An epidemiologic study of risk factors associated with pregnancy following female sterilization

Data on 14,700 female sterilization patients were collected by the International Fertility Research Program (IFRP) from 1972 to 1978 and analyzed to determine risk factors associated with the incidence of pregnancy following sterilization. With a case-control approach, it was found that younger patients (less than or equal to 34 years old) and those who did not lactate after sterilization had a higher risk of becoming pregnant. Patients who were sterilized in the early phases of a service program had a higher risk of pregnancy than those sterilized later. In the laparoscopic series, the relative risk of pregnancy was four times greater in patients who had the prototype spring clip than in patients who had the Falope ring. The relative risk increased to 7.0 when patients who had the prototype spring clip were compared to those who had the Falope ring, electrocoagulation, or the Rocket clip. Patients sterilized by electrocoagulation had a low pregnancy risk, but the risk of an ectopic pregnancy was significantly higher than for those sterilized with mechanical devices. In the culdoscopic series, the tantalum clip had an unacceptable pregnancy risk.     

Less severe retinopathy of prematurity induced by surfactant replacement therapy

To assess the effect of surfactant replacement therapy (SRT) on the prevalence and severity of retinopathy of prematurity (ROP), we compared data from 160 SRT-treated preterm infants with data from 230 historic controls. The prevalence of ROP was 30.6% in the treatment group and 23.4% in the control group. Severe ROP (stages 3-4) was seen in 6.1% of the infants with ROP in the treatment group and 20.3% of the ROP patients in the control group. Surfactant therapy had no influence on the prevalence of ROP (odds ratio 1.4, 95% confidence interval 0.797-2.459, p = 0.242). However, SRT was associated with a decreased risk for severe ROP, compared to mild ROP (odds ratio 0.226, 95% confidence interval 0.056-0.905, p = 0.036). These data suggest that SRT is associated with a decreased risk for severe ROP.     

What Can Be Expected of Balloon Aortic Valvuloplasty in Adults?

Introduced more than 15 years ago, balloon aortic valvuloplasty (BAV) has clearly delineated indications and limitations. Although, aortic valve replacement is undoubtedly the treatment of choice for healthy patients with aortic stenosis, BAV has been demonstrated as a valuable and safe palliative procedure for patients considered too risky or old for current day surgery. Between January 1991 and December 1999, 858 patients (mean age 76 ± 11 years, 479 [57%] women) underwent BAV at our center. Indications for BAV were contraindication to surgery in 16.2% of the patients, high risk in 40.4%, refusal of surgery in 10.7%, personal decision in 18.5%, and other in 14.2%. The mean gradient decreased from 65 ± 23 to 27 ± 12 mmHg and the valve area increased from 0.56 ± 0.19 cm² to 1.0 ± 0.38 cm². Eleven (1.1%) patients died during the procedure. The other severe complications were complete AV block in 18 (1.8%) patients, stroke in 8 (0.8%), tamponade in 6 (0.6%), and massive aortic insufficiency in 4 (0.4%). In conclusion, BAV does not replace valve replacement, even in the elderly. All those who can be operated on, should be. However, if surgical intervention is not considered reasonable, BAV offers good immediate results with an acceptable complication rate. Furthermore, previous published series have demonstrated that BAV is particularly indicated in specific subgroups, such as very old patients with high operative risk, end-stage heart failure, cardiogenic shock, or general anesthesia for noncardiac surgery.     

Mortality studies of machining-fluid exposure in the automobile industry. II. Risks associated with specific fluid types.

Excesses of digestive and respiratory cancers have been reported previously in association with exposure to machining fluids, agents in widespread use as coolants and lubricants in machining operations. Previous studies have had limited power to distinguish the effects of the different types of machining fluids in use. In a cohort of over 30,000 workers employed at two automotive plants in Michigan, mortality patterns were studied in relation to exposure to each of the three major fluid types--straight oils, soluble oils, and synthetic fluids. Standardized mortality ratios were estimated for subgroups of the cohort ever exposed to each of the three fluid types, and Poisson regression analyses were used to assess trends in risk with duration of exposure. The data suggest modest positive associations between exposure to straight oils and rectal, laryngeal, and prostatic cancer and a negative association between soluble and synthetic fluid exposure and lung cancer.     

