Abnormalities of body fat distribution in HIV-infected persons treated with antiretroviral drugs: The Swiss HIV Cohort Study

We prospectively assessed the 1-month prevalence of abnormal body fat distribution in HIV-infected individuals. Of 1,359 patients treated with antiretroviral drugs, 578 (43%) had signs of abnormal fat distribution. Peripheral fat loss was observed in 382 patients (28%), whereas 412 (30%) had signs of fat accumulation. The presence of lipodystrophy (peripheral fat loss with or without fat accumulation) was found to be independently associated with increasing age (less than 35 years of age as a reference group: 35 to 41 years of age, OR = 1.5 [95% CI, 1.1-2.3]; and older than 41 years of age, OR = 2.4 [95% CI, 1.7-3.5]), current use of stavudine (OR = 2.4 [95% CI, 1.8-3.3]), current use of abacavir (OR = 2.1 [95% CI, 1.3-3.4]), and elevated lactate level (OR = 1.6 [95% CI, 1.1-2.4]). The prevalence of lipodystrophy was higher among patients who had received stavudine for a longer period (no stavudine in the current combination as a reference group: <6 months, OR = 1.1 [95% CI, 0.6-1.8]; 6-24 months, OR = 2.4 [95% CI, 1.7-3.5]; and >24 months, OR = 3.2 [95% CI, 2.4-4.3]). This study confirms the association between the use of stavudine and lipodystrophy.     

Somatic and psychological complaints and their correlates with insomnia in the Japanese general population

OBJECTIVE: This cross-sectional study was conducted to estimate the prevalence of somatic and psychological complaints (SPCs) and to investigate the association of SPCs with insomnia in a sample of the general adult population of Japan. METHODS: We randomly selected 4000 adult residents (-20 years old) from five areas of Japan using stratified sampling and conducted interviews using a structured questionnaire. The questionnaire solicited information about eight somatic symptoms, eight psychological symptoms, three sleep problems, and demographic and health-related information. A total of 3,030 subjects completed questionnaires, giving a response rate of 75.8%. RESULTS: Stiff neck/shoulder (45.3%), backache (35.1%), and fatigue (31.4%) were the most common complaints in this population. In general, SPCs were more prevalent in younger persons and in women. Logistic regression analyses, controlling for other factors, showed that insomnia was significantly associated with a number of SPCs: backache (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.1-1.6), epigastric discomfort (OR = 1.7, 95% CI = 1.3-2.2), weight loss (OR = 2.0, 95% CI = 1.2-3.3), headache (OR = 1.7, 95% CI = 1.3-2.2), fatigue (OR = 1.7, 95% CI = 1.4-2.1), worrying (OR = 1.6, 95% CI = 1.1-2.3), irritability (OR = 1.4, 95% CI = 1.1-1.7), and loss of interest (OR = 1.8, 95% CI = 1.2-2.7). CONCLUSIONS: SPCs were common and were largely associated with insomnia in the general adult population of Japan. Further study is needed to examine the causal links between SPCs and insomnia.     

Neonatal outcome and congenital malformations in children born after in-vitro fertilization

BACKGROUND: To evaluate the neonatal outcome and the prevalence of congenital malformations in children born after IVF in northern Finland we carried out a population-based study with matched controls. METHODS: Firstly, 304 IVF children born in 1990-1995 were compared with 569 controls, representing the general population in proportion of multiple births, randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and social class. Secondly, plurality matched controls (n = 103) for IVF twins (n =103) were randomly chosen from the FMBR and analysed separately. Additionally, IVF singletons (n = 153) were compared with singleton controls (n = 287). Mortality rates were compared with national figures from FMBR. RESULTS: Most mortality rates were twice as high as national figures in the general population. When compared with the control group representing the general population, the incidences of preterm birth [odds ratio (OR) 5.6, 95% confidence interval (CI) 3.7-8.6], very low birth weight (OR 6.2, 95% CI 2.0-19.0), low birth weight (OR 9.8, 95% CI 5.6-17.3), neonatal morbidity (OR 2.4, 95% CI 1.7-3.4) and hospitalization (OR 3.2, 95% CI 2.2-4.6) were significantly higher in the IVF group. The prevalence of heart malformations was four-fold in the IVF population than in the controls representing the general population (OR 4.0, 95% CI 1.4-11.7). CONCLUSIONS: Neonatal outcome after IVF is worse than in the general population with similar maternal age, parity and social standing, mainly due to the large proportion of multifetal births after IVF. The higher prevalence of heart malformations does not solely arise from multiplicity but from other causes. In order to improve neonatal outcome after IVF, the number of embryos transferred should be limited to a minimum.     

