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PubMed1992

Risk factors for cervical intraepithelial neoplasia.

To evaluate risk factors for cervical intraepithelial neoplasia (CIN), data were collected in a case-control study based on 366 patients (58 with CIN class 1, 70 with CIN class 2, and 238 with CIN class 3) and 323 control subjects with normal cervical smears interviewed on selected days at the same screening clinics where cases had been identified. No relationship emerged between indicators of socioeconomic status (education and social class) and risk of mild/moderate (considered together) and severe dysplasia. A total of 55 (43%) patients with CIN class 1 or 2, 107 (45%) patients with CIN class 3, and 94 (29%) controls were current smokers. The corresponding relative risk (RR) estimates for current versus never smokers were 1.9 (95% confidence interval [CI] 1.2 to 3.0) for patients with CIN class 1 or 2 and 2.5 (95% CI 1.7 to 3.6) for patients with CIN class 3, and the risk increased with the number of cigarettes smoked per day. No relationship was observed between oral contraceptive use, parity, spontaneous or induced abortions and the risk of CIN, but patients tended to report earlier age at first birth than control subjects. Compared with women reporting their first birth before the age of 20 years, the risk estimates were 0.5 and 0.4, respectively, for patients with CIN 1 or 2 and patients with CIN 3 in women reporting first birth at 20 to 24 years of age. The risk estimates were 0.5 and 0.6 for those reporting their first birth at age 25 or later, but the trends in risk were not statistically significant. The number of sexual partners was directly associated with the risk for both histopathologic subgroups. Compared with women reporting no intercourse or their first intercourse after 22 years of age, women with first intercourse before the age 18 had a RR estimate of CIN class 1 or 2 of 2.3 and of CIN class 3 of 2.4, with the trends in risk being statistically significant. This study confirms considerable similarities in the epidemiology of mild/moderate and severe cervical dysplasia. In addition, it suggests consistency between the epidemiology of intraepithelial and invasive cervical neoplasia for risk factors that are likely to act on one of the first stages of the process of carcinogenesis (i.e., indications of sexual habits) but differences for hormone-mediated factors (i.e., reproductive variables or oral contraceptives).

Abortion, Spontaneous↗

PubMed1985

MMPI correlates of verbal-intellectual deficits in patients with left hemisphere lesions.

This study investigated the emotional adjustment of patients (N = 31) with left hemisphere damage (LHD) as a function of the degree of impairment in verbal intelligence as measured by the Wechsler Adult Intelligence Scale. A multivariate comparison was made of the composite MMPI profiles of three groups of LHD patients classified according to Verbal IQ. The three groups produced fairly similar composite profiles, which indicated the presence of mild dysphoria, dissatisfaction, withdrawal, decreased initiative, and mild somatic preoccupations. Significant correlations emerged between the degree of verbal-intellectual disability and MMPI F, PT, SC, and SI. However, when the variance in MMPI scores due to premorbid status (education) was partialled out, these correlations dropped to nonsignificant levels. These findings failed to support previous studies that linked verbal deficits with emotional disturbance, and they underscore the importance of premorbid intelligence in the psychological adjustment to organic impairment.

Adult↗

PubMed2001

Religious preference, church activity, and physical exercise.

BACKGROUND: Utah has the highest percentage of physically active adults in the United States. It also has a high percentage of religiously active people. About 90% of the adult population has a religious preference and 62% of those individuals attend church weekly. This study evaluates the relationship between religious preference, church attendance, and physical activity. METHODS: Analysis is based on 6,188 adult respondents ages 18 years and older to a cross-sectional random telephone survey involving 12 health districts in the state of Utah from June 1 to August 31, 1996. RESULTS: Within religious groups, those attending church weekly were more likely to exercise than individuals attending church less than weekly. About 70% of Utah consists of members of the Church of Jesus Christ of Latter-day Saints (LDS). LDS attending church less than weekly were least physically active in Utah. The percentages of those exercising vigorously at least 20 min three times per week were 52.3% (LDS who attend church weekly), 44.5% (LDS who attend church less than weekly), 57.6% (non-LDS who attend church weekly), 54.3% (non-LDS who attend church less than weekly), and 53.1% (no religious preference) (P = 0.0070). When adjustment was made for age, smoking status, education, marital status, and general health, differences in exercise between church activity levels within religious groups became insignificant. Smoking and general health have the greatest influences on the relationship between religious preference, church attendance, and exercise. LDS were significantly less physically active than non-LDS in the adjusted model. CONCLUSIONS: Although differential smoking levels and general health status explained differences between church activity levels within religious groups, lower levels of exercise among LDS versus non-LDS could not be explained and require further study.