The Association Between Acculturation and Health Insurance Coverage for Immigrant Children from Socioeconomically Disadvantaged Regions of Origin

Among immigrant children whose parents have historically had lower education, the study explored which immigrant children were most likely to have coverage based on maternal region of origin. The direct and indirect relationship of acculturation on immigrant children’s coverage was also assessed. A subsample of US-born children with foreign-born mothers from the Early Childhood Longitudinal Survey-Kindergarten Cohort was analyzed using multinomial logistic regressions (n = 1,686). Children whose mothers emigrated from the Caribbean or Indochina had greater odds of being insured compared to children whose mothers emigrated from Mexico. Moreover, Latin American children did not statistically differ from Mexican children in being uninsured. Maternal citizenship was positively associated with children’s coverage; while living in a household with a mother who migrated as a child was negatively associated with private insurance. To increase immigrant children’s coverage, Latin American and Mexican families may benefit from additional financial assistance, rather than cultural assistance.     

Evolution of Ebola Virus Disease from Exotic Infection to Global Health Priority,Liberia, Mid-2014

Over the span of a few weeks during July and August 2014, events in West Africa changed perceptions of Ebola virus disease (EVD) from an exotic tropical disease to a priority for global health security. We describe observations during that time of a field team from the Centers for Disease Control and Prevention and personnel of the Liberian Ministry of Health and Social Welfare. We outline the early epidemiology of EVD within Liberia, including the practical limitations on surveillance and the effect on the country’s health care system, such as infections among health care workers. During this time, priorities included strengthening EVD surveillance; establishing safe settings for EVD patient care (and considering alternative isolation and care models when Ebola Treatment Units were overwhelmed); improving infection control practices; establishing an incident management system; and working with Liberian airport authorities to implement EVD screening of departing passengers.     

Cluster of Ebola Virus Disease,Bong and Montserrado Counties,Liberia

Lack of trust in government-supported services after the death of a health care worker with symptoms of Ebola resulted in ongoing Ebola transmission in 2 Liberia counties. Ebola transmission was facilitated by attempts to avoid cremation of the deceased patient and delays in identifying and monitoring contacts.     

Occupational exposure to chlorophenol and the risk of nasal and nasopharyngeal cancers among U.S. men aged 30 to 60

BACKGROUND: Elevated rates of nasal and nasopharyngeal cancers have been associated with wood-related occupational exposures, including chlorophenols, formaldehyde, and wood dust. METHODS: Occupational information was obtained from 43 nasal carcinoma cases, 92 nasopharyngeal carcinoma cases, and 1909 controls, by interview. Exact conditional logistic regression was used to evaluate the association of these cancers with chlorophenol exposure, estimated from a review of verbatim responses. RESULTS: Both nasal and nasopharyngeal cancers were significantly associated with estimated duration of chlorophenol exposure. For nasopharyngeal cancer, elevated risk was observed among those who held jobs assigned medium or high intensity chlorophenol exposure (n(exposed)=18, OR=1.94, 95% CI=1.03-3.50) and among those with 10+ years in jobs assigned high intensity with high certainty (n(exposed)=3, OR=9.07, 95% CI=1.41-42. 9). Controlling for estimated formaldehyde and wood dust exposure did not alter these findings, as much of the estimated chlorophenol exposure was among machinists. CONCLUSIONS: These findings support the hypothesis that occupational exposure to chlorophenol is a risk factor for nasal and nasopharyngeal cancer, although the role of machining-related exposures warrants further assessment.     

Physical Activity Disparities Between US-born and Immigrant Children by Maternal Region of Origin

We examined and compared patterns in physical activity participation for children of US-born and immigrant mothers from seven world geographic regions, and tested whether the physical activity differences were attenuated by socioeconomic status or maternal language proficiency. Using the Early Childhood Longitudinal Study-Kindergarten data (N = 18,850) we utilized logistic regression to predict adequate vigorous physical activity and participation in group and individual sports for kindergarten children. US-born children of US-born parents have significantly higher rates of physical activity compared to immigrant children. Children of Mexican, Southeast Asian, and Caribbean immigrants were especially unlikely to participate in sports. These disparities were not significantly attenuated by socioeconomic status, but accounting for language proficiency reduced some differences between the US-born and immigrant children, particularly for group sports participation. Researchers interested in improving the physical activity patterns of second-generation children should consider the relevance of language barriers in promoting healthy living.