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PubMed1999

Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension.

AIM: To investigate the effect of several types of congenital heart disease (CHD) on nutrition and growth. PATIENTS AND METHODS: The prevalence of malnutrition and growth failure was investigated in 89 patients with CHD aged 1-45 months. They were grouped according to cardiac diagnosis: group aP (n = 26), acyanotic patients with pulmonary hypertension; group ap (n = 5), acyanotic patients without pulmonary hypertension; group cp (n = 42), cyanotic patients without pulmonary hypertension; and group cP (n = 16), cyanotic patients with pulmonary hypertension. Information on socioeconomic level, parental education status, birth weight and nutrition history, number of siblings, and the timing, quality, and quantity of nutrients ingested during weaning period and at the time of the examination were obtained through interviews with parents. RESULTS: There was no significant difference between groups in terms of parental education status, socioeconomic level, duration of breast feeding, and number of siblings (p > 0.05). Group cP patients ingested fewer nutrients for their age compared to other groups. 37 of the 89 patients were below the 5th centile for both weight and length, and 58 of 89 patients were below the 5th centile for weight. Mild or borderline malnutrition was more common in group aP patients. Most group cp patients were in normal nutritional state, and stunting was more common than wasting. Both moderate to severe malnutrition and failure to thrive were more common in group cP patients. CONCLUSION: Patients with CHD are prone to malnutrition and growth failure. Pulmonary hypertension appears to be the most important factor, and cyanotic patients with pulmonary hypertension are the ones most severely affected. This study shows the additive effects of hypoxia and pulmonary hypertension on nutrition and growth of children with CHD.

Child, Preschool↗

PubMed1979

Plasma lipids, lipoproteins, and blood pressure in female adolescents using oral contraceptives.

Comparative profiles are reported for plasma lipids and lipoproteins, blood pressure, smoking, and selected socioeconomic variables for females less than 20 years of age using oral contraceptives and for pair-matched non-users from the Lipid Research Clinics Prevalence Study. About 5% of adolescent females reported OC use; they had significantly higher levels of plasma total cholesterol, triglyceride, and high-density lipoprotein-cholesterol than did the non-users. Significantly more non-users of OC belonged to households of the lowest occupational status; no differences in OC usage by educational status of the head of household were discernible. Of the OC users, 58% were classified as current smokers, as compared with 23% of the non-OC users.

Adolescent↗

PubMed2001

Gender equity in undergraduate medical education: a status report.

This status report summarizes recent data on and studies of women's experiences as medical students. Women medical students in the United States now number over 29,000--44% of enrollees. Despite large increases in the numbers of women students, harassment and gender stereotyping continue to detract from their education and opportunities. Moreover, specialty choices have remained remarkably stable, with comparatively few women entering surgery and most subspecialties. Because equal opportunity has not yet been achieved, medical schools need to monitor the experiences of their trainees and to target interventions where problems still exist in order to ensure that progress toward gender equity continues.

Career Choice↗

PubMed2004

Episiotomy use among residents and faculty compared with private practitioners.

OBJECTIVE: To describe trends in episiotomy use among residents, faculty, and private practitioners at an academic institution. METHODS: We reviewed data from the Magee Obstetric Medical and Infant database, containing details of every delivery at Magee-Womens Hospital since 1995. The study population was women who had spontaneous or operative vaginal delivery of a singleton, liveborn, vertex-presenting infant, at 37 weeks or more, from 1995 to 2000 (completed data set years). The first delivery recorded for a patient in the database was analyzed. Residents and faculty were described as "academic" practitioners. Data were analyzed with the Fisher exact test, chi2 test for linear trend, and logistic regression models. RESULTS: There were 27702 women with 15190 episiotomies, for an episiotomy rate of 54.8%. The rate of episiotomies decreased from 59.7% to 45.0% during the study period (P <.001). Independent risk factors for episiotomy included age 30 years or more, white race, higher educational status, married, nulliparity, and history of cesarean delivery. The strongest predictor of episiotomy use was practitioner type, with women attending private physicians having an adjusted 7-fold increased risk of episiotomy (odds ratio 7.1; 95% confidence interval 6.5, 7.7). Patient characteristics related to practitioner type included age, race, educational status, marital status, nulliparity, and mode of delivery (P <.001). CONCLUSION: High rates of episiotomy use were found among private practitioners, despite current evidence-based literature that supports restricted use of episiotomy.

