Radiofrequency electromagnetic fields; male infertility and sex ratio of offspring

Concern is growing about exposure to electromagnetic fields and male reproductive health. The authors performed a cross-sectional study among military men employed in the Royal Norwegian Navy, including information about work close to equipment emitting radiofrequency electromagnetic fields, one-year infertility, children and sex of the offspring. Among 10,497 respondents, 22% had worked close to high-frequency aerials to a “high” or “very high” degree. Infertility increased significantly along with increasing self-reported exposure to radiofrequency electromagnetic fields. In a logistic regression, odds ratio (OR) for infertility among those who had worked closer than 10 m from high-frequency aerials to a “very high” degree relative to those who reported no work near high-frequency aerials was 1.86 (95% confidence interval (CI): 1.46–2.37), adjusted for age, smoking habits, alcohol consumption and exposure to organic solvents, welding and lead. Similar adjusted OR for those exposed to a “high”, “some” and “low” degree were 1.93 (95% CI: 1.55–2.40), 1.52 (95% CI: 1.25–1.84), and 1.39 (95% CI: 1.15–1.68), respectively. In all age groups there were significant linear trends with higher prevalence of involuntary childlessness with higher self-reported exposure to radiofrequency fields. However, the degree of exposure to radiofrequency radiation and the number of children were not associated. For self-reported exposure both to high-frequency aerials and communication equipment there were significant linear trends with lower ratio of boys to girls at birth when the father reported a higher degree of radiofrequency electromagnetic exposure.     

Association between diabetes mellitus and hypertension with anthropometric indicators in older adults: Results of the Mexican Health Survey, 2000

Objective: To determine the association between anthropometric indicators of adiposity with type 2 diabetes mellitus (T2DM) and hypertension (HTN) in older adults.Design: Cross-sectional study of participants of the Mexican Health Survey 2000 (MHS).Setting: Mexico, subjects recruited from the general community.Participants: The analytic sample included 7,322 adults who were ≥60 years of age at the time of the survey. T2DM data were available on 6,994 individuals, who represent 95.5% of the original sample; data on HTN was available on 6,268 subjects, which accounted for 86.5% of the original sample.Measurements: Type 2 diabetes mellitus and hypertension, as well as anthropometric indicators including body mass index (BMI), waist circumference (WC), and conicity index (CI).Results: The prevalence of T2DM and HTN in this age group was 34.3% and 73.9%, respectively. After adjusting for other variables, the association between high WC and T2DM (OR=1.59 95%CI=1.26-2.01, P < 0.001) was stronger than the association with overweight (OR=1.26, 95%CI= 1.01–1.58, P=0.04) and obesity (OR=1.38, 95%CI= 1.08–1.79, P< 0.01) using BMI, and slightly higher than tertile 2 of the CI (OR=1.49, 95%CI=1.20–1.88, P< 0.01), while tertile 3 showed a stronger association with T2DM (OR=1.60, 95%CI=1.22–2.08, P< 0.001). However, the association between obesity and HTN measured by BMI (OR=1.98, 95%CI=1.48–2.65, P< 0.001) was stronger than what was observed with overweight (OR=1.42, 95%CI 1.13–1.77, P< 0.01), with high WC (OR=1.62, 95%CI=1.25–2.10, P< 0.001) and tertiles 2 and 3 of the CI (OR=1.23, 95%CI=0.99–1.55, P= 0.09); (OR=1.53, 95%CI= 1.16–2.03, P< 0.01) respectively.Conclusions: BMI and abdominal obesity are significantly and independently associated with an increase in the prevalence of T2DM and HTN among older Mexican adults.     

Early Healthcare Provider Communication with Patients and Their Workplace Following a Lost-time Claim for an Occupational Musculoskeletal Injury

Problem: One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. Methods: In this cross-sectional study 187 Ontario workers completed a telephone survey 17–43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items “your HCP told you the date you could RTW,” “your HCP advised you on how to prevent re-injury or recurrence,” “your HCP made contact with your workplace” on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. Results: The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62–6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24–5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09–4.09; adjusted OR=1.72, 95% CI=0.83–3.58). Interpretation: Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.

