Occupational injuries and illnesses among Washington State agricultural workers.

In Washington state 29,451 workers' compensation claims were filed by farm workers between 1982 and 1986. Five percent of claimants were under 18 years of age, including 1.3% under the age of 16. Agricultural workers were found to be at higher risk than other workers in the state for fatal injury (relative risk [RR] = 2.5, 95% confidence interval [CI] = 1.7-3.7), sprains and strains (RR = 1.4, CI = 1.3-1.4), fractures (RR = 2.3, CI = 2.2-2.4), dislocations (RR = 1.9, CI = 1.7-2.2), concussions (RR = 1.9, CI = 1.6-2.3), amputations (RR = 2.5, CI = 2.0-3.1), dermatitis (RR = 4.3, CI = 4.0-4.7), systemic poisoning (RR = 3.4, CI = 3.1-3.7), respiratory disease (RR = 1.7, CI = 1.0-2.9), and tendonitis (RR = 1.2, CI = 1.1-1.4).     

Risk factors for neonatal seizures: a population-based study, Harris County, Texas, 1992-1994.

Risk factors for neonatal seizures were evaluated in 116,048 infants born between 1992 and 1994 to residents of Harris County, Texas; 207 of these infants were diagnosed with clinical neonatal seizures. Information was obtained from the infant's birth certificate to assess the relation between seizures and birth weight, gender, ethnicity, place of birth, mother's age, method of delivery, parity, and multiple births. These factors were evaluated by univariate and multivariate analysis using logistic regression. For preterm infants, a birth weight of <1,500 g was the strongest risk factor (relative risk (RR) = 9.1, 95% confidence interval (CI): 4.7, 17.5), followed by birth in a private/university hospital (RR = 2.8, 95% CI: 1.5, 5.0) and male gender (RR = 1.8, 95% CI: 1.0, 3.4). For term infants, significant risk factors included birth by cesarean section (RR = 2.2, 95% CI: 1.5, 3.2), small birth weight for gestational age (RR = 1.9, 95% CI: 1.2, 2.9), birth in a private/university hospital (RR = 1.8, 95% CI: 1.1, 3.0), and maternal age of 18-24 compared with 25-29 years (RR = 1.6, 95% CI: 1.1, 2.3). Birth by assisted vaginal delivery and primiparity were marginally significant for term infants. Birth weight is a significant risk factor for neonatal seizures. The role of perinatal complications warrants further evaluation.     

Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women

In 1980, 84,484 US women aged 34-59 y completed an independently validated dietary questionnaire. During the ensuing 6 y, 593 forearm and 65 hip fractures occurred in association with mild to moderate trauma. We observed a positive relation between caffeine intake and risk of hip but not forearm fracture. After potential risk factors were controlled for the relative risk (RR) of hip fracture for women in the top quintile of caffeine consumption was 2.95 (95% CI = 1.18-7.38, P, trend = 0.003). Alcohol intake was independently associated with increased risk of both hip and forearm fractures and with a dose-response relation. Compared with nondrinkers, women consuming greater than or equal to 25 g alcohol/d had an RR of 2.33 (95% CI = 1.18-4.57) for hip fractures and an RR of 1.38 (95% CI = 1.09-1.74) for forearm fractures. These prospective data suggest that caffeine and alcohol consumption both increase the risk of osteoporotic fractures in middle-aged women.     

The low cholesterol-mortality association in a national cohort.

The relationship of low serum cholesterol and mortality was examined in data from the NHANES I Epidemiologic Followup Study (NHEFS) for 10,295 persons aged 35-74, 5833 women with 1281 deaths and 4462 men with 1748 deaths (mean (followup = 14.1 years). Serum cholesterol below 4.1 mmol/l was associated with increased risk of death in comparison with serum cholesterol of 4.1-5.1 mmol/l (relative risk (RR) for women = 1.7, 95% confidence interval (CI) = (1.2, 2.3); for men RR = 1.4, CI = (1.1, 1.7)). However, the low serum cholesterol-mortality relationship was modified by time, age, and among older persons, activity level. The low serum cholesterol-mortality association was strongest in the first 10 years of followup. Moreover, this relationship occurred primarily among older persons (RR for low serum cholesterol for women 35-59 = 1.0 (0.6, 1.8), for women 70-74, RR = 2.1 (1.2, 3.7); RR for low serum cholesterol for men 35-59 = 1.2 (0.8, 2.0), for men 70-74, RR = 1.9 (1.3, 2.7)). Among older persons, however, the low serum cholesterol-mortality association was confined only to those with low activity at baseline. Factors related to underlying health status, rather than a mortality-enhancing effect of low cholesterol, likely accounts for the excess risk of death among persons with low cholesterol. The observed low cholesterol-mortality association therefore should not discourage public health programs directed at lowering serum cholesterol.     