Adult↗

PubMedDate not supplied

Epidemiology of otitis media in a local tropical African population.

BACKGROUND: Otitis media is one of the most common childhood infections. There are however very few community based studies on the prevalence of this disease in Nigeria children. OBJECTIVES: To establish the community prevalence of otitis media: and to identify associated environmental and the host risk factors in Nigerian children. SETTING: A semi urban community of Ife Central Local Government area of Osun State, Southwestern part of Nigeria. MATERIAL AND METHODS: Thirty enumeration areas within the study location were randomly picked and their boundaries were defined with the assistance of the National Population Commission (NPC) Officials. Households were used as sampling units within the area. Children aged 1 day old-12 years in each selected household were identified. A questionnaire was administered to the mother/guardian of each child. Otoscopic examination, in addition to the general physical examination was carried out on each child. The data were analyzed using simple descriptive statistics, correlation and multivariate regression technique. RESULT: 600 children aged 0-12 years were investigated. There were 299 males and 301 females. The prevalence of otitis media was found to be 14.7%. This comprises of acute otitis media (AOM) in 11.8%, chronic suppurative otitis media (CSOM) in 2.5%, while Otitis media with effusion (OME) was diagnosed in less than 1%. The peak age of incidence was found to be in the age group 1-4 years 55 (9.2%), while the least age of occurrence was found to be in the age group less than 1 year 10 (1.7%). There was no statistical association between the duration of breastfeeding practice and occurrence of otitis media among the subject (P>0.05). There was no statistical association between the occurrence of otitis media and immunization (p>0.05). However there were 3 children who had otitis media associated with measles infection. A highly significant association was shown between exposure to household cooking fuel (wood smoke) and the occurrence of otitis media (P<0.05). Mother's educational status, number of children sleeping in the same room greater than four was found to demonstrate a strong association with the occurrence of Otitis media (p<0.05). CONCLUSION: Otitis media is prevalent among Nigeria children and it is found to occur more in children of mothers with lower educational status and in number of children greater than 4 sleeping in the same room. A strong association was found between exposure to wood smoke in the living environment and the occurrence of otitis media.

Air Pollution, Indoor↗

PubMed2006

Awareness about glaucoma and related eye health attitudes in Switzerland: a survey of the general public.

OBJECTIVE: To assess the level of awareness about glaucoma and its consequences and to evaluate associated eye health attitudes in a randomly selected general urban and rural population in Switzerland. METHODS: A cluster random sample of the Swiss population was interviewed. Five-hundred and two telephone interviews with subjects who were representative of the 35- to 70-year-old population of the German- and French-speaking parts of Switzerland were conducted. Data were collected about their gender, age, educational status and professional situation. STUDY TYPE: Cross-sectional survey. RESULTS: In total, 76% (n = 383) of respondents did not have any (or any correct) association with the term 'glaucoma'. Only 24.7% (n = 123) of the interviewees could describe glaucoma as an eye condition. Awareness of glaucoma was independent of age, gender, educational status, and household income. Associated therapeutic measures were surgery (75%) and medical treatment (57%). Seventy-one percent of all respondents wear eyeglasses, 74% of all females and 67% of males. CONCLUSION: Awareness and knowledge about glaucoma are relatively low in the average Swiss population across all segments of society. The lack of awareness on this insidious disease has important implications for the uptake of ophthalmic care and may result in avoidable blindness. These data also show that the ophthalmologist is considered by the majority of people to be the primary contact for eye health-related information and sight corrections.