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Intra-familial Transmission of Helicobacter pylori Infection in Children of Households with Multiple Generations in Vietnam

This community-based cross-sectional study in 533 participants from 135 households with multiple generations living in the same household aimed at investigating the relationship between Helicobacter pylori infection in children and the other household members. H. pylori infection in children was found significantly associated with the infection in mothers [OR (95% CI): 2.50 (1.19–5.26)], even after being adjusted for sex, age group and sibling number [adjusted OR (95% CI): 2.47 (1.12–5.47)]. It was also significantly associated with the infection in␣both parents [adjusted OR (95% CI): 4.14 (1.29–13.23)]. No significant association between H. pylori infection in the father, grandparent(s), uncle or aunt with that in their children was found. Results from the present study showed intra-familial transmission in a multi-generation population and supported the␣hypothesis of person-to-person transmission of H.␣pylori infection.     

Lifestyle-Related Determinants of Hookah and Cigarette Smoking in Iranian Adults

To identify lifestyle-related determinants of hookah and cigarette smoking in Iranian adults, a total of 12,514 men and women aged ≥19 years in three counties in central Iran (Isfahan, Najafabad, Arak) were selected in multistage random sampling. Data on socio-demographic characteristics and lifestyle were collected in interviewer-administered questionnaires, as part of the baseline survey of the Isfahan Healthy Heart Program. Unhealthy lifestyle-related factors independently associated with cigarette and hookah smoking, were identified in sex-specific multivariate logistic regression analyses. High stress levels (OR: 1.55; 95% CI: 1.35–1.78 for men; OR: 1.63; 95% CI: 1.17–2.27 for women), family member smoking (OR: 1.61; 95% CI: 1.27–4.92 for men; OR: 2.49; 95% CI: 2.20–2.95 for women), and short/long sleep duration (OR: 1.18; 95% CI: 1.01–1.39 for men; OR: 1.52; 95% CI: 1.10–2.35 for women) were associated with cigarette smoking in both men and women. Poor diet was also related to cigarette smoking in men (OR: 1.55; 95% CI: 1.62–1.89). Family member smoking was associated with hookah smoking in both men (OR: 1.16; 95% CI: 1.05–3.12) and women (OR: 1.56; 95% CI: 1.02–4.92), and in addition high stress levels (OR: 2.87; 95% CI: 1.14–5.83) and short/long sleep duration (OR: 1.07; 95% CI: 1.02–2.41) were associated with hookah smoking in women. Unhealthy lifestyle-related factors co-occur with cigarette and hookah smoking in Iranian adults, likely increasing the risk for chronic health problems. Sex differences in the determinants of hookah and cigarette smoking may need to be taken into account in planning tobacco control strategies.     

Language Preference and Perceptions of Healthcare Providers’ Communication and Autonomy Making Behaviors among Hispanics

Background To examine influence of language preference—English versus Spanish—on Hispanics’ perceptions of their healthcare providers’ communication behaviors. Methods Using the 2005 Medical Expenditure Panel Survey (MEPS), we observed non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged ≥18 years, reporting visiting a healthcare provider within the past 12 months. Results When compared to Spanish responders (reference group), English responders were more likely to report that their healthcare provider “always” listened to them carefully (adjusted odds ratio (OR) = 1.39, 95% confidence interval (CI) 1.09–1.78), “always” explained things so that they understood (adjusted OR 1.37, 95% CI 1.08–1.73), “always” spent enough time with them (adjusted OR = 1.62, 95% CI 1.24–2.11),”always” asked them to help make decisions (adjusted OR 1.37, 95% CI 1.03–1.82), and “always” showed respect for treatment decisions (adjusted OR = 1.66, 95% CI 1.27–2.19). Discussion Healthcare providers should consider the complex needs of Hispanic patients whose language of choice is not English.     

