Community-based epidemiological study on breastfeeding and associated factors with respect to postpartum periods in Taiwan

Aims. To explore the prevalence of breastfeeding in different geographical areas and identify the factors influencing breastfeeding practices during in‐hospital stay and at one, four and six months postpartum in Taiwan. Background. The national data on prevalence for breastfeeding patterns are still unknown. Design. Community‐based epidemiological survey design. Methods. A total of 12,201 women were sampled from the birth registration and surveyed between June–October 2004. Data were collected through a computer‐assisted telephone interview at four different postpartum periods. Logistic regression modelling was applied to determine factors influencing breastfeeding patterns and postpartum time‐specific odds ratios. Results. Rates of breastfeeding practices were 29·4, 33·2, 16·9 and 13·1% for in‐hospital stay, the first‐, fourth‐ and sixth‐month postpartum respectively. Mother's intention to breastfeed was the most important factor to lengthen breastfeeding practices over time. The effect of an advocate programme in the hospital was significantly associated with breastfeeding only at the time of in‐hospital stay. Age, family support and singleton were found to be significantly related to the continuation of breastfeeding at the fourth month postpartum. Employment status was significantly associated with the termination of breastfeeding, particularly at the later postpartum period. Geographical variation in breastfeeding practices within the first month postpartum was identified. In contrast, ethnic variation was more apparent at the later postpartum period. Conclusions. This large‐scale study revealed a significantly decreasing trend after one month postpartum of breastfeeding rate in each geographical area of Taiwan. Factors associated with women's decision and continuation on breastfeeding patterns tended to be dependent on the time‐specific postpartum period and varied between geographical areas. Relevance to clinical practice. If breastfeeding rates are to increase, more attention should be paid to establish early breastfeeding and counter the negative influences of factors within the social environment.     

Link between hypertension and diabetes mellitus epidemiological study of Chinese adults in Taiwan.

OBJECTIVE: To elucidate the relationship between hypertension and non-insulin-dependent diabetes. RESEARCH DESIGN AND METHODS: The study consisted of a random sample of adults aged greater than or equal to 40 yr from the Ta-An district of Taipei City and 5 of 12 villages of Taiwan province, which had established primary health-care centers since 1984. A total of 11,478 subjects were recruited into the survey with a response rate of 65.3 and 72%, respectively. Blood glucose and blood pressure levels were measured, and a structured questionnaire was given to each participant. Those identified as having diabetes received further blood tests for lipids and creatinine and were evaluated for vascular complications. RESULTS: The age- and sex-adjusted prevalence of hypertension among diabetic subjects was twice that of nondiabetic subjects (30.6 vs. 16.4%, P less than 0.0005). Hypertensive subjects had a higher prevalence of diabetes than normotensive subjects (10.2 vs. 4.9%, P less than 0.0005). Among hypertensive subjects, the prevalence of diabetes was 12.7% for those taking antihypertensive drugs and 9.1% for those not taking any drug (P less than 0.05). The prevalence of diabetes significantly increased as mean arterial pressure rose, whether the subjects were stratified by various factors. Multiple regression analysis, including sex, age, body mass index, and other risk factors as independent variables, also showed a significant association between diabetes and hypertension. CONCLUSIONS: The univariate and multivariate analyses revealed that there seemed to be a tight link between hypertension and non-insulin-dependent diabetes. Family history of diabetes, diabetes duration, diabetes regimen, control of blood glucose, and the presence of nephropathy, as attested by proteinuria, did not contribute to the risk of hypertension. Further studies are necessary to determine whether these two conditions are causally related.     

