Influence of diabetes mellitus type 2 and prolonged estrogen exposure on risk of breast cancer among women in Armenia

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

Prediction of complicated urinary tract infections in patients with type 2 diabetes: a questionnaire study in primary care

Background Relatively few data are available to predict a complicated course of community-acquired complicated urinary tract infections (UTIs) in patients with diabetes type 2 (DM2). The aim of this study was to assess predictors for a complicated course of UTIs in DM2 patients in primary care. Method We conducted a cross-sectional questionnaire study among DM2 patients aged over 45 years as part of an educational trial. The combined outcome measure was a complicated course of UTI, defined as a self-reported episode of acute pyelonephritis, prostatitis or recurrent cystitis in the 12 months before the trial. Patients with an outcome were all verified by review of medical records. A prediction model was derived with multivariable logistic regression analysis. Results Of the 1151 trial participants, 94 (8%) had a self-reported community-acquired complicated course of UTIs and 62 (66%) of these were medically-attended. Independent predictors for a complicated course were age above 60 years (adjusted odds ratio (OR): 1.74; 95% confidence interval (CI): 0.99–3.03), chronic use of antibiotics (adjusted OR: 5.50; 95% CI: 2.31–13.08), more than 6 physician contacts in previous year (adjusted OR: 3.60; 95% CI: 2.00–6.49), hospitalization in previous year (adjusted OR: 1.36; 95% CI: 1.00–1.85), renal disease (adjusted OR: 4.92; 95% CI: 1.59–15.18) and incontinence of urine (adjusted OR: 3.78; 95% CI: 1.93–7.38). Area under the receiver-operating curve was 0.72 (95% CI: 0.66–0.78). Analysis according to medically attended complicated UTIs did not change our findings. Conclusion Easily obtainable predictors from medical history can be used to accurately predict a complicated course of UTIs in DM2 patients.     

A case-control study of parental occupation, leukemia, and brain tumors in an industrial city in Taiwan

We conducted a case-control study in an industrial city in Taiwan to determine whether parents of newly diagnosed patients who were younger than 30 years old with leukemia or brain tumors or the patients themselves were more likely to have been employed in certain occupations or industries. Job histories were collected for parents (and for subjects if they worked) on 103 newly diagnosed cases of leukemia, 74 newly diagnosed cases of brain tumors, and 417 controls matched for age and sex. All jobs since the age of 16 that the subjects held for more than 6 months, a total of approximately 4,000 jobs, were coded for occupation and industry according the standard four-digit system used in Taiwan. Matched-pair analyses were performed comparing cases and controls among all jobs held by subjects and both parents using four-digit occupation and industry codes. Separate analyses also were performed for parental jobs held during the preconception, perinatal, and postnatal periods. Odds ratios (ORs) were adjusted for subject smoking, parental smoking, and exposure to medical radiation. Certain industry and occupation four-digit codes were significantly associated with increased odds ratios of childhood tumors. Including work during any or all periods, leukemias were more common in children of fathers who had worked (1) as wood treaters (adjusted OR 16.03, 95% confidence interval CI = 1.77-145.5), and (2) as building finishers and related trades workers (adjusted OR 4.08, 95% CI = 1.12-14.8), whereas brain tumors were more common in children of mothers who had worked (1) in electronic parts and components manufacturing (adjusted OR 13.78, 95% CI = 1.47-129.0) and 2) as textile and garment workers (adjusted OR 7.25, 95% CI = 1.42-37.0), as well as in subjects who had worked with certain electronic parts and components (adjusted OR 28.67, 95% CI = 2.88-285.6). Leukemias were more common in children of fathers who had worked in the preconception period (1) as wood treaters (adjusted OR 12.17, 95% CI = 1.36-109.2), (2) as building finishers and related trades workers (adjusted OR 4.08, 95% CI = 1.12-14.8), (3) as electronic equipment assemblers (adjusted OR 4.56, 95% CI = I 1.05-19.9), and (4) as certain other assemblers (adjusted OR 10.24, 95% CI = 1.02-102.6). In addition, leukemias were more common in children of fathers who had worked in the perinatal period (1) as wood treaters (adjusted OR 13.08, 95% CI = 1.36-125.5) and (2) as building finishers and related trades workers (adjusted OR 4.51, 95% CI = 1.04-19.6). Brain tumors were more common in children of mothers who had worked in the preconception period (1) in electronic parts and components manufacturing (adjusted OR 11.81, 95% CI = 1.20-116.3), and (2) as textile and garment workers (adjusted OR 7.25, 95% CI = 1.18-31.0).     

