Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study in the international clinical epidemiology network (INCLEN)

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables.

Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35–65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country.

For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the “Developed” World.

The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World. As this happens, knowledge of the patterns of association between risk and socio-economic status is likely to be important in both understanding the reasons for the patterns of disease and directing efforts at prevention.     

Risk of Respiratory Cancer around a Sewage Plant in Prato,Italy

In this study, the authors evaluated the risk of respiratory cancer related to environmental pollutants among a population that resided near a sewage plant in Prato, Italy. Subjects included lung cancer deaths (1987-1996) and incident cases of lung and laryngeal cancers (1987-1994) among residents of Prato. The authors used the mortality or incidence rates for the entire population of Prato (by gender and by 5-yr age group) to calculate the expected cases in each census unit. Data were analyzed and adjusted for an index of social deprivation (Stone test). Among males, the excess risk of lung cancer mortality decreased as distance from the plant increased for 2 time periods (1987-1996 [p = .008] and 1990-1996 [p = .030]) and for lung cancer incidence during 1987-1994 (p = .011). Similar results were obtained when sewage plant workers were excluded from the analysis. A similar, but not statistically significant, trend was observed among female incident lung cancer cases, as well as among male incident laryngeal cancer cases. Despite methodological limitations common to geographic studies, the results were consistent with those previously published on mortality excesses for lung cancer among plant workers under study. The role of environmental pollutants as a risk for respiratory cancer must be further clarified with additional epidemiological studies and an environmental monitoring program.     

Cardiovascular risk factors and hyperinsulinemia in elderly men: The Honolulu Heart Program

Associations of cardiovascular risk factors, including several measures of adiposity, with hyperinsulinemia were assessed in 3562 elderly (71 to 93 years of age) Japanese American men from the Honolulu Heart Program who were examined between 1991 and 1993. In addition, cardiovascular risk factors measured 25 years earlier were also examined in relation to hyperinsulinemia. Hyperinsulinemia was defined as fasting insulin 95th percentile (20 μU/mL) among the subset of subjects (n = 504) who were nonobese and free of clinical diabetes and glucose intolerance. When this definition was applied to the entire population, the prevalence of hyperinsulinemia declined cross-sectionally with age (P < 0.001) from 24.2% in men aged 71 to 74 years to 16.4% in men aged 85 to 93 years. Factors having a positive and independent association with hyperinsulinemia included body mass index (BMI), triglycerides, glucose, hematocrit, use of diabetic medication, heart rate, and hypertension. The association with physical activity was negative. Triglycerides, BMI, diabetic medication, hypertension, and smoking levels measured 25 years earlier were also associated independently with hyperinsulinemia. Associations were similar in nondiabetic subjects. Three measures of adiposity (BMI, waist circumference, and subscapular skinfold thickness) were independently related to hyperinsulinemia cross-sectionally. However, associations involving a difference between the 80th and 20th percentiles in each adiposity measure appeared strongest for BMI (odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.7 to 5.6) and waist circumference (OR = 4.1, 95% CI = 3.3–5.1) and slightly weaker for subscapular skinfold thickness (OR = 2.1, 95% CI = 1.8–2.5). These findings suggest that features of an insulin resistance syndrome including dyslipidemia, glucose intolerance, hypertension, and obesity, assessed both cross-sectionally and 25 years previously, are associated independently with hyperinsulinemia in elderly Japanese American men.     

The Contribution of Subsistence Foods to the Total Diet of Alaska Natives in 13 Rural Communities

The goal of this study was to describe the use of subsistence and purchased foods by residents of rural Alaska villages. Interviewers administered food frequency questionnaires referring to the previous 12 months to 665 participants between the ages of 13 and 88 years in 13 villages in three ecological zones of Alaska. Participants reported consuming a wide variety of subsistence foods, in some cases in large quantities, including salmon, other fish, moose, caribou, and a wide variety of plant foods. Subsistence foods were dense in protein, iron, vitamin A, vitamin B12, and omega-3 fatty acids. Participants also reported consuming purchased staples and sugared beverages.     

