Maternal use of oral contraceptives and risk of hypospadias – a population-based case-control study

The aim of this population-based case-control study was to examine the risk of isolated hypospadias in boys born to mothers who have used oral contraceptives in early pregnancy. The study was based on data from the Hungarian Case-Control Surveillance of Congenital Abnormalities from 1980 to 1996, and included 3,038 boys with hypospadias (cases), 24,799 boys without congenital abnormalities (CA-free controls), and 11,881 boys with abnormalities other than hypospadias. We used unconditional logistic regression to adjust for birth order, maternal age, maternal employment status, maternal diabetes, and pre-eclampsia. When comparing cases with CA-free controls the OR for maternal use of OC was 1.21 (95% CI: 0.67–2.17). When comparing cases with boys with other abnormalities, the OR for maternal use of OC was 0.83 (95% CI: 0.46–1.50). Our data showed that self-reported maternal use of oral contraceptives during pregnancy was not associated with an increased risk of hypospadias in the offspring.     

A case–control study of occupational exposures and systemic sclerosis

Objectives A case–control study was conducted in Verona, Italy, to assess the relationship between occupation, occupational exposures and systemic sclerosis (SSc).Methods Fifty-five cases (46 female and nine male) and 171 controls were recruited. Interviews provided work histories, including job titles, industry and likelihood of occupational exposure to silica, hand–arm vibration, organic solvents, and other chemicals. Odds ratios (ORs) and 95% confidence intervals (95% CI) were estimated.Results Female teachers (OR 3.4, 95% CI 1.2–10.1) and textile workers (OR 2.1, 95% CI 1.0–4.6) were at an increased risk of SSc. Compared with those never exposed, age-adjusted and gender-adjusted ORs were 2.3 (95% CI 1.0–5.4) among subjects exposed to organic solvents, 2.5 (95% CI 0.8–8.0) for exposure to selected chemicals, 1.7 (95% CI 0.4–7.6) for exposure to silica, and 1.5 (95% CI 0.5–4.8) for usage of vibrating tools. When data analysis was stratified according to gender, only men showed a significant increase in risk for exposure to solvents and selected chemicals.Conclusions The findings of this study tend to support the role of organic solvents and certain chemicals in SSc causation. The association with teaching and working in the textile industry suggests that other exposures are involved in the aetiology of SSc among women. However, because of the small number of subjects, particularly in stratified analyses, chance cannot be ruled out as an explanation of some findings of this study.     

Health hazards of unemployment--only a boom phenomenon? A study of young men and women during times of prosperity and times of recession

BACKGROUND: It has been suggested that high unemployment rates in society may be less harmful to the health of people than low unemployment rates. Therefore, a study was carried out to compare, among young men and women, the relationship between health and long-term unemployment during periods of rapid economic growth 'boom' and economic recession. METHODS: Two study groups were chosen at age 21 y (5 y after compulsory schooling ended) from an industrial town in northern Sweden. The first group (number 1083) was chosen and surveyed in 1986 (under 'boom' conditions); the second (number 898) was chosen in 1994 (under economic recession conditions). The non-response rate was 2% for the boom group and 10% for the recession group. The main outcome measurements examined were somatic and psychological symptoms. RESULTS: Health criteria for general health among long-term unemployed young men and women did not differ between the group surveyed in boom conditions and the group surveyed in recession conditions. The only exception was for psychological symptoms, which scored lower among the men in the recession group. Individual unemployment had a high explanatory power for poor health, in particular, psychological ill health. CONCLUSIONS: When comparing periods of boom and recession there was no difference in somatic and psychological symptoms for those who were long-term unemployed. Thus, the trade cycle appeared to have had no impact on their health.     

Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence,risk factors and diagnostic validity

The validity of atrial fibrillation (AF) diagnoses in national registers for use as endpoints in prospective studies has not been evaluated. We studied the validity of AF diagnoses in Swedish national hospital discharge and cause of death registers and the occurrence of and risk factors for AF in a middle-aged Swedish population using these registers. Our study included the 30,447 individuals (age 44–73) who attended baseline visits in 1991–1996 of the Malmö Diet and Cancer study. Individuals with a first AF diagnosis were identified by record linkage with national registers. A subset of cases was randomly selected for validation by examination of electrocardiograms and patient records. Electrocardiograms were available in 98% of the validation sample (95% definitive AF, 3% no AF). The 2% with ECGs unavailable had probable AF. Baseline AF prevalence was 1.3%, higher in men and increased with age. During 11.2 years of follow-up 1430 first AF diagnoses occurred. Risk factors were age, hypertension, BMI, diabetes, history of heart failure, history of myocardial infarction and, in men but not women, current smoking. The strongest risk factors were history of heart failure (hazard ratio men 4.5, women 8.7) and myocardial infarction (hazard ratio men 2.0, women 1.8). The largest population attributable risks were observed for hypertension (men 38%, women 34%) and obesity (men 11%, women 10%). In conclusion, case misclassification of AF in national registers is small, indicating feasibility of use in prospective studies. Hypertension and obesity account for large portions of population risk in middle-aged individuals with low prevalence of manifest cardiac disease.     