蚌埠市社区绿地暴露与成年居民糖尿病患病率的关系: BMI的中介作用

目的  了解蚌埠市龙子湖区社区绿地暴露与糖尿病(diabetes mellitus, DM)患病率的相关性,并探讨BMI在社区绿地暴露与DM之间的中介效应。方法  2015年8月,采用分层随机抽样,调查蚌埠市龙子湖区成年居民3 354人。居民基本信息以问卷形式收集,社区绿地暴露用归一化植被指数(normalized difference vegetation index,NDVI)和土壤调整植被指数(soil adjusted vegetation index,SAVI)1 000 m缓冲区的值表示。用二分类Logistic回归分析探究社区绿地暴露与DM的相关性,并评估BMI的中介效应。结果  NDVI-1 000 m (χ²=36.39, P < 0.001)与SAVI-1 000 m(χ²=20.14, P < 0.001)不同组之间患病率均存在统计学差异。调整模型下,NDVI-1 000 m和SAVI-1 000 m Q3组患病率分别是Q1组的0.538倍(OR=0.538,95% CI: 0.388~0.745)和0.605倍(OR=0.605,95% CI: 0.440~0.833)。BMI在NDVI-1 000 m和SAVI-1 000 m与DM的关联分别存在6.42%(95% CI: 1.83%~16.00%)和7.43%(95% CI: 2.36%~19.00%)的中介效应。结论  社区绿地暴露越高,DM患病率越低。BMI在社区绿地暴露与DM之间有中介效应。     

Human papillomavirus type 18/16 infection and prevalence among middle-aged and older Chinese rural women: a cross-sectional survey in Wufeng,Hubei Province

This study aimed to measure the prevalence and potential factors related to HPV 16/18 infection among middle-aged and older Chinese rural women. The study was conducted among women aged 35–65 years in rural villages within Wufeng in Hubei Province. Data were collected using a pretested questionnaire between July and August 2015. Cervical specimens were collected for HPV DNA detection and typing by using careHPV. Pearson’s Chi-square and logistic regression analyses were used to examine associations with HPV positivity. Among 1001 participants, the prevalence of HPV 18/16 positive genotyping was 15.88% (n = 159). Husbands’ extramarital sex (adjusted odds ratio [OR] = 15.85, 95% confidence interval [CI] 5.76–43.59), cervicitis (adjusted OR = 9.27, 95% CI 5.06–16.99), condom usage (adjusted OR = 0.16, 95% CI 0.05–0.53), higher average number of live births (adjusted OR = 1.98, 95% CI 1.32–2.96 for two live births; adjusted OR = 3.29, 95% CI 1.39–7.81 for three or more live births) were associated with HPV infection. The prevalence of HPV infection among participating women from rural areas was higher than that in several other areas in China. Our findings can aid efforts to prevent HPV infection to lower the risk of cervical cancer.     