Adult↗

PubMed2006

A case-control study on the association of idiopathic recurrent pregnancy loss with autoantibodies against beta2-glycoprotein I and annexin V.

Whereas antiphospholipid antibodies (aPL) are associated with thrombotic events and recurrent spontaneous abortion (RSA), the contribution of anti-beta2 glycoprotein 1 (beta2GP1) and anti-annexin V antibodies as risk factors for RSA remain poorly understood. We investigated anti-beta2-GPI and anti-annexin V IgM and IgG antibodies as potential risk factors for RSA in 200 women with more than three consecutive idiopathic RSA, and 200 age-matched, healthy, parous women. Pearson's chi squared test analysis showed that while anti-beta2-GPI IgG (P = 0.416) and IgM (P = 0.72) were comparable between patients and controls, elevated anti-annexin V IgG (P = 0.006), but not IgM (P = 0.084), was more pronounced in patients. Higher frequencies of elevated IgG-only (P = 0.005), but not IgM-only (P = 1.000; OR = 6.66), anti-annexin V antibodies were noted among patients. Multinomial regression analysis showed that body-mass index (overweight and obesity; P = 0.008), education status (P < 0.001) and anti-beta2-GPI IgM (P = 0.033), but not IgG (P = 0.723), were associated with early abortion, while anti-beta2-GPI IgG (P = 0.030) and anti-annexin V IgG (P = 0.004) were associated with late RSA. For combined early-late RSA, the only variable selected was education status (P < 0.001), and neither anti-annexin V nor anti-beta2-GPI IgM and IgG was associated with early-late RSA. Accordingly, anti-annexin V and anti-beta2-GPI should be regarded as independent risk markers of RSA.

Abortion, Habitual↗

PubMedDate not supplied

Smoking behavior among French and American women.

BACKGROUND: This paper presents an analysis of the sociodemographic factors related to cigarette smoking prevalence and the number of cigarettes smoked daily among nationally representative samples of 18- to 64-year-old French (n = 1,956) and American (n = 20,234) women. METHODS: This analysis combines 2 separate years (1992 and 1993) of data collected by the National Health Interview Survey in the United States and the Comité Francais d'Education pour la Santé in France. Weighted data analysis of the effects of age, employment status, education, and socioprofessional status was conducted using both SPSS and the SUDAAN complex sample survey analysis program. RESULTS: The prevalence of smoking among French female smokers was significantly higher than among American women (30.8% vs 26.3%) and particularly among the younger age groups. However, the average number of cigarettes smoked per day was appreciably and significantly lower for French women (12.3) than for American women (18.2). Multivariate logistic regression analysis revealed statistically significant interaction terms differentiating the impact of marital status, age, and education on the smoking status of French and American women, as well as the sociodemographic determinants of the number of cigarettes smoked. Education was inversely related to smoking among American women but positively associated with the smoking behavior of French women. CONCLUSIONS: Differences in the smoking behavior of French and American women support the view that sociodemographic factors do not affect the smoking behavior of women in Western industrialized countries similarly and reinforce the importance of international public health measures targeting the increasing rate of smoking among women.

Adolescent↗

PubMed2000

[Intellectual development in the second year of life in healthy breast-fed children compared with formula-fed children].

BACKGROUND: The role of breast milk with regard to W3 long-chain polyunsaturated fatty acids and infant intellectual development remains controversial. PATIENTS AND METHODS: Thirty-nine children born at term and from homogeneous sociocultural status were enrolled in a blind-prospective trial. Children were divided in two non-randomized groups: a breast-fed group and a standard formula-fed group. Red blood cell phospholipid fatty acids were analyzed at 7 and 60 days of life. Cognitive development was evaluated at the end of the second year of life through Bailey s test. RESULTS: Concentrations of phosphatidylethanolamine and phosphatidylcholine docosahexaenoic acid were significantly lower in the formula-fed group. No statistically significant differences between groups were found in cognitive function. Brain development index was significantly correlated with infant head circumference and educational status of the mother. CONCLUSIONS: Maternal nutrition provides higher red blood cell docosahexaenoic acid, but is not related to a higher developmental quotient at the age of 2 years. However, infant head circumference and maternal educational status were correlated with developmental cognition.

