The stability of health and illness behavior: results from a 16-year follow-up.

In 1977, 302 young adults who were among 350 children first studied in 1961 responded to a questionnaire related to their health and illness behavior. Ten types of adult health and illness behaviors and orientations are examined including seat belt use, smoking, exercise, drinking, and risk taking. These patterns are associated only to a modest degree, and patterns of health and illness behavior appear to have low levels of continuity over a 16-year period (correlations varying from .02 to .20).     

Clinical study of ectopic pregnancy

Ectopic pregnancy remains a leading cause of maternal mortality and accounts for a sizeable proportion of infertility and ectopic recurrence. The possibility that a woman is experiencing an ectopic pregnancy must be considered when evaluating a woman, especially a sterilized woman, who has a possible pregnancy, amenorrhea, abdominal pain, or abnormal bleeding; studies have found that one in six pregnancies occurring after tubal sterilization are ectopic. The authors present a clinical study of 82 cases of ectopic pregnancy admitted to the department of Obstetrics and Gynecology of Mahatma Gandhi Institute of Medical Sciences, Sevagram. Cases of ectopic pregnancy represent 0.99% of total obstetric admissions, of whom 69.51% were diagnosed as such on admission. 40.24% of the women were older than 30 years, while 34.14% were elderly beyond third parity. 70.73% of the women presented before missing their second period. Patients presented with multiple complaints, but the most common was abdominal pain reported by 61.70%. 78.04% were admitted with an acute abdomen, but shock was present in only 7.14% of cases. The main surgical treatment modality was salpingectomy among 59.75%. There was no maternal mortality through postoperative morbidity in the form of paralytic ileus, although fever did occur in some women.     

Evaluation of insulin response in glucose tolerance test in a patient with Werner's syndrome: a 16-year follow-up study

To clarify the effect of Werner's syndrome (WS) on beta-islet cell function, the oral glucose tolerance test (OGTT) was repeatedly performed over a period of 16 years in one patient with WS. The data obtained on insulin secretion were assessed in this study. The patient was a 50-yr-old woman of consanguineous parentage. She presented with gray hair, cataracts, a beak-shaped nose and high-pitched voice. She was diagnosed as WS on the basis of her characteristic appearance. OGTT was performed 14 times during 9 admissions to our hospital. After ingestion of glucose, plasma glucose (PG) levels and immuno-reactive insulin (IRI) at 0, 30, 60, 90, 120 and 180 min were determined. PG levels during OGTT gradually increased during dietary therapy and, at the age of 48, insulin treatment was started [PG level at 120 min during OGTT at 46 yr (before treatment) was 1.5 times that at 34 yr]. Insulin secretion had also gradually decreased during the follow-up period (sum of IRI at 34 yr during OGTT post-treatment; 550.8 IU/ml, sum of IRI at 50 yr during OGTT post-treatment; 244.5 IU/ml). However, the insulinogenic indices were maintained at almost the same level value. Our results indicate that insufficient insulin secretion, which could not overcome insulin resistance, might play a crucial role in the pathophysiology and progression of diabetes in WS along with insulin resistance due to a post-receptor defect.     

Interstitial pregnancy: a rare type of ectopic pregnancy

Three women, aged 21, 28 and 37 years, respectively, were diagnosed with interstitial pregnancies. The first patient presented with lateral abdominal pain, the second patient was asymptomatic and consulted the physician for a routine first trimester scan and the third patient had painless vaginal bleeding in the first trimester. Each was treated with systemic methotrexate in a multiple dose regimen, which was successful in the latter two patients. The first patient was discharged in good condition after her last methotrexate injection, but developed severe abdominal pain and collapsed at home after the interstitial pregnancy had ruptured. She underwent surgery and recovered. Today, the incidence of ectopic pregnancy in the Netherlands is around 8 per 1000 live births. Interstitial pregnancies, which nidate in the portion of the fallopian tube embedded in the uterine wall, account for 2-3% of all ectopic pregnancies. A urinary pregnancy test should be performed for any fertile woman with abdominal pain or abnormal vaginal bleeding. If the result is positive, the patient should be referred to a gynaecologist for transvaginal ultrasound to exclude ectopic pregnancy. In case of a pregnancy of unknown location, one should search for specific ultrasound markers of non-tubal ectopic pregnancy and assess serum human chorionic gonadotropin (HCG). Interstitial ectopic pregnancy should be considered if the serum HCG level is above 2000 U/l.     