A prospective study of organochlorines in adipose tissue and risk of non‑Hodgkin lymphoma

Background: Exposure to organochlorines has been examined as a potential risk factor for non-Hodgkin lymphoma (NHL), with inconsistent results that may be related to limited statistical power or to imprecise exposure measurements.Objective: Our purpose was to examine associations between organochlorine concentrations in prediagnostic adipose tissue samples and the risk of NHL.Methods: We conducted a case–cohort study using a prospective Danish cohort of 57,053 persons enrolled between 1993 and 1997. Within the cohort we identified 256 persons diagnosed with NHL in the population-based nationwide Danish Cancer Registry and randomly selected 256 subcohort persons. We measured concentrations of 8 pesticides and 10 polychlorinated biphenyl (PCB) congeners in adipose tissue collected upon enrollment. Associations between the 18 organochlorines and NHL were analyzed in Cox regression models, adjusting for body mass index.Results: Incidence rate ratios and confidence intervals (CIs) for interquartile range increases in concentrations of dichlorodiphenyltrichlorethane (DDT), cis-nonachlor, and oxychlordane were 1.35 (95% CI: 1.10, 1.66), 1.13 (95% CI: 0.94, 1.36), and 1.11 (95% CI: 0.89, 1.38), respectively, with monotonic dose–response trends for DDT and cis-nonachlor based on categorical models. The relative risk estimates were higher for men than for women. In contrast, no clear association was found between NHL and PCBs.Conclusion: We found a higher risk of NHL in association with higher adipose tissue levels of DDT, cis-nonachlor, and oxychlordane, but no association with PCBs. This is the first study of organochlorines and NHL using prediagnostic adipose tissue samples in the exposure assessment and provides new environmental health evidence that these organochlorines contribute to NHL risk.     

Do student-defined learning issues increase quality and quantity of individual study?

An experiment was conducted in the context of a problem-based learning course to investigate the influence of a learning-goal-free problem scenario on the quality and quantity of individual study. In half of the tutorial groups, the problem scenario was constructed in such a way that it provided useful learning issues (goal-specified condition), whereas in the other half of the tutorial groups, the problem scenario did not provide learning issues (goal-free condition). It was demonstrated that students in the goal-free condition read more articles, studied longer, and spent more time reporting the studied literature than their peers in the goal-specified condition. These findings suggest that the use of goal-free problems has a positive effect on the students’ individual study and the extensiveness of the tutorial group meeting.     

Evaluation of evaporation and concentration distribution models—A test chamber study

Occupational exposure to airborne volatile organic compounds is governed by the source strength and dispersion of the pollutant into workroom air. The purpose of the present test chamber study was to validate suggested models for the prediction of evaporation rates and concentration distributions. The study design was organized into different scenarios to simulate workplace conditions. Evaporation rates of organic compounds of different volatilities were recorded gravimetrically and the corresponding concentrations in air were measured at various locations equally distributed in the test chamber. The evaporation models generally showed a fair agreement with experiments but tended to underestimate the evaporation rate especially at low air velocity. Based on factorial experiments a new simple evaporation model was suggested. The performances of the concentration distribution models were of different quality. The model developed by Roach (Annals of Occupational Hygiene24, 105–132, 1981) cannot be used in predicting the concentration distribution in case of a convective air flow. If knowledge of the evaporation rate and pollutant concentration at some distances from the source were available, the model suggested by Scheff et al. (Applied Occupational and Environmental Hygiene7, 127–134, 1992) generated a concentration distribution in reasonable agreement with the observed data. The box-model (Sinden, Building and Environment13, 21–28, 1978) generally offered a fair performance but tended to underestimate the pollutant concentration in a region close to the source in the direction of the main air flow.     