Breast Feeding↗

PubMed2002

Ten-year trends in smoking behaviour among adults in southern Germany.

SETTING: The city of Augsburg and two adjacent counties, covering a population of 532,987. OBJECTIVE: To provide a detailed description of trends in smoking behaviour among adults according to age, gender and educational status in southern Germany. DESIGN: Cross sectional surveys performed 10 years apart (1985 and 1995) in the Augsburg region as part of the WHO MONICA project. PARTICIPANTS: Of a total of 9261 eligible subjects, 7938 adults aged 25-64 years (4022 in 1985 and 3916 in 1995) from two separate random samples responded to the survey, giving a response rate of 79% in 1985 and 75% in 1995. RESULTS: In both surveys, daily smoking among men showed a clear pattern of reverse association with age and educational status, while women showed only an age-smoking pattern. Between 1985 and 1995, daily smoking showed a general increase among women and a decrease among men, with most of the increase in smoking prevalence as well as in numbers of cigarettes consumed by smokers occurring in women with a low level of education. Smoking cessation generally showed a positive relation to education in each survey for both sexes, and an increasing trend among all educational groups in the 10-year period between 1985 and 1995. CONCLUSION: The 10-year trends in smoking behaviour in southern Germany show features of early stage III of the smoking epidemic, where smoking is decreasing among men and continuing to rise among women, but with signs of levelling off in some social strata. Particular attention should be paid to combating smoking trends among women with low levels of education.

Adult↗

PubMedDate not supplied

Chronic osteomyelitis of long bones: reasons for delay in presentation.

BACKGROUND: Chronic osteomyelitis is a common orthopaedic infection and a major medical problem in developing countries. Time is a critical factor in the evolution of the chronic disease as most of our cases are a progression from acute haematogenous osteomyelitis. Our patients present very late. OBJECTIVE: To identify the reasons for this delayed presentation and suggest possible solutions. METHOD: Over three years (2000-2003) in a multi-centre study (2000-2003), we prospectively evaluated patients with both clinical and radiological diagnosis of chronic osteomyelitis. Besides personal data, mode of onset, duration of illness, father's educational status and occupation and reasons for delayed presentation were documented using a questionnaire. Previous surgery was an exclusion criterion. RESULTS: One hundred and thirty-six patients comprising 81 males and 55 females with a mean age of 17.7(2-55) years were recruited. The mean duration between onset of disease and presentation for treatment was 13.3(2-120) months. Sixty-one (44.9%) presented to a health facility were misdiagnosed and inappropriately treated; ignorance was the reason in 37(27.2%) and lack of finances in 32(23.2%). There was no statistically significant association between the father's educational status and occupation and the attitude to hospital attendance. CONCLUSION: Misdiagnosis, ignorance and poverty are the reasons for delayed presentation in patients with chronic osteomyelitis in this environment. A high index of suspicion, accurate diagnosis and appropriate therapy offer the only hope in containing the acute phase. Continuing medical education, improvement in social and medical amenities and the national health insurance scheme are possible ways of overcoming undue delay in presentation for specialist consultation.

Adolescent↗

PubMed2000

Clinical, cognitive and functional characteristics of long-stay patients with schizophrenia: a comparison of VA and state hospital patients.