Adolescent↗

PubMed2001

Risk factors for diabetes mellitus by age and sex: results of the National Population Health Survey.

AIMS/HYPOTHESIS: We aimed to assess the risk factors for diabetes mellitus, by age and sex in Canada and to recommend prevention and control strategies. METHODS: This study was based on the Canadian 1996-1997 National Population Health Survey which comprised 69 494 participants aged 12 years and over. The prevalence of diabetes mellitus was analysed in relation to age, sex, body mass index, overweight status, energy expenditure, physical activity, smoking, drinking, income, marital status, education and rural or urban residence. RESULTS: The prevalence of diabetes increased with age and body mass index and increased inversely with energy expenditure in both males and females. Current and former smokers were associated with a higher prevalence of diabetes. No effect was observed in regular or former drinkers. Prevalence of diabetes increased inversely with income, especially among women. Women who were single and 35 to 64 years old had a higher prevalence of diabetes than women of the same age who were married. The prevalence of diabetes was not found to be related to the level of education. Urban or rural residence was not found to have an effect on the prevalence of diabetes. CONCLUSION/INTERPRETATION: Women and men of all ages should avoid becoming overweight, by maintaining their body mass index below 25 kg/m(2) and 27 kg/m(2), respectively. They should maintain a moderate level of physical activity. Patients with diabetes should give up smoking completely. Diabetes prevention and control strategies should be targeted for women in low income groups.

Adult↗

PubMed2005

Reduced fracture risk in users of thiazide diuretics.

Thiazide diuretics (TD) reduce renal calcium excretion and may increase bone mineral density. A reduced fracture risk has been reported in some but not all studies. The aim of this study was to assess fracture risk in users of TD. The study design was nationwide population-based pharmacoepidemiological case-control study with fracture in year 2000 as outcome and use of TD during the previous 5 years as the exposure variable. Individual use of TD was derived from the Danish National Pharmacological Database and related to fracture data from the National Hospital Discharge Register. These data were combined with information on use of other drugs, social status, working status, income, educational status, contacts with general practitioners and practicing specialists, and comorbidity. A total of 64,699 patients (age = 40 years) who sustained a fracture during the year 2000 were compared to 194,111 age- and gender-matched controls. After adjustment for potential confounders, current use of TD was associated with a 10% (95% confidence interval [CI], 7% to 12%) reduced risk of any fracture and a 17% (95% CI 11% to 23%) reduced risk of forearm fractures. In former TD users, the risk reduction was slightly less pronounced. Similar results were found in men and women, and in subjects younger or > or = 65 years of age. Dose-effect analysis revealed a decreased risk of any fracture and fractures at the forearm and hip with an increased number of redeemed defined daily dosages (DDDs) of TD. Therefore, use of more than 2000 DDD was associated with a 19% (95% CI 10% to 27%) decreased hip fracture risk. We conclude that use of TD is associated with a significantly reduced fracture risk.

Aged↗

PubMed2005

The association between body weight, unintended pregnancy resulting in a livebirth, and contraception at the time of conception.