Cigarette smoking and risk of cancers of the colon and rectum: A case–control study from Italy

The relationship between smoking habit and risk of colon and rectal cancers was considered in a case–control study conducted between 1991 and 1996 in six Italian centers. Cases were 1225 patients below age 75 with histologically confirmed cancer of the colon and 728 with cancer of the rectum.Controls were 4154 patients admitted to hospital for a wide spectrum of acute, non-neoplastic diseases. Compared to neversmokers, the odds ratios (OR) for current smokers of 25 or more cigarettes/day was 0.90 for patients with colon and 0.86 for those with rectal cancer and those for ex-smokers were 1.02 and 1.09 for colon and rectal cancer, respectively. No increase in risk was found with duration of the habit, the OR for 40 or more years being 0.79 for colon and 0.87 for rectal cancer. Furthermore, no relationship was apparent with time since starting (the OR for 40 or more years were 0.94 for colon and 1.01 for rectal cancer), or age at starting (the OR for < 18 years were 1.02 for colon and 1.00 for rectal cancer), or for pack-years smoked (the OR for 40 or more pack-years were 0.93 for colon and 0.91 for rectal cancer) or time since stopping among ex-smokers. No increase in risk was found in smokers of 15 cigarettes/day for 40 years or longer (OR: 0.93). No significant heterogeneity was found across strata of age at diagnosis, sex, education, physical activity at work, intake of alcohol, coffee, vegetables, total energy, and number of meals/day. Likewise, no significant association was apparent for various intestinal subsites. Thus, this study did not find cigarette smokers at higher risk for cancer of the bowel even after a long duration and a long period since starting.     

University students’ awareness of causes and risk factors of miscarriage: a cross-sectional study

Background

Spontaneous miscarriage is the most common complication of pregnancy, occurring in up to 20% of pregnancies. Despite the prevalence of miscarriage, little is known regarding peoples’ awareness and understanding of causes of pregnancy loss. The aim of this study was to explore university students’ understanding of rates, causes and risk factors of miscarriage.

Methods

A cross-sectional study including university students. An online questionnaire was circulated to all students at the University College Cork using their university email accounts in April and May 2016. Main outcomes included identification of prevalence, weeks of gestation at which miscarriage occurs and causative risk factors for miscarriage.

Results

A sample of 746 students were included in the analysis. Only 20% (n?=?149) of students correctly identified the prevalence of miscarriage, and almost 30% (n?=?207) incorrectly believed that miscarriage occurs in less than 10% of pregnancies. Female were more likely to correctly identify the rate of miscarriage than men (21.8% versus 14.5%). However, men tended to underestimate the rate and females overestimate it. Students who did not know someone who had a miscarriage underestimated the rate of miscarriage, and those who were aware of some celebrities who had a miscarriage overestimated the rate. Almost 43% (n?=?316) of students correctly identified fetal chromosomal abnormalities as the main cause of miscarriage. Females, older students, those from Medical and Health disciplines and those who were aware of a celebrity who had a miscarriage were more likely to identify chromosomal abnormalities as a main cause. However, more than 90% of the students believed that having a fall, consuming drugs or the medical condition of the mother was a causative risk factor for miscarriage. Finally, stress was identified as a risk factor more frequently than advanced maternal age or smoking.

Conclusion

Although almost half of the participants identified chromosomal abnormalities as the main cause of miscarriage, there is still a lack of understanding about the prevalence and most important risk factors among university students. University represents an ideal opportunity for health promotion strategies to increase awareness of potential adverse outcomes in pregnancy.

     

Who should abstract medical records? A study of accuracy and cost

The accuracy of patient record data depends not only on the quality of medical record keeping but also on the accuracy of the process of abstracting patient records to produce data suitable for analysis. This article reports results comparing record abstracts produced by four classes of abstracter: physicians, tumor registrars, nurses, and fourth-year medical students. The purpose of the comparison was to determine whether or not there were differences in accuracy among the four groups and, if accuracy was approximately equal, whether there were substantial differences among the costs of employing the four groups.     

What was the first epidemiological study of smoking and lung cancer?

Based on his critique of the early case-control study of smoking and lung cancer by Mueller, Morabia questions the priority that has been assigned to this research. I examine Morabia's approach to retrospectively assess quality and question its general applicability and replicability. By citation analyses, the case-control studies published in the 1950s have had far greater impact. Morabia's commentary points to the complexity and subtlety of re-interpreting older literature.     

Nurse-work instability and incidence of sick leave – results of a prospective study of nurses aged over 40

Background

The Nurse Work Instability Scale (Nurse-WIS) is an occupation-specific instrument that ascertains “work instability,” the interval before restricted work ability or prolonged sick leave occurs. The objective of the study was to assess if nurses with a high risk baseline-score in the Nurse-WIS take longer periods of sick leave due to musculoskeletal diseases and/or psychological impairments than other nurses.