Machine-related occupational injuries in farm residents

Farm machinery is an important contributor to the high rates of occupational injury in agriculture. As part of a population-based case-control study, we studied risk factors for machine-related farm injuries. Case patients were farm residents residing in a geographically defined area of central Wisconsin who experienced a farm injury associated with a tractor, farm implement, or other machine which required medical or chiropractic care from May 1990 through April 1992. Controls were selected from an ad hoc census of farm residents in the same area. Telephone interviews regarding demographic characteristics, safety behaviors, and farming practices were completed for 97.8% of 90 case patients and for 82.8% of 221 control subjects. Personal characteristics significantly associated with an increased risk of machine-related injury included the number of hours worked per week and working primarily as a farmer. Dairy farms, farms with nonresident workers, and large farms were associated with an increased risk of injury while farms with registered cows and farms where cows were fed in the barn even in summer experienced fewer injuries. Based on a logistic regression model, the independent risk factors for machine-related farm injury included hours worked per week (2% increased risk/ nonresident workers on farm (odds ratio) (OR) = 2.32; 95% confidence interval (CI): 1.07 to 5.06), cows fed in barn in summer (OR = 0.28; 95% CI: 0.12 to 0.64), and registered cows on farm (OR = 0.36; 95% CI: 0.17 to 0.79). Farm safety practices did not appreciably influence the risk of machine-related farm injury.     

Comparison of HHV-6 antibody titers in West Africa and the Caribbean

Human herpesvirus-6 (HHV-6) infection seems to be ubiquitous early in life, but antibody responses vary by geographic area. We compared HHV-6 antibody titer in 123 West African and 122 Caribbean serum samples. A quantitative immunofluorescence assay (IFA) using antigens derived from an HSB-2 cell line was used to test for IgG HHV-6 (GS strain) antibodies. The prevalence of HHV-6 antibodies was high (98%) in both sites. African samples had a significantly higher geometric mean titer (GMT: 697) than did Caribbean samples (GMT: 99). There was no difference between males (GMT: 260) and females (GMT: 270) overall. Children up to and including 9 years old had significantly higher titers (GMT: 483) than did all others (GMT: 237), and female children tended to have higher titers than did male children. In both areas there was a trend towards highest titer at younger age, followed by a decrease in titer during adulthood and middle age, and a secondary rise in titer in the oldest age group. Environmental and host factors may explain these geographic differences in antibody responses between two groups of African origin.     

Residential Radon and Risk of Lung Cancer in an Italian Alpine Area

To evaluate whether residential radon exposure explains the excess mortality for lung cancer in an Italian alpine valley with high natural radioactivity, the authors conducted a population-based case-control study on 138 deceased cases and 291 sex- and year-of-birth-matched controls. Year-long alpha-track measurements of radon were performed in the most recent residence, and information about occupational history and lifetime smoking habits was obtained. The authors adjusted for smoking, and radon was associated with lung cancer risk among men: compared with a radon level of < 40 becquerels (Bq) per cubic meter (m³), the odds ratios for 40–76 Bq/m³, 77–139 Bq/m³, 140–199 Bq/m³, and 200+ Bq/m³ were 2.1, 2.0, 2.7, and 1.4, respectively. The association between radon and lung cancer, as determined with a multiplicative model, was found only among male smokers.     

沙颍河沿岸不同水质地区居民恶性肿瘤死亡率比较

[目的]比较沙颍（以下简称“SY”）河污染区及对照区居民恶性肿瘤死亡率,探索环境污染对恶性肿瘤发病率可能存在的影响。[方法]在sY河流经的某县境内,依据该县以往水质监测报告数据,对报告进行分析后,设定水质状况较好的某乡镇为对照区,较差的某乡镇为污染区,运用全国第三次死因回顾调查方法,对2007-2009年间两区人群死亡状况进行调查。[结果]污染区恶性肿瘤标化死亡率为178．7／10万,高于对照区109．5／10万（X^2=30．906,P=0．000）。两区男性肿瘤发病率高于女性。污染区居民肺癌、肝癌、直肠癌死亡率均高于对照区（分别为X^2=15．645,P=0．000;X^2=10．582,P=0．001;X^2==4．321,P=0．038）。0-及20-年龄组的肿瘤死亡率差异无统计学意义,55～年龄组污染区肿瘤死亡率高于对照区（X^2=38．992,P=0．000）。[结论]SY河污染可能致使当地居民恶性肿瘤死亡率升高。     

Is there a relationship between proximity to industry and the occurrence of otitis media with effusion in school entrant children?