Serum cholesterol--risk factor for coronary disease mortality in younger and older blacks and whites. The Charleston Heart Study, 1960-1988.

Serum total cholesterol (> or = 6.7 mmol/L) measured in 1960 in the Charleston Heart Study cohort was found to be a risk for mortality from coronary heart disease during the period of 1960 to 1988 in white men (relative risk [RR] 1.5; 95% confidence interval [CI]: 1.1, 2.2), white women (RR 1.7; 95% CI: 1.1, 2.7), and black women (RR 1.6; 95% CI: .9, 2.9) after age, systolic blood pressure, smoking status, education level, obesity, and diabetes were considered. For black men, the relative risk was .96 (95% CI, .39, 2.39). Only among white women was the relative risk (RR 2.4; 95% CI, 1.2, 4.5) increased among those in the older ages (55 to 74) in 1960. The evidence for cholesterol as a risk factor for coronary disease mortality in black men is inconclusive and requires further study.     

Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985--1994.

We estimated risk of suicide in adults in New South Wales (NSW) by sex, country of birth and rural/urban residence, after adjusting for age; we also examined youth suicide (age 15-24 years). The study population was the entire population of NSW, Australia, aged > or =15 years during the period 1985-1994. Poisson regression was used to examine the relationship between predictor variables and the risk of suicide, with the focus on migrant status and area of residence. A significantly higher risk of suicide was found in male migrants from Northern Europe and Eastern Europe/former USSR, compared to Australian-born males; a significantly lower suicide risk occurred in males from Southern Europe, the Middle East and Asia. In female migrants, those from UK/Eire, Northern Europe, Eastern Europe/former USSR and New Zealand exhibited a significantly higher risk of suicide compared to Australian-born females. A significantly lower risk of suicide occurred in females from the Middle East. Male migrants overall were at significantly lower risk of suicide than the Australian-born, while female migrants overall had a significantly higher risk of suicide than Australian-born females. Among migrant males overall, the rural-urban suicide risk differential was significantly higher for those living in non-metropolitan areas (RR = 1.9; 95% CI: 1.7-2.1). Suicide risk was significantly higher in non-metropolitan male immigrants from the UK/Eire (RR = 1.4; 95% CI: 1.1-1.7), Southern Europe (RR = 1.7; 95% CI: 1.2-2.4), Northern/Western Europe (1.5; 95% CI: 1.2-1.9), the Middle East (RR = 3.8; 95% CI: 1.9-7.8), New Zealand (RR = 1.4; 95% CI: 1.0-1.8) and 'other' (RR = 2.6; 95% CI: 1.9-3.5), when compared to their urban counterparts. There was no statistically significant difference in suicide risk between rural and urban Australian-born males. For female suicide, significantly lower risk was found in female immigrants living in non-metropolitan areas who were from Northern/Western Europe (RR = 0.7; 95% CI: 0.4-0.96), as well as the Australian-born (RR = 0.7; 95% CI: 0.6-0.8), when compared to their urban counterparts. The non-metropolitan/metropolitan relative risk for suicide in female migrants overall was not significantly different from one. Among male youth there was a significantly higher suicide risk in non-metropolitan areas, with a relative risk estimate of 1.4 for Australian-born youth (95% CI: 1.2-1.5) and 1.7 for migrant youth (95% CI: 1.2-2.4), when compared with metropolitan counterparts. We conclude that suicide among migrant males living in non-metropolitan areas accounts for most of the excess of male suicide in rural NSW, and the significantly lower risk of suicide for non-metropolitan Australian-born women does not apply to migrant women.     