The effects of non-response in a prospective study of cancer: 15-year follow-up

Out of 11,136 Japanese men identified on the island of Oahu, Hawaii in 1965 by the Honolulu Heart Program, 8006 responded to a mailed questionnaire and were examined. Some 1871 responded only to the mailed questionnaire, and 1259 did not respond at all. After 15 years of follow-up, the examined men had significantly lower risk of death from all causes and death from cancer. Minor differences were also noted between the two groups in the risk of cancer of the lung, stomach, colon, and rectum. However, the examined men had a significantly higher risk of prostate cancer. In general, the strength of these non-response effects was mainly due to risk differences in the first five years of the 15-year follow-up period. The relative risk (RR) of each of the seven endpoint events tended towards 1.0 as each of the three successive five-year follow-up intervals were considered. An exception to this was the prostate cancer incidence RR which favoured the unexamined men throughout the entire 15 years, but significantly so only in the last five-year follow-up interval. When the 8006 examined and 1871 unexamined men who responded to the mailed questionnaire were evaluated with respect to the association of cigarette smoking with lung cancer incidence, the RR for smokers was 9.77 for the examined men, and 6.73 for the unexamined men. Since these RRs are not significantly different, there should be little bias in RR estimates of cigarette smoking for lung cancer if the observation was limited to only the examined men. With regard to the association of body mass index (BMI) with colon cancer in older men, the RRs for men in the highest BMI quintile were quite comparable, at 1.37 for the examined group and 1.60 for the unexamined men. We conclude that although some non-response effects on cancer incidence exist in this cohort, they do not appear to be serious enough to have changed conclusions drawn about risk relationships.     

异位妊娠影响因素的对照研究

目的探讨异位妊娠发生的影响因素,为预防异位妊娠的发生提供理论参考依据。方法采用患者对照研究,选取2011年12月-2012年5月期间芜湖某两医院收治的71例异位妊娠患者作为病例组．按1：2的比例选取同期住院的142例正常妊娠者作为对照组,调查其既往生活习惯、婚育状况、疾病手术史和焦虑情况等。结果患者组和对照组的焦虑检出率分别为56．34％、20。42％,差异具有统计学意义（χ^2=27．88,P〈0．01）。多因素非条件Logistic回归分析显示焦虑（OR=6．08,P〈0．01）、妇科炎症史（OR=8．39,P〈0．01）、宫内节育器史（OR=6．92,P〈0．01）、流产史（OR=5．88,P=0．03）及被动吸烟（OR=6．58,P〈0．01）是导致异位妊娠发生的危险因素,月经规律（OR=0．28,P〈0．01）为保护性因素。结论对计划生育者进一步加大心理辅导力度,并开展与异位妊娠相关的孕期健康教育,能有效减少异位妊娠的发生几率。     