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

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

Risk factors for cryptorchidism: a nested case-control study

Summary. .A nested case-control study of cryptorchidism (i.e. undescended testicles) was undertaken as part of a hospital-based cohort study of 6699 singleton male neonates in New York City. Since some of the cryptorchid infants experienced spontaneous descent of their testes, separate analysis was performed for this third group of late descenders' ( n = 140). Cases ( n = 63) represented infants whose testes remained undescended at the one year assessment. Controls ( n =219) represented the next male infant who was delivered immediately after an infant who was cryptorchid at birth. The only independent risk factors for cryptorchidism were Asian ethnic group (adjusted odds ratio (OR) = 3.90,95% confidence interval (CI) = 1.22-12.41), swollen legs or feet during pregnancy (adjusted OR=2.16, 95% CI = 1.15-4.04), a family history of cryptorchidism (adjusted OR=4.32, 95% CI = 1.91-9.80), low birthweight (adjusted OR = 4.10, 95% CI = 1.39-12.08), and use of analgesics during pregnancy (adjusted OR = 1.93/95% CI = 1.03-3.62). Multiple logistic regression analysis was also performed to identify those factors that were associated with late testicular descent. In this analysis the independent risk factors were black or Hispanic ethnicity (adjusted OR = 2.05, 95% CI = 1.09-3.83), a family history of cryptorchidism (adjusted OR = 4.25,95% CI = 1.84-9.78), consumption of cola-containing drinks during the pregnancy (adjusted OR = 2.09, 95% CI = 1.10-3.99), a low birthweight delivery (adjusted OR = 9.78, 95% CI = 3.39-28.20), and preterm birth (adjusted OR = 4.01, 95% CI = 1.66-9.70).     

Parkinson's disease: a case-control study of occupational and environmental risk factors

We compared personal histories of 57 cases and 122 age-matched controls to identify possible environmental determinants of Parkinson's disease (PD). Odds ratios (OR) adjusted for sex, age, and smoking were computed using stepwise logistic regression. We found a statistically significant increased risk for working in orchards (OR = 3.69, p = 0.012, 95% CI = 1.34, 10.27) and a marginally significant increased risk associated with working in planer mills (OR = 4.11, p = 0.065, 95% CI = 0.91, 18.50). A Fisher's exact test of the association between PD development and (1) paraquat contact, and (2) postural tremor gave statistically significant probability estimates of 0.01 and 0.03, respectively. The relative risk of PD decreased with smoking, an inverse relationship supported by many studies.     

Relationship between Diabetes Status and Sarcopenia in Community-Dwelling Older Adults

ObjectivesDiabetes mellitus (DM) is associated with risk of sarcopenia. However, whether glycated hemoglobin (HbA1c) levels are associated with sarcopenia has not reached a consensus. The purpose of this study was to examine the association between diabetes status based on HbA1c levels and sarcopenia indices in community-dwelling older adults stratified by body mass index (BMI) status.DesignAn observational cross-sectional study.Setting and ParticipantsGeneral community setting. The participants were 18,940 community-dwelling older adults (mean age 73.7 ± 5.7 years, 45.0% men).MethodsAccording to their medical history for diabetes mellitus and blood HbA1c levels the participants were classified into the control group (no DM history and HbA1c ≤5.6%), pre-DM group (no DM history and HbA1c 5.7%–6.4%), or DM group (DM history or HbA1c ≥6.5%). For assessments of sarcopenia, muscle mass and muscle strength were measured based on the clinical definition.ResultsA multiple logistic regression analysis showed that the DM group did not have a clear association with sarcopenia [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.82–1.38] or low muscle mass (OR 1.15, 95% CI 0.94–1.39), and was associated with low muscle strength (OR 1.21, 95% CI 1.08–1.36) in the adjusted model including BMI. There was a positive correlation between BMI and skeletal muscle index (r = 0.57, P < .001). Stratified by BMI, the DM group was associated with low muscle mass among the underweight participants (OR 1.87, 95% CI 1.03–3.39), and low muscle strength among the overweight participants (OR 1.22, 95% CI 1.04–1.43).Conclusions and ImplicationsDiabetes status was associated with low muscle mass and low muscle strength, and the association depended on BMI. Our findings could be helpful for identifying older adults with a high risk of sarcopenia, although further study is needed.     

