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PubMed2006

Admixture in Mexico City: implications for admixture mapping of type 2 diabetes genetic risk factors.

Admixture mapping is a recently developed method for identifying genetic risk factors involved in complex traits or diseases showing prevalence differences between major continental groups. Type 2 diabetes (T2D) is at least twice as prevalent in Native American populations as in populations of European ancestry, so admixture mapping is well suited to study the genetic basis of this complex disease. We have characterized the admixture proportions in a sample of 286 unrelated T2D patients and 275 controls from Mexico City and we discuss the implications of the results for admixture mapping studies. Admixture proportions were estimated using 69 autosomal ancestry-informative markers (AIMs). Maternal and paternal contributions were estimated from geographically informative mtDNA and Y-specific polymorphisms. The average proportions of Native American, European and, West African admixture were estimated as 65, 30, and 5%, respectively. The contributions of Native American ancestors to maternal and paternal lineages were estimated as 90 and 40%, respectively. In a logistic model with higher educational status as dependent variable, the odds ratio for higher educational status associated with an increase from 0 to 1 in European admixture proportions was 9.4 (95%, credible interval 3.8-22.6). This association of socioeconomic status with individual admixture proportion shows that genetic stratification in this population is paralleled, and possibly maintained, by socioeconomic stratification. The effective number of generations back to unadmixed ancestors was 6.7 (95% CI 5.7-8.0), from which we can estimate that genome-wide admixture mapping will require typing about 1,400 evenly distributed AIMs to localize genes underlying disease risk between populations of European and Native American ancestry. Sample sizes of about 2,000 cases will be required to detect any locus that contributes an ancestry risk ratio of at least 1.5.

Africa, Western↗
PubMed1991

Use of estrogens among middle-aged Massachusetts women.

This study describes estrogen use among 45- to 55-year-old white women in Massachusetts from 1981 to 1987. In a 1981 cross-sectional survey, 7705 white women (77 percent response rate) returned a questionnaire or were interviewed by phone. Premenopausal women were invited into a 4.5-year follow-up study including telephone interviews every nine months, and 2236 (approximately 91 percent of the eligible women) had a complete follow-up. In the cross-sectional survey, 7.9 percent had used oral estrogens in the last two weeks, but most (77 percent) had had a hysterectomy; use varied notably from one area to another. Vaginal estrogens were used by 2.9 percent. Users and nonusers of oral estrogens were quite similar in regard to sociodemographic background. Data from the follow-up surveys showed that estrogen use increased throughout the study period and by the final follow-up women with higher education status reported more estrogen use than those with lower education status. Most women used estrogens only for a short time.

Drug Utilization↗
PubMed2005

Pediatric pharmacotherapeutic education: current status and recommendations to fill the growing need.

The Accreditation Council for Pharmacy Education and the Canadian Council for Accreditation of Pharmacy Programs state that their respective programs should provide a curriculum appropriate to produce general practitioners of pharmacy. Millions of prescriptions are written for infants and children each year, and relatively few pharmacists practice in environments devoid of pediatric patients. To fulfill the stated mandate, professional pharmacy curricula must include adequate content dedicated to pharmaceutical care of the pediatric patient. Current pediatric curricula are inadequate and must be improved. Pediatric topics should be introduced early in the curriculum to increase students' awareness of the special needs of this vulnerable population. Other recommendations include the provision at least 25 hours of didactic instruction in core pediatric areas and at least one pediatric clinical rotation to all students. Pharmaceutical care of pediatric patients can also be improved by offering pediatric rotations to all pharmacy practice residents and encouraging their participation. However, a change in attitude may be most important. The contention that pediatric pharmacy practice is an isolated subspecialty can no longer be supported.

Clinical Competence↗
PubMed1980

The effect of education, marital status and sexual behaviour on the incidence of puerperal endometritis and bacteriuria.

During a one year study period, 5058 patients were delivered in the State Maternity Hospital of Helsinki. Caesarean section was performed on 774 patients (15.3%). The puerperal endometritis rate was 1.8% after vaginal delivery and 9.8% after Caesarean section. After vaginal delivery, the frequency of endometritis in unmarried women (3.9%) was more than twice as high as in married women (1.5%) (p less than 0.001). After Caesarean section, endometritis occurred in 20.7% of unmarried and in 8.9% of married women (p less than 0.001). Patients who had sexual intercourse during the last week of pregnancy had endometritis after vaginal delivery at a rate of 2.4% and in 20.0% after Caesarean section. In patients who had not sexual intercourse the percentages were 1.6 and 8.3 respectively. In vaginal deliveries the difference was small but in Caesarean sections statistically significant (p less than 0.05). Maternal education had no significant effect on the frequency of endometritis. Bacteriuria corresponding to greater than or equal to 10(5) bacteria/ml of urine was found in 179 patients (5.0%). The frequency of bacteriuria did not have a statistically significant correlation with the marital status of the patients, nor with their education or sexual behaviour during the last week of pregnancy.