In a study of the relationship between the prevalence of persistent otitis media with effusion (OME) in school entrant children in Redcar and Cleveland and the distance of the homes of these children from known industrial emission points, 1156 school entrant children were screened for the presence of persistent OME. The social disadvantage scores and map references were determined from the postcode area of each of the study entrants and map references were also obtained of known industrial emission points in the locality. Analyses were conducted on the association between the presence of OME and distance from emission sources and between the presence of OME and disadvantage score. A significantly greater proportion of study entrants with OME lived within 1000 metres of an industrial emission point than further away. However, there was no trend established between the proportion of study entrants with OME and increasing distance from an emissions source, nor was there any significant relationship established between the social disadvantage score of the areas of residence of the study entrants and the presence of OME. Further research is required to establish the effect of confounding variables on this relationship.     

Environmental carcinogen releases and lung cancer mortality in rural-urban areas of the United States

Purpose: Environmental hazards are unevenly distributed across communities and populations; however, little is known about the distribution of environmental carcinogenic pollutants and lung cancer risk across populations defined by race, sex, and rural‐urban setting. Methods: We used the Toxics Release Inventory (TRI) database to conduct an ecological study at the county level (a total of 3,141 counties). Multiple linear regressions were used to assess the associations of carcinogenic discharges from TRI sites and lung cancer mortality rates at the county level in the United States during the years 1990 through 2007. Findings: We observed an excess risk of population lung cancer mortality associated with higher amounts of environmental carcinogen releases from TRI facilities in both males and females, and in both whites and African Americans. The strength of these associations tended to be stronger in African Americans. A significant dose‐response relationship was observed for the total volume of carcinogen releases or carcinogen releases to the air, but not releases to water. These associations appeared to be present within nonmetropolitan counties but not metropolitan counties, and to be concentrated in certain urban‐rural county typologies. Conclusions: Our results suggest that exposure to higher carcinogen releases from industrial or chemical facilities in rural areas may increase the risk of lung cancer mortality. Our findings add to the evidence for undertaking prudent efforts to limit the release of carcinogenic chemicals into the environment.     

Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestation

The effectiveness of oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration was compared in women in the 6th to 12th week of pregnancy. Sixty-four nulliparous women requesting termination of pregnancy between 6th to 12th weeks of gestation were randomized to receive either 400 μg misoprostol orally or 1 mg vaginal gemeprost at 12 hr or 3 hr prior to vacuum aspiration, respectively. The cervical dilatation at vacuum aspiration, the ease of the subsequent surgical procedure, and the incidence of complications and side effects were compared between these two methods of cervical priming. The median cervical dilatation at vacuum aspiration in the misoprostol group was significantly greater than that in the gemeprost group (8.0 mm versus 7.0 mm, p<0.02). Preoperative side effects were significantly less frequent in the misoprostol group (p<0.01). The ease of dilatation assessed subjectively by the operating surgeons was also improved significantly in the misoprostol group (p<0.01). However, the duration of operation and blood loss were similar in both groups. Since misoprostol is also much cheaper and more convenient to use, we conclude that oral misoprostol is better than vaginal gemeprost for cervical dilatation prior to vacuum aspiration in first trimester pregnancy.     

A Standard Tool for the Analysis of Occupational Lung Cancer in Epidemiologic Studies

Abstract

A standard tool for the analysis of known and suspected causes of occupational lung cancer in population-based studies is proposed in order to allow comparable definitions of exposure or of categorizations of occupations. It is based on a list of occupations and industries known (list A) or suspected (list B) to be associated with lung cancer. The lists were translated into codes of the International Standard Classification of Occupations (1968) and the International Standard Industrial Classification (1971). The specificity of the categorization is compromised for some groups that are defined by highly specific production processes or exposures. Nevertheless, the grouping is based on a highly valid source of information in population-based studies. It is proposed for use in the assessment of the public health impact of occupational lung cancer.     

Infant feeding patterns during the first year of life in Denmark: Factors associated with the discontinuation of breast-feeding

We prospectively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, over the first 12 months of life using a detailed monthly mailed questionnaire (overall response RATE = 73%) which focused on feeding practices and illnesses. Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19% at 12 months of life. Analysis of breast-feeding behavior using survival analysis showed that 50% of the mothers who breast-fed since the first month of their infant's life were still breast-feeding at 7 months of life. Also, there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare (RR = 2.08, 95% CI = 1.43, 3.01). Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class.

These results give insight into infant feeding patterns in a developed country and suggest that: (1) breast-feeding is the dominant method of feeding during the infant's first year of life, and (2) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare.     

