Second primary gastric cancers in a region with an overall high risk of gastric cancer

ObjectiveTo compare the incidence rates of gastric cancer among cancer survivors with those in the general population, and estimate the probability of a gastric second primary cancer being diagnosed 10 years after any other first primary cancer.MethodA cohort of first primary cancers (other than gastric) diagnosed in Northern Portugal between 2000 and 2006 (n = 64,648) was followed until 31/12/2012 for gastric second primary cancers. Incidence rates, standardized incidence ratios and the cumulative incidence of gastric second primary cancers were calculated.ResultsOverall, 330 patients developed gastric second primary cancers (21.2% within two months). The incidence rate of gastric second primary cancers was higher within two months of the first primary cancer (standardized incidence ratios: 5.20 in males and 7.89 in females), particularly among survivors of cancers of the oesophagus, colon and rectum, than in the remaining period (standardized incidence ratios: 0.64 in males and 0.74 in females). The 10-year risk of a gastric second primary cancer was 0.6% (males: 0.7%; females: 0.4%).ConclusionThe incidence rate of gastric second primary cancers among cancer survivors was higher than in the general population only soon after the first primary cancer, and lower thereafter. Despite the high mortality, the probability of a gastric second primary cancer within 10-years of the first primary cancer was 0.6%.     

Time trends in the incidence of eating disorders: a primary care study in the Netherlands

OBJECTIVE: This Dutch epidemiological study used primary care-based data to examine changes in the incidence of eating disorders in the 1990s compared to the 1980s. METHOD: A nationwide network of general practitioners, serving a representative sample of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practices during 1985-1989 and 1995-1999. RESULTS: The overall incidence of AN was stable (from 7.4 to 7.7 per 100,000). However, the incidence among 15-19-year-old females increased significantly (from 56.4 to 109.2 per 100,000). The incidence rate of BN decreased nonsignificantly from 8.6 to 6.1 per 100,000. CONCLUSION: The time trend of an increasing AN incidence among the high risk group continued to the end of the past century. The BN incidence did not rise as was expected.     

Comparative validity of three methods for assessment of the quality of primary health care.

OBJECTIVE: This study compared the sensitivity and specificity of three assessment methods to detect the performance of key clinical tasks by health workers in a primary care setting. DESIGN: Health worker performance during patient encounters for acute respiratory infections, acute diarrhea and family planning counseling was assessed through checklist-based observation of the consultation, interview with the mother following the consultation, and review of the patient's clinical record. The results of each method regarding the performance of key tasks by health workers were compared to a 'gold standard', defined as the application of the observation checklist by observers with extensive quality assessment experience. Patient encounters were studied in three Ministry of Health facilities in the Department of Totonicapán, Guatemala, involving care by physicians, nurses and auxiliary staff RESULTS: The three methods showed reasonably high levels of sensitivity (generally about 70%) for the detection of failures in the performance of most health worker tasks. The greatest problem experienced by each method related to specificity, i.e. capacity to recognize quality successes and only detect real failures. CONCLUSION: Direct observation demonstrated the best overall balance of sensitivity and specificity. Exit interview of the mother demonstrated good sensitivity and better specificity than record review.     

Patient based 'burden-of-illness' in Swedish primary health care. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records

Patients from one municipality in Sweden utilizing primary health care (PHC) during 1998 and 1999 have been categorized into 81 groups. The groups show each patient's own case-mix in terms of illness. Grouping was carried out using the case-mix instrument adjusted clinical groups (ACG), developed by the School of Hygiene and Public Health at Johns Hopkins University in Baltimore, USA. The resulting pattern provided a more adequate reflection of the scope of primary care's task than that yielded by diagnoses alone. Changes over time in terms of illness patterns for a population could be described, analysed and assessed from medical and health economic perspectives. One of the conclusions from this study was that the ACG instrument is a relevant tool in describing the outcome of work by the primary health care centre. The ACG is of interest in the improvement of the quality of primary care in Sweden. The ACG should be a driving force in the development of health indices in both national and international comparisons, as a result of its focus on the health status of patients and populations instead of on diagnoses and diseases.     

