Development quality criteria to evaluate nontherapeutic studies of incidence, prevalence, or risk factors of chronic diseases: pilot study of new checklists

Objective

To develop two checklists for the quality of observational studies of incidence or risk factors of diseases.

Study Design and Setting

Initial development of the checklists was based on a systematic literature review. The checklists were refined after pilot trials of validity and reliability were conducted by seven experts, who tested the checklists on 10 articles.

Results

The checklist for studies of incidence or prevalence of chronic disease had six criteria for external validity and five for internal validity. The checklist for risk factor studies had six criteria for external validity, 13 criteria for internal validity, and two aspects of causality. A Microsoft Access database produced automated standardized reports about external and internal validities. Pilot testing demonstrated face and content validities and discrimination of reporting vs. methodological qualities. Interrater agreement was poor. The experts suggested future reliability testing of the checklists in systematic reviews with preplanned protocols, a priori consensus about research-specific quality criteria, and training of the reviewers.

Conclusion

We propose transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence.     

The influence of a behavioral weight management program on disordered eating attitudes and behaviors in children with overweight

Background

Behavioral interventions targeting children with overweight have been successful in facilitating weight loss; however, there is concern that these programs produce disordered eating attitudes among youth.

Objective

The purpose of this research was to determine whether youth with overweight receiving one of two behavioral interventions were more likely to report an increase in disordered eating attitudes over time compared to a waitlist control and to determine psychosocial predictors of eating-disordered attitudes at 6-month follow-up.

Design

Participants were randomized to one of two behavioral lifestyle interventions or a waitlist control. Data were collected at baseline, post-treatment, and 6-month follow-up.

Participants/setting

Participants were 68 youths with overweight, aged 8 to 13 years, and their parent(s) who lived in rural north central Florida. The project ran from January 2006 to January 2008.

Intervention

Each treatment condition consisted of 12 group sessions over 16 weeks.

Main outcome measures

Parents completed a demographic form and the Child Feeding Questionnaire. Children completed the Children's Eating Attitudes Test, Schwartz Peer Victimization Scale, and Children's Body Image Scale.

Statistical analyses performed

Mixed 2×2 analyses of variance were used to examine the effect of treatment on eating attitudes. Hierarchical linear regression was used to assess whether baseline levels of psychosocial variables predicted disordered eating attitudes at follow-up, controlling for baseline eating attitudes and treatment condition.

Results

Youth who participated in the behavioral interventions did not report significant increases in disordered eating attitudes over time compared to the waitlist control. Across all conditions, higher levels of body dissatisfaction, peer victimization, parent restrictive feeding practices, and concern for child weight at baseline predicted higher levels of disordered eating attitudes at follow-up.

Conclusions

These findings do not provide evidence that behavioral interventions lead to an increase in unhealthy eating attitudes and behaviors. Future research should examine the effects of incorporating eating disorder prevention in pediatric weight management programs.     

Associations between Lifestyle Patterns and Body Mass Index in a Sample of Greek Children and Adolescents

Background

Although eating and physical activity behaviors have been previously individually investigated with regard to overweight in children, multidimensional lifestyle patterns, based on these behaviors, have not been explored.

Objective

To assess lifestyle patterns in relation to body mass index (BMI), in a nationally representative sample of the Greek pediatric population

Design

Cross-sectional study. Data were collected from May through July 2007.

Subjects

The sample consisted of 1,305 children and adolescents (ages 3 to 18 years).

Main outcome measures

Information on participants' dietary intake, eating behaviors, physical activity habits, and BMI were collected. Adherence to the Mediterranean diet guidelines was evaluated using the KIDMED Mediterranean diet quality index; the higher the score in this index the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake/basal metabolic rate were used to evaluate dietary low energy reporting and participants were accordingly classified as low-energy reporters.

Statistical analysis

Principal component analysis was performed to identify participants' lifestyle patterns. Associations between BMI and lifestyle patterns were further evaluated using multiple linear regression analyses, after controlling for potential confounders.

Results

Principal component analysis identified seven lifestyle patterns explaining 85% of the total variance of lifestyle habits. A lifestyle pattern characterized by higher eating frequency, breakfast consumption and higher KIDMED score was negatively associated with BMI (standardized β=−.125, P<0.001), after controlling for age, sex, and parental education. The association remained significant even when low-energy reporters were excluded from the analysis.