OBJECTIVES: Annually, 3 million pregnancies in the United States are classified as unintended, with many of these unintended pregnancies occurring to women who use some type of contraceptive. Obesity may be affecting the biological effectiveness of contraceptives. We investigated whether there is an association between body weight and unintended pregnancy and whether this association differs by a woman's contraceptive status at the time of conception. METHODS: We conducted a case-control study using multistate data from the 1999 Pregnancy Risk Assessment Monitoring System. A total of 18,445 women provided complete information on pregnancy intention, contraceptive use at the time of conception, weight, height, and other covariates. Multivariable logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Among contraceptors, overweight and obese women had nearly twice the odds of having an unintended pregnancy as compared to women with normal body mass indices (OR=1.73 [95% CI: 1.20, 2.36] and OR=1.75 [95% CI: 1.21, 2.52], respectively) after adjustment for age, marital status, education, socioeconomic status, Medicaid, race/ethnicity, and parity. No association was found between heavier weight and unintended pregnancy among noncontraceptors. CONCLUSIONS: Though the observed associations could be the result of selection bias or unmeasured confounding, the findings suggest that the effect of obesity on unintended pregnancy is limited to contraceptive failure. Prospective studies designed specifically to examine a body weight-contraceptive failure association are needed to determine if heavier women should be advised to use contraceptive methods other than hormonal contraceptives to prevent unintended pregnancy.

Adolescent↗

PubMed1985

Socioeconomic and demographic characteristics of induced abortion cases.

The age, parity, marital and socioeconomic status, education, religion, profession and the period of gestation of 200 patients who applied for legal abortions are analyzed. In this study 74% of the women were more than 20 years of age, 75% had attended secondary school, 63% were students or clerks, 53% came from lower- or middle-class families, 40% were Roman Catholics, 45% were unmarried, 40% were nulliparous and 57% had little or no knowledge of contraception.

Abortion Applicants↗

PubMed1993

Wife battering in Nigeria.

OBJECTIVE: To determine the prevalence, types and regularity of spouse abuse among Nigerian women. The effects of socio-economic status, education and alcohol consumption were also investigated. METHOD: Questionnaire survey of 1000 randomly chosen Nigerian women was undertaken. RESULT: Wife abuse was found to be as prevalent in Nigeria as in other parts of the world, 81.0% of the respondents had suffered either verbal abuse (68.6%) or both physical and verbal abuse (31.4%); occasionally (77.4%), regularly (16.2%) or always (6.0%), Almost half of them (46.2%) were abused in the presence of their children. Education and occupation were found to influence the prevalence, type and regularity of abuse and their children witnessing the abuse. CONCLUSION: Wife battering has been found to be very prevalent in Nigeria. However, further research is needed to identify the causes and the psychological effects on these women and their children. This information will be invaluable for designing appropriate medico-social rehabilitation for them.

Alcohol Drinking↗

PubMed1992

[Convergent validity of the preliminary Spanish version of the Child Abuse Potential Inventory: depression and marital adjustment].

This paper studies the "convergent validity" of the preliminary spanish version of the Child Abuse Potential (CAP) Inventory. In relation to the ecological-systemic model of child maltreatment, this inventory evaluates individual, family, and social factors which facilitate the occurrence of physical child abuse. Depression and marital adjustment were measured in three groups of mothers: one group of mother-perpetrators of physical child abuse (n = 20), another group of mothers with a rate superior to cut-off (percentile = 95) in the CAP Inventory (n = 15), and a group of mothers with low punctuation (under percentile 25) in the CAP Inventory (n = 15). The two last groups (High CAP and Low CAP) come from a larger sample of 829 subjects which are a demographically representative sample of the population of País Vasco (in Spain). Because of variations in the detection of social services, the physically abused group is formed by the most extreme and severe cases. The three groups of mothers were matched as to socio-economic family status, education, civil status, age of the mother, sex of the child, number of children. It was expected that in these variables, depression and marital adjustment, the group with physical abuse would resemble the High CAP group and that both groups would be significantly different from the Low CAP group. Results partially confirm these hypothesis, supporting the possibilities of developing a Spanish version of the CAP Inventory for detection of physical child abuse.

Adult↗

PubMed2005

The impact of depression is unevenly distributed in the population.