以人群为基础的食管癌高发区危险因素病例对照家系研究

目的 探讨食管癌高发区食管癌发生的危险因素,为食管癌的综合防治提供理论依据.方法 采用以人群为基础的病例一对照家系研究方法,在河南省食管痛高发区以匹配方式选择病例和对照家系各505户,家庭成员各1171名,进行以家庭为单位的问卷调查,应用单因素和多因素logistic回归模型分析食管癌危险因素.结果 病例组和对照组比较,食用炯熏食物[2.10%(36/1711),0.82%(14/1711);X2=9.82,P=0.00;OR=2.61,95%C/:1.40～4.85],常吃油炸食品[7.17%(66/921),3.91%(35/894);X2=9.13,P=0.00;OR=1.90,95%C/:1.24～2.89],常吃生硬食物[13.36%(123/921),8.95%(80/894);X2=8.87,P=0.03;OR=1.57,95%CI/:1.16～2.11],喜食热烫食物[20.05%(343/1711),15.20%(260/1711);X2=13.87,P=0.00;OR:1.40,95%C/:1.17～1.67],有精神刺激史[6.72%(115/1711),3.10%(53/1711);X2=24.06,P=0.00;OR=2.25,95%CI:1.62～3.14]和有E消化道不适症状[19.40%(332/1711),12.74%(218/1711);X2=28.15,P=0.00;OR=1.65,95%CI:1.37～1.99]等因素,是食管癌发生的危险因素.而进食速度较快则显示是保护因素[20.85%(192/921),25.14%(225/895);X2=4.73,P=0.03;OR=0.78,95%Cl:0.63～0.98].结论 食管癌发生是多因素综合作用所致,要从生活行为方式、环境因素、社会心理因素和生物遗传因素等多方面进行综合防治.     

Twenty-five-year coronary mortality trends in the seven countries study using the accelerated failure time model

The accelerated failure time model (AFT) was tested in the 25-year experience of the Seven Countries Study, to describe the shape of hazard for coronary heart disease (CHD) mortality during long-term follow-up. Sixteen cohorts of men aged 40–59 at entry were enrolled in eight countries (USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan) for a total of 12,763 subjects. Risk factors were measured and CHD mortality data collected during 25 years. The AFT incorporating the Weibull survival distribution was applied to the pooled cohorts of each country, with CHD mortality as end-point. Cumulative hazards and the annual hazard for CHD mortality were estimated during 25 years and compared among countries. The annual hazard for CHD in 25 years tended to reduce relatively or flatten out in the northern American and northern European countries, exponentially increased in Serbia and Japan, and increased moderately in the other countries of southern Europe. Positive correlations were found between the shape of the hazard curve and population mean risk factor changes (serum cholesterol and systolic blood pressure) observed during the first 10 years follow-up. The Japanese group was an outlier. The countries with the largest relative decline in the annual hazard function were the same where, during the same historical period, the largest decreases in official death rates from CHD were recorded and vice versa. The curve shape in the annual hazard for CHD mortality in different countries seems related to changes in mean levels of serum cholesterol and systolic blood pressure.     

武汉市东西湖区巨大胎儿发生率及其危险因素的病例对照研究

目的:了解武汉市东西湖区巨大胎儿发生率及影响因素。方法:以2006年在武汉市东西湖区妇幼保健院建册的761例孕妇及分娩的活产儿为研究对象,新生巨大儿为病例组,正常出生体重新生儿为对照组,进行病例对照研究。结果:男女出生性别比为1.13∶1。巨大儿发生率为6.31%(男女新生儿的发生率分别为7.00%和5.64%);单因素分析显示,巨大儿组产妇的身高、分娩前BMI、产前检查次数均高于对照组(P<0.05),多因素非条件Logistic回归分析结果显示,孕期BMI≥28是巨大胎儿的独立预测因子(OR95%CI=1.102～1.38,P<0.05)。结论:孕妇身高、孕期肥胖与巨大胎儿的发生有关。应加强孕期保健,避免孕期体重过度增长,以预防巨大儿发生。     

Elevated hepatic enzymes and incidence of venous thromboembolism: a prospective study

PurposeApproximately 10% of the general population has elevated blood concentrations of hepatic enzymes, which are linked to increased coagulation markers. We tested whether elevated hepatic enzymes are associated with increased risk of venous thromboembolism (VTE).MethodsWe followed 12,604 adults with measurements of alanine transaminase, aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT) prospectively for VTE occurrence.ResultsAST and GGT above the laboratory normal values were associated over two decades of follow-up with increased risk of total (n = 532) and provoked VTE (n = 332), but with not unprovoked VTE (n = 200). In a model adjusted for age, race, sex, hormone replacement, alcohol intake, diabetes, body mass index, estimated glomerular filtration rate, and C-reactive protein, the hazard ratios (HR) (95% confidence interval) for high versus normal AST were 1.46 (1.00–2.11) for total VTE and 1.83 (1.21–2.79) for provoked VTE. For high GGT, the HR were 1.34 (1.06–1.69) for total VTE and 1.43 (1.07–1.91) for provoked VTE. When follow-up was limited to the first 10 years, associations were even stronger (HR ≈ 1.7 for total VTE).ConclusionsElevated concentrations of two hepatic enzymes (AST and GGT) in this general middle-aged population are associated with a modestly increased risk of VTE.     