Dietary Fat,Cooking Fat,and Breast Cancer Risk in a Multiethnic Population

Our objective was to examine the association between dietary fat intake, cooking fat usage, and breast cancer risk in a population-based, multiethnic, case-control study conducted in the San Francisco Bay area. Intake of total fat and types of fat were assessed with a food frequency questionnaire among 1,703 breast cancer cases diagnosed between 1995 and 1999 and 2,045 controls. In addition, preferred use of fat for cooking was assessed. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). High fat intake was associated with increased risk of breast cancer (highest vs. lowest quartile, adjusted OR = 1.35, 95% CI = 1.10–1.65, P _trend < 0.01). A positive association was found for oleic acid (OR = 1.55, 95% CI = 1.14–2.10, P _trend < 0.01) but not for linoleic acid or saturated fat. Risk was increased for women cooking with hydrogenated fats (OR = 1.58, 95% CI = 1.20–2.10) or vegetable/corn oil (rich in linoleic acid; OR = 1.30, 95% CI = 1.06–1.58) compared to women using olive/canola oil (rich in oleic acid). Our results suggest that a low-fat diet may play a role in breast cancer prevention. We speculate that monounsaturated trans fats may have driven the discrepant associations between types of fat and breast cancer.     

南方女性复发性流产环境因素分析

目的:探讨南方女性不明原因复发性流产(undentifiedrecurrentspontaneousabortion,URSA)流行病学因素。方法:对326例URSA及400例正常对照育龄妇女进行健康问卷调查,用Logistic回归模型,纳入体重指数(BMI)、自然流产家族史、吸烟史、被动吸烟史、饮酒史、饮咖啡史,找出有独立意义的环境危险因素,并对自然流产次数3次及≥4次者进行分层分析。结果:吸烟史、饮酒史和饮咖啡史不是URSA的危险因素,短时间被动吸烟(1h/天)及长时间被动吸烟(≥1h/天)是URSA的危险因素,OR及95%CI分别是2.30,1.50～3.52及4.76,3.24～6.99。家族史及BMI≥24.0kg/m2是URSA危险因素,OR及95%CI分别是2.12,1.28～3.49及1.55,1.12～2.14。结论:被动吸烟史、BMI≥24.0kg/m2、自然流产家族史是中国南方女性URSA独立危险因素。     

Serum dioxin and hepatic abnormalities in veterans of Operation Ranch Hand

PURPOSE: We studied hepatic abnormalities and indices of hepatic function in relation to exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin) in veterans of Operation Ranch Hand, the Air Force unit responsible for the aerial spraying of herbicides in Vietnam from 1962 to 1971. METHODS: The prevalence of ever having liver disease through March 1993, and level of alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase (GGT), lactic dehydrogenase (LDH), alkaline phosphatase, and total bilirubin were examined according to serum dioxin levels. RESULTS: We found an increased risk of "other liver disorders" among veterans with the highest dioxin levels [adjusted odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.2 to 2.1], due primarily to increased transaminases or LDH (adjusted OR = 2.7, 95% CI 1.4 to 5.1) and to other nonspecific liver abnormalities (adjusted OR = 1.4, 95% CI 1.0 to 2.0). CONCLUSIONS: Whether the associations observed were causal is unclear from these data.     

The relationship between diabetes mellitus and traffic-related air pollution

OBJECTIVE: Air pollution is associated with an increased risk for cardiovascular events. Many of the biological pathways involved could also promote diabetes mellitus (DM). We therefore investigated the association between DM prevalence and exposure to traffic-related air pollution (nitrogen dioxide [NO 2]). METHODS: Study participants were patients who attended two respiratory clinics in Hamilton (n = 5228) and Toronto (n = 2406). The diagnosis of DM was ascertained by linkage to administrative databases of the Ontario universal Health Insurance Plan for patients aged 40 years and above. Geographic Information systems methodology was used to assign individual estimates of NO2 based on a network of samplers in each city. Logistic regression was used to estimate the relations between NO2 exposures and the odds of DM diagnosis. RESULTS: After adjusting for age, body mass index, and neighborhood income there were positive effects in women on the odds ratio for DM for each 1 ppb NO2 exposure in Toronto (OR 1.055, 95% CI: 0.99 to 1.11) and Hamilton (OR 1.029, 95% CI: 0.98 to 1.08). In a meta-analytic model including both cities, there was a significant effect in women (OR = 1.04; 95% CI: 1.00 to 1.08). Across the inter-quartile range (approximately 4 ppb NO2) there was nearly a 17% increase in the odds of DM for women. There were no positive associations among men. CONCLUSIONS: Exposure to NO2, a marker of traffic-related air pollutants, was associated with DM prevalence among women. Exposure estimate errors in men may explain the apparent gender difference. These results suggest that common air pollutants are associated with DM and warrant more investigation to determine if this is a cause-and-effect relationship.     