抑郁症状对社区亚老龄及老龄人群心身健康结局影响的随访研究

目的 探索抑郁症对社区老年人群健康结局的影响。方法 对上海市静安区同一批非痴呆55岁以上人群应用中文版流行病学调查用抑郁自评量表（CES-D）等调查工具，进行5年随访。按当年抑郁症状的严重程度，对5年后多项心理和躯体健康结局指标进行多因素分析。结果 （1）2次面访者2927名。按照首次CES-D得分将有无抑郁症状分为4个等级，基线分布除年龄外、性别、教育程度、中文版简易智能状态检查（MMSE）、日常生活活动能力量表（ADL）差异均存在显著性。（2）以首次CES-D分数、年龄、性别、教育程度、MMSE、ADL为自变量，进行多元回归分析发现，CES-D得分与5年后MMSE、ADL、生活满意度指数A（LSIA）得分无显著性相关。（3）在控制基线变量后，首次CES-D得分与5年自我健康评价、记忆力自我评价呈显著性正相关。（4）分别以5年后躯体疾病指数、是否死亡为因变量，以首次CES-D得分等级、年龄、性别、教育程度、MMSE、ADL为自变量，进行多元logistic回归分析。在躯体疾病影响指数和死亡的风险预测中，5年前抑郁症状影响最大，其OR值分别为1.52(95%CI:1.19-1.95)和2.68(95%CI:1.41-5.06)。结论 抑郁症状是影响社区老年人心身健康结局的主要因素之一。     

Long-term weight development in women: a 15-year follow-up of the effects of pregnancy

OBJECTIVE: The aim of this study was to evaluate how well prepregnancy BMI, gestational weight gain, and postpartum weight retention predict retention of weight 15 years later among parous women. RESEARCH METHODS AND PROCEDURES: The Stockholm Pregnancy and Women's Nutrition (SPAWN) study is a long-term follow-up study of women who delivered children in 1984 to 1985 (n = 2342). The participants initially filled out questionnaires about their eating and exercise habits, social circumstances, etc. before, during, and at 1 year after pregnancy. Anthropometric data were also sampled. Fifteen years later, these women were invited to take part in the follow-up study. Anthropometric measurements were collected, and similar questions were asked. Five hundred sixty-three women participated in the SPAWN 15-year follow-up study. The sample was divided into groups to examine three presumably critical time periods: 1) overweight and normal weight before pregnancy; 2) low, intermediate, and high weight gainers during pregnancy; and 3) low, intermediate, and high weight retainers at 1 year after pregnancy. RESULTS: The overweight women did not gain more weight during pregnancy or retain more weight at 1 year follow-up. High weight gainers during pregnancy retained more weight at the 1-year and the 15-year follow-ups. High weight retainers had gained more during pregnancy and retained it at the 15-year follow-up. Fifty-six percent of the high weight gainers during pregnancy ended up in the high weight retainers group. DISCUSSION: Women who are overweight before pregnancy do not have a higher risk of postpartum weight retention than normal weight women. Thus, it is not necessarily the initially overweight woman who should be the target or focus of weight control programs during or after pregnancy. Both high weight gainers and high weight retainers had higher BMI at the 15-year follow-up, although only 56% of the high weight gainers during pregnancy were also classified as high weight retainers at the 1-year follow-up. Weight retention at the end of the postpartum year predicts future overweight 15 years later.     

Shift-work and cardiovascular disease: a population-based 22-year follow-up study

Studies on the association between shift-work and cardiovascular disease (CVD), in particular coronary heart disease (CHD), have given conflicting results. In this prospective population-based study we assessed the association of shift-work with three endpoints: CHD mortality, disability retirement due to CVD, and incident hypertension. A cohort of 20,142 adults (the Finnish Twin Cohort) was followed from 1982 to 2003. Type of working time (daytime/nighttime/shift-work) was assessed by questionnaires in 1975 (response rate 89%) and in 1981 (84%). Causes of death, information on disability retirement and hypertension medication were obtained from nationwide official registers. Cox proportional hazard models were used to obtain hazard ratios (HR) for each endpoint by type of working time. Adjustments were made for 14 socio-demographic and lifestyle covariates. 76.9% were daytime workers and 9.5% shift-workers both in 1975 and in 1981. During the follow-up, 857 deaths due to CHD, 721 disability retirements due to CVD, and 2,642 new cases of medicated hypertension were observed. However, HRs for shift-work were not significant (mortality HR men 1.09 and women 1.22; retirement 1.15 and 0.96; hypertension 1.15 and 0.98, respectively). The results were essentially similar after full adjustments for all covariates. Within twin pairs, no association between shift work and outcome was observed. Our results do not support an association between shift-work and cardiovascular morbidity.     