Characterising socio-economic inequalities in exposure to air pollution: a comparison of socio-economic markers and scales of measurement

This study examines traffic-related air pollution in London in relation to area- and individual-level socio-economic position (SEP). Mean air pollution concentrations were generally higher in postcodes of low SEP as classified by small-area markers of deprivation (Index of Multiple Deprivation (IMD) domains) and by the postcode-level ACORN geodemographic marker. There were exceptions, however, including reversed directions of associations in central London and for SEP markers relating to education. ACORN predicted air pollution independently of IMD and explained additional variation at the postcode level, indicating the potential value of using both markers in air pollution epidemiology studies. By contrast, after including IMD and ACORN there remained little relationship between air pollution and individual-level SEP or smoking, suggesting limited residual socio-economic confounding in epidemiological studies with comprehensive area-level adjustment.     

Real life is different: a qualitative study of why women delay abortion until the second trimester in Vietnam

Although legal and safe-induced abortion services are available on request in Vietnam, second-trimester abortion still occurs. Given the increased risks and higher costs associated with later-term abortions, we conducted a qualitative study to understand the determinants of delaying abortion until the second trimester. We used purposive sampling to conduct semi-structured face-to-face interviews with 60 women aged 14-47 receiving an abortion at 13-24 weeks of gestation in 5 health facilities in 3 provinces in Vietnam. We also interviewed 6 providers from the study facilities. Three broad categories for factors influencing delays in obtaining abortions emerged: most women failed to recognize their pregnancy during the first trimester; women described structural barriers to accessing services earlier; and some women either needed time to make a decision or only decided to abort after other events had transpired. A richer understanding of the factors that prevent women from obtaining an abortion during the first trimester could be useful for informing interventions that support women in receiving care earlier during their pregnancies.     

广州市大学生校园暴力发生情况与危险因素

目的 了解广州市大学生校园暴力发生情况,探讨施暴和受暴的危险因素。方法 以2010年广州市高校在校本科生为调查对象,采取分层整群抽样的方法抽取3所高校,对其中的2200名大学生实施校园暴力及其影响因素问卷调查,共回收有效问卷2103份。采用卡方检验分析校园暴力的性别、年级、专业分布情况。对可能影响校园暴力中施暴和受暴的因素进行非条件logistic回归分析。结果 广州市大学生校同暴力发生率为69.9％( 1471/2103),男、女生校园暴力发生率分别为75.6％ (830/1098)、63.8％ (641/1005)( x2= 34.82,P＜0.05)。校园暴力施暴和受暴发生率分别为63.6％ (1338/2103)、55.3％( 1163/2103),男生施暴和受暴发生率分别为70.9％ (778/1098)、60.0％ (659/1098),女生施暴和受暴发生率分别为55.7％( 560/1005)、50.1％ (504/1005) (x2施暴=51.93,x2受暴=20.68,P值均＜0.01)。精神暴力发生率最高,为68.0％(1430/2103),其次为性暴力,发生率为34.2％ (719/2103),躯体暴力最低,为16.5％( 348/2103)。Logistic回归分析显示,男生(OR= 1.60)、文科专业(OR= 1.82)、非独生子女（OR =1.31）、生活费不足(基本够用OR= 1.35,不够用OR= 1.54)、玩电脑游戏(OR= 1.70)、玩滑板等特技(0R=2.03)、喜欢暴力节目（一般OR=1.30,喜欢0R=1.44）、母亲有赌博行为(OR =4.29)、父亲放纵型教养方式(OR= 1.60)、高中之前有时遭他人欺负（OR =1.61）、对学校现行环境和制度不满(没什么特别感觉OR= 1.67,有部分不满OR=1.89)、小学老师对自己有不良行为（有1种时OR =1.35,有2种及以上时OR= 1.90）（P值均＜0.05）是校园暴力施暴的危险因素。男生(0R=1.23)、少数民族(OR=1.71)、非独生子女(OR= 1.39)、自身有不良行为习惯（OR= 1.32）、家庭经济困难（一般OR= 1.51,困难OR= 1.88）、母亲有赌博行为(OR =2.33)、父亲放纵型教养方式(0R=1.37)、偶尔被母亲体罚(OR= 1.35)、高中之前曾遭他人欺负（有时OR= 1.61,经常OR= 1.85）、上学期间压力大(有点大OR= 1.37,非常大OR= 1.40)、对学校现行环境和制度不满（有部分不满OR= 1.56,完全不满OR =2.04）、小学老师对自己有不良行为(有1种时OR= 1.70,有2种及以上时OR=2.04)（P值均＜0.05）是校园暴力受暴的危险因素。结论 广州市大学生校园暴力现象较严重,尤其是精神暴力和性暴力,校园暴力施暴和受暴的危险因素种类多。     