Relationship between body mass index and insulin measured during oral glucose tolerance testing in severely obese children and adolescents

PRIMARY OBJECTIVE: The study evaluated the accuracy of body mass index (BMI) in detecting hyperinsulinaemia during oral glucose tolerance testing (OGTT) in severely obese children. RESEARCH DESIGN: A cross-sectional study was carried out. MATERIALS AND METHODS: A total of 118 obese children and adolescents (49 females and 69 males) aged 6-19 years were consecutively studied at an outpatient paediatric clinic. Hyperinsulinaemia was defined as a value of log-transformed fasting insulin >/= 80th percentile and OGTT hyperinsulinaemia as a value of the log-transformed area under the curve (AUC) of insulin >/= 80th percentile. The study hypothesis was tested using a logistic regression model with hyperinsulinaemia as the outcome variable and the z-score of BMI corrected for age (z-BMI(age)) as the predictor variable. Receiver-operator characteristic (ROC) curves were used to evaluate accuracy. RESULTS: The mean (SD) BMI for age of the children was 28.6 (4.0) kg m(-2), corresponding to 2.2 (0.5) standard deviation scores. The odds ratio (OR) of OGTT hyperinsulinaemia was 2.0 (95% CI 1.2-3.3; p = 0.007) for each unit increase of z-BMI(age) and the corresponding ROC-AUC was 0.74 (95% CI 0.61-0.86; p = 0.0001). In comparison, the OR of fasting hyperinsulinaemia was 1.1 (95% CI 0.7-1.7; p = 0.716) for each unit increase of z-BMI(age) and the corresponding ROC-AUC was 0.49 (95% CI 0.35-0.62; p = 0.863). CONCLUSION: BMI is reasonably accurate in detecting OGTT hyperinsulinaemia in severely obese children.     

Breastfeeding and prevalence of allergic diseases in Japanese university students

BACKGROUND: Although historical support exists for the concept that breastfeeding might be protective against allergic diseases, contradictory findings have been observed recently. OBJECTIVE: To investigate the cumulative prevalence of allergic diseases in Japanese university students and to identify explanatory variables including breastfeeding. METHODS: From March 18, 2003, through March 29, 2005, a total of 9,615 students newly enrolled at the University of Tokyo responded to a written questionnaire on allergic diseases. RESULTS: Cumulative prevalence of allergic rhinitis, atopic dermatitis, and asthma was 47.2%, 17.4%, and 9.3%, respectively. These data were closely correlated, and prevalence of any 1 of the 3 diseases significantly increased the odds for historical prevalence of the other 2 (P < .001). Male sex (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.4-1.7) and maternal (OR, 2.2; 95% CI, 2.0-2.5) or paternal (OR, 1.6; 95% CI, 1.4-1.8) history of allergic rhinitis were significant correlates of increased odds for allergic rhinitis. Maternal (OR, 2.7; 95% CI, 1.6-4.5), paternal (OR, 3.8; 95% CI, 2.2-6.6), or sibling (OR, 1.9; 95% CI, 1.5-2.4) history of atopic dermatitis was a significant correlate of increased odds for atopic dermatitis. As for asthma, maternal (OR, 4.9; 95% CI, 3.0-7.9), paternal (OR, 4.0; 95% CI, 2.3-7.0), or sibling (OR, 3.3; 95% CI, 2.4-4.5) history of asthma was a significant correlate of increased odds. Logistic regression analysis showed no consistent evidence of the effects of breastfeeding on the cumulative prevalence. CONCLUSION: The cumulative prevalence of these diseases among young adults revealed that the effect of breastfeeding is negligible when compared with genetic factors.     