Community-based screening for diabetes in Michigan

OBJECTIVE: To describe and evaluate a community-based diabetes screening program supported by the Michigan Department of Community Health. RESEARCH DESIGN AND METHODS: Between 1 June 1999 and 31 December 1999, community screening for diabetes was conducted by voluntary organizations using a standard protocol, American Diabetes Association (ADA) questionnaires, and ADA capillary plasma glucose criteria. RESULTS: A total of 3506 individuals were screened, 14% of whom did not meet criteria for screening. Of the 3031 individuals appropriately screened, 57% were classified as being at high risk based on the ADA questionnaire and 5% had positive screening tests based on ADA capillary plasma glucose criteria. Despite systematic follow-up, the screening program's yield of individuals with undiagnosed diabetes was <1%. CONCLUSIONS: Community screening for diabetes conducted according to ADA recommendations was extremely inefficient at identifying individuals with undiagnosed diabetes. The ADA diabetes screening questionnaire resulted in many false positive tests, and the ADA criteria for positive plasma glucose tests likely missed a substantial portion of individuals with undiagnosed diabetes. Relying on biochemical tests such as random plasma glucose, changing the criteria for a positive plasma glucose test, targeting racial and ethnic minority groups, and targeting medically underserved individuals might improve the yield of community-based diabetes screening.     

Community-based lifestyle interventions to prevent type 2 diabetes

OBJECTIVE: To conduct a literature review of community-based interventions intended to prevent or delay type 2 diabetes. RESEARCH DESIGN AND METHODS: Recently published findings about the potential to prevent or delay type 2 diabetes with intensive lifestyle interventions prompted a literature search for community-based diabetes prevention interventions. The literature review design was a search of databases for publications in 1990-2001 that identified reports on community-based interventions designed to prevent or modify risk factors for type 2 diabetes. RESULTS: The search revealed 16 published interventions, 8 of which were conducted in the U.S. and involved populations disproportionately burdened by diabetes (e.g., American Indians, Native Hawaiians, Mexican Americans, and African Americans). Of the studies reporting results among youth, there were posttest improvements in intervention groups in knowledge, preventive behaviors, and self-esteem. Among studies reporting results among adults, most reported improvements in intervention groups in knowledge or adoption of regular physical activity. Several investigators offered important reflections about the process of engaging communities and sharing decision making in participatory research approaches, as well as insights about the expectations and limitations of community-based diabetes prevention research. Many of the studies reported limitations in their design, including the lack of control or comparison groups, low response rates or lack of information on nonresponders, or brief intervention periods. CONCLUSIONS: There is a critical need to conduct and publish reports on well-designed community-based diabetes prevention research and share information on the process, results, and lessons learned. Armed with recent positive findings about diabetes prevention and literature documenting community-based efforts, advocates at local, state, and national levels can collaborate to stem the rising tide of diabetes in communities.     

The effect of diabetes mellitus on organ dysfunction with sepsis: an epidemiological study

Introduction

Diabetes mellitus (DM) is one of the most common chronic co-morbid medical conditions in the USA and is frequently present in patients with sepsis. Previous studies reported that people with DM and severe sepsis are less likely to develop acute lung injury (ALI). We sought to determine whether organ dysfunction differed between people with and without DM and sepsis.

Methods

Using the National Hospital Discharge Survey US, sepsis cases from 1979 to 2003 were integrated with DM prevalence from the Centers for Disease Control and Prevention (CDC) Diabetes Surveillance System.

Results

During the study period 930 million acute-care hospitalisations and 14.3 million people with DM were identified. Sepsis occurred in 12.5 million hospitalisations and DM was present in 17% of patients with sepsis. In the population, acute respiratory failure was the most common organ dysfunction (13%) followed by acute renal failure (6%). People with DM were less likely to develop acute respiratory failure (9% vs. 14%, p < 0.05) and more likely to develop acute renal failure (13% vs. 7%, p < 0.05). Of people with DM and sepsis, 27% had a respiratory source of infection compared with 34% in people with no DM (p < 0.05). Among patients with a pulmonary source of sepsis, 16% of those with DM and 23% of those with no DM developed acute respiratory failure (p < 0.05); in non-pulmonary sepsis acute respiratory failure occurred in 6% of people with DM and 10% in those with no DM (p < 0.05).

