001), death from pneumonia (OR = 0.07, 95% CI = 0.059–0.082, p < 0.001), and all-cause mortality (OR = 0.07, 95% CI = 0.069–0.072, p < 0.001) compared with those who were not vaccinated.ConclusionsPPV vaccination in the previous year was associated with a 60% reduction in pneumonia hospitalization, a 76% reduction in IPD, and a greater than 90% reduction in death from pneumonia, IPD and all causes among people over 75 years old in Taiwan. Data from subsequent years in Taiwan and similar populations elsewhere are needed to evaluate the contribution of underlying variations in the mortality rate and the confounding effects of prior disease severity to these findings.  相似文献   

18.
ObjectiveTo evaluate the efficacy of a program of home blood pressure monitoring (HBPM) on therapeutic Inertia (TI) in mild-to-moderate hypertension (AHT).DesignControlled, randomised clinical trial.SettingForty six clinics in 35 primary care centres. Spain.ParticipantsA total of 232 patients with uncontrolled hypertension were included.InterventionTwo groups with 116 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention group (IG): patients who were included in the HBPM program.Main measurementsTI was calculated by the ratio: Number of patients whose pharmacological treatment was not changed in each visit/Number of patients with an average BP 140mmHg and/or 90mmHg in the general population or 130 and/or 90 mmHg in diabetics. The mean BPs and the percentage of controlled patients were calculated. The mean number of people that required an intervention in order to avoid TI was calculated (NI).ResultsA total of 209 patients completed the study, with TI in 35.64% (95% CI = 29.85%-41.43%) of the sample, and in 71.63% (95% CI = 63.9-79.36%) of the uncontrolled hypertensive patients.The TI was 22.42% (95% CI = 24.2-37%) in the IG and 50% (95% CI = 37.75-62.25) in the CG (p < .05) in visit 2, and 25.23% (95% CI = 14.84-35.62) and 46.07% (95% CI = 33.85-58.29) in the final visit for IG and CG, respectively (P < .05). The NI was 4.3.ConclusionsTI was very significant among the uncontrolled hypertensive patients. The studied interventions are effective for improving TI.  相似文献   

19.
《Contraception》2016,94(6):478-484
ObjectivesTo test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.Study designRetrospective cohort study, Mexico, nationally representative sample of women 12–39 years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association.ResultsOur analytic sample included 7022 women (population, N = 9,881,470). Twenty percent of the population was 12–19 years old at last birth, 55% aged 20–29 and 25% 30–39 years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio = 0.52; 95% Confidence Interval (CI) = 0.40–0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI = 74–78%) of adolescents (12–19 years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI = 56–62%) who deliver in public facilities.ConclusionBoth adolescents and women ages 20–39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy.ImplicationsAdolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.  相似文献   

20.
BackgroundDiabetes is a highly prevalent chronic disease that has been increasing globally and is the seventh leading cause of death in the United States. Sedentary behavior is associated with increased risk of diabetes and is unfavorably related to all-cause mortality, but there are limited studies examining the sedentary–mortality relationship among those with diabetes, which was the purpose of this study.MethodsUsing data from the 2003–2006 NHANES, 712 adult participants with evidence of diabetes had complete data on the study variables. A multivariable Cox proportional hazard model was used to examine the association between objectively measured sedentary behavior and all-cause mortality among this diabetic sample.ResultsResults showed that for every 60 min/day increase in sedentary behavior, independent of moderate-to-vigorous physical activity (MVPA) and other covariates, adults with diabetes had a 13% increased risk of all-cause mortality (HRadjusted = 1.13; 95% CI = 1.03–1.24; P = 0.01). However, after adjusting for total physical activity (light and MVPA), sedentary behavior was no longer associated with mortality risk (HRadjusted = 1.04; 95% CI = 0.92–1.16; P = 0.46).ConclusionAmong those with diabetes, sedentary behavior may not have increased mortality risk independent of total physical activity behavior.  相似文献   

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