Conclusions

Results from the study suggest a potential intercorrelation and protective action of selected eating behaviors, namely eating frequency, breakfast consumption, and adherence to the Mediterranean diet, against overweight and obesity in children and adolescents.     

Microbiology of facial cellulitis related to dental infection

Objective

The study objective was to identify bacteria responsible for facial cellulitis of dental origin.

Design

Adult patients, admitted for facial cellulitis of dental origin were included. The pus sample was taken by swabbing during the surgical incision and drainage performed under general anesthesia. The bacteriological diagnosis was performed by microscopic examination and bacterial culture in aerobic and anaerobic atmosphere.

Results

Two hundred and seven bacterial species were isolated from 100 samplings, that is to say 2.07 bacterial species per sample. 19% of the samples contained only aerobic germs, 36% only anaerobic ones, and 45% contained mixed aerobic and anaerobic flora. Streptococcus (65.38%) and Capnocytophaga (11.54%) were the most frequently isolated aerobic bacteria. The anaerobic bacteria accounted for 62.32% of isolates and the most frequently isolated were Prevotella (55%) and Fusobacterium (16.28%). Bacterial species were not significantly different according to the age (P-value = 0.06) and sex (P-value = 0.584). There was a significant statistical association between aerobic or anaerobic bacteria and clinical symptoms such as cheek edema (P-value = 0.03) and pus at tooth root (P-value = 0.02). Patients previously treated by antibiotic therapy presented significantly more infections due to the same respiratory germ type (P-value = 0.009).

Conclusions

Even though the bacterial flora responsible for facial cellulitis of dental origin is polymorphic, anaerobic bacteria were predominant.     

Real-world effectiveness of a German school-based intervention for primary prevention of anorexia nervosa in preadolescent girls

Objective

Anorexia nervosa (‘AN’) is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program (‘PriMa’) for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls.

Method

Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n = 1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge.

Results

After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d = .24) and body self esteem (d = .29), but not for eating behavior.

Conclusion

The PriMa intervention provides an efficient and practical model to increase AN-related protection factors.     

Vaccination coverage of healthcare professionals in an infectious diseases department

Objectives

The study's objective was to evaluate with a standardized questionnaire the knowledge of healthcare workers (HCWs) regarding occupational vaccinations and their vaccination coverage.

Population and Methods

This cross-sectional survey was conducted in the department of infectious diseases of a 1796 bed-teaching hospital in Dijon, France.

Results

Fifty-seven (93%) out of 61 HCPs completed the questionnaire. Vaccination against HVB was the most frequently mentioned vaccination (79%), followed by BCG (66%), and combine vaccine against diphteria, tetanus, and polio (DTP) (66 %). Influenza was the most often quoted among recommended vaccinations (70%), followed by measles (61%), pertussis (39%), and varicella (14%). The number of correct answers was significantly correlated with age of participants, being a physician, and having had courses on vaccination. Almost all HCPs were up to date for mandatory vaccinations. In 2009 to 2010, vaccination rates against seasonal flu and H1N1 flu reached 88%. Only 52% of HCPs knew about their pertussis immunization and only a third of those born before 1980 had been tested for measles.

Conclusions

HCPs knowledge of mandatory vaccinations is adequate but more limited for recommended vaccinations. Information on influenza vaccination has significantly improved its perception among HCPs resulting in a better adhesion to vaccination.     

The Relationship of Ready-to-Eat Cereal Consumption to Nutrient Intake, Blood Lipids, and Body Mass Index of Children as They Age through Adolescence

Objective

To examine sex differences and longitudinal changes in ready-to-eat (RTE) cereal and breakfast consumption in the Dietary Intervention Study in Children, and the relationship between RTE cereal intake with nutrient intake, blood lipids, and body mass index (BMI).

Design

Secondary analyses based on data from Dietary Intervention Study in Children, a randomized, controlled, multicenter, clinical trial with five sets of three 24-hour recalls.

Subjects/setting

Children (n=660) from six clinics aged 8 to 10 years at study entry. Participants had serum low-density lipoprotein cholesterol levels between the 80th and 98th percentiles for age, and were followed for a mean of 7.5 years.