Muscle Strength Definitions Matter: Prevalence of Sarcopenia and Predictive Validity for Adverse Outcomes Using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Criteria

EWGSOP2 criteria for sarcopenia recommends the use of either handgrip strength (GS) or 5-times repeated chair stand test (RCS) as a muscle strength measure. We aim to compare the impact of different muscle strength definitions on sarcopenia prevalence and predictive validity for 2-year outcomes, using the EWGSOP2 clinical algorithm. We studied 200 community-dwelling older adults, comparing sarcopenia prevalence using three muscle strength definitions: 1) maximum GS (Asian Working Group cutoffs); 2) RCS-1 (standard cutoff >15s); and 3) RCS-2 (ROC-derived cutoff >12.5s). Two-year outcomes include: 1) Incident frailty (modified Fried criteria); 2) Physical performance [Short Physical Performance Battery (SPPB) score <10]; and 3) Quality of life [EuroQol-5 dimension (EQ-5D) <25th percentile]. We performed logistic regression on 2-year outcomes adjusted for age, gender, cognition and mood. Prevalence of confirmed sarcopenia was 14.5%, 4% and 9% for GS, RCS-1 and RCS-2 respectively. For 2-year outcomes (N=183), RCS-2 predicted incident frailty (OR: 5.7, 95% CI 1.4–22.8, p=0.013), low SPPB (OR: 4.4, 95% CI 1.4–13.1, p=0.009), and trended towards predicting low QOL (OR: 2.1, 95% CI 0.9–4.9, p=0.095). In contrast, GS and RCS-1 did not predict frailty nor low QOL, but predicted low SPPB only (GS: OR 3.8, 95% CI 1.3–10.6, p=0.01; RCS-1: OR: 8.8, 95% CI 2.2–35.0, p=0.002). Sarcopenia prevalence varies with muscle strength definitions, with GS being significantly higher vis-á-vis RCS definitions. Our results also support the use of population-specific over standard cutoffs for RCS to obtain intermediate estimates of sarcopenia prevalence and the best predictive validity for two-year outcomes.     

Asthma,eczema, and reports on pollen and cat allergy among pupils in Shanxi province,China

Objectives To study self-reported asthma, eczema, and pollen and furry pet allergy among pupils (9–20 years) in Shanxi province, China, in relation to dietary and environmental factors. Methods A standardised questionnaire was distributed to pupils in two primary and two secondary schools, one in Taiyuan city (3.0 milj. inhabitants), the others in Qingxu county, a rural area 30 km outside Taiyuan. Totally, 2,116 pupils (90%) participated. Results Fifty percent were girls, 61% had been growing up on the countryside, 18% lived in Taiyuan now, 1.7% had ever had asthma, 0.8% had doctor’s diagnosed asthma, 1.4% pollen allergy, 1.7% cat allergy, and 0% had dog allergy. Multiple logistic regression was applied, controlling for age, gender, diet, indoor exposures, rural childhood, and current urban residency. Girls had less eczema (OR = 0.51; 95%CI 0.28–0.92). Pupils in the city had more eczema (OR = 5.05; 95% CI 1.11–23.3). Those with a rural childhood had less asthma (OR = 0.17; 95% CI 0.05–0.60), eczema (OR = 0.15; 95% CI 0.13–0.66) and pollen/cat allergy (OR = 0.50; 95%CI 0.25–0.99). None of the indoor variables was related to asthma or allergy. Children with frequent fruit consumption had less asthma (OR = 0.40; 95% CI 0.19–0.82) and pollen/cat allergy (OR = 0.49; 95% CI 0.29–0.84). Those with frequent fish consumption had less asthma (OR = 0.32; 95% CI 0.11–0.97). Those with frequent hamburgers consumption had more asthma (OR = 2.05; 95% CI 1.09–3.87) and eczema (OR = 1.85; 95% CI 1.12–3.04). Conclusion Asthma, eczema, and pollen or pet allergy was uncommon, compared with western countries and other areas in China. Pupils with a rural childhood had less asthma and allergy, which is consistent with the “hygiene hypothesis”. Fruit and fish consumption may reduce, and fast food consumption may increase the risk for asthma. Finally, the higher prevalence of asthma and eczema among younger children, born in the 1990s, indicates a cohort effect similar to that observed in western countries.     