Methods

A total of 4500 nurses randomly selected from one of the largest health insurance funds in Germany (DAK-Gesundheit) were invited by letter to participate in the study. The participants answered a questionnaire at baseline and gave consent to a transfer of data concerning sick leave during the twelve months following completion of the questionnaire from the health insurance to the study centre. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) for long-term sick leave were calculated. In order to analyze the association between the Nurse-WIS and sick leave during follow-up, a multiple ordinal logistic model (proportional odds model) was applied.

Results

A total of 1592 nurses took part in the study (response 35.6%). No loss of follow-up occurred. The number of nurses with a high score (20–28 points) in the Nurse-WIS was 628 (39.4%), and 639 (40.1%) had taken sick leave due to musculoskeletal diseases or psychological impairment during the follow-up period. The odds ratio for sick leave in nurses with a high Nurse-WIS score was 3.42 (95%CI 2.54–4.60). Sensitivity for long-term sick leave (<?42 days) was 64.1%, specificity 63.4%, PPV 17.0% and NPP 93.8%.

Conclusion

The German version of the Nurse-WIS predicts long-term sick leave, but the PPV is rather low. Combining questionnaire data with secondary data from a health insurer was feasible. Therefore further studies employing this combination of data are advisable.

     

A prospective study of adiposity and all-cause mortality: the Malmö Diet and Cancer Study

OBJECTIVE: This study aims to examine the association between various measures of adiposity and all-cause mortality in Swedish middle-aged and older men and women and, additionally, to describe the influences of age and sex on these associations. RESEARCH METHODS AND PROCEDURES: A prospective analysis was performed in a cohort of 10,902 men and 16,814 women ages 45 to 73 years who participated in the Malm? Diet and Cancer Study in Sweden. Baseline examinations took place between 1991 and 1996, and 982 deaths were documented during an average follow-up of 5.7 years. All-cause mortality was related to the following variables measured at baseline: body mass index (BMI), percentage of body fat, lean body mass (LBM), and waist-to-hip ratio (WHR), with adjustment for age and selected covariates. Body composition data were derived from bioelectrical impedance analysis. RESULTS: The association between percentage of body fat and mortality was modified by age, particularly in women. For instance, fatness was associated with excess mortality in the younger women but with reduced mortality in the older women. Weaker associations were seen for BMI than for percentage of body fat in both sexes. Placement in the top quintiles of waist-to-hip ratio, independent of overall body fat, was a stronger predictor of mortality in women than in men. The observed associations could not be explained by bias from early death or antecedent disease. DISCUSSION: The findings reveal sex and age differences for the effects of adiposity and WHR on mortality and indicate the importance of considering direct measures of adiposity, as opposed to BMI, when describing obesity-related mortality risks.     

Stroke survivors’ and relatives’ negotiation of relational and activity changes: A qualitative study

Objective: This study explores stroke survivors’ and relatives’ negotiation of relational and activity change in their interrelated long-term meaning-making processes of everyday life and what it means for the experience of progress and well-being. Material and methods: Repeated retrospective in-depth interviews were conducted with both the stroke survivor and relatives. A Critical Psychological Perspective gives the frame of reference to study more closely what is going on in and across particular contexts in family members’ ongoing social practices. Results: An asymmetric problematic relationship can develop among the participants in the context of family life. However, the analysis identifies six beneficial relational and activity changes, which contribute to a reciprocal, balanced repositioning, and help the family move in a more positive direction. The repositioning processes facilitate a new transformation of family we-ness, which is important for the participants’ experience of process and well-being. The comprehensive family work that has to be done is about managing the imbalance of everyday life, upholding separate activities outside the family sphere and dealing with the fact that peripheral others become more peripheral. Conclusion: The study addresses some arguments for taking a family-centred perspective in occupational therapy practice, as well as in a stroke rehabilitation service in general.     

A large‐scale longitudinal study of the utilization and effects of early childhood education and care in The Netherlands

Early childhood education and care (ECEC) services are expected to make an important contribution to the prevention of educational disadvantages stemming from social–ethnic factors. In the present study, three services are central: daycare centers, preschools, and special parent–child programs. Whether or not relations exist between the utilization of ECEC services and a number of the characteristics of the parent and the child is examined initially. Thereafter, the effects of such participation in ECEC services on the cognitive and non‐cognitive competencies of the children involved are examined. The recent data from the Dutch cohort study Elementary Education involving a total of approximately 33,500 students from 600 elementary schools are analyzed. The results show significant relations between the utilization of ECEC services and such parent characteristics as education, ethnic origin and paid employment. With regard to the effects of participation in ECEC services, only very weak associations with the cognitive and non‐cognitive competencies of the children are detected but they disappear when the relevant background characteristics of the parents are taken into consideration.