Intervention

Children were randomized to a total fat- and saturated fat-modified dietary intervention or usual care.

Statistical analyses

Frequency of RTE cereal and breakfast consumption was examined by sex and age. Mixed models by sex were used to examine the relationship of RTE cereal consumption to average daily intake of nutrients, blood lipids, and BMI.

Results

For all children, RTE cereal and breakfast consumption declined with age. Boys consumed RTE cereal more often compared with girls. Except for energy, RTE cereal consumption was positively associated with all measures of nutrients for both sexes. In boys, higher RTE cereal consumption was associated with lower total and low-density lipoprotein cholesterol levels and lower BMI.

Conclusions

Food and nutrition professionals should continue to educate youth and their parents on the nutritional benefits of routinely eating RTE cereal.     

Effects of Food Form and Timing of Ingestion on Appetite and Energy Intake in Lean Young Adults and in Young Adults with Obesity

Objective

Overweight and obesity have been attributed to increased eating frequency and the size of eating events. This study explored the influence of the timing of eating events and food form on appetite and daily energy intake.

Design

Crossover, clinical intervention where participants consumed 300-kcal loads of a solid (apple), semisolid (apple sauce), and beverage (apple juice) at a meal or 2 hours later (snack).

Subjects

Twenty normal-weight (body mass index 22.6±1.8) and 20 obese (body mass index 32.3±1.5) adults. There were 10 men and 10 women within each body mass index group.

Measurements

On six occasions, participants reported to the laboratory at their customary midday mealtime. Appetite questionnaires and motor skills tests were completed upon arrival and at 30-minute intervals for the 2 hours participants were in the laboratory and at 30-minute intervals for 4 hours after leaving the laboratory. Diet recalls were collected the next day. Data were collected between January 2006 and March 2007.

Results

Whether consumed with a meal or alone as a snack, the beverage elicited the weakest appetitive response, the solid food form elicited the strongest appetitive response and the semisolid response was intermediate. The appetite shift was greatest for the solid food when consumed as a snack. The interval between test food consumption and the first spontaneous eating event >100 kcal was shortest for the beverage. No significant treatment effects were observed for test day energy intake or between lean individuals and individuals with obesity.

Conclusions

Based on the appetitive findings, consumption of an energy-yielding beverage either with a meal or as a snack poses a greater risk for promoting positive energy than macronutrient-matched semisolid or solid foods consumed at these times.     

Health-At-Every-Size and Eating Behaviors: 1-Year Follow-Up Results of a Size Acceptance Intervention

Background

Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches.

Objective

To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention.

Design

Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006.

Participants/setting

Premenopausal overweight/obese women (n=144; mean age of 42.3±5.6 years), recruited from free-living, general community.

Intervention

Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48).

Main outcome measures

Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost ≥1.2 kcal×kg⁻¹×15 minutes⁻¹ [≥4.8 metabolic equivalents]).

Statistical analyses performed

Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design.

Results

Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (−0.9±0.2 and −1.3±0.5, respectively) and the social support group (−0.4± 0.2 and −1.4±0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5±0.2 in HAES group vs 2.7 ± 0.2 in social support group; susceptibility to hunger: 4.2±0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3±0.2 for situational susceptibility to disinhibition and 5.9±0.5 for susceptibility to hunger).

Conclusions

These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention.     

Weight Control Behaviors and Dietary Intake among Adolescents and Young Adults: Longitudinal Findings from Project EAT

Background

Cross-sectional research has found that dieting during adolesence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships.

Objective

To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults.

Design

Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004.

Subjects/setting

The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2.

Outcome measures and statistical analyses performed

Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting).

Results

Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior.

Conclusions

Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals.     

Defense mechanisms and perceived adverse effects in a population of 70 HIV infected adults

Objective

We assessed the relations between defense mechanisms and perceived adverse effects of ART in a population of 70 HIV positive patients.

Design

The Bond Defense Style questionnaire was used to evaluate defense mechanisms. We used Justice's questionnaire to assess adverse effects and their psychological impact. We carried out multiple regression and mediation analyses to define the relations between the number of adverse effects, defensive styles, and the impact of adverse effects.