2010年广州市大学生精神暴力发生情况及影响因素分析

目的 了解2010年广州市大学生精神暴力的发生情况和影响因素.方法 于2010年以方便抽样法抽取广州市3所高校61个班级共2 200名大学生,运用自行设计的问卷对大学生精神暴力发生情况及其影响因素进行调查,共回收有效问卷2 060份.分别采用x2检验和多分类logistic回归分析比较不同性别大学生精神暴力发生情况和影响因素.结果 近1年内,有66.3％(1 365/2 060)的大学生经历了精神暴力,或作为施暴者,或作为受暴者,其中,男性为72.3％(775/1 072),女性为59.7％(590/988),男性高于女性(x2=36.39,P＜0.05).精神暴力仅施暴、仅受暴和既施暴又受暴的发生率分别为16.1％(331/2 060)、8.9％(184/2 060)和41.3％(850/2 060),女性仅受暴发生率为10.4％(103/988),高于男性的7.6％(81/1072)(x2 =5.20,P＜0.05);男性既施暴又受暴的发生率为47.3％(507/1 072),高于女性的34.7％ (343/988)(x2=33.56,P＜0.05).多分类logistic回归分析显示,广州市男性大学生精神暴力仅施暴的危险因素为个人不良行为习惯(OR=1.90);仅受暴的危险因素为非独生子女(OR =2.42)、小学至高中老师对自己有不良行为(OR =1.78);既施暴又受暴的危险因素为非独生子女(OR=1.88)、个人有不良行为习惯(OR=1.98)、家庭经济条件困难(OR=1.99)和一般(OR=1.67)、小学至高中老师对自己有不良行为(OR=2.07).女生仅施暴的危险因素为自认月生活费不够用(OR=2.14)或基本够用(OR=2.26)、个人有不良行为习惯(OR=1.69);仅受暴的危险因素为家庭经济条件困难(OR =6.67)或一般(OR =3.81)、在大学以前曾经受人欺负(OR=2.05);既施暴又受暴的危险因素为自认月生活费不够用(OR=1.81)、家庭经济条件困难(OR=2.43)、父母间关系不和谐(OR=1.76)、父母曾对自己体罚(OR=1.66)、小学至高中老师对自己有不良行为(OR=1.73)、在大学以前曾经有受人欺负(OR =2.14),保护因素为宗教信仰(OR=0.38)(P值均＜0.05).结论 2010年广州市大学生精神暴力形势严峻.不同性别精神暴力的影响因素不同,女性受影响的范围较男性广,且受家庭和父母的影响更大.     

Methodological issues in the development of a national database for primary care groups and trusts

At the National Primary Care Research and Development Centre (NPCRDC) we have constructed a national database for all primary care groups (PCGs) in England. At its core, the database links information about population socio-economic and demographic characteristics to generic health status and to the organisation, resourcing and activities of general practice. In this paper we describe and discuss the problems with linking these data, and with defining the boundaries and the local populations of PCGs, given that they have been established on the basis of administrative expediency rather than geographical coherence. We then consider the implications of these difficulties for needs assessment in primary care groups.     

Incidence of non-lung solid cancers in Czech uranium miners: a case-cohort study

Objectives: Uranium miners are chronically exposed to radon and its progeny, which are known to cause lung cancer and may be associated with leukemia. This study was undertaken to evaluate risk of non-lung solid cancers among uranium miners in P?íbram region, Czech Republic.Methods: A retrospective stratified case–cohort study in a cohort of 22,816 underground miners who were employed between 1949 and 1975. All incident non-lung solid cancers were ascertained among miners who worked underground for at least 12 months (n=1020). A subcohort of 1707 subjects was randomly drawn from the same population by random sampling stratified on age. The follow-up period lasted from 1977 to 1996.Results: Relative risks comparing 180 WLM (90th percentile) of cumulative lifetime radon exposure to 3 WLM (10th percentile) were 0.88 for all non-lung solid cancers combined (95% CI 0.73–1.04, n=1020), 0.87 for all digestive cancers (95% CI 0.69–1.09, n=561), 2.39 for gallbladder cancer (95% CI 0.52–10.98, n=13), 0.79 for larynx cancer (95% CI 0.38–1.64, n=62), 2.92 for malignant melanoma (95% CI 0.91–9.42, n=23), 0.84 for bladder cancer (95% CI 0.43–1.65, n=73), and 1.13 for kidney cancer (95% CI 0.62–2.04, n=66). No cancer type was significantly associated with radon exposure; only malignant melanoma and gallbladder cancer showed elevated but non-significant association with radon.Conclusions: Radon was not significantly associated with incidence of any cancer of interest, although a positive association of radon with malignant melanoma and gallbladder cancer cannot be entirely ruled out.     