A study of the self-perception of being overweight in adult inhabitants of cracow

The self-assessment of body weight (normal vs overweight) reported in an interview in a group of 783 men and 1085 women aged 32–83, was compared with weight and height measurements taken a few days after the interview. Among subjects with body mass indices revealing excess weight (over 27 kg/m² in men and 45 kg/m in women), 24% of men and 15% of women reported having normal body weight. The proportion of overweight persons unaware of their condition was related to age, smoking habit, education and physical activity. In men with hypertension, the proportion of subjects unaware of being overweight was smaller by 25% compared with others: This was not the case in women. A history of cardiovascular disease, diabetes, dyspnea or poor health status had no effect on the awareness of being overweight.     

2004-2013年保山市麻疹流行特征及 人群麻疹抗体水平分析

摘要:目的　分析2004-2013年保山市麻疹流行病学特征以及人群麻疹抗体水平,为消除麻疹提供理论依据。方法　收集麻疹网络监测系统数据以及整理历年档案进行描述性流行病学分析。2014年,采用多阶段随机抽样方法抽取我市1 948名人群进行个案调查和采集血标本,用酶联免疫吸附试验检测麻疹抗体。结果　2004-2013年,保山市麻疹病例共 403 例,麻疹平均发病率为1.70/10万,保山市麻疹病例主要集中在7岁以下儿童以及20岁以上农民人群,全市麻疹抗体阳性（≥250）率为94.82%,麻疹抗体保护（≥800）率为 70.12%。8～17月龄阳性率为88.05%、18～23月龄阳性率为97.39%、2～3岁阳性率为95.96%、4～5岁阳性率为94.51%、6～9岁阳性率为97.12%、10～13岁阳性率为96.76%、14～17岁阳性率为96.53%,≥18岁阳性率为91.80%,各年龄组间抗体阳性率差异有统计学意义（χ2＝35.317,P＜0.01）。结论　保山市麻疹疫情近年来有上升趋势,小年龄段儿童以及20岁以上农民人群是高危人群。需重点强化小年龄段儿童以及20岁以上农民人群的麻疹防控措施,防止麻疹疫情发生。     

Lung function, smoking and survival in severe alpha 1-antitrypsin deficiency, PiZZ

Lung function, smoking, age and mortality data in 158 adult severe alpha₁-antitrypsin deficient, PiZZ individuals, followed from 1963 to 1982 were analyzed. Low initial FEV₁ value was significantly associated with increased mortality (p < 0.005). A 3 yr mortality rate of 40% was found in individuals whose initial FEV₁ values were less than 30% of that predicted. In contrast, the corresponding 3-yr mortality among those whose initial FEV₁ values were between 30 and 65% of that predicted was only 7%. Smokers were found to have significantly lower FEV₁ levels (p = 0.008) and higher mortality (p < 0.005) than non-smokers. The difference between current and ex-smokers in mortality and FEV₁ level were not statistically significant (p = 0.9 and p>0.25, respectively). Cross-sectional analysis of the initial FEV₁ values indicated a significant decline (p < 0.005) of FEV₁ with increasing age. This decline was greater among smokers than non-smokers. Longitudinal analysis of FEV₁ rates of decline in 80 cases with follow-up FEV₁ measurements failed to detect any significant differences between smokers and non-smokers, but was performed late in the disease process. The application of these results to the planning of studies on replacement therapy, smoking intervention strategy and longitudinal follow-up is discussed.     

2006-2013年东营市人间布鲁氏菌病流行特征分析

摘要:目的　了解东营市布病疫情流行特征及其影响因素,为制定防控策略提供依据。方法　采取被动监测和主动监测的方法发现病例,采用血清试管凝集试验方法确诊病例,对高发区实施综合干预措施。结果　2006-2013年东营市报告布病病例300例,年均发病率为1.81/10万;疫区从2006年的1个乡镇扩大到2013年5个县区25个乡镇;2006-2009年病例以家畜屠宰及畜产品加工职业人群为主,无明显季节性;2010-2013年病例以饲养职业人群为主,在3-6月份呈现明显季节高峰;采取综合干预措施的地区病例“发病-诊断”时间较其他地区明显缩短。结论　东营市布病发病职业由屠宰加工转为饲养,疫情呈上升趋势,疫区扩大的原因与动物检疫、淘汰措施不到位有关,实施人群综合干预措施可使病人在发病早期及时得到治疗。