AIMS: The aim of this study was to evaluate the impact of depression on quality of life in the general population by studying its effects on i) health-related quality of life (HRQoL), ii) health state utilities, and iii) the burden of disease in the population according to age, sex, marital status, education, economy and employment. METHOD: Cross-sectional survey in the County of Uppsala, Sweden. A statistical sample of the general population aged 20-64 years (N=4506) was used. Information on current state of depression was obtained by self-report. HRQoL was measured using Short Form 36 (SF-36). The time trade-off (TTO) method was used to measure health state utilities. The decrease of total health state utilities associated with depression in the population was used as a measure of burden of disease. RESULTS: Depression was reported by 4.0% of the population. Those with depression scored significantly lower (P<0.001) than those without on all eight of the SF-36 domains. The depressed group also rated their health state utilities significantly lower than the others: 0.796 versus 0.933 (P<0.001). In the multivariate analysis of decrease in utilities with various medical disorders, depression was associated with the greatest decrease (-0.090, P<0.001). Persons with depression accounted for 10.9% of the total decrease in utilities in the whole population, but this proportion varied according to the specific subgroup. For example, 16.4% and 8.6% of the total burden of disease was linked to depression among single and married people, respectively. The corresponding figures for those with the lowest and highest incomes were 15.0% and 7.9%, respectively. Among the unemployed, persons reporting depression accounted for 15.3% of the decrease in utilities in contrast to 4.9% among the employed. CONCLUSIONS: Depression has a strong impact on the quality of life and total disability in the general population. Further, the impact of depression is unevenly distributed in the population.

Adult↗

PubMed2005

Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States.

The empirical relationship between income inequality and health has been much debated and discussed. Recent reviews suggest that the current evidence is mixed, with the relationship between state income inequality and health in the United States (US) being perhaps the most robust. In this paper, we examine the multilevel interactions between state income inequality, individual poor self-rated health, and a range of individual demographic and socioeconomic markers in the US. We use the pooled data from the 1995 and 1997 Current Population Surveys, and the data on state income inequality (represented using Gini coefficient) from the 1990, 1980, and 1970 US Censuses. Utilizing a cross-sectional multilevel design of 201,221 adults nested within 50 US states we calibrated two-level binomial hierarchical mixed models (with states specified as a random effect). Our analyses suggest that for a 0.05 change in the state income inequality, the odds ratio (OR) of reporting poor health was 1.30 (95% CI: 1.17-1.45) in a conditional model that included individual age, sex, race, marital status, education, income, and health insurance coverage as well as state median income. With few exceptions, we did not find strong statistical support for differential effects of state income inequality across different population groups. For instance, the relationship between state income inequality and poor health was steeper for whites compared to blacks (OR=1.34; 95% CI: 1.20-1.48) and for individuals with incomes greater than $75,000 compared to less affluent individuals (OR=1.65; 95% CI: 1.26-2.15). Our findings, however, primarily suggests an overall (as opposed to differential) contextual effect of state income inequality on individual self-rated poor health. To the extent that contemporaneous state income inequality differentially affects population sub-groups, our analyses suggest that the adverse impact of inequality is somewhat stronger for the relatively advantaged socioeconomic groups. This pattern was found to be consistent regardless of whether we consider contemporaneous or lagged effects of state income inequality on health. At the same time, the contemporaneous main effect of state income inequality remained statistically significant even when conditioned for past levels of income inequality and median income of states.

Adult↗

PubMed2006

Jordanian patients' perception of stressors in critical care units: a questionnaire survey.

BACKGROUND: Critical care units' CCUs environment has been regarded as a leading stressor because of the complex nature of patient's health problems that require an extensive use of very sophisticated technology. Multiple and complex care predominates in CCUs have been described by patients to be stressful and emotionally demanding. RATIONALE: Number of CCUs in Jordan has been increasing and so does the advanced technology, which calls for adaptability in dealing with unit stressors as they affect patient recovery and rehabilitation. OBJECTIVES: To identify the principal physical and psychological stressors as perceived by Jordanian patients in CCUs and to examine the effects of selected patients' characteristics on their perception of stressors. METHODS: In this cross-sectional study, data was collected from 165 patients, 2-3 days after being discharged from CCUs in two Jordanian governmental hospitals. A structured interview guide including the Intensive Care Unit Environmental Stressor Scale was used. RESULTS: Having tubes in nose or mouth, being in pain, not able to sleep and hearing the buzzers and alarms from the machinery, being thirsty, and not being in control of your-self were considered by patients as the main stressors. Psychological stressors were the least stressful items identified by patients. Marital status, educational level, age, and income were the most significant characteristics which affected patients' perception of stressors. CONCLUSIONS: The findings suggest that single and older patients with low income and low education experience more difficulties than their counterparts. Nurses must utilize more effective communication techniques and interventions to relieve patients' pain, and provide an atmosphere in which rest is possible, with less light, noise, and the fewest possible interruptions. Although the results of this study indicate the need to provide the best possible physical care, it is equally important to give adequate attention to patients' and families' psychological aspects.