The prevalence of and potential risk factors for female urinary incontinence in Beijing, China

OBJECTIVES: To survey and evaluate the prevalence and potential risk factors of female urinary incontinence (UI) in Beijing, China. DESIGN: A population-based cross-sectional study was performed from April to July 2005. We randomly sampled 1.0% of female residents aged 20 years and older from year 2000 national census data, totaling 5,300 women. All of the women were interviewed face to face using a modified questionnaire based on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms. Data were collected and analyzed. RESULTS: The overall prevalence of female UI was 38.5%. Prevalence rates of female stress urinary incontinence (SUI), female urge urinary incontinence, and female mixed urinary incontinence were 22.9%, 2.8%, and 12.4%, respectively. The prevalence rate of female UI was more than 50% in postmenopausal women. In multiple logistic models, multiple vaginal deliveries (odds ratio [OR]=2.1; 95% CI: 1.443-3.179), age (OR=1.7; 95% CI: 1.039-2.742), postmenopausal status (OR=1.5; 95% CI: 1.182-1.983), chronic pelvic pain (OR=1.4; 95% CI: 1.134-1.814), obesity (OR=1.4; 95% CI: 1.205-1.721), lack of exercise (OR=1.3; 95% CI: 1.105-1.509), constipation (OR=1.3; 95% CI: 1.109-1.586), and hypertension (OR=1.2; 95% CI: 1.053-1.474) were identified as potential risk factors of female SUI. No association between female SUI and offspring birth weight, occupation, or chronic diseases was observed in this study. Only 12.8% of women with UI and 7.4% of women with SUI seek medical help. CONCLUSIONS: UI is a major disorder that affects female quality of life. The prevalence of female UI is high (38.5%) in Beijing. Among the different types of UI, SUI was the most prevalent (22.9%). Potential risk factors identified for female SUI were multiple vaginal deliveries, age, postmenopausal status, chronic pelvic pain, obesity, lack of exercise, constipation, and hypertension.     

Does the use of antibiotics in early childhood increase the risk of asthma and allergic disease?

BACKGROUND: One of the mechanisms evoked to explain the increasing prevalences of asthma and allergy, in particular among children, is the 'Western lifestyle' or 'hygiene' hypothesis. As early childhood infections are assumed to hold a protective effect on the development of asthma and allergies, the use of antibiotics at that sensitive age may lead to an increased risk of asthma and allergy. OBJECTIVE: The aim of this study is to investigate the association between the use of antibiotics in the first year of life and the subsequent development of asthma and allergic disorders. METHODS: In a population-based sample of 7-and-8-year-old children questionnaire and skin prick test data were collected from 1206 and 675 subjects, respectively. Prevalence rates of asthma, allergic disorders and skin test positivity were compared between children with and without early life use of antibiotics, taking into account other possible risk factors including early respiratory infections. The effect of genetic predisposition was investigated by stratified analyses of children with and without parental hay fever. RESULTS: The use of antibiotics during the first year of life was significantly associated with asthma (OR = 1.7, 95% CI 1.0-3.1), hay fever (OR = 2.3, 95% CI 1.3-3.8) and eczema (OR = 1.3, 95% CI 1.0-1.8). No significant relationship was found with skin test positivity (OR = 1.1, 95% CI 0.7-1.7). After stratification for the presence of parental hay fever, children without parental hay fever did not show any significant associations between antibiotics use and asthma or allergy, whereas in children with parental hay fever the use of antibiotics was significantly related with asthma (OR = 2.3, 95% CI 1.1-5.1), hay fever (OR = 2.8, 95% CI 1.5-5.1) and eczema (OR = 1.6, 95% CI 1.0-2.6), and of borderline statistical significance with skin test positivity (OR = 1.6, 95% CI 0.9-3.0). CONCLUSION: Early childhood use of antibiotics is associated with an increased risk of developing asthma and allergic disorders in children who are predisposed to atopic immune responses. These findings support recent immunological understanding of the maturation of the immune system.     