Predictive Value for Outcome and Evolution of Geriatric Parameters after Transcatheter Aortic Valve Implantation

To identify parameters of comprehensive geriatric assessment (CGA) CGA including ABCDEF score, a multidomain frailty assessment, associated with poor outcome after TAVI and to assess the evolution of CGA parameters at 6-months follow-up. One-year monocentric prospective cohort study. Departments of geriatric medicine and cardiology in Rouen University Hospital, Normandy, France. All patients over 70, selected for TAVI by a multidisciplinary “heart team”. 8-areas CGA was performed before TAVI and at 6-months follow-up. Poor outcome was defined as decrease in 1 BADL or unplanned readmission at 6 months or death within the first year after TAVI. Geriatric characteristics associated with poor outcome were assessed by logistic regression with surgical scores as bivariable. Geriatric characteristics were compared between baseline and 6-months follow-up. 114 patients (mean age 85.8±5.3 years) were included. Mean EuroSCORE was 19.1±10.6%. Poor outcome occurred in 57(50.0%) patients. Loss of one BADL (OR: 1.66, 95CI[1.11–2.48]), decrease in IADL (OR: 1.41, 95CI[1.14–1.74]), in plasmatic albumin (OR: 1.10, 95CI[1.01–1.20]), in MMSe (OR: 1.13, 95CI[1.02–1.26]), low walking speed (OR: 1.53, 95CI[1.01–2.33]) and ABCDEF score ≥2 (OR: 1.63, 95CI[1.09–2.42]) were independently associated with poor outcome. In survivors with complete follow-up (n=80), most geriatric parameters were maintained 6 months after TAVI, but IADL decreased (5.6±1.9 to 4.9±2.2, p<0.001). MMSe increased in patients with previous cognitive impairments whereas it decreased in those without (p<0.001). CGA parameters are independently associated with poor outcome after TAVI. These parameters, but IADL, are maintained at 6 months and course of the MMSe depends on previous cognitive status.     

Follow-up of asbestosis patients and predictors for radiographic progression

Objective: We followed a group of 85 Finnish asbestosis patients radiographically for an average of 6.5 (range 2–10) years to examine the progression of the disease and to assess possible explanations for the progression. Methods: The examinations included full-size chest radiographs and a blood specimen analysis. The radiographs were classified according to the 1980 International Labor Office (ILO) classification. Progression was accepted if the second or third radiography was estimated (in a side-by-side comparison) to have more profusion of small opacities qualitatively than the first, even if the radiographs were classified into the same profusion category. Results: In all, 38% of the patients showed progression during the follow-up period. The average progression of small opacities ranged from ILO 1/1 to ILO 2/2 (0.4 minor ILO categories/year). The asbestosis was progressive more often among the sprayers than among the insulators and asbestos factory workers [cross-tabulation, odds ratio (OR) 5.0, 95% confidence interval (95% CI) 1.2–20]. In the logistic regression model the ILO classification category at the beginning of the follow-up (OR 1.54; 95% CI 0.96–2.47), the fibronectin (OR 1.01; 95% CI 1.00–1.01) and angiotensin-converting enzyme (ACE; OR 1.10; 95% CI 1.00–1.20) levels, and the erythrocyte sedimentation rate (ESR; OR 1.05; 95% CI 1.00–1.10) were statistically associated with the radiographic progression of small opacities. Abnormalities of the pleura were found to progress more often among the patients with progressive parenchymal opacities. Conclusion: For the progression of small-opacity profusion the significant predictors in the logistic regression model were the ILO profusion category at the beginning of the follow-up period, the fibronectin level, the ACE value, and the ESR. The model correctly classified 94% of the patients with progression and 65% of those without progression. The differences in the mean values recorded for the biomarkers between the progressors and nonprogressors, however, were small and may therefore not be of any importance to the clinician. Received: 17 November 1997 / Accepted: 8 May 1998     