Occupation and asthma: a population-based incident case-control study

The authors assessed the relations between occupation and risk of developing asthma in adulthood in a 1997-2000 population-based incident case-control study of 521 cases and 932 controls in south Finland. The occupations were classified according to potential exposure to asthma-causing inhalants. Asthma risk was increased consistently for both men and women in the chemical (adjusted odds ratio (OR) = 5.69, 95% confidence interval (CI): 1.08, 29.8), rubber and plastic (OR = 2.61, 95% CI: 0.92, 7.42), and wood and paper (OR = 1.72, 95% CI: 0.71, 4.17) industries. Risk in relation to occupation was increased only for men-for bakers and food processors (OR = 8.62, 95% CI: 0.86, 86.5), textile workers (OR = 4.70, 95% CI: 0.29, 77.1), electrical and electronic production workers (OR = 2.83, 95% CI: 0.82, 6.93), laboratory technicians (OR = 1.66, 95% CI: 0.17, 16.6), and storage workers (OR = 1.57, 95% CI: 0.40, 6.19). Of the predominantly men's occupations, metal (OR = 4.52, 95% CI: 2.35, 8.70) and forestry (OR = 6.00, 95% CI: 0.96, 37.5) work were the strongest determinants of asthma. For women, asthma risk increased for waiters (OR = 3.03, 95% CI: 1.10, 8.31), cleaners (OR = 1.42, 95% CI: 0.81, 2.48), and dental workers (OR = 4.74, 95% CI: 0.48, 46.5). Results suggest an increased asthma risk both in traditional industries and forestry and in several nonindustrial occupations.     

农村居民空腹血糖受损及糖尿病患病调查

目的 调查吉林延边地区农村居民空腹血糖受损和糖尿病检出率及其相关因素。方法 对延边地区30～60岁常住居民5 335人进行现况调查。结果 朝鲜族和汉族空腹血糖受损(IFG)粗检出率分别为6.1%(159/2 600)和5.9%(161/2 735),其标化检出率分别为5.5%和5.5%;糖尿病(DM)粗患病率分别为7.2%(186/2 600)和5.7%(156/2 735),其标化患病率分别为6.1%和4.9%:不同性别、不同年龄IFG和DM检出率差异均有统计学意义;多因素分析显示,IFG患病与性别、饮酒、腹型肥胖(OR=1.329,95%CI=1.022～1.730)、高甘油三酯血症(OR=1.745,95%CI=1.333～2.283)、高胆固醇血症(OR=2.033,95%CI=1.497～2.761)和代谢综合征(OR=6.630,95%CI=5.106～8.608)密切相关(均P<0.05):DM患病与性别、年龄、文化程度、腹型肥胖(OR=1.855,95%CI=1.407～2.446)、高胆固醇血症(OR=1.864,95%CI=1.379～2.520)、高甘油三酯血症(OR=2.281,95%CI=1.737～2.996)和代谢综合征(OR=7.779,95%CI=5.937～10.191)密切相关(均P=0.000),其中年龄和文化程度对DM影响具有计量反应关系。结论 延边地区农村居民空腹血糖受损和糖尿病分别与性别、年龄(DM)、饮酒(IFG)、文化程度(DM)、腹型肥胖、高胆固醇血症、高甘油三酯血症和代谢综合征密切相关。     

Routinely Assessed Biochemical Markers Tested on Admission as Predictors of Adverse Outcomes in Hospitalized Elderly Patients