Cocaine use during pregnancy: perinatal outcomes

The relation between maternal cocaine use and perinatal outcomes was investigated among 17,466 non-Asian singleton deliveries in 1988 from the University of Illinois Perinatal Network data base in the metropolitan Chicago area. Elevated adjusted relative risks (RR) of low birth weight (RR = 2.8, 95% confidence interval (CI) 2.2-3.7), prematurity (RR = 2.4, 95% CI 1.9-3.1), abruptio placentae (RR = 4.5, 95% CI 2.4-8.5), and perinatal death (RR = 2.1, 95% CI 1.1-4.0) were observed for "any" cocaine users (n = 408) compared with women who did not use cocaine or any other drugs or alcohol (n = 17,058). There was an increased (although unstable) risk of intrapartum placenta previa not previously reported (RR = 2.3, 95% CI 1.0-5.1). The relative risk of small-for-gestational-age births for cocaine users who did not smoke (RR = 3.4, 95% CI 1.8-6.5) was greater than that for cocaine users who did (RR = 2.1, 95% CI 1.1-4.1). Irrespective of smoking status, cocaine use during pregnancy increased the risk of small-for-gestational-age births.     

A population-based case-control study of occupation and renal cell carcinoma risk in Iowa

A case-control study involving 406 incident cases and 2,434 controls was conducted in Iowa to examine the association between occupational exposures and renal cell carcinoma risk. After adjusting for major confounders, an increased risk was observed for men among mechanics and repairers (odds ratio [OR] 1.9, 95% confidence interval [CI] = 1.2-2.9); assemblers (OR 2.5, 95% CI = 0.8-7.6); automotive dealership and service station employees (OR 1.9, 95% CI = 0.9-3.9); wholesale traders of durable goods (OR 1.5, 95% CI = 0.7-3.2); farm product vendors (OR 4.4, 95% CI = 1.3-15.5); service organization managers (OR 2.2, 95% CI = 1.0-5.1); financial specialists (OR 2.7, 95% CI = 1.0-7.6); sales occupation supervisors (OR 1.8, 95% CI = 1.0-3.3); guards (OR 5.4, 95% CI = 1.4-20.7); and general farm workers (OR 1.9, 95% CI = 1.0-3.7). Among women, an increased risk was found for employees in depository institutions (OR 3.6, 95% CI = 1.1-11.3); colleges and universities (OR 7.6-95% CI = 2.3-25.6); and retail, including those in grocery stores (OR 2.2, 95% CI = 1.0-4.7). Our results indicate that occupational exposures may increase the risk of renal cell carcinoma.     

Ex-smokers and risk of hip fracture.

OBJECTIVES: The purpose of this study was to examine the reversibility of the effect of smoking on hip fracture incidence rates. METHODS: A 3-year follow-up cohort study was conducted involving 35,767 adults 50 years of age or older. Of these individuals, 421 suffered a hip fracture. RESULTS: Among participants less than 75 years of age, the relative risk (RR) of hip fracture was elevated for ex-smokers, even for those who had quit smoking more than 5 years previously (men: RR = 4.4, 95% confidence interval [CI] = 1.2, 15.3; women: RR = 1.3, 95% CI = 0.6, 3.0), but was not as high as that for current smokers (men: RR = 5.0, 95% CI = 1.5, 16.9; women: RR = 1.9, 95% CI = 1.2, 3.1). CONCLUSIONS: The effect of smoking on risk of hip fracture was not reversed completely 5 years after smoking cessation.     

Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: obesity, joint injury, and occupational activities

