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A multivariate analysis of risk factors for pneumonia following cardiac transplantation.

Fifty cardiac transplant recipients were followed over a 34-month period for evidence of pneumonia that developed in twelve patients. Potential risk factors evaluated fell into three categories: demographic (age, sex, race, and underlying cardiac disease); pretransplant status (hospitalized, intubated, pulmonary infiltrate, requirement for antibiotics, or the need for a ventricular assist device); and posttransplant therapy (amount and type of blood products, prolonged endotracheal intubation or reintubation, use of ventricular assist devices, immunosuppressive protocols, lymphocyte subset ratios, and occurrence of rejection, leukopenia, or CMV infection). The Cox proportional hazards model identified posttransplant reintubation (P = 0.009) and the use of protocols employing larger steroid dosages (P = 0.02) as significant risk factors for pneumonia. In a separate analysis, the occurrence of pneumonia was shown to be a significant risk factor for mortality (P = 0.018).

Heart Transplantation↗

Factors influencing the relationship between a newborn assessment of gestational maturity and the gestational age interval.

This study examines the correlation and agreement between the calculated 'gestational interval' from the date of last menstrual period (LMP) and the Ballard newborn assessment of gestational maturity. It then investigates selected maternal socio-demographic, prenatal, intrapartum and infant factors which may account for differences between these two gestational age determination methods. Single live-born deliveries (n = 10,794) were selected from a 1982-1986 medical university perinatal information data system for analysis. The Ballard assessment overestimates the LMP at earlier gestational ages and underestimates in the post-term range. The discrepancy between LMP and Ballard varies across the range of gestational age values and the extent of variation differs by several maternal and infant risk factors. These findings suggest considerable bias may result from the indiscriminate case mixing of LMP and Ballard values for use in gestational age research or in standardising developmental tests. We highlight the deficiencies in using correlation coefficients or mean differences to assess agreement between these measures.

Delivery, Obstetric↗

Cerebrovascular deaths before and after the appearance of oral contraceptives.

The mortality of cerebrovascular diseases in Denmark was analysed for men and women 15-44 years of age, in a 14-year period before and after the appearance of oral contraceptives (OC) in 1966. 1,670 deaths were registered over 28 years, during which the female incidence of cerebrovascular deaths increased by 19% (P less than 0.025), while the male mortality was unchanged. Women showed a percentage increase in deaths from cerebral thromboembolic attacks (CTA) of 33%, men a fall of 14%. The increase of female CTA deaths was most pronounced in the young fertile group, the age group with a high OC use. A relative risk of CTA of 3.3-4.5 for OC users compared with non-users could explain the CTA trend difference between women and men. No other single risk factor responsible for the observed trends could be identified. Both women and men had a significant increase in the mortality of subarachnoidal hemorrhages, and a significant fall in the mortality of intracerebral hemorrhages.

Adolescent↗

Dynamics of spread of HIV-I infection in a rural district of Uganda.

OBJECTIVE: To define the geographical distribution of HIV infection and the community characteristics associated with HIV prevalence in a rural population of Uganda. DESIGN: Seroprevalence survey and interviews of the population aged 13 years and older in 21 randomly selected clusters. SETTING: Rural population of Rakai district, south west Uganda. SUBJECTS: 1292 adults, of whom 594 men and 698 women gave a blood sample and answered the questionnaire. MAIN OUTCOME MEASURES: HIV status determined by ELISA and western blotting in relation to community characteristics. RESULTS: The weighted seroprevalence of HIV for the district was 12.6% with prevalence by cluster varying from 1.2% to 52.8%. Seroprevalence was highest in main road trading centres (men 26%, women 47%), intermediate in rural trading villages on secondary roads (men 22%, women 29%), and lowest in rural agricultural villages (men 8%, women 9%). For both men and women, multiple regression showed a strong negative association between cluster seroprevalence and the proportion of the population employed in agriculture (beta = -0.677 for men, -0.807 for women). Among women, cluster seroprevalence increased with a higher proportion of the population reporting multiple sex partners (beta = 0.814), external travel (beta = 0.579), and injections (beta = 0.483). CONCLUSIONS: Community characteristics, particularly the proportion of the population in agriculture, are associated with HIV prevalence and can be used for targeting interventions. The seroprevalences of HIV suggest spread of infection from main road trading centres, through intermediate trading villages, to rural agricultural villages.

Adolescent↗

Women's health and women's work in health services: what statistics tell us.

This article draws together statistical information in several broad areas that relate to women's health, women's reproductive activities and women's occupations in Sweden. The statistical analysis reflects the major changes that have occurred in Swedish society and that have had a major impact on the health and well-being, as well as on the social participation rate, of women. Much of the data is drawn from a recent special effort at Statistic Sweden aimed at influencing the classification, collection and presentation of statistical data in all fields in such a way that family, working, education, health and other conditions of women can be more readily and equitably compared with those of men. In addition, social changes have seen the shifting of the responsibility of health care from the unpaid duties of women in the home to health care institutions, where female employees predominate. These trends are also discussed.

Adolescent↗

Statistical analysis of an urban population of 236 patients with head and neck pain. Part I. Patient profile.