Long-stay patients constitute a small proportion of all patients with schizophrenia, but in both VA and state psychiatric systems these patients account for a majority of the costs associated with treatment of the illness. VA and state patients would be expected to differ in several respects, including age at onset and premorbid educational status. Little additional information is available about the differences between these samples. Seventy-four long-stay male patients at a chronic state psychiatric center were compared with 50 male veterans from long-stay psychiatric facilities on positive and negative symptoms, cognitive deficits and functional status. The two samples did not differ on positive symptom severity, but the state patients had more severe negative and cognitive symptoms as well as functional deficits. Of all of the variables measured, deficit in self care was the only variable that entered a stepwise discriminant analysis. The correlation between functional and symptomatic variables was the same in both groups, and the group differences and correlations were not influenced by differences in educational status. These data indicate that VA patients may have reduced severity of functional and cognitive impairments relative to state hospital patients, but that the relationship between the different illness variables was similar in the two groups.

Aged↗

PubMed2005

Socioeconomic status and insomnia.

This investigation compared the likelihood of insomnia and insomnia-related health consequences among individuals of different socioeconomic status. A random-digit dialing procedure was used to recruit at least 50 men and 50 women in each age decade from 20 to 80+ years old. Participants completed 2 weeks of sleep diaries as well as questionnaires related to fatigue, sleepiness, and psychological distress. Socioeconomic status was measured by education status assessed at 3 different levels: individual, household, and community. Results indicated that individuals of lower individual and household education were significantly more likely to experience insomnia even after researchers accounted for ethnicity, gender, and age. Additionally, individuals with fewer years of education, particularly those who had dropped out of high school, experienced greater subjective impairment because of their insomnia.

Adult↗

PubMed1979

Relationship of level of functioning to self-reported and rated psychopathology.

Performed a principal components analysis on the intercorrelations among the nine same-named scales of the Symptom Check List-90R (SCL-90R) and the Symptom Check List-90 Analogue (Analogue) for 118 female and 62 male outpatients admitted to a community mental health center. The SCL-90R scales constituted one component that reflected self-reported psychopathology, whereas the Analogue scales revealed two components that represented rated psychotic and nonpsychotic aspects of psychopathology. When the three latter components, age, race, sex, marital status, educational attainment, and employment status were correlated with Philadelphia's Adult Level of Functioning Scale (LOF scale), only the two clinically rated components and educational attainment were related significantly to level of functioning. The findings were discussed as supporting use of both self-report and clinical measures for evaluating psychopathology.

Adolescent↗

PubMed2006

Antecedents and concomitants of parenting stress in adolescent mothers in foster care.

OBJECTIVE: This study's aim was to examine variables associated with different short-term trajectories in multiply disadvantaged adolescent mothers by investigating antecedents and concomitants of parenting stress. METHOD: We followed 49 adolescent mothers (ages 14-18 at study outset) who were wards in Illinois foster care using a longitudinal correlational design. We examined whether parenting variables (childrearing beliefs, quality of parent-child interactions, and child abuse risk) and personal adjustment variables (emotional distress and social support) at initial assessment predicted parenting stress measured at follow-up (a mean of 22.5 months later). We also examined concurrent relationships between parenting stress and mothers' adaptive functioning in educational, social support, and childbirth areas at follow-up. RESULTS: We found that parenting variables, but not personal adjustment variables, predicted later parenting stress. Results also showed that current adaptive functioning was significantly related to parenting stress. Specifically, educational status and social support predicted concurrent parenting stress, whereas number of childbirths did not. CONCLUSIONS: These findings extend the small literature on the link between parenting difficulties and parenting stress to adolescent mothers in foster care. Parenting challenges, particularly as reflected in unrealistic childrearing expectations, appear to be markers for later parenting stress. Considering the longitudinal relationships observed, early and periodic assessment of adolescent mothers' parenting knowledge, skills, and interactions is recommended. Also, given that this study found concurrent social support and educational status to covary with current parental stress, these variables, and others for which they may serve as proxy, are implicated for careful monitoring.

Adolescent↗

PubMed2004

Mental health and physical activity in the European Union.