In 1998, a case-control study was conducted in Hong Kong on hospital patients with osteoarthritis of the hip (n = 138) and osteoarthritis of the knee (n = 658). Age- and sex-matched controls were recruited consecutively from general practice clinics in the same region. The following three risk factors were found to be associated with osteoarthritis of both the hip and the knee: first, a history of joint injury: for osteoarthritis of the hip, the odds ratio = 25.1 (95% confidence interval (CI): 3.5, 181) in men and 43.3 (95% CI: 11.7, 161) in women; for osteoarthritis of the knee, the odds ratio = 12.1 (95% CI: 3.4, 42.5) in men and 7.6 (95% CI: 3.8, 15.2) in women; second, climbing stairs frequently: for osteoarthritis of the hip, the odds ratio = 12.5 (95% CI: 1.5, 104.3) in men and 2.3 (95% CI: 0.6, 8.1) in women; for osteoarthritis of the knee, the odds ratio = 2.5 (95% CI: 1.0, 6.4) in men and 5.1 (95% CI: 2.5, 10.2) in women; third, lifting heavy weight frequently: for osteoarthritis of the hip, the odds ratio = 3.1 (95% CI: 0.7, 14.3) in men and 2.4 (95% CI: 1.1, 5.3) in women; for osteoarthritis of the knee, the odds ratio = 5.4 (95% CI: 2.4, 12.4) in men and 2.0 (95% CI: 1.2, 3.1) in women. In addition, subjects whose height and weight were in the highest quartile were at increased risk of osteoarthritis of the hip and knee, respectively (p < 0.05).     

Occupational risk factors for renal cell carcinoma: agent-specific results from a case-control study in Germany. MURC Study Group. Multicenter urothelial and renal cancer study

BACKGROUND: This case-control study was conducted to estimate the renal cell cancer (RCC) risk for exposure to occupation-related agents, besides other suspected risk factors. METHODS: In a population-based multicentre study, 935 incident RCC cases and 4298 controls matched for region, sex, and age were interviewed between 1991 and 1995 for their occupational history and lifestyle habits. Agent-specific exposure was expert-rated with two job-exposure matrices and a job task-exposure matrix. Conditional logistic regression was used to calculate smoking adjusted odds ratios (OR). RESULTS: Very long exposures in the chemical, rubber, and printing industries were associated with risk for RCC. Males considered as 'substantially exposed to organic solvents' showed a significant excess risk (OR = 1.6, 95% CI : 1.1-2.3). In females substantial exposure to solvents was also a significant risk factor (OR = 2.1, 95% CI : 1.0-4.4). Excess risks were shown for high exposure to cadmium (OR = 1.4, 95% CI : 1.1-1.8, in men, OR = 2.5, 95% CI : 1.2-5.3 in women), for substantial exposure to lead (OR = 1.5, 95% CI : 1.0-2.3, in men, OR = 2.6, 95% CI : 1.2-5.5, in women) and to solder fumes (OR = 1.5, 95% CI : 1.0-2.4, in men). In females, an excess risk for the task 'soldering, welding, milling' was found (OR = 3.0, 95% CI : 1.1-7.8). Exposure to paints, mineral oils, cutting fluids, benzene, polycyclic aromatic hydrocarbons, and asbestos showed an association with RCC development. CONCLUSIONS: Our results indicate that substantial exposure to metals and solvents may be nephrocarcinogenic. There is evidence for a gender-specific susceptibility of the kidneys.     

Health effects of dioxin exposure: a 20-year mortality study

Follow-up of the population exposed to dioxin after the 1976 accident in Seveso, Italy, was extended to 1996. During the entire observation period, all-cause and all-cancer mortality did not increase. Fifteen years after the accident, mortality among men in high-exposure zones A (804 inhabitants) and B (5,941 inhabitants) increased from all cancers (rate ratio (RR) = 1.3, 95% confidence interval (CI): 1.0, 1.7), rectal cancer (RR = 2.4, 95% CI: 1.2, 4.6), and lung cancer (RR = 1.3, 95% CI: 1.0, 1.7), with no latency-related pattern for rectal or lung cancer. An excess of lymphohemopoietic neoplasms was found in both genders (RR = 1.7, 95% CI: 1.2, 2.5). Hodgkin's disease risk was elevated in the first 10-year observation period (RR = 4.9, 95% CI: 1.5, 16.4), whereas the highest increase for non-Hodgkin's lymphoma (RR = 2.8, 95% CI: 1.1, 7.0) and myeloid leukemia (RR = 3.8, 95% CI: 1.2, 12.5) occurred after 15 years. No soft tissue sarcoma cases were found in these zones (0.8 expected). An overall increase in diabetes was reported, notably among women (RR = 2.4, 95% CI: 1.2, 4.6). Chronic circulatory and respiratory diseases were moderately increased, suggesting a link with accident-related stressors and chemical exposure. Results support evaluation of dioxin as carcinogenic to humans and corroborate the hypotheses of its association with other health outcomes, including cardiovascular- and endocrine-related effects.     