Results

The global model accounts for nearly 40 % of the score variance. Mature and immature defense styles bring significant contribution to understanding the impact of adverse effects, even when their number is controlled.

Conclusion

Working on defense mechanisms should lower the psychological impact of adverse effects, therefore, improving the patient's quality of life and compliance.     

Text message reminders to promote human papillomavirus vaccination

Objective

To implement and evaluate text message reminders for the second (HPV2) and third (HPV3) vaccine doses.

Design

Site-based intervention.

Setting

Nine pediatric sites (5 academic and 4 private) located in New York City.

Participants

Parents of adolescents 9-20 years who received HPV1 or HPV2 during the intervention period, January-June 2009.

Intervention

Parents who enrolled received up to three weekly text message reminders that their daughter was due for her next vaccine dose.

Outcome measure

On-time receipt of the next vaccine dose, within one month of its due date.

Results

During the intervention period, of 765 eligible HPV vaccine events, 434 enrollment instructions were distributed to parents (56.7% of doses). Parents of 124 adolescent girls (28.6% of those handed instructions) activated text message reminders. Comparing children of parents who enrolled versus those who did not, on-time receipt of next HPV vaccine dose occurred among 51.6% (95% CI 42.8-60.4%) versus 35.0% (95% CI 29.6-40.2%) of adolescents (p = .001). Similarly, among a historical cohort of adolescents, receiving HPV1 or HPV2 in the six months prior to the intervention period, on-time receipt of next vaccine dose was noted for 38.1% (95% CI 35.2-41.0%) (p = .003). Increases in receipt of next vaccine dose among intervention subjects were sustained at 4 months following the vaccine due date. Using a logistic regression model, after controlling for insurance and site of care, intervention subjects were significantly more likely than either control population to receive their next HPV vaccine dose on-time.

Conclusion

Among those choosing to enroll, text message reminders were an effective intervention to increase on-time receipt of HPV2 or HPV3.     

Cluster Analysis Defines Distinct Dietary Patterns for African-American Men and Women

Background

African Americans have a higher prevalence of diet-related chronic diseases than the general US population. Recent evidence suggests that examining dietary patterns rather than specific nutrients may better allow public health professionals to translate national dietary goals into practical dietary recommendations that are culturally relevant and sex-specific.

Objective

To examine and characterize the dietary patterns of African-American men and women using cluster analysis.

Design

Participants older than the age of 18 years were recruited from a variety of locations and completed a self-administered questionnaire.

Subjects/setting

Seven-hundred sixty-three African-American men and women in North Central Florida.

Statistical analyses performed

Cluster analysis was done with the VARCLUS procedure and Ward's clustering approach in the Statistical Analysis System program. The pseudo-t² statistic was then used to identify the optimal numbers of clusters of men and women with distinctive food-consumption patterns.

Results

Cluster analyses identified six clusters of men with 13 distinctive dietary patterns and six clusters of women with 15 distinctive dietary patterns. Pairwise comparisons of group means indicated notable differences in intakes between clusters of women in all but two food clusters. Pairwise comparisons of group means indicated notable differences in intakes between clusters of men in all but two food clusters.

Conclusions

The study illustrated that cluster analysis can be used to identify groups of African Americans with unique patterns of food consumption. They also suggest that a single “typical” eating pattern does not exist for African Americans and that dietary pattern vary by sex.     

The association between use of spermicides or male condoms and major structural birth defects

Background

Women may become pregnant while using contraceptives. Commonly used contraceptives containing spermicides may or may not be associated with an increased occurrence of structural birth defects.

Study Design

Utilizing data from the National Birth Defects Prevention Study, we assessed maternal reports of spermicide and male condom use 1 to 3 months following conception among case (n=11,050) and control (n=4723) mothers. We assessed the association between spermicide use and 27 types of birth defects and that between condom use and 32 types of birth defects.

Results

Maternal spermicide use during the first 3 months following conception was associated with a significant increase in the occurrence of only 1 of 27 birth defects, perimembranous ventricular septal defects (adjusted odds ratio=2.40, 95% confidence interval=1.25-4.62). There was no significant association between maternal use of male condoms during the first 3 months following conception and any of 32 types of birth defects.