Comparison of metabolic syndrome variables among pregnant women with and without eclampsia

BACKGROUND: Similarities in the pathogenesis of pre-eclampsia and metabolic syndrome have been described. This study is aimed at determining whether metabolic syndrome variables occur in eclampsia. METHODS: Consecutive 45 patients with eclampsia were prospectively compared with age, gestational age and parity-matched women with uncomplicated pregnancy. The main outcome measures included plasma lipids, glucose, electrolytes and uric acid levels. RESULTS: The patients were predominantly made up of ethnic Hausa primigravidae aged 15-30 years (mean: 19.5 +/- 4.2 years). As expected, patients with eclampsia had significantly higher blood pressure than controls: (systolic 163.0 +/- 24.7 vs. 124.8 +/- 18.1 mmHg, p = 0.001; diastolic 120.8 +/- 8.7 vs. 79.6 +/- 10.7 mmHg, p = 0.001). Compared to the controls, the eclamptics also had significantly higher total plasma cholesterol (5.1 +/- 0.7 vs. 4.6 +/- 0.4 mmol/L, p = 0.001), triglyceride (1.9 +/- 0.2 vs. 1.7 +/- 0.2 mmol/L, p = 0.01), uric acid (10.4 +/- 2.7 vs. 4.4 +/- 0.8 mol/L, p = 0.005) and blood glucose (6.3 +/- 2.3 vs. 5.0 +/- 1.0 mg/dL, p = 0.01). The risk for intrapartum eclampsia was significantly increased for women with hypercholesterolemia [odds ratio (OR) = 6.9; 95% CI: 2.5-20.7] hypertriglyceridemia (OR = 5.0; 95% CI: 1.79-14.32) and hyperuricemia (OR = 35.3; 95% CI: 9.6-14.3). CONCLUSIONS: These results demonstrate that markers of metabolic syndrome also exist in this cohort of pregnant women with eclampsia and could suggest that both conditions are linked.     

Relationship Between Low Bone Mineral Density and Highly Active Antiretroviral Therapy Including Protease Inhibitors in HIV-Infected Patients

Abstract

Purpose: The objectives of this study were to determine the prevalence of osteopenia and the factors associated with its presence in HIV-infected patients under highly active antiretroviral therapy (HAART) and to assess the changes of bone mineral density (BMD) in a population followed prospectively. Method: BMD was assessed by dual-energy X-ray absorptiometry (DEXA) scans at the lumbar spine and at the femoral neck in 78 HIV-infected patients who had previously received HAART as the first antiretroviral regimen and in 11 antiretroviral-naive HIV-infected patients. BMD measurements were repeated in 70 treated patients who had completed 1 year of follow-up. Results: Thirty-seven (42%) patients showed osteopenia at any localization. The prevalence of osteopenia in PI-naive patients was 23% versus 49% in individuals who had received PI at any moment [p = .001; adjusted odds ratio (95% CI) = 0.11 (0.02-0.48)]. The frequency of osteopenia was significantly higher among men than among women [50% vs. 17%; p = .016; adjusted OR (95% CI) = 12.1 (2.22-66.20)]. The level of plasma albumin was independently associated with osteopenia [adjusted OR (95% CI) per each g/dL of plasma albumin decrease 2.55 (1.18-10)]. In patients in whom a second DEXA was done, no significant changes in BMD were found. Conclusion: The prevalence of osteopenia in HIV-infected patients on HAART is high. Loss of BMD is associated with PI therapy, low plasma albumin level, and male sex. Osteopenia does not progress after 1 year of continued HAART.     