Childhood asthma in Beijing,China: a population-based case-control study

China is the most populous country in the world. Few studies, however, have been conducted there to investigate the risk factors for childhood asthma. A population-based case-control study was conducted in Shunyi County, People's Republic of China, in January 1999 and March 2001 to investigate the issue. An increased risk of childhood asthma was associated with smoking by relatives in front of the mother while she was pregnant with the child (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.0, 1.6) and with smoking by relatives in front of the child (OR = 1.4, 95% CI: 1.1, 1.9). The risk increased with the increasing number of smokers and the total minutes of smoking by relatives in front of both the child and the mother while she was pregnant with the child. An increased risk was observed for use of coal for heating (OR = 1.5, 95% CI: 1.1, 1.9). Those who reported using coal for cooking without ventilation also had an increased risk (OR = 2.3, 95% CI: 1.5, 3.5). An increased risk was observed for those who reported having molds or fungi on the ceilings of their houses (OR = 1.8, 95% CI: 1.1, 2.9) or inside the child's room (OR = 1.8, 95% CI: 1.0, 3.2). An increased risk was also found for those having both a dog and a cat as pets (OR = 1.5, 95% CI: 1.0, 2.3) or for finding both cockroaches and rats inside their houses (OR = 1.8, 95% CI: 1.2, 2.8).     

Organisational justice and health of employees: prospective cohort study

Aims: To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees.

Methods: The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998–2000 in 10 hospitals in Finland.

Results: Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics. The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality).

Conclusions: This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health.

     

Referral and delivery outcomes in Kivu,Democratic Republic of Congo

BACKGROUND: The process of referral between the first and the second level of the health system in the Democratic Republic of Congo is poorly understood. This report intends to study the association between the referral and the hospital perinatal outcomes. METHODS: Delivery outcomes in a retrospective cohort of 1162 women admitted between June 95 and May 96, in two referral hospitals in Kivu were analyzed according to the referral status and the women's characteristics. RESULTS: Forty-three percent (n=492)of women admitted, corresponding to 2.3% of expected pregnant women, were referred. Referred women had higher risks of obstetrical complications (OR=2.0; CI95%: 1.3-3.1) and intervention (OR=1.5; CI95%: 1.0-2.3) and similar risks of low birth weight and perinatal mortality. Women with complications during the antenatal period had a double risk of intervention and perinatal mortality. The risk of obstetrical intervention was lower when women had attended 2 visits (OR=0.5; CI95%: 0.3-0.8); the risk of low birth weight was lowest only for mothers who had attended one visit (OR=0.5; CI95%: 0.3-0.9). Distance > or =90 minutes walking from home to hospital raised the risk of obstetrical complication (OR=1.7; CI95%: 1.1-2.5), the risk of obstetrical intervention (OR=1.5; CI95%: 1.0-2.1), and the risk of perinatal mortality (OR=1.6; CI95%: 1.0-2.7). Late admission raised the risk of perinatal mortality (OR=1.8; CI95%: 1.2-2.9) and lowered the risk of obstetrical complication (OR=0.7; CI95%: 0.5-1.0). Part payment of care was associated with higher risks of low birth weight (OR=1.9; CI95%: 1.3-2.9), perinatal mortality (OR=2.2; CI95%: 1.4-3.5) and obstetrical intervention (OR=2.4; CI95%: 1.7-3.4). CONCLUSION: These results suggest a deficit of referred cases considering that 15% of pregnant women in the area covered by the referral hospitals should have been referred. They confirm the negative influence of economic and geographic constraints on the delivery outcomes. They point out the relevance of making reorganization of the referral system a priority.     