Prospective Analysis of Factors Associated with Work Reentry in Patients with Accident-Related Injuries

Introduction: The objective of this study was to investigate the influence of accidents, the physical and psychological consequences, the patient’s predisposition as well as work-related cognitions on return to work (RTW) post accident. Despite the costs of time-off from work after accidental injuries, very few investigations have been carried out so far. Method: In a consecutive sample, 163 patients were investigated directly and 12 months after an accident. Results: 32% of the patients had a poor occupational integration 12 months after an accident. As predictors for return to work were found type of prior work: laborer (OR=4.34; 1.79–10.50 CI 95%), type of accident: recreational (OR=0.27; 0.11–0.69 CI 95%) and subjective perception of the accident severity (OR=0.98; 0.96–0.99 CI 95%). Conclusion: Laborers after a traffic or work accident, who estimate the accident as severe, are at greater risk of developping long-term disability. Future efforts should be conducted especially for this target group. Corinna Lange and Markus Burgmer contributed equally to the present work and should therefore both be considered as first authors.     

Association of passive and active smoking with incident type 2 diabetes mellitus in the elderly population: the KORA S4/F4 cohort study

Active smoking is a risk factor for type 2 diabetes (T2DM), but it is unclear whether exposure to environmental tobacco smoke (ETS) is also associated with T2DM. The effect of passive and active smoking on the 7-year T2DM incidence was investigated in a population-based cohort in Southern Germany (KORA S4/F4; 1,223 subjects aged 55–74 years at baseline in 1999–2001, 887 subjects at follow-up). Incident diabetes was identified by oral glucose tolerance tests or by validated physician diagnoses. Among never smokers, subjects exposed to ETS had an increased diabetes risk in the total sample (odds ratio (OR) = 2.5; 95% confidence interval (CI): 1.1, 5.6) and in a subgroup of subjects having prediabetes at baseline (OR = 4.4; 95% CI: 1.5, 13.4) after adjusting for age, sex, parental diabetes, socioeconomic status, and lifestyle factors. Active smoking also had a statistically significant effect on diabetes incidence in the total sample (OR = 2.8; 95% CI: 1.3, 6.1) and in prediabetic subjects (OR = 7.8; 95% CI: 2.4, 25.7). Additional adjustment for components of the metabolic syndrome including waist circumference did not attenuate any of these associations. This study provides evidence that both passive and active smoking is associated with T2DM.     

Maternal acute respiratory infectious diseases during pregnancy and birth outcomes

The objective of the study was to evaluate the possible association between maternal acute respiratory infectious diseases (ARID) during pregnancy and birth outcomes. Newborn infants born to mothers with or without ARID as reference were compared in the population-based large data set of newborns without any defect in the Hungarian Case–Control Surveillance System of Congenital Abnormalities. Main outcome measures were birth weight and gestational age at delivery, in addition the rate of preterm births and low birthweight newborns. Of 38,151 newborns, 3,455 (9.1%) had mothers with ARID during pregnancy which were differentiated according to six manifestations from sinusitis to the pneumonia. Mothers with ARID in pregnancy had a longer (0.3 week) gestational age at delivery (adjusted t = 5.4; p < 0.0001) and a lower rate of preterm births (6.7% vs. 9.4%) [adjusted odds ratio (OR) with 95% confidence interval (CI): 0.72, 0.63–0.83] than mothers without ARID. However, severe ARID (bronchitis–bronchiolitis and particularly pneumonia) associated with a higher rate of preterm births (13.0%, adjusted OR with 95% CI: 1.4, 1.1–1.8), while mild ARID (sinusitis, pharyngitis, tonsillitis, laryngitis–tracheitis) resulted in a lower rate of preterm births (5.5%, adjusted OR with 95% CI: 0.5, 0.4–0.7). In conclusion, there was an obvious correlation between severity of ARID in pregnant women and rate of preterm births.     