The I,105V polymorphism in glutathione S-transferase P1, parental smoking and the risk for nonsyndromic cleft lip with or without cleft palate

Genetic variations in the detoxification enzyme glutathione S-transferase P1 (GSTP1) may modify the teratogenicity of lifestyles, such as smoking. We investigated the role of the I105V polymorphism in GSTP1, parental periconception smoking, and their interaction with nonsyndromic cleft lip with or without cleft palate (CL/P) risk in the offspring. The GSTP1 I105V polymorphisms were determined in Dutch non-consanguineous Caucasians comprising of 155 CL/P triads (mother, father, child) and 195 control triads. The analyses were also carried out on complete triads only (n=69 CL/P and n=95 controls). Transmission disequilibrium testing and logistic regression analyses were performed. Neither maternal nor paternal smoking increased CL/P risk; odds ratios (OR): 1.2, 95 confidence intervals (CI)=0.7-2.0 and OR: 1.0, 95% CI=0.6-1.6, respectively. Carriership of the polymorphic Val105 allele in mothers may increase CL/P risk, OR: 1.5, 95% CI=0.96-2.5. Children homozygous for the Val105 allele may show an increased risk of CL/P, OR: 2.2, 95% CI=0.8-6.4. Maternal smoking tended to increase CL/P risk in mothers and children carrying Val105 alleles, OR=1.9, 95% CI=0.9-4.0 and OR=2.2, 95% CI=0.98-4.9, respectively. The highest risk for CL/P in children carrying Val105 alleles with a smoking father was 1.7, 95% CI=0.8-3.5. The GSTP1 I105V polymorphism in mothers and/or children either alone or in combination with maternal smoking may contribute to CL/P risk. Although of borderline significance, these results may underline the importance of smoking cessation in the periconception period for the prevention of CL/P in future generations.     

Delayed onset of pubertal development in children and adolescents with perinatally acquired HIV infection

OBJECTIVE: To examine whether greater severity of HIV infection is associated with delayed initiation of pubertal development among perinatally HIV-infected children, and to compare sexual maturation of perinatally HIV-infected children with children in the general US population using the National Health and Nutrition Examination Survey III. METHODS: In a prospective cohort study, the authors studied 983 HIV-infected children aged 6 to 18 years, who had Tanner stage assessed on at least two occasions between 1995 and 2000. Analyses were conducted separately for girls and boys to identify factors associated with onset of puberty or adrenarche (progression beyond Tanner stage 1). RESULTS: Among children who were in Tanner stage 1 at their first assessment, 185 of 413 (45%) girls and 144 of 434 (33%) boys entered puberty during the observation period. In multivariate longitudinal regression analyses adjusted for age, race/ethnicity, time interval between study visits, and other clinical factors, girls with severe immunosuppression (CD4% <15) were significantly less likely to enter adrenarche (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.29-0.83) and puberty (OR, 0.57; 95% CI, 0.33-0.96) compared with girls who were not immunosuppressed (CD4% > or =25). For boys, those with severe immunosuppression were significantly less likely to enter adrenarche (OR, 0.52; 95% CI, 0.28-0.96) and tended to be less likely to begin puberty (OR, 0.69; 95% CI, 0.39-1.22) compared with boys who were not immunosuppressed. Qualitative comparisons suggested that HIV-infected children may experience delayed puberty and adrenarche compared with similarly aged children in the general US population. CONCLUSIONS: Immunosuppression was associated with delayed pubertal onset in perinatally HIV-infected children. Further studies of perinatally HIV-infected and uninfected children are needed to better quantify the delay in pubertal onset and to compare the pace of pubertal maturation.     

Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe

OBJECTIVE: To investigate the effect of isolated or concomitant infection with malaria and HIV on pregnancy and neonatal outcome. METHODS: Data were collected on pregnant women admitted during the rainy seasons in the obstetric division of a district referral hospital in northern Zimbabwe in 2000 and 2001. The effects of malaria and HIV infection were determined by multivariate analysis. RESULTS: The prevalence of HIV seropositivity and symptomatic malaria in 986 pregnant women was 8.3% and 14.7%, respectively. HIV-infected women were more likely to develop malaria attacks during pregnancy than seronegative women (odds ratio [OR] = 3.96, 95% confidence interval (CI): 2.42-6.46). Malaria and HIV infections were associated with increased risk of stillbirth (OR = 4.74, 95% CI: 1.34-16.78) and preterm delivery (OR = 4.10, 95% CI: 2.17-7.75), respectively. They were independently associated with increased risk of low birth weight (malaria: OR = 10.09, 95% CI: 6.50-15.65; HIV: OR = 3.16, 95% CI: 1.80-5.54) and very low birth weight (malaria: OR = 5.04, 95% CI: 1.00-25.43; HIV: OR = 10.74, 95% CI: 2.12-54.41), low Apgar score (malaria: OR = 4.45, 95% CI: 1.42-13.94; HIV: OR = 5.94, 95% CI: 1.66-21.30), and fetal growth restriction (malaria: OR = 3.98, 95% CI: 2.51-6.30; HIV: OR = 4.07, 95% CI: 2.40-6.92). Dual infection with malaria and HIV was associated with increased risk of maternal, perinatal, and early infant death. CONCLUSIONS: Women with single HIV or malaria infection have a significantly increased risk of adverse outcomes of pregnancy and childbirth. Dual infection has additional detrimental effects on maternal and infant survival in an area where HIV and malaria coexist.     

Exposure to antiretroviral therapy in utero or early life: the health of uninfected children born to HIV-infected women

Concerns have been raised over possible adverse effects of prophylactic antiretroviral therapy (ART) on the fetus and newborn. We analyzed data relating to uninfected children enrolled in the European Collaborative Study and investigated the association between ART exposure, perinatal problems, and major adverse health events later in life. Median length of follow-up was 2.2 (0-15.9) years. Of the 2414 uninfected children, 687 (28%) were exposed to ART in all three periods (antenatal, intrapartum, and neonatal). Of the 1008 infants exposed to ART at any time, 906 (90%) were exposed antenatally, 840 (83%) neonatally, and 750 (74%) both antenatally and neonatally. ART exposure was not significantly associated with pattern or prevalence of congenital abnormalities or low birth weight. In multivariate analysis, prematurity was associated with exposure to combination therapy without a protease inhibitor (PI) (OR = 2.66; 95% CI: 1.52-4.67) and with a PI (OR = 4.14; 95% CI: 2.36-7.23). ART exposure was associated with anemia in early life ( <.001). There was no evidence of an association with clinical manifestations suggestive of mitochondrial abnormalities. The absence of serious adverse events in this large cohort of uninfected children exposed to prophylactic ART in the short to medium term is reassuring.     

Adult-onset asthma is associated with self-reported mold or environmental tobacco smoke exposures in the home

BACKGROUND: In recent years, we have gained better knowledge about the influence of indoor environments on respiratory symptoms and asthma. The purpose of this study was to examine certain exposures in the home environment and the risk of adult-onset asthma. METHODS: A nested case-referent study of adult-onset asthma was performed in a random population sample (n = 15813), aged 20-50 years. Cases for the study included subjects reporting "physician-diagnosed" asthma (n= 174). The referents (n = 870) were randomly selected from the whole population sample. The case-referent sample was investigated with a comprehensive mailed questionnaire about exposures in the home environment, asthma, respiratory symptoms, smoking habits, and atopy. Odds ratios (OR) with 95% confidence intervals (CI) were calculated while controlling for age, sex, smoking, and atopy. RESULTS: Increased adjusted OR for asthma were associated with exposure to molds (OR 2.2, 95%, CI 1.4-3.5), environmental tobacco smoke (OR 2.4, 95%, CI 1.4-4.1), and the presence of a wood stove (OR 1.7, 95% CI 1.2-2.5). CONCLUSIONS: This population-based case-referent study indicates that self-reported domestic exposures to molds or environmental tobacco smoke can be associated with adult-onset asthma.     