Rates and relative risk of hospital admission among women in violent intimate partner relationships

OBJECTIVES: This study assessed the history of hospitalization among women involved in violent intimate relationships. METHODS: In this 1-year retrospective cohort study, female residents of King County, Washington, who were aged 18 to 44 years and who had filed for a protection order were compared with nonabused women in the same age group. Outcome measures included overall and diagnosis-specific hospital admission rates and relative risk of hospitalization associated with abuse. RESULTS: Women known to be exposed to a violent intimate relationship were significantly more likely to be hospitalized with any diagnosis (age-specific relative risks [RRs] ranging from 1.2 to 2.1), psychiatric diagnoses (RR = 3.6, 95% confidence interval [CI] = 2.8, 4.6), injury and poisoning diagnoses (RR = 1.8, 95% CI = 1.2, 2.8), digestive system diseases (RR = 1.9, 95% CI = 1.3, 2.9), and diagnoses of assault (RR = 4.9, 95% CI = 1.1, 22.1) or attempted suicide (RR = 3.7, 95% CI = 1.6, 9.2) in the year before filing a protection order. CONCLUSIONS: This study showed an increased relative risk of both overall and diagnosis-specific hospitalizations among abused women. Intimate partner violence has a significant impact on women's health and use of health care.     

Vaginal bleeding during pregnancy and preterm birth

This study investigated the relation between self-reported vaginal bleeding during pregnancy and preterm birth in a prospective cohort of 2,829 pregnant women enrolled from prenatal clinics between 1995 and 2000 in central North Carolina. The overall association between vaginal bleeding and preterm birth was modest (risk ratio (RR) = 1.3, 95% confidence interval (CI): 1.1, 1.6). Bleeding in the first trimester only was associated with earlier preterm birth (< or =34 weeks' gestation) (RR = 1.6, 95% CI: 1.1, 2.4) and preterm birth due to preterm premature rupture of the membranes (PPROM) (RR = 1.9, 95% CI: 1.1, 3.3). Bleeding in both trimesters was associated with preterm birth due to preterm labor (RR = 3.6, 95% CI: 1.9, 6.8). Bleeding of multiple episodes, on multiple days, and with more total blood loss was associated with an approximate twofold increased risk of earlier preterm birth, PPROM, and preterm labor. In contrast, bleeding in the second trimester only, of a single episode, on a single day, and with less total blood loss was not associated with any category of preterm birth. Vaginal bleeding was not associated with preterm birth among African Amercians (RR = 1.2, 95% CI: 0.9, 1.7). This study indicates that more intense but not less intense bleeding is associated with earlier preterm birth and spontaneous preterm birth presenting as PPROM or preterm labor, and it suggests that bleeding is less predictive of preterm birth among African-American compared with White women.     

The relation between hip fracture and alzheimer's disease in the canadian national population health survey health institutions data, 1994-1995. A cross-sectional study

PURPOSE: The purpose of this study is to examine the relation between hip fractures and Alzheimer's disease in institutionalized men and women who participated in the 1994-1995 Canadian National Population Health Survey (NPHS).METHODS: Participants in the institutional component of NPHS were randomly chosen from selected health care institutions from all provinces in Canada. A questionnaire, which assessed health, demographic and socio-economic status, risk factors, medication use, and falls, was administered by an interviewer. Proxy respondents were sought for residents who were ill or incapacitated. Logistic regression was used to examine the association between hip fractures and Alzheimer's disease in 408 men and 1105 women >/=65 years. Models were examined with either hip fracture or Alzheimer's disease as the dependent variable. Covariates that were assessed included osteoporosis, age group, sex, medications, reported falls and comorbid conditions.RESULTS: All hip fractures reported in this survey were the result of a fall, however only 3.7% of falls resulted in a hip fracture. Those who had sustained a hip fracture were more likely to have Alzheimer's disease (OR 2.0, 95% CI 1.1-3.5), osteoporosis (OR 4.3, 95% CI 2.5-7.4) and heart disease (OR 2.4, 95% CI 1.1-5.0). Respondents who had Alzheimer's disease were more likely to have sustained a hip fracture (OR 2.1 95% CI 1.2-3.6), to have osteoporosis (OR 1.9, 95% CI 1.5-2.5), and to have fallen (OR 1.4, 95% CI 1.1-1.8) and were less likely to be taking anti-psychotic medication (OR 0.4, 95% CI 0.3-0.6) than those with no diagnosis of Alzheimer's disease.CONCLUSIONS: There is an association between Alzheimer's disease and hip fractures that is independent of other covariates in this representative sample of institutionalized elderly Canadians.     

Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture

The authors conducted a systematic review of published data on the association between diabetes mellitus and fracture. The authors searched MEDLINE through June 2006 and examined the reference lists of pertinent articles (limited to studies in humans). Summary relative risks and 95% confidence intervals were calculated with a random-effects model. The 16 eligible studies (two case-control studies and 14 cohort studies) included 836,941 participants and 139,531 incident cases of fracture. Type 2 diabetes was associated with an increased risk of hip fracture in both men (summary relative risk (RR) = 2.8, 95% confidence interval (CI): 1.2, 6.6) and women (summary RR = 2.1, 95% CI: 1.6, 2.7). Results were consistent between studies of men and women and between studies conducted in the United States and Europe. The association between type of diabetes and hip fracture incidence was stronger for type 1 diabetes (summary RR = 6.3, 95% CI: 2.6, 15.1) than for type 2 diabetes (summary RR = 1.7, 95% CI: 1.3, 2.2). Type 2 diabetes was weakly associated with fractures at other sites, and most effect estimates were not statistically significant. These findings strongly support an association between both type 1 and type 2 diabetes and increased risk of hip fracture in men and women.     

Body weight dissatisfaction by socioeconomic status among obese, preobese and normal weight women and men: results of the cross-sectional KORA Augsburg S4 population survey

ABSTRACT: BACKGROUND: Body weight dissatisfaction is an important factor in preventing weight gain and promoting weight loss or maintenance. This study focuses on differences in the rates of body weight dissatisfaction among obese, preobese and normal weight women and men by socioeconomic status within a general adult population in Germany. METHODS: Data were analyzed from 4186 adults aged 25 to 74 who participated in a cross-sectional, representative population-based health survey (KORA S4, 1999-2001, Augsburg region/Germany). Body mass was measured anthropometrically and indexed following international standards. Among the 2123 women participating in the survey, 40.3% had a normal weight, 34.9% were preobese, and 24.8% were obese (compared to 25.9%, 51.4% and 22.6% among men, respectively). Body weight dissatisfaction, educational level, household income and occupational status were assessed by computer-aided personal interviewing. An index for socioeconomic status was calculated and categorized into quintiles. Multiple logistic regressions were performed to test for differences in the odds of body weight dissatisfaction across socioeconomic strata in normal weight, preobese and obese groups. Body mass index, age, family status, place of residence and health behaviors were adjusted for. RESULTS: Overall, being dissatisfied with one's body weight was more prevalent in women (48.3%) than in men (33.2%). In the normal weight group, no significant differences in the odds of being dissatisfied were found across socioeconomic groups among women or men. Among preobese men, compared to the lowest socioeconomic stratum, increased odds of being dissatisfied with one's body weight were associated with the highest socioeconomic index group (OR=2.3, 95% CI: 1.4-3.8), middle and high educational level (OR=1.6, 95% CI: 1.1-2.3, and OR=1.9, 95% CI: 1.3-3.7), high income (OR=1.8, 95% CI: 1.2-2.7), and middle and high occupational status (both OR=1.8, 95% CI: 1.2-2.6). Among preobese women, the odds of being dissatisfied were only significantly elevated in those with a middle educational level (OR=1.6, 95% CI: 1.1-2.3). Among obese men, elevated odds were found in the highest socioeconomic index group (OR=3.7, 95% CI: 1.8-7.5) and in those with a high educational level (OR=2.3, 95% CI: 1.3-4.1), high income (OR=2.6, 95% CI: 1.4-4.7), and middle and high occupational status (both OR=2.2, 95% CI: 1.3-3.6). The odds of dissatisfaction among obese women were not associated with socioeconomic status as a whole, but were associated with a high educational level, albeit with a comparatively large confidence interval (OR=3.6, 95% CI: 1.0-12.8). CONCLUSIONS: In Germany, body weight dissatisfaction is more prevalent among obese and preobese men in high socioeconomic status groups, a pattern not found in women. The exception to this is a greater prevalence of dissatisfaction among obese and preobese women with a high educational level (albeit inconsistently). Moreover, there is a social gradient in body weight dissatisfaction, especially in obese men, which may partly explain why obesity is more prevalent in men with low socioeconomic status. It also suggests that they are a target group for obesity care in which body weight satisfaction is an important topic.