Pooled analysis of two case–control studies on use of cellular and cordless telephones and the risk for malignant brain tumours diagnosed in 1997–2003

Objectives: To study the use of cellular and cordless telephones and the risk for malignant brain tumours. Methods: Two case–control studies on malignant brain tumours diagnosed during 1997–2003 included answers from 905 (90%) cases and 2,162 (89%) controls aged 20–80 years. We present pooled analysis of the results in the two studies. Results: Cumulative lifetime use for >2,000 h yielded for analogue cellular phones odds ratio (OR)=5.9, 95% confidence interval (CI)=2.5–14, digital cellular phones OR=3.7, 95% CI=1.7–7.7, and for cordless phones OR=2.3, 95% CI=1.5–3.6. Ipsilateral exposure increased the risk for malignant brain tumours; analogue OR=2.1, 95% CI=1.5–2.9, digital OR=1.8, 95% CI=1.4–2.4, and cordless OR=1.7, 95% CI=1.3–2.2. For high-grade astrocytoma using >10 year latency period analogue phones yielded OR=2.7, 95% CI=1.8–4.2, digital phones OR=3.8, 95% CI=1.8–8.1, and cordless phones OR=2.2, 95% CI=1.3–3.9. In the multivariate analysis all phone types increased the risk. Regarding digital phones OR=3.7, 95% CI=1.5–9.1 and cordless phones OR=2.1, 95% CI=0.97–4.6 were calculated for malignant brain tumours for subjects with first use use <20 years of age, higher than in older persons. Conclusion: Increased risk was obtained for both cellular and cordless phones, highest in the group with >10 years latency period.     

Self-Reported Moisture or Mildew in the Homes of Head Start Children with Asthma is Associated with Greater Asthma Morbidity

This study used results from a cross-sectional survey of parents of 3- to 5-year-old children with asthma to assess the frequency of self-reported home environmental conditions that could contribute to worsening asthma and examined the relationship between these factors and the child's asthma morbidity. Participants were 149 parents drawn from the two largest agencies that provide subsidized preschool childcare services in East and Central Harlem, inner-city communities with high prevalence of asthma. The sample represented 77% of eligibles determined by a validated case-identification instrument. Data were collected on demographics, symptoms, medication use, Emergency Department visits and hospitalization, and environmental conditions in the home. One or more of these home environmental conditions were reported by 92% of participants. Controlling for other environmental conditions and demographics, associations were found between self-reported presence of moisture or mildew on ceilings, walls, or windows and higher frequency of hospitalizations for breathing-related problems (OR = 3.31; 95% CI 1.62–6.75), frequent episodes of wheezing (OR = 3.25; 95% CI 1.8–6.0), and higher frequency of night symptoms due to asthma (OR = 2.19; 95% CI 1.4–3.41). Having a carpet or rug in the child's bedroom or the living room was also associated with hospitalizations (OR = 3.23; 95% CI 1.53–6.8), and male gender was marginally associated with the frequency of night symptoms (OR = 1.51; 95% CI .95–2.4). Asthma is prevalent in the Head Start population, and exposure to home environmental conditions that may worsen asthma is common in the socially disadvantaged populations served by Head Start programs. Drs. Bonner PhD, Matte and Fagan and Ms. Andreopoulus are with the Center for Urban Epidemiologic Studies (CUES) of the New York Academy of Medicine.     

A new measurement for optimal antenatal care: determinants and outcomes in Cameroon

A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28–2.36), greater wealth (OR 2.31; 95% CI 1.73–3.1), urban residence (OR 1.42; 95% CI 1.12–1.82) and parity of 3–4 (OR 0.79; 95% CI 0.62–0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42–3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49–2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11–2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country’s development in maternal health.     