Conclusions

The increased occurrence of perimembranous ventricular septal defects among spermicide users may be real or may be a chance finding. Overall, the findings are consistent with those of most previous studies that observed no increased risk for birth defects among spermicide users.     

Adolescent and Young Adult Vegetarianism: Better Dietary Intake and Weight Outcomes but Increased Risk of Disordered Eating Behaviors

Objective

Examine characteristics of current and former adolescent and young adult vegetarians and investigate the relationships between vegetarianism, weight, dietary intake, and weight-control behaviors.

Design

Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT-II: Eating Among Teens).

Setting

Participants completed a mailed survey and food frequency questionnaire in 2004.

Participants

Males and females (n=2,516), ages 15-23 years.

Main outcome measures

Weight status, dietary intake (fruit, vegetables, fat, calories), unhealthful weight-control behaviors.

Analysis

Multiple regression models controlling for socioeconomic status and sex were used to test for significant differences between current, former, and never vegetarians within the younger and older cohort.

Results

Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Current vegetarians in the younger and older cohorts had healthier dietary intakes than nonvegetarians with regard to fruits, vegetables, and fat. Among young adults, current vegetarians were less likely than never vegetarians to be overweight or obese. Adolescent and young adult current vegetarians were more likely to report binge eating with loss of control when compared to nonvegetarians. Among adolescents, former vegetarians were more likely than never vegetarians to engage in extreme unhealthful weight-control behaviors. Among young adults, former vegetarians were more likely than current and never vegetarians to engage in extreme unhealthful weight-control behaviors.

Conclusions and implications

Adolescent and young adult vegetarians may experience the health benefits associated with increased fruit and vegetable intake and young adults may experience the added benefit of decreased risk for overweight and obesity. However, current vegetarians may be at increased risk for binge eating with loss of control, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors. It would be beneficial for clinicians to inquire about current and former vegetarian status when assessing risk for disordered eating behaviors.     

Nibbling: frequency and relationship to BMI, pattern of eating, and shape, weight, and eating concerns among university women

Objective

Nibbling has been defined by the Eating Disorder Examination (EDE 16.0) as eating in an unplanned and repetitious manner between meals and snacks without an accompanying sense of loss of control. We investigated the nature and frequency of nibbling in young women.

Method

Fifty-eight university women aged 19-41 years with an average BMI of 22.8 (4.8) were administered the EDE-interview.

Results

Only 9% of women reported no nibbling during the preceding 28 days, 14% nibbled on 1-5 days; 40% on 6-12 days; 21% on 13-15 days and 17% nibbled on 16-28 days. Nibbling was not significantly related to BMI, frequency of meals, binge eating, dietary restraint, or shape, eating, or weight concerns. Significant inverse relationships were found between nibbling and food avoidance (−.27, p = .03) and sensitivity to weight gain (−.26; p = .04).

Discussion

Nibbling occurred frequently among young women but did not appear to have significant consequences for BMI, the overall pattern or eating, shape or weight concerns, or for any measured pathological eating behaviors.     

Making Time for Meals: Meal Structure and Associations with Dietary Intake in Young Adults

Background

Prior studies have found that family meals and other aspects of meal structure are associated with dietary intake during adolescence, but little research has characterized meals in young adulthood.

Objective

This study was designed to describe attitudes regarding the social nature of meals, time constraints on meals, and meal regularity in young adults. In addition, this study aimed to describe the sociodemographic characteristics of young adults who report eating dinner with others and “eating on the run,” and examine associations of these behaviors with meal attitudes and dietary intake.

Design

Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a Minnesota population-based study.

Subjects/setting

Mailed surveys and food frequency questionnaires were completed in 2003-2004 by 1,687 young adult (mean age=20.5 years; 44% male) participants.

Main outcomes measured and statistical analyses performed

χ² tests were calculated to examine differences in meal attitudes and behaviors according to sociodemographic characteristics. Relationships between meal attitudes and behaviors were explored using Spearman's correlation coefficients. Linear regression models adjusted for demographic characteristics were used to examine associations between meal behaviors and dietary intake variables.