Adult↗
PubMed2003

The association between occupational stress and the risk of developing acute coronary syndromes: the CARDIO2000 Study.

OBJECTIVE: The aim of this study was to investigate the association between occupational stress and the risk of developing acute coronary syndromes, in a population-based sample of patients and controls. METHODOLOGY: During 2000-01, a case-control study was conducted (CARDIO2000). A random and stratified sample of 848 middle aged patients with a first of an acute coronary syndrome and 1078 cardiovascular disease free participants, matched with the patients by gender, age and region, was selected from all regions of Greece. In addition to the common cardiovascular risk factors, the effect of occupational stress on coronary risk was evaluated, after taking into account income, marital status, educational and occupational level of the participants. The levels of occupational stress were measured by administering to the individuals a self-reported questionnaire. RESULTS: After controlling for age, gender and region, by design, and the presence of smoking, hypertension, hypercholesterolaemia, diabetes mellitus, physical activity status, educational and financial status and nutritional habits, multivariate analysis showed that the levels of occupational stress are positively associated with the risk of developing acute coronary syndromes in the investigated sample (Odds Ratio = 2.2, p < 0.01). Moreover, the presence of occupational stress seems to affect more significantly males than females, smokers than non-smokers, hypertensives than normotensives and high alcohol consumers compared to low alcohol consumers. CONCLUSIONS: Although the design of the present study does not provide evidence of causality, a strong positive association between occupational stress and acute coronary syndromes seems to exist. Thus, public health policies should take into account lifestyle conditions related to work in the design of preventive strategies at the primary level.

Acute Disease↗
PubMed1993

Spirit possession and healing among Chinese psychiatric patients.

This is a study of the illness behaviour of 100 Chinese psychiatric patients referred consecutively to the psychiatric unit of a general hospital in Singapore. More women than men felt that their illness was due to spirit possession; but belief in possession was not related to educational status. Thirty-six patients or their relatives had consulted a traditional healer before going to the hospital. Duration of illness, sex and educational status were not associated with the tendency to seek help from the traditional healer; there was also no significant difference between psychotic or neurotic patients. The majority of depressed patients (72%) presented with somatic complaints of chest discomfort, headache and abdominal discomfort. Somatization was not related to the educational level or sex of the patients.

Adult↗
PubMedDate not supplied

Epilepsy: knowledge, attitude and practice in literate urban population, Accra, Ghana.

A cross sectional survey was conducted among Government workers and the general public in Accra, Ghana. A total of 380 persons were interviewed. Almost everybody could describe accurately, an epileptic person. However, 172 (45.3%) out of the 380 respondents did not know the cause of epilepsy, and 37.6% did not know how it could be treated. Out of the 358 responses to the cause of epilepsy, 114 (31.8%) said it was inherited disease, 100 (27.9%) said it was due to witchcraft/juju or spiritual. With respect to treatment, 150 out of 333 responses mentioned sending the individual to the medical doctor, 95 (28.5%) said the use of herbs/visits to fetish priest, 59 (17.7%) suggested prayers, 20 (6.0%) said to do nothing. For prevention, 77 (29.1%) out of 319 responses indicated prayers, 49 (15.45%) cautioned marrying into epileptic family, and 13 (4.1%) responses indicated not to touch patient fitting. Those who answered "don't know" regarding knowledge about epilepsy were mostly the young, the lower educational status and the single respondents. However, the most important characteristic of the respondent that was associated with the appropriateness of the responses was the educational status. Although a lot of misconceptions about epilepsy existed in the study population, e.g. epilepsy can be spread by contact and that epileptics must be isolated or avoided, several respondents would share a room, eat or employ persons with epilepsy. The study has shown that the traditional beliefs and attitudes about epilepsy are still held firmly by the adult working population and that the educational level of the respondent was positively related to the appropriateness of the responses. It is therefore suggested that additional efforts must be made to increase the knowledge of the general population through the use of social marketing strategies in order to improve the management of persons with epilepsy.