Conclusions

In sepsis, people with diabetes are less likely to develop acute respiratory failure, irrespective of source of infection. Future studies should determine the relationship of these findings to reduced risk of ALI in people with DM and causative mechanisms.     

Contraception in women with IDDM. An epidemiological study.

OBJECTIVE--To study whether suitable contraceptive methods to women with diabetes mellitus in fact are applied. RESEARCH DESIGN AND METHODS--A questionnaire survey on the use of contraceptives in all 18-to-49-yr-old women (n = 261) with IDDM in Funen County, Denmark, and an age-comparable control group, (n = 287) was performed. Data were collected from 1987 to 1990. Response was achieved from 94% diabetic women and 88% control subjects. RESULTS--The overall use of contraception in diabetic women (77.1%) was almost identical to that of control subjects (73.6%). Compared with control subjects, significantly fewer diabetic women were using the OCP (P < 0.005) and partner sterilization (P < 0.05), whereas more diabetic women were sterilized (P < 0.0005). Among diabetic contraceptive users, the IUD, female sterilization, condoms, and the OCP each accounted for roughly 20%. Diabetic women using the OCP were predominantly young, and most had never been pregnant; approximately 20% of them used high-dose formulations. Sterilization was frequently used by older diabetic women, and most of these women had 2 or more children; 27% of the diabetic women using an IUD were nulligravidae. Further, 18% used a method with an unsuitable high failure rate. CONCLUSIONS--Our study demonstrates that diabetic women are not sufficiently advised concerning use of contraception.     

Community-based learning in occupational therapy.

A community-based field work experience for senior occupational therapy students is described. The program was designed to meet five objectives: to provide students with an effective integration of theory and practice; to allow an application of theoretical concepts to early intervention and prevention programs; to enable students to confront complexities of community service delivery; to allow students to learn new roles in community programs; and to demonstrate the role of occupational therapy within a public health model of service delivery. In addition to these project objectives, placement sites, student roles, and organization of supervision are discussed. Examples are given to illustrate the diversity of student experience. Student and consumer feedback indicated that positive gains had been made toward fulfillment of the project objectives.     

Ten-year epidemiological study of pediatric burns in Canada.

The aim of this study was to report on the temporal trends, incidence rates, demographic, and external-cause data for all burn injury related deaths and hospital admissions among children Canadian aged 0 to 19 years for the years 1994 to 2003. Statistics Canada and Canadian Institute of Health Information data were used to describe burn injury related deaths and hospital admission trends in children aged 0 to 19 years who were residents of Canada (1994-2003). Population estimates were derived from census data provided by Statistics Canada. During the 10-year period, 494 children died and 10,229 were admitted to a Canadian hospital because of a burn-related injury. Males and children aged less than 5 years of age were at the highest risk of injury, with children aged 1 to 5 years at the highest risk of death. Scalds represented the major etiological factor contributing to thermal injuries accounting for 50% of all hospital admissions. Temporal trends indicate a significant a significant decline in burn injuries across all age groups during the period 1994 to 2003. There has been a clear reduction in the number of patients with burn injury requiring hospital admission. This trend indicates success in safety initiative to prevent burn injuries as well as in improvements in the treatments of burn and hospital admission procedures. Nonetheless, burn injury remains a serious threat to the well-being of the Canadian pediatric population.     

Development of inhibitors in haemophilia. Ongoing epidemiological study

A number of 513 consecutive patients (494-haemophilia A and 19-haemophilia B) from eight haemophilia treatment centers have been investigated with Bethesda assay for the presence of factor VIII or IX inhibitors. The overall prevalence of inhibitors was 15.20%, 18.48% in severe, 5.60% in moderate and 12.24% in mild forms. The prevalence was higher than reported in most of the western countries. The age at start of substitution (p = 0.9775), the frequent switching of factor concentrates (p = 0.8931) were not relevant factors for the development of inhibitors. It is worth to be mentioned the unexpectedly occurrence of inhibitors in prior inhibitor negative (6/72) patients (during surgical interventions) probably due to their previous scarce substitution, occurrence which seems not being connected with the continuous infusion modality of factor VIII administration (p = 0.8341). In controversial situations, in the field of low titer (≤ 1 BU/ml) inhibitors for a reliable interpretation of the results the performance of recovery index and half-life time assessment of FVIII/IX was undertaken.     