Abstract

Aim: To explore whether routinely assessed biochemical markers tested on admission will predict 3 predefined adverse outcomes for hospitalized elderly patients: discharge to a long-term care facility, in-hospital mortality, and prolonged hospital length of stay (> 14 days). Methods: A prospective observational study of elderly patients (aged ≥ 75 years) admitted to an acute-care geriatric ward over a 6-month period. Patients were assessed on admission and baseline characteristics were collected. Activities of daily living were assessed by the Barthel Index and cognitive function by the abbreviated mental test. Results from biochemical markers tested on admission were downloaded from the pathology laboratory database using patient details. Patients were folio wed-up with until discharge or in-hospital mortality. Results: A total of 392 patients formed the study population. Mean (standard deviation) age was 83.2 (± 5.5) years and 283 (72%) patients were men. Thirty-eight (10%) patients were discharged to a long-term care facility, 134 (34%) had a prolonged hospital length of stay, and 33 (8%) died in the hospital. Results from testing 5 biochemical markers independently predicted in-hospital mortality: hypoalbuminemia (adjusted odds ratio [OR], 2.5; 95% CI, 0.9–6.7; P = 0.04), low total cholesterol level (adjusted OR, 2.9; 95% CI, 1.3–6.3; P = 0.01), hyperglycemia (adjusted OR, 2.9; 95% CI, 1.2–7.4; P = 0.02), high C-reactive protein level (adjusted OR, 4.2; 95% CI, 1.3–13.4; P = 0.01), and renal impairment (adjusted OR, 3.8; 95% CI, 1.7–8.7; P = 0.002). High C-reactive protein level independently predicted prolonged hospital length of stay (OR, 1.7; 95% CI, 1.1–2.9; P = 0.03). Hypoalbuminemia predicted discharge to a long-term care facility independent of confounding factors except for physical dysfunction (OR, 2.4; 95% CI, 1.1–5.1; P = 0.03). Significance was reduced after adjustment for Barthel Index score (OR, 1.9; 95% CI, 0.9–4.1; P = 0.08). Conclusion: Testing of routinely assessed biochemical markers on admission predicted adverse hospital outcomes for elderly patients. Their inclusion in a standardized prediction tool may help to create interventions to improve such outcomes.     

A population-based case-control study of risk factors for neural tube defects in four high-prevalence areas of Shanxi province, China

Shanxi province in Northern China has one of the highest reported prevalence rates of neural tube defects (NTD) in the world. To explore the risk factors for NTDs in Shanxi province, we carried out a population-based case-control study in four selected counties with prevalence rates >10 per 1000 births during 2003. Using a multi-logistic regression model analysis (alpha = 0.10), 158 NTD cases were compared with 226 control mothers. Maternal factors significantly associated with increased risk for an NTD were a primary school education or lower (adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 1.09, 4.97); a history of a previous birth defect-affected pregnancy (adjusted OR 5.27, 95% CI 0.98, 28.37); history of a fever or 'cold' (adjusted OR 3.36, 95% CI 1.68, 6.72); use of analgesic and antipyretic drugs (adjusted OR 4.89, 95% CI 0.92, 25.97); daily passive exposure to cigarette smoke (adjusted OR 1.60, 95% CI 0.94, 2.73); poor ventilation during heating (adjusted OR 3.91, 95% CI 0.75, 20.81); and consumption of >or= six meals per week containing pickled vegetables (adjusted OR 3.86, 95% CI 1.11, 13.47) during pregnancy. Factors which appeared to be protective were meat consumption one to three times per week (adjusted OR 0.62, 95% CI 0.37, 1.06), or >or= four times per week (adjusted OR 0.28, 95% CI 0.11, 0.77); and legume consumption >or= six times per week (adjusted OR 0.39, 95% CI 0.17, 0.89). Differences in risk were found between the two most common phenotypes, anencephaly and spina bifida. Most of the environmental factors had stronger positive and negative associations with risk for anencephaly rather than spina bifida, whereas history of a previous birth defect-associated pregnancy, as well as legume consumption, were more strongly associated with the risk for spina bifida than for anencephaly. The findings suggest that aetiological heterogeneity may exist between anencephaly and spina bifida.     

Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women's health across the nation

Objectives. We investigated whether vasomotor symptom reporting or patterns of change in symptom reporting over the perimenopausal transition among women enrolled in a national study differed according to race/ethnicity. We also sought to determine whether racial/ethnic differences were explained by sociodemographic, health, or lifestyle factors.