Adult↗

PubMed2006

The association between burnout and physical illness in the general population--results from the Finnish Health 2000 Study.

OBJECTIVE: The association between burnout and physical diseases has been studied very little. The purpose of this study was to examine the relationship between burnout and physical illness in a representative nationwide population health study. METHODS: As a part of the "Health 2000 Study" in Finland, 3368 employees aged 30-64 years were studied. Burnout was assessed with the Maslach Burnout Inventory-General Survey. Physical diseases were diagnosed in a comprehensive health examination by research physicians. RESULTS: Physical illness was more common among subjects with burnout than others (64% vs. 54%, P<.0001), and the prevalence of diseases increased with the severity of burnout (P<.0001). Burnout was an important correlate of cardiovascular diseases among men (OR=1.35; 95% CI, 1.13-1.61) and musculoskeletal disorders among women (OR=1.22, 95% CI, 1.07-1.38) when adjusted for age, marital status, education, socioeconomic status, physical strenuousness of work, smoking, physical activity, alcohol consumption, body mass index, and depressive symptoms. The prevalence of musculoskeletal disorders and cardiovascular diseases increased with the severity of all three dimensions of burnout, that is, exhaustion (P<.0001 and P<.001, respectively), cynicism (P=.0001 and P<.001, respectively), and lack of professional efficacy (P<.01 and P<.0001, respectively). CONCLUSIONS: Burnout is associated with musculoskeletal diseases among women and with cardiovascular diseases among men. These associations are not explained by sociodemographic factors, health behavior, or depression. Physical illnesses are associated with all three dimensions of burnout and not only with the exhaustion dimension. In the future, the causal relationships between burnout and physical diseases need to be investigated in prospective studies.

Adult↗

PubMed2005

Comparative analysis of invasive cervical cancer incidence rates in three Appalachian states.

BACKGROUND: Invasive cervical cancer (ICC) rates remain elevated in the Appalachian region of the United States. We investigated patterns of invasive cervical cancer incidence rates in three Appalachian states (Kentucky, West Virginia, Pennsylvania) to uncover specific high-risk subgroups within this large and heterogeneous region. METHODS: The analysis was conducted for the three states combined and individually. Invasive cervical cancer rates were characterized by individual and county-level sociodemographic variables, including age, race, poverty, education, Appalachian status, and rural/urban status. Bivariate analyses and multivariable Poisson regression models were conducted to address the relative contributions of each variable to the risk of invasive cervical cancer. RESULTS: The three states differed in the contribution of each factor to the risk of invasive cervical cancer. The overall invasive cervical cancer incidence rates for Kentucky, West Virginia, and Pennsylvania were 13.4, 13.9, and 10.2 per 100,000/yr, respectively. After controlling for other demographic variables, the effect of Appalachian status on invasive cervical cancer was weaker, while rural status, education, and race were stronger, significant predictors. CONCLUSIONS: This study illustrates the heterogeneity of population demographics and invasive cervical cancer risk, and the need to identify subregions and subgroups within Appalachia at highest risk for this disease.

Adult↗

PubMed1985

Characteristics of women undergoing induced abortion: results of a case-control study from Northern Italy.