Results

The majority of young adults reported they enjoy and value eating with others, but 35% of males and 42% of females reported lacking time to sit down and eat a meal. Eating dinner with others was significantly associated (P≤0.01) with several markers of better dietary intake, including higher intakes of fruit, vegetables, and dark-green and orange vegetables. Eating on the run was significantly associated (P<0.01) with higher intakes of soft drinks, fast food, total fat and saturated fat, and lower intake of several healthful foods.

Conclusions

Findings suggest that health services and programs for young adults should encourage taking the time to sit down for meals and to share meals with others.     

Cancer risk after sterilization with transcervical quinacrine: updated findings from a Chilean cohort

Background

Dating back to the 1970s, thousands of women worldwide have voluntarily been sterilized with transcervical insertion of quinacrine pellets. The safety and efficacy of the technology are still being assessed today; in particular, better estimates on the incidence of human cancers are now feasible.

Methods

We conducted a cohort study of 1492 women in Santiago and Valdivia, Chile, who received transcervical quinacrine pellets for contraceptive sterilization between l977 and l989. We periodically interviewed women with the last interviews in 2006-2007 and reviewed their medical records. We calculated age and site-specific incidence of invasive cancers and compared the observed cases to the number of expected cases based on data from the Cali, Colombia, cancer registry, gathered by the International Agency for Research on Cancer.

Results

During 23,894 person-years of follow-up, 41 invasive cancers were identified, including 16 new cases that had occurred since the previous analysis. Ten cases of cervical cancer were observed, compared with 12.1 expected. Since the initial study's confirmation of a single case of leiomyosarcoma, no other uterine cancers have been diagnosed. We would expect 2.0 uterine cancers during this number of observed women-years. One case of ovarian cancer was diagnosed, compared with 3.1 expected.

Conclusion

Rates of cancer among women exposed to intrauterine quinacrine are similar to population-based rates.     

Public perception and behavior change in relationship to hot weather and air pollution

Background

Changes in climate systems are increasing heat wave frequency and air stagnation, both conditions associated with exacerbating poor air quality and of considerable public health concern.

Objectives

Heat and air pollution advisory systems are in place in many cities for early detection and response to reduce health consequences, or severity of adverse conditions. Whereas the ability to forecast heat waves and/or air pollution episodes has become increasingly sophisticated and accurate, little is known about the effectiveness of advisories in altering public behavior.

Methods

Air quality and meteorological conditions were measured during advisory and control days in Portland, OR and Houston, TX in 2005 and 2006 and 1962 subjects were interviewed by telephone about their perception and response to these conditions.

Results

Elevated ambient temperatures were accurately recognized regardless of air conditioning use; in Portland, respondents resorted to active cooling behavior (AC, fan, etc.), while in Houston no such change was observed. More heat-related symptoms were reported in Portland compared to Houston, probably due to low air conditioning use in the northwest. One-third of study participants were aware of air quality advisories but only ∼10-15% claimed to have changed activities during such an episode. Not the advisory, however, drove their behavior change, but rather the perception of poor air quality, which was not related to PM_2.5 or ozone measurements.

Conclusions

Messages are not reaching the public during potentially hazardous weather and air quality conditions. Climatic forecasts are increasingly predictive but public agencies fail to mount an appropriate outreach response.     

Hormonal contraception and risk of bacterial vaginosis diagnosis in an observational study of women attending STD clinics in Baltimore, MD

Background

The protective effect of hormonal contraception may offer a potential intervention against bacterial vaginosis (BV).

Study Design

Three hundred thirty reproductive-age women enrolled in a contraceptive program from April 2005 to October 2006 at two sexually transmitted diseases clinics in Baltimore, MD. Participants were supplied with hormonal contraceptives of their choice and followed prospectively. BV was diagnosed by Amsel's criteria. Results from population-level analysis were compared to a case-crossover analysis.

Results

BV was diagnosed in 189 (13.0%) of the visits among 133 (40.3%) women. In the population-level analysis, the use of progestin-only and combined contraception was associated with a decreased risk of BV compared to intervals of no hormonal contraceptive use [adjusted odds ratio (AOR): 0.42 (95% CI: 0.20-0.88) and AOR: 0.66 (95% CI: 0.39-1.10), respectively]. The case-crossover analysis demonstrated a similar trend in findings.

Conclusion

Hormonal contraception was associated with a decreased risk of BV in an STD clinic cohort.