Growth, psychomotor development and morbidity up to 3 years of age in children born after IVF

BACKGROUND: To examine the long-term child outcome after IVF until the age of 3 years in Northern Finland, we conducted a population-based cohort study. METHODS: First, a cohort of 299 IVF children born in 1990-1995 was compared with a cohort of 558 controls representing the general population in terms of a multiple birth rate of 1.2%, randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and social class (full sample analyses). Second, IVF singletons (n = 150) were compared with singleton controls (n = 280). Third, a plurality matched control cohort (n = 100) for IVF twins (n = 100) was randomly chosen, matched as above, from the FMBR and analysed separately. Infant mortality rate was compared with the national rate from the FMBR. RESULTS: Infant mortality in the IVF group was >2-fold higher compared to the national rate in the general population. The risk (OR, 95% CI) of low weight and height, below the lowest quartile, at 1 year of age (1.6, 1.1-2.2; 1.6, 1.1-2.4) and 2 years of age (1.5, 1.1-2.4; 1.7, 1.2-2.5) was significantly higher in the IVF group when compared with the general population control group. No statistically significant differences were found in the psychomotor development between the cohorts. Cumulative incidence of different diseases up to 3 years of age was significantly higher among IVF children in the full sample and singleton analyses (OR, 95% CI: 2.3, 1.7-3.2; 2.1, 1.3-3.3 respectively) especially regarding respiratory diseases (3.5, 1.9-6.5; 3.1, 1.0-9.4) and diarrhoea (3.7, 2.2-6.2; 5.7, 2.6-12.7), but not in twin comparisons. CONCLUSIONS: The growth of IVF children was behind that of control children during the first 3 years of life, but their psychomotor development was similar. Their postnatal health was worse, probably reflecting the problems in the neonatal period.     

High HIV sexual risk behaviors and sexually transmitted disease prevalence among injection drug users in Northern Vietnam: implications for a generalized HIV epidemic

BACKGROUND: HIV prevalence in Vietnam is currently concentrated among injection drug users (IDUs). The extent to which this core risk group represents a potential for broader HIV transmission to the general population is currently unknown. METHODS: A community-based cross-sectional study among IDUs in Vietnam assessed sexually transmitted disease (STD) prevalence and behavioral risk factors. Qualitative interview data enhanced quantitative findings. RESULTS: The prevalence of any STDs among 272 IDUs was 30% (chlamydia, 9%; herpes simplex virus type 2 [HSV-2], 22%; gonorrhea, 0%; and syphilis, 1%). Part-time work or unemployment (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 1.1 to 6.9), sex with > or =2 sex workers in the past year (OR = 4.9, 95% CI: 1.91 to 12.6), having ever smoked heroin (OR = 4.5, 95% CI: 1.1 to 18.3), and injecting less frequently than daily (OR = 3.9, 95% CI: 1.43 to 10.6) were independently associated with chlamydial infection. Urban residency (OR = 4.0, 95% CI: 1.4 to 11.0) and daily injecting (OR = 2.2, 95% CI: 1.1 to 4.4) were independently associated with HSV-2. Odds of HSV-2 among older (> or =28 years of age) IDUs who had sex with <2 sex workers in the past year was higher than among younger IDUs who had sex with more sex workers (OR = 6.4, 95% CI: 2.1 to 18.4). CONCLUSIONS: High STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.     