Workplace bullying and sleep difficulties: a 2-year follow-up study

Purpose

The aims of the present study were to investigate whether being subjected to bullying and witnessing bullying at the workplace was associated with concurrent sleep difficulties, whether frequently bullied/witnesses have more sleep difficulties than occasionally bullied/witnesses, and whether there were associations between being subjected to bullying or witnessing bullying at the workplace and subsequent sleep difficulties.

Methods

A total of 3,382 respondents (67 % women and 33 % men) completed a baseline questionnaire about their psychosocial work environment and health. The overall response rate was 46 %. At follow-up 2 years later, 1671 of those responded to a second questionnaire (49 % of the 3,382 respondents at baseline). Sleep difficulties were measured in terms of disturbed sleep, awakening problems, and poor quality of sleep.

Results

Bullied persons and witnesses reported more sleep difficulties than those who were neither bullied nor witnesses to bullying at baseline. Frequently bullied/witnesses reported more sleep difficulties than respondents who were occasionally bullied or witnessing bullying at baseline. Further, odds ratios for subsequent sleep difficulties were increased among the occasionally bullied, but not among witnesses. However, the associations weakened when adjusting for sleep difficulties at baseline.

Conclusion

Being subjected to occasional bullying at baseline was predictive of subsequent sleep difficulties. Witnessing bullying at baseline did not predict sleep difficulties at follow-up.     

Prevalence of Salmonella serotypes in India: a 16-year study

During the period 1958-73, 8 027 strains of Salmonella were tested at the National Salmonella and Escherichia Centre: 3 834 strains from man, 3 018 from animals, 839 from sewage and water sources, and 336 of unknown origin. A total of 99 serotypes were identified: 47 from man, 83 from animals, and 35 from sewage and water sources. S. typhi was the commonest serotype in man, followed by S. weltevreden and S. paratyphi A. S. typhimurium was the commonest serotype isolated from animals, followed by S. weltevreden and S. anatum. In sewage and other water sources S. weltevreden was the commonest serotype identified followed by S. typhimurium and S. bareilly. Infection due to S. weltevreden in both man and animals increased considerably after 1970. Out of a total of 99 serotypes isolated from different sources, 13 were isolated from man only, 49 from animals only, 34 from both man and animals, 30 from both animals and water sources, and 22 from man, animals, and water sources.     

深圳市孕妇异位妊娠的危险因素

目的探讨异位妊娠的危险因素并制定相应的干预措施。方法以2005年10月至2006年9月在深圳市22家医院确诊的宫外孕患者1215例为异位妊娠组，选取正常妊娠早期人工流产238例为对照组，2组对象在生殖道感染史、人工流产史、避孕史等方面进行问卷调查，对异位妊娠进行保守治疗的155例患者和238早期终止妊娠者进行宫颈分泌物和微生物检测。结果异位妊娠组中曾患盆腔炎和输卵管炎的占35．63％（433／1215）；有人工流产史占57．20％（695／1215），明显高于正常妊娠组，差异有统计学意义（Х^2=21．82，P〈0．01）；异位妊娠组中宫颈分泌物病原微生物检出率，衣原体为6．45％（8／124）、解脲支原体为29．13％（37／127）、人型支原体为26．44％（32／121）、淋球菌为12．30％（15／122）、加特纳菌为37．50％（45／120），均高于对照组，差异有统计学意义（P〈0．05）。结论异位妊娠与人工流产手术、生殖道微生物感染的慢性盆腔炎和输卵管炎有一定的相关性。     

异位妊娠发生因素的病例对照研究

目的探讨发生异位妊娠（EP）的相关危险因素,提出预防措施。方法采用病例对照法,将遂平县人民医院收治的EP孕妇130例作为研究组,选择同期行人工流产或药物流产的健康妊娠妇女130例作为对照。收集两组患者的相关信息,包括患者的一般情况、婚育史、妇科疾病史、腹部手术史等,对可能影响EP的因素进行单因素和多因素Logistic回归分析。结果单因素分析结果显示盆腔炎史、流产史、既往分娩史、不孕史、腹部手术史、EP史、IUD使用是EP发病的危险因素（P〈0.05）。多因素分析筛选出4个主要危险因素,即流产史（OR=3.698）、腹部手术史（OR=3.471）、IUD使用（OR=3.207）、盆腔炎史（OR=2.706）。结论 EP与多种因素有关,积极采取相应预防措施,对降低EP的发病率有积极作用。     