Pesticide prioritization for a case-control study on childhood leukemia in Costa Rica: a simple stepwise approach

Multiple exposures and rapidly changing use patterns are obstacles for adequate recall of pesticide exposures in epidemiologic studies. We present a simple stepwise approach for prioritization of pesticides as part of the exposure assessment strategy in an ongoing case-control study on pesticides and childhood leukemia in Costa Rica. Pesticide imports between 1977 and 2000, approximately the pertinent exposure period, were surrogates for use data. In the first phase, 323 active ingredients were identified, of which 219 were eliminated based on low usage and absence or negative results in a preliminary search in three major toxicity databases. In the second phase, the remaining 104 pesticides underwent scoring for their toxicodynamic potential (TDP) with regard to carcinogenicity, mutagenicity, and teratogenicity, weighted in this order. Bioavailability was assessed when TDP was multiplied by a weight for persistence and bioaccumulation, producing the intrinsic toxic potential (ITP). ITP was multiplied by an index of quantity (QI) of pesticide used in the exposure period, resulting in a weighted toxic potential (WTP). The top 25 positions in each of the four rankings (TDP, ITP, QI, and WTP) yielded together 64 highest-priority pesticides. This prioritization process has to be complemented with a further breakdown into crop-, time-, and biocide-specific shortlists to achieve a recall tool suitable for developing countries. Different parameters for prioritization assure inclusion of all relevant pesticides with regard to toxicity and bioavailability. The method contributes to cancer epidemiology in developing countries with access to basic use data and the Internet. The method is adaptable to other health outcomes.     

某医学院学生吸烟状况与相关因素研究

目的 研究医学生吸烟状况与相关因素的关系。方法 采用无记名问卷调查，描述并采用非条件Logistic回归分析评价各因素与吸烟间的关系。结果 总吸烟率为37．8％，男生总吸烟率为51．6％，女生为6．8％，男生中性格内向和月支出低吸烟率低于性格外向和月支出高，年级越高，吸烟率越高。家住农村、父亲从事农业生产，吸烟率低于城镇和非农业，家人是否吸烟不影响学生吸烟，而他周围的人对其吸烟影响明显。有24．2％的男生在大学学会吸烟，其纸烟来源主要是自购，吸烟的最初诱因以解闷、消遣占首位。经分析、城镇学生、高年级、月支出高、周围有人吸烟、赞成吸烟的态度等是经常吸烟的危险因素。结论 医学生吸烟率高，必须对医学生吸烟采取干预措施。     

Temporal trends in the leading causes of death among a large national cohort of patients with colorectal cancer from 1975 to 2009 in the United States

PurposeTo assess the distribution of proportion of deaths from causes other than colorectal cancer (CRC) over time and temporal trends of cause-specific cumulative incidence of death due to six leading causes in patients with CRC.MethodsOverall, 375,462 patients with CRC in nine Surveillance, Epidemiology, and End Results registries from 1975 to 2009 were included. Competing risks proportional hazards regression was used to examine the effect of diagnostic periods on the risk of cause-specific death.ResultsFrom 1975 to 2009 by 5-year interval, the proportion of deaths from causes other than CRC increased significantly with diagnostic periods according to the lengths of follow-up (P < .0001). The 5-year risk of death significantly decreased with diagnostic periods for all-cause, CRC, and circulation diseases among all age groups (<65, 65–74, and ≥75 years) but increased for chronic obstructive pulmonary disease, diabetes, and Alzheimer disease among patients aged 65 years or older.ConclusionsDeaths due to causes other than CRC increased significantly over time regardless of tumor stage and site but more sharply in those with early-stage and distal colon cancer. The increasing leading causes of death are chronic obstructive pulmonary disease, diabetes, and Alzheimer disease, which may be prevented or delayed substantially by modification or intervention in lifestyle or other factors.