Adolescent↗
PubMed1991

Influence of education on aspects of cognitive functions in non-demented elderly Nigerians.

Cognitive function was assessed in 930 elderly Nigerians living in an urban community by trained medical students who were blinded to the educational status of the subjects. They used a pretested and validated questionnaire. The subjects were later evaluated for the presence of dementia according to DSM-IIIR criteria by neurologists who then determined the educational status of the subjects. There were 361 males and 569 females with a mean age of 58.5 years (SD = 14.8). One hundred and sixty-one subjects (17%) with at least 6 years of education performed better on all aspects of cognition assessed (p less than 0.001). The differences in performance were statistically significant on assessment of general knowledge, intelligence, abstract thinking, depth of information and immediate recall (p less than 0.001) but not for calculation, orientation, attention and language comprehension. Our findings confirm the confounding effect of education on cognitive assessment and suggest the possibility of developing a short culture-free and educationally unbiased instrument for assessing cognitive functions in Nigerians.

Adult↗
PubMed1991

Comparison of two methods of assessing physical activity in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Physical activity was assessed by questionnaire among 4,956 young blacks and whites aged 18-30 years at the baseline examination (1985-1986) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study of cardiovascular risk factors. The Physical Activity Recall questionnaire categorized all activity during the previous week, while the Physical Activity History questionnaire quantified participation in 13 specific activities during the previous year. This report compares the two questionnaires with regard to their characterization of the activity levels of the sociodemographic subgroups of the study population and their associations with known physiologic correlates of physical activity. Both questionnaires resulted in the same physical activity patterns for sex (men greater than women) and age (younger greater than older) strata. However, the mean Physical Activity History score was higher in white women than in black women, while the Physical Activity Recall scores were nearly equal. The Physical Activity History score was directly related to educational status, and the Physical Activity Recall score was inversely related to educational status. The Physical Activity History score was generally more strongly associated with physiologic variables known to be related to physical activity (e.g., treadmill test duration). Based upon these findings, which may only be appropriate in this age group, it was concluded that the Physical Activity History score was the more valid measure of habitual physical activity in this study group of young adults.

Adolescent↗
PubMed2006

A cross-sectional study of health-related quality of life deficits in individuals with comorbid diabetes and cancer.

BACKGROUND: Numerous studies have identified a reduced health related quality of life (HRQL) in patients that have either diabetes or cancer. We assessed the HRQL burden in patients with these comorbid conditions, postulating that they would have even greater HRQL deficits. METHODS: Data from the Public Use File of the Canadian Community Health Survey (PUF CCHS) Cycle 1.1 (September 2000-November 2001) were used for this analysis. The total sample size of the CCHS PUF is 130,880 individuals. We used the Health Utilities Index Mark 3 (HUI3) to assess HRQL in patients with: 1) comorbid diabetes and cancer, 2) diabetes alone, 3) cancer alone, and 4) no diabetes or cancer. Analysis of covariance was used to compare the mean overall HUI3 score, controlling for age, sex, marital status, body mass index (BMI), physical activity level, smoking status, education level, depression status, and other chronic conditions. RESULTS: We identified 113,587 individuals (87%) with complete data for the analysis. The comorbid diabetes and cancer group were older and a larger proportion reported being obese, inactive, having less than a secondary education and more chronic conditions when compared to the other three cohorts (p < 0.0001). However, the diabetes and cancer cohort was less likely to be depressed (p < 0.0001). Overall HUI3 scores were significantly lower for the diabetes and cancer group (unadjusted mean (SD): 0.67 (0.30)), compared to diabetes (0.78 (0.27)), cancer (0.78 (0.25)), and the reference group (0.89 (0.18)) (p < 0.0001). After adjusting for covariates, the comorbid diabetes and cancer group continued to have significantly lower overall HUI3 scores than the reference group (unstandardized mean difference: -0.11, 95% CI: -0.13 to -.0.09) (p < 0.0001). CONCLUSION: Individuals with diabetes and cancer had a clinically important and significantly lower HRQL than those with either condition alone. A better understanding of the relationship between diabetes and cancer, and their associated comorbidities, complications, and HRQL deficits may have important implications for prevention and management strategies.