Increased risk of infection in patients with diabetes mellitus type 1 or 2

OBJECTIVE: To determine the risk of common infections in patients with diabetes mellitus type 1 (DM1) or type 2 (DM2). DESIGN: Prospective controlled study. METHODS: In a 12-month prospective cohort study as part of the Second Dutch National Survey of General Practice, 705 adult DM1 and 6,712 DM2 patients were compared with 18,911 control patients who had hypertension without diabetes. Outcome measures were medically-attended episodes of infections of the respiratory tract, urinary tract, skin and mucous membranes. Multivariate and multinomial logistic regression analysis was applied to determine independent risks of infections and their recurrence in patients with diabetes compared to controls. RESULTS: Upper respiratory-tract infections were as common in diabetes patients as in controls. Diabetes patients had a higher risk of lower respiratory-tract infections (DM2: odds ratio (OR): 1.30; 95% CI: 1.11-1.52), urinary-tract infections (DM1: OR: 1.56; 95% CI: 1.13-2.15; DM2: OR: 1.21; 95% CI: 1.07-1.38), bacterial skin or mucous-membrane infections (DM1: OR: 1.48; 95% CI: 1.01-2.15; DM2: OR: 1.32; 95% CI: 1.13-1.55) and mycotic skin or mucous-membrane infections (DM2: OR: 1.41; 95% CI: 1.24-1.61). The risk of recurrence of these common infections was seen to be increased. CONCLUSIONS: Patients with type-1 and type-2 diabetes are at increased risk of lower respiratory-tract infections, urinary-tract infections and skin or mucous-membrane infections.     

Prognostic factors for serious morbidity and mortality from community-acquired lower respiratory tract infections among the elderly in primary care

BACKGROUND: Uncertainty about the prognosis of lower respiratory tract infections (LRTI) hinders optimal management in primary care. OBJECTIVE: We determined prognostic factors for a severe complicated course of LRTI among elderly patients in primary care. METHODS: In a retrospective clinical database study we examined 455 patients with a first LRTI episode; 226 with physician-diagnosed acute bronchitis or lung exacerbations and 229 with pneumonia. Multivariate logistic regression analysis was used to assess independent associations of the potential predictors with the endpoint. RESULTS: Occurrence of the combined endpoint 30-day home-treated complications from LRTI (4.4%) or hospitalisation (4.6%), or all-cause mortality (5.3%) was 14.3%. In a logistic regression model, increasing age [odds ratio (OR) 1.04; 95% confidence interval (95% CI) 1.00-1.08], male sex (OR 3.12; 95% CI 1.66-5.87), heart failure (OR 5.14; 95% CI 2.33-11.34), stroke or dementia (OR 3.36; 95% CI 1.18-9.58), use of antidepressants or benzodiazepines (OR 1.89; 95% CI 1.02-3.52) and a diagnosis of pneumonia (OR 4.24; 95% CI 2.17-8.28) were independent predictors. CONCLUSION: GPs need to be aware of readily available prognostic factors that can be used in primary care to complement physical examination and laboratory data in LRTI to guide preventive and therapeutic management decisions.     

Education,income, occupational status and health risk behaviour

Aim Socio-economic status is associated with a variety of health-related behaviours. In our study, we determined the independent effects of income, educational attainment and occupational status on overweight, smoking and physical activity in the German population. Subjects and methods The German National Health Interview and Examination Survey is a representative sample of the German adult population and includes 7,124 men and women. Prevalences of obesity, smoking and physical inactivity stratified for education, income and occupational status were calculated. Multiple logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for education, income, occupational status and health-related behaviour, adjusted for age and gender. Results Health risk behaviours were more prevalent in subjects with lower education, income or occupational status. After mutual adjustment, education, income and occupation were independently associated with physical inactivity. Low education was strongly associated with both obesity (OR: 2.58, 95% CI: 1.99–3.34) and smoking (OR: 2.09, 95% CI: 1.71–2.54). Low income was associated with smoking (OR: 1.40, 95% CI: 1.07–1.83), but not with obesity, and low occupational status was associated with obesity (OR: 1.42, 95% CI: 1.05–1.92), but not with smoking. High income or occupation could not compensate for the impact of low education on obesity and smoking. Conclusion Low socio-economic status is associated with health risk behaviours. Concerning obesity and smoking, education was more important than income or occupational status. Public health programmes to reduce these risk factors should focus on early-life health education.     

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

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