School performance as a predictor of adulthood obesity: a 21-year follow-up study

We examined the impact of school performance measured in terms of grade point averages (GPAs) in early and middle adolescence (ages 9, 12, and 15), and the impact of school performance throughout the different school stages on adult obesity. The participants were 732 healthy women and men derived from a population-based Cardiovascular Risk in Young Finns Study. GPAs were measured at the ages of 9, 12, and 15. The body mass index (BMI; kg/m2), and the waist circumference (WC) were conducted participants being aged 27 or 30. Birth weight, childhood BMI, adulthood physical activity, maternal and paternal BMI, and maternal education were controlled for. The results showed that low GPAs in each measurement and low GPAs throughout the comprehensive school were a risk factor of adulthood obesity, but only among women. The association remained when controlling for potential confounding variables (p-values in the fully adjusted models 0.026, 0.007, and 0.004 at the ages of 9, 12, and 15, respectively). The results were similar when the BMI was used as a dichotomous variable (BMI ≥ 30 and BMI < 30). Low school performance has previously been associated with higher rates of smoking and alcohol consumption later in life. Our result underscores that low school performance is a health risk factor that should be taken seriously in preventive health education.     

基于Logistic回归的早期可疑异位妊娠诊断模型的研究

目的 建立由超声及血清指标组成的综合诊断模型,以获得早期诊断异位妊娠(EP)患者的较佳指标组合,提高早期不明位置妊娠患者(PUL)的综合诊断水平.方法 早期PUL患者随机分成建模组(184例)和测试组(90例),按最终妊娠结果分为EP组与非EP组.以拟合累积方式得出建模组每个病例EP的诊断概率,并利用受试者工作特性曲线(ROC)评价诊断指标,最后在独立的测试组中检验模型的诊断效率、正确性与稳定性.结果 采用logistic逐步回归分析显示,血清孕酮、内膜厚度和对称性的意义较大,对PUL的妊娠结局有影响.受试者工作特征曲线(ROC)证实,logistic模型较单一变量的诊断性能高(P＜0.05).当模型预测概率临界值取0.25时,对EP鉴别的敏感度和特异度分别为98.4%、92.6%,正确指数为0.91,曲线下面积为0.992.以同样标准应用于测试组,2组的诊断效率相仿.结论 综合考虑子宫内膜形态学变化与相应的生化指标,将有助于提高阴道超声诊断EP的正确率,能较为准确地判断早期PUL的妊娠状态.     

Sleep patterns and total mortality: a 12-year follow-up study in Japan

A population-based cohort study was conducted to assess the relationship between total mortality and self-reported sleep patterns as regards not only to sleep duration but also subjective sleep quality. A total of 5,322 inhabitants in Gifu Prefecture, Japan, completed a self-administered questionnaire on health status and lifestyles including habitual sleep patterns, and were followed-up for an average of 11.9 years. Relative risks were computed by using Cox proportional hazards models. Both longer and shorter sleep, compared to 7-8 hour-sleep, was related to significantly increased risk of total mortality in males (relative risk [RR] for > or = 10 hours = 1.94, and RR for < 7 hour = 1.90), but not in females. Females complaining of poor awakening state experienced a higher mortality risk compared to those who woke up normally (RR: 1.97). Males who usually fell asleep easily showed a marginally lower mortality risk compared to those who fell asleep normally (RR: 0.70). Female users of sleeping pills were at an elevated risk (RR: 1.89). These findings were almost unchanged after adjustment for sleep duration and other confounders. Poor self-reported quality of sleep seemed to be associated with an increased risk of mortality independently of sleep duration.