Adolescent↗
PubMedDate not supplied

[Clinical profile in children under five year old with acute respiratory tract infections]

OBJECTIVE: To describe the clinical and epidemiological profile of acute respiratory infections (ARI) in children younger than five years old, of both sexes, diagnosed at the University Hospital Júlio Müller.METHODS: This is a descriptive and cross sectional study. A standard questionnaire was answered by the childreńs parents, during the period of October/1996 to February/1997. The cases were classified according to the Health Ministry criteria in Upper Airway Infection (UAI) or Acute Lower Respiratory Infection (ALRI). The following data were analyzed: signs and symptoms, clinical diagnosis, socioeconomic variables, nutritional appraisal and passive smoking. The data were analyzed with EPI-Info 6.02b program. The X(2) test was used with confidence interval of 95% (a = 5%).RESULTS: The ARI prevalence in children under five years was 25.6%. From the total number of 491 children, 76.4% (n=375) had UAI and 23.6% (n=116) ALRI. The most frequent diagnosis was nasopharyngitis. The most frequent respiratory symptoms were nasal discharge (82.1%) and cough (80.4%). Around 6.1% of the total number of the cases were due to pneumonia (77.7% of the cases involving hospitalization). There were no associations of ARI with children s nutritional status, family income or passive smoking. There was statistical association between maternal educational status and ALRI (X(2)= 16.57).CONCLUSIONS: The findings show that most of the children presented nasopharyngitis (UAI), being most of them male. Pneumonia (ALRI) was the main cause of hospitalization. The most common symptoms were nasal discharge and cough. Besides, the most important risk factor associated was the mothers educational status.

Journal Article↗
PubMed1996

Risk factor analysis of patients with chronic hepatitis C in Taiwan.

BACKGROUND: Parenteral transmission is the major route for hepatitis C virus (HCV) infection. However, in western countries, 40% of patients with chronic hepatitis C have no apparent risk factor of HCV infection. This study was designed to investigate the possible risk factors of HCV transmission in chronic hepatitis C patients in Taiwan. METHODS: One hundred and sixty-one consecutive patients with chronic hepatitis C and 161 age- and sex-matched healthy subjects were enrolled. Risk factors, including blood transfusion, injection with nondisposable needles, education status, surgery, dental procedure, tattooing, ear-piercing, sexual behavior and alcoholism, were obtained in every patient through questionnairing and interviewing. RESULTS: Patients with chronic hepatitis C, compared with healthy controls, had significantly higher rates of previous history of blood transfusion, frequent nondisposable needle injections, and lower education status (43.5% vs. 10.6%, 19.9% vs. 6.2%, 42.2% vs. 23.0%, respectively, all p < 0.05). Univariate logistic regression analysis showed blood transfusion, frequent nondisposable needle injections and low education as significant risk factors of HCV infection (all p < 0.05). Multivariate analysis again revealed them all to be independent significant risk factors associated with HCV infection in chronic hepatitis C patients. CONCLUSIONS: Parenteral transmission of HCV via transfusion and frequent nondisposable needle injections were the main routes of contracting HCV infection in patients with chronic hepatitis C in Taiwan. Also, people with low education ran the higher risk of transmission by HCV. Meticulous screening of the transfused blood for HCV, usage of disposable needles, and mass public education are important in our efforts to decrease chronic HCV infection in Taiwan.

Adolescent↗
PubMed1998

The body mass index-mortality relationship in white and African American women.

OBJECTIVE: To examine the association of body mass index to all-cause and cardiovascular disease (CVD) mortality in white and African American women. RESEARCH METHODS AND PROCEDURES: Women who were members of the American Cancer Society Prevention Study I were examined in 1959 to 1960 and then followed 12 years for vital status. Data for this analysis were from 8,142 black and 100,000 white women. Body mass index (BMI) was calculated from reported height and weight. Associations were examined using Cox proportional hazards modeling with some analyses stratified by smoking (current or never) and educational status (less than complete high school or high school graduate). RESULTS: There was a significant interaction between ethnicity and BMI for both all-cause (p<0.05) and CVD mortality (p<0.001). BMI (as a continuous variable) was associated with all-cause mortality in white women in all four groups defined by smoking and education. In black women with less than a high school education, there were no significant associations between BMI mortality. For high school-educated black women, there was a significant association between BMI and all-cause mortality. Among never smoking women with at least a high school education, models using the lowest BMI as the reference indicated a 40% higher risk of all-cause mortality at a BMI of 35.9 in black women vs. 27.3 in white women. DISCUSSION: The impact of BMI on mortality was modified by educational level in black women; however, BMI was a less potent risk factor in black women than in white women in the same category of educational status.

Adult↗