Low back pain in schoolchildren. An epidemiological study

A prospective epidemiological study was conducted to determine the prevalence of backache and the aetiological role of several contributing factors. 1715 schoolchildren of both sexes answered a previously validated questionnaire. Approximately 33% of our sample had already suffered from low back pain (LBP) at some time. There was a statistically significant positive correlation between LBP and age, female sex, time spent watching TV, smoking and competitive sports.     

Type II diabetes mellitus. Interface between clinical and epidemiological investigation

The field of cardiovascular disease and atherosclerosis has been enriched by a fruitful interplay between basic and clinical scientists and epidemiologists. Such interaction has been less highly developed in the field of diabetes. I present an epidemiological perspective on certain problems in type II (non-insulin-dependent) diabetes research and point out some potentially useful directions for future interdisciplinary efforts involving both basic and clinical scientists and epidemiologists. Early research on diabetes has been marred by variable case definitions. The demonstration in numerous epidemiological studies that plasma glucose has a bimodal distribution in populations has contributed to the widely accepted National Diabetes Data Group (NDDG) and the nearly identical World Health Organization (WHO) definitions of diabetes. This development has markedly ameliorated many of the difficulties resulting from variable case definitions. Appreciation of the phenomenon of bimodality has also contributed to a better understanding of impaired glucose tolerance. Many studies on the pathogenesis of type II diabetes take the form of case-control (i.e., cross-sectional) studies. The weaknesses of this research design are well known to epidemiologists. Prospective studies, a much stronger research design for inferring causal relationships, are much less common in the field of diabetes than in the field of cardiovascular disease and atherosclerosis. Recently, however, two prospective studies have helped define the role of serum insulin levels and insulin resistance as diabetes risk factors. These studies were carried out in small, relatively isolated populations, and there is a great need to replicate these findings in larger, more representative populations and to further evaluate the relative role of insulin secretion and insulin resistance as diabetes risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)     

An epidemiological study of headache in Florianopolis, Brazil

The aim of this study was to estimate the 1-year prevalence of headache, migraine, tension-type headache (TTH) and chronic daily headache (CDH), and the degree of association of migraine with some sociodemographic characteristics of the population of Florianopolis, Brazil. This is a cross-sectional, door-to-door, population-based study. In 300 randomly selected households, 625 subjects, aged 15-64 years, responded to a structured questionnaire. The 1-year prevalence of headache was 80.8%, of migraine 22.1%, of TTH 22.9%, and of CDH 6.4%. Migraine and CDH were significantly more prevalent in females than in males. Migraine was significantly associated with the following variables: low household income, low electricity consumption, and divorced or widowed marital status. We have shown high prevalences of migraine and CDH in Florianopolis, close to the higher rates of previous studies. There was a preponderance of migraine in females, divorced or widowed, with a low socioeconomic level.     