OBJECTIVES: This article is the 3rd in a series of four that present data about physical activity in 15 member states of the European Union collected by the Eurobarometer 58.2. On a descriptive level it investigates the relationships between physical activity (MET-h/week) and mental health. METHODS: Data were collected in 2002 as part of the Eurobarometer by face-to-face interviews. A total of 16,230 respondents age 15 years and older were interviewed. Sample sizes were about 1,000 respondents in most nations. Mental health was assessed with the Mental Health Inventory (MHI-5) and the Energy and Vitality Scale (EVI-scale). Physical activity was assessed with the last 7-days short version of the International Physical Activity Questionnaire (IPAQ). RESULTS: Across sociodemographic subgroups of the populations investigated (age, gender, marital status, gross household income, educational status) it was found, that those being more physically active had in general a better mental health. In some of the 15 nations evidence for a dose-response relationship between physical activity and mental health was found, while in others this was not the case. CONCLUSION: Results seem to indicate a positive relationship between physical activity level and mental health for population subgroups. However, analysis found no evidence that this relationship can be characterized as being dose-response in all nations.

Adolescent↗

PubMed2004

Overweight and obesity among urban Sahraoui women of South Morocco.

OBJECTIVES: To estimate the prevalence of obesity in Moroccan Sahraoui women; to describe their distribution of body fat; and to examine the influence of age, calorie intake, physical activity, marital status, education level, and desire to lose weight on obesity. DESIGN: Randomized samples of adult women who visited the public health centers during a immunization campaign period. PARTICIPANTS: Data were obtained on 249 non-pregnant urban women aged 15 and older, who live in the city of Laayoune in South Morocco. Only subjects identified as Sahraoui origin were eligible for this investigation. MAIN OUTCOME MEASURE: The following data were collected: body weight, height, circumference of waist and hip, calorie intake, physical activity, marital status, education level, and desire to lose weight. RESULTS: The overall prevalence of overweight and obesity was 30% and 49%, respectively, and was found to be very high in younger age groups. The prevalence of abdominal obesity was also high and increased with age. Sixty-eight percent of women had a waist-to-hip ratio (WHR) > 0.85 and 76% had a waist circumference (WC) > or = 88. The calorie intake, the time spent in a walking activity, and the time spent in traditional sedentary occupation were associated with obesity. The prevalence of obesity was higher among married women compare to unmarried women and was not influenced by education level. A very small percentage of the female population expressed a desire to lose weight. CONCLUSION: High prevalence of obesity, even in young adult women, needs immediate attention in terms of prevention and health education among the urban Sahraoui women.

Adolescent↗

PubMed1998

A quantitative study of genital skin flora and urinary colonization in spinal cord injured patients.

This study was performed to define the relation between colonization of genital skin flora and bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction. Twenty-seven female and 23 male spinal cord injured patients were included in the study. Patients were evaluated regarding their type of bladder management, educational status, level and degree of the spinal cord lesion. Quantitative cultures were obtained from the perineum labium/dorsum of penis, external meatus of urethra, and urine. We investigated whether the organisms isolated from urine were also present in one or more skin sites in every patient. In total 54 identical bacterial isolates were observed both from urine and one or more skin sites in 43 of the patients. Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Proteus stuartii were the most common bacterial isolates. The distribution of identical colonization of genital skin flora with urine were as follows: 30 in urethra, one in perineum, four in urethra and perineum, nine in urethra and labium/dorsum of penis, and 10 in both three skin sites. Identical colonization of both perineum and labium/dorsum of penis with urine were significantly higher in female patients than those of males (P = 0.037, P = 0.003, respectively). No significant difference was found in the presence/distribution of colonization with respect to type of bladder management, educational status, and neurologic status. These results demonstrate the importance of the urethra, perineum, and labium/dorsum of penis as a source of bacteria causing urinary infection in spinal cord injured patients.

Adolescent↗