Older age and markers of inflammation are strong predictors of clinical events in women with asymptomatic carotid lesions

OBJECTIVE: Limited information exists regarding the association between markers of inflammation, such as high-sensitivity C-reactive protein (hs-CRP) and fibrinogen, and adverse events in postmenopausal women with subclinical atherosclerosis. Therefore, we investigated the prognostic impact of traditional risk factors and inflammation on adverse cardiac events in women with asymptomatic carotid lesions. DESIGN: We studied 250 postmenopausal women who were free of cardiovascular disease. Traditional cardiovascular risk factors were investigated, and laboratory analysis included measurement of plasma lipids, fibrinogen, and hs-CRP. The early phases of carotid atherosclerosis were assessed by B-mode ultrasonography. Women were asked about symptoms or a previous history of coronary artery disease and were followed for a period of 5 years. RESULTS: We found that the increment in age (in quintiles) was significantly associated with higher incidence of current smokers (P = 0.0286), hypertension (P = 0.0230), family history of coronary artery disease (P = 0.0216), dyslipidemia (P = 0.0330), and higher levels of fibrinogen (P = 0.0158). Moreover, older women had a higher prevalence of carotid lesions (P < 0.0001). After the follow-up, cardio- and cerebrovascular events were registered in 22% of the women. Using multivariate analysis, we observed that older age (odds ratio [OR], 1.7; 95% CI, 1.3-2.2; P < 0.0001), fibrinogen (OR, 1.6; 95% CI, 1.2-2.0; P < 0.0001), the presence of carotid lesions (OR, 2.0; 95% CI, 1.4-3.0; P = 0.0002), and hs-CRP (OR, 1.3; 95% CI, 1.2-2.0; P = 0.0175) were predictors of adverse events during the follow-up. CONCLUSIONS: Adverse events occurred more frequently in women with higher levels of fibrinogen and hs-CRP. The significance of these results requires confirmation in other studies, but they may have important implications for screening subjects at risk for cardiovascular disease and identifying candidates for anti-inflammatory therapy.     

Nocturia and health in women aged 40-64 years

To analyse the relationship between nocturnal micturition and health in 40- to 64-year-old women. A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of J?mtland, Sweden. Questions were asked about the general health status of health, health development during the last 5 years, nocturnal micturition, parity, menstrual status, menopausal symptoms, hormone replacement therapy, cardiac diseases, diabetes and snoring. Poor health was reported by 10.4%. In 24.1% of the women health development had been unfavourable in the last 5 years. Poor health was reported by 4.7% of women without nocturnal micturition, and by 11.2, 20.1 and 39.0% (P<0.0001) of women with one, two, and three or more nocturnal voiding episodes, respectively. In a multiple logistic regression analysis significant independent correlates of health were: one versus no nocturnal micturitions (odds ratio [OR] 2.2; confidence interval [CI] 1.5-3.3), two versus none (OR 3.2; 1.9-5.3), and three or more versus none (OR 6.5; 3.5-11.9), spasmodic chest pain (OR 6.6; CI 3.0-14.5), irregular heart beats (OR 3.0; CI 2.1-4.3), diabetes (OR 5.1; CI 2.8-9.4), leg oedema> or =6 days/month versus <6 days/month (OR 23; CI 1.6-3.3), snoring: < or =3 times/week versus never (OR 1.4; CI 1.0-2.0), snoring 4-7 times/week versus never (OR 1.6; CI 1.1-2.2), being<5 years after versus being before the menopause (OR 1.6; 95% CI 1.0-2.5), 5-9 years after versus before the menopause (OR 1.7; CI 1.0-2.9), > or =10 years after versus before the menopause (OR 2.2; CI 1.3-3.7), diuretic treatment (OR 2.8; CI 1.7-4.6). The perceived state of health in 40- to 64- year-old women is profoundly affected by nocturia, independently of heart diseases, diabetes, snoring, age and menopausal status.