上海市社区康复资源分析

目的 调查上海市社区卫生服务中心康复资源现状。方法 2018年12月,调查上海全市16个区所有社区卫生服务中心,共计247家。发放《医疗机构调查表》,内容包括康复人员数(康复医师数、康复治疗师数)、康复床位数等资源情况。结果 截至2017年底,上海市社区共有康复医师152人,康复治疗师597人。每千户籍人口康复医师、康复治疗师分别为0.01人、0.04人,每千户籍老年人口康复医师、康复治疗师分别为0.03人、0.12人。社区共有床位17 484张,其中康复床位1425张(8.15%)。上海市每千户籍人口、户籍老年人口的康复床位数分别为0.10张和0.30张。结论 上海社区康复发展不充分,资源较为缺乏,服务供给规模相对较小,供需不匹配。建议加强对社区康复工作的支持、增加社区康复资源供给。     

枸橼酸杆菌致小儿腹泻临床流行病学研究

目的 :探讨枸橼酸杆菌肠炎的发病情况及相关因素。方法 :对腹泻组患儿 2 196例 ,应用抗生素 ,非腹泻对照组(患其它疾病 )患儿 40 0例 ,应用抗生素 ,健康对照组 40 0例 ,均进行枸橼酸杆菌检出率、药敏试验、临床特征等比较。结果 :腹泻组患儿的枸橼酸杆菌检出率为 5 87% ,明显高于非腹泻组、对照组 ,且与年龄、季节、喂养方式等有一定相关性。但临床症状及实验室常规检查缺少特异性。药敏试验结果对丁胺卡那霉素、喹喏酮类药物敏感 ,而对头孢菌素类及氨苄青霉素等耐药。结论 :枸橼酸杆菌肠炎在各类腹泻患儿中占较高比例 ,且以 <1岁人工或混合喂养儿及夏秋季节多发 ,应引起重视     

Community-based rehabilitation in Moshupa village, Botswana

This article presents a summary of findings from the 'Moshupa Community Based Rehabilitation (CBR) project', which to date have been the subject of three studies: one initial survey of disabled people and two follow-up studies. Of the 132 disabled people who were identified in the survey, all but three could be accounted for in the first follow-up. Seventy-seven were interviewed about independence of activities of daily living, school/jobs and quality of life. A high percentage of elderly (17% were 65 and over) were alive, and most had maintained high levels of ADL skills. Twenty per cent of the adult disabled were working, 10 out of 14 school-aged children were enrolled in schools, and life satisfaction was high. The second follow-up study indicated that personnel, although acknowledging the benefits of the programme, pointed to several remaining problems such as lack of rehabilitation education for the personnel. The results are discussed with reference to the CBR programme's aims, and implications drawn for industrialized countries.     

Community-based rehabilitation in Moshupa village, Botswana

This article presents a summary of findings from the 'Moshupa Community Based Rehabilitation (CBR) project', which to date have been the subject of three studies: one initial survey of disabled people and two follow-up studies. Of the 132 disabled people who were identified in the survey, all but three could be accounted for in the first follow-up. Seventy-seven were interviewed about independence of activities of daily living, school/jobs and quality of life. A high percentage of elderly (17% were 65 and over) were alive, and most had maintained high levels of ADL skills. Twenty per cent of the adult disabled were working, 10 out of 14 school-aged children were enrolled in schools, and life satisfaction was high. The second follow-up study indicated that personnel, although acknowledging the benefits of the programme, pointed to several remaining problems such as lack of rehabilitation education for the personnel. The results are discussed with reference to the CBR programme's aims, and implications drawn for industrialized countries.     

Community-based rehabilitation in Moshupa village,Botswana

This article presents a summary of findings from the 'Moshupa Community Based Rehabilitation (CBR) project', which to date have been the subject of three studies: one initial survey of disabled people and two follow-up studies. Of the 132 disabled people who were identified in the survey, all but three could be accounted for in the first follow-up. Seventy-seven were interviewed about independence of activities of daily living, school/jobs and quality of life. A high percentage of elderly (17% were 65 and over) were alive, and most had maintained high levels of ADL skills. Twenty per cent of the adult disabled were working, 10 out of 14 school-aged children were enrolled in schools, and life satisfaction was high. The second follow-up study indicated that personnel, although acknowledging the benefits of the programme, pointed to several remaining problems such as lack of rehabilitation education for the personnel. The results are discussed with reference to the CBR programme's aims, and implications drawn for industrialized countries.