In order to identify subgroups of women at elevated risk of induced abortion, personal characteristics and habits, selected medical histories and contraceptive practices of 873 women undergoing legal abortion in various areas of Northern Italy were compared with those of 504 control subjects identified in family planning clinics of the same hospitals or area health authorities. When age was allowed for, the risk of induced abortion was not strongly influenced by marital status, education or other indicators of social class. However, women who were employed, independently from the type of occupation, showed markedly lower abortion risks than housewives. Among various indicators of sexual habits investigated, the strongest determinant of legal abortion was the frequency of sexual intercourses over the previous six months, women with less frequent intercourses showing a markedly elevated risk estimate (RR = 2.82). Induced abortion was less frequent among ex-smokers and more frequent in heavy smokers, but was not appreciably influenced by several other indicators of lifestyle habits and history of gynaecological or psychiatric complaints. The risk of abortion was not influenced by the number of livebirths, but was lower for women with later age at first birth. Less than 5% of case and control subjects reported more than two previous induced abortions, thus indicating that abortion is more of an "accidental" event rather than a widespread contraceptive practice. However, over three-quarters of abortions occurred in women reporting no contraception at all or coitus interruptus, thus underlining the scope for family planning education in this population.

Abortion, Legal↗

PubMed2000

Overestimation and underestimation of labor pain.

OBJECTIVE: To define factors affecting the ability of the medical staff to estimate the level of pain during labor. METHODS: The study population consisted of 255 consecutive women. All parturients were asked to rate their pain level, using a visual analog scale. At the same time, the caregivers estimated the degree of pain as was exhibited by the parturients, using the same scale. Patients whose pain level was either overestimated or underestimated were compared to patients whose pain was correctly estimated. RESULTS: In about half of the women (50.6%) enrolled in our study the level of pain was estimated correctly by the caregivers, while similar proportions of women had their pain level overestimated (24.3%) and underestimated (25.1%) by the caregivers. While the majority (54.5%) of patients who were in their second or third deliveries were equally estimated by the personnel with regard to their pain intensity levels, most of the grandmultiparous women had their labor pain underestimated by the medical staff. (57.1%, P<0.001). None of the caregivers had more than five children. Although the mostly secular medical staff could properly estimate the pain levels of most secular patients (52.3%), the labor pain of 44% of the religious parturients was underestimated (P=0.003). The ability to estimate properly the patients' suffering was found to be unaffected by age, family status, educational level, presence of companion during labor and participation in childbirth preparation course. CONCLUSION: The wider the cultural gap between the caregiver and the patient, the less accurate was the interpretation of patient's pain.

Adult↗

PubMed1998

Sociodemographic representation in published studies of cocaine abuse pharmacotherapy.

This study evaluated: (1) the reporting of sociodemographic characteristics of research subjects in published outpatient studies of cocaine abuse pharmacotherapy; (2) the association of study characteristics with such reporting and with the distribution of characteristics; and (3) the comparison of sociodemographic characteristics in the research subjects with those of a community-based sample of cocaine abusers who had sought treatment. Medline search identified 68 articles on cocaine abuse outpatient pharmacotherapy published from 1983 to 1993 in an English language, peer-reviewed journal. Sociodemographic characteristics of research subjects (n = 1802) were compared with those of respondents (weighted n = 135) to the National Comorbidity Survey (1990-1992), who reported at least one cocaine-related problem and had sought substance abuse treatment. Only three (4.4%) articles reported all six of the following sociodemographic characteristics of their subjects: 82.4%, reported mean age; 58.8%, race/ethnicity; 85.3%, sex; 22.1%, employment status; 13.2%, educational status; and 5.9%, socioeconomic status/income. Compared to survey respondents, research subjects were significantly more likely to be African-American and live in the Northeast region of the US and marginally more likely to be male and currently unemployed. These findings indicate that many published articles do not follow currently recommended guidelines for describing sociodemographic characteristics of research subjects and that, aside from race/ethnicity and geographic location, research subjects are fairly comparable in basic sociodemographic characteristics to the larger population of treatment-seeking individuals with cocaine-related problems.

Adult↗

PubMed1997

Multiple induced abortions: Danish experience.

Experience with 50 first time aborters, 50 second time aborters, and 50 third time aborters residing in an urban area of Copenhagen suggests that women having a repeat abortion are more similar than dissimilar to women having a first induced abortion. There were no differences in socioeconomic status, educational level, or stated reasons for choosing abortion (usually socioeconomic and family considerations). Though similar to first and second time aborters in their life situations and greater contraceptive risk-taking, third timers seemed to become pregnant more readily. They were also less willing to be interviewed. Related studies and suggestions for postabortion counseling are discussed.

Abortion, Induced↗