Methods. We followed 3198 women enrolled in the Study of Women’s Health Across the Nation during 1996 through 2002. We analyzed frequency of vasomotor symptom reporting using longitudinal multiple logistic regressions.

Results. Rates of vasomotor symptom reporting were highest among African Americans (adjusted odds ratio [OR]=1.63; 95% confidence interval [CI]=1.21, 2.20). The transition to late perimenopause exhibited the strongest association with vasomotor symptoms (adjusted OR = 6.64; 95% CI = 4.80, 9.20). Other risk factors were age (adjusted OR=1.17; 95% CI=1.13, 1.21), having less than a college education (adjusted OR = 1.91; 95% CI = 1.40, 2.61), increasing body mass index (adjusted OR=1.03 per unit of increase; 95% CI=1.01, 1.04), smoking (adjusted OR=1.63; 95% CI=1.25, 2.12), and anxiety symptoms at baseline (adjusted OR=3.10; 95% CI=2.33, 4.12).

Conclusions. Among the risk factors assessed, vasomotor symptoms were most strongly associated with menopausal status. After adjustment for covariates, symptoms were reported most often in all racial/ethnic groups in late perimenopause and nearly as often in postmenopause.

     

Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets.

OBJECTIVE: To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients. DESIGN: Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years. SETTING: 76 not-for-profit US dialysis clinics. STUDY PARTICIPANTS: 678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey. MAIN OUTCOME MEASURES: Achievement of accepted 6 month clinical performance targets of albumin (> or =3.5 g/dl), calcium-phosphate (Ca-P) product (<60 mg(2)/dl(2)), dialysis dose (Kt/V > or = 1.2), vascular access type (fistula), and hemoglobin (> or =11 g/dl). RESULTS: By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR) = 0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR = 0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR = 0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR = 0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR = 1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR = 1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR = 0.43, 95% CI, 0.20-0.94). CONCLUSIONS: More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.     

云南省某市锡矿工人性病与艾滋病的流行病学调查

目的 估计云南省某市矿区锡矿工人性病、艾滋病感染状况及相关知识,并分析可能的危险因素。方法 2006年3-6月在云南省某市的5个矿区开展以矿区为基础的横断面研究,共纳入1796名矿工。采用标准化问卷匿名收集研究对象的性病与艾滋病知识、性行为等信息,并采集7ml静脉血和15ml尿检测4种性病和艾滋病感染情况。结果 调查矿工中共检出12例人类免疫缺陷病毒（human immunodeficiency virus,HIV）抗体阳性者,阳性率为0．7％（12／1760）,其他性病阳性率分别为梅毒1．8％（31／1760）,2型单纯疱疹（herpes simplex virustype-2,HSV-2）9．6％（169／1760）,淋球菌0．8％（14／1773）,沙眼衣原体4．8％（85／1773）,除HIV外的其他性病总患病率为14．9％（264／1776）。HIV感染和吸毒（调整OR=17．8;95％CI：4．0—78．8）、12个月内嫖娼次数（调整OR=8．7,95％CI：1．9—39．0）、文身（调整OR=6．6;95％CI：1．8—24．0）、手术（调整OR：6．0;95％CI：1．6—22．5）、共用牙刷（调整OR=5．6;95％CI：1．0—31．3）等因素的联系有统计学意义。性病感染和民族（调整OR=2．0;95％CI：1．5—2．7）、年龄（调整OR=1．7;95％CI．1．0—2．9）、吸毒（调整OR=2．3;95％CI：1．0～5．2）、和配偶住一起（调整OR=1．4;95％CI：1．1—1．9）及嫖娼（调整OR=1．9;95％CI：1．4—2．6）等因素的联系有统计学意义。艾滋病相关知识全部回答正确率为4．1％（49／1201）,有性经历的矿工中自我报告嫖娼的比例为21．6％（339／1569）。结论 该地区矿工性病、艾滋病感染率较高,性病、艾滋病知识匮乏,不安全性行为比较普遍,安全套使用率低,自我保护意识差,存在多种性病、艾滋病的传播途径,应加强该人群教育干预工作。