A large group of patients (236) was examined for myofascial pain dysfunction syndrome. The parameters used for diagnosis of the syndrome were pain and tenderness in the head and neck muscles and temporomandibular joint, joint sounds, and limited function. It was found that the demographic profile of our patient population did not vary greatly from those reported previously in other studies. However, we did examine more details of the patients' backgrounds than any other single study. The relationships of age, sex, occupation, marital status, emotional stress, and head trauma were discussed.

Adolescent↗

Application of an Euclidian distance measure to the selection of reference areas in epidemiologic research concerning environmental issues.

A procedure for selecting reference areas in epidemiologic research employing census data and squared Euclidian distance is described. The procedure was adapted from cluster analysis, a multivariate statistical technique that has been applied in many disciplines. With the use of 12 census variables as the basis for evaluating sociodemographic differentiation, squared Euclidian distances were calculated between a geographically delineated index area in southwest Alberta, where residents had complained for several years about the effects of exposure to sour gas emissions, and 119 provincial census tracts in the rest of nonmetropolitan southern Alberta. The Euclidian distances can be interpreted as social distance scores with values close to zero representing a high level of sociodemographic similarity between the index area and potential reference areas. The social distance scores, in association with environmental data, suggested a clear choice for the most comparable unexposed reference area and illustrated the difficulty of finding a suitable most comparable exposed reference area. Results from the demographic component of the subsequent health survey indicated that the index area and reference area were similar in most respects. Furthermore, tests with and without statistical adjustment for confounding variables produced negligible differences on most of the important target outcome variables.

Adolescent↗

Levels and patterns of infant and child mortality in Ghana.

This paper attempts to measure infant and child mortality levels and also to determine their structure by utilizing the results of the 1968-1069 National Demographic Sample Survey which was conducted under the directorship of the author. Among the major problems encountered in the exercise are the adjustment of the current raw mortality data and the estimation of infant and child mortality from independent source material. The estimated infant mortality rates range from 56 per 1,000 live births in the Accra Capital District to 192 in the Upper Region during the late 1960's. The urban rate is lower than the rural rate, 98, as against 161 per 1,000 live births. A large proportion of the deaths among children aged 0-4 occur in the second year of life, and deaths in this age group account for the bulk of the deaths within the age group 1-4 years.

Age Factors↗

Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

Abortion, Legal↗

Do statements about desired family size predict fertility? The case of Taiwan, 1967-1970.

The predictive accuracy of respondents' statements about their future fertility is examined, using interview data from a longitudinal study conducted in Taiwan. Two measures of preference are found to be highly intercorrelated; and regardless of which one is used, Taiwanese women are shown to predict their subsequent fertility at least as well as U.S. women. The preference measures are also predictive of rates of contraceptive use and abortion. While demographic and social characteristics are correlated with fertility in expected directions, statements about wanting more children prove to be highly predictive of subsequent fertility for both modern and less advanced segments of the population.

Abortion, Induced↗

Parents and AIDS education.

The objective of this research was to study parents' attitudes toward AIDS education in schools. Questionnaires were mailed to employees in an industrial plant and a hospital in a city of 150,000 in Ontario, Canada. Two hundred and sixteen questionnaires from parents with children in schools were analyzed. Two thirds of the parents agreed that AIDS education should discourage premarital sex; whereas, 88% believed that AIDS education should teach about condoms. Pearson correlations and multiple regression were used to analyze hypotheses that tested attitudes toward AIDS education in the schools. Two predictor variables--attitude toward premarital intercourse and fear of casual contact of AIDS--were significantly correlated with all three measures of attitudes toward AIDS education in the schools. Church attendance and knowledge of AIDS were related to both attitudes toward discouraging premarital sex and teaching about condoms. Three multiple regression models were constructed to predict attitudes toward AIDS education in the schools. The final models accounted for between 11% and 33% of the variance.

Acquired Immunodeficiency Syndrome↗

Environmental indicators: a tool for evaluating community-based health-promotion programs.

We propose using a class of community-level measures--environmental indicators--as part of the evaluation of community-based health-promotion programs. Community-level measures of health-related behavior can be divided into three conceptual categories. The first two categories comprise statistical aggregates (e.g., means, sums, percentages) of measurements made on individuals, distinguished by whether individual-level covariates are also available. Individual-disaggregated measures include covariates, such as a comprehensive survey of health-risk behavior, including demographic information; individual-aggregated measures, such as sales data, do not. Our main focus is on the third category, environmental indicators, derived from observations of the community environment. Environmental indicators measures aspects of the physical, legal, social, and economic environment in a community that reflect, and likely influence, the attitudes and behavior of individual community members. They also measure an important intermediate step in community-based health-promotion interventions, namely environmental factors that programs target to modify individual attitudes and behavior. We present examples of environmental indicators for tobacco use and diet.

Attitude to Health↗

Sociodemographic correlates of breast feeding in Ghana.

This study utilizes data from the Ghana Fertility Survey (GFS) (1979-1980) to investigate breast feeding in Ghana and the factors that affect it. Using life table procedures, we found evidence that, when other factors are held constant, older cohorts, women with no schooling, those who work in the agricultural sector, those affiliated with traditional Ghanaian religions, Mole-Dagbanis, rural residents, residents of the Volta, Brong-Ahafo, northern, and upper regions, and low-parity women show longer durations of breast feeding. It is recommended that, along with other fertility reduction measures, prolonged breast feeding among all Ghanaian mothers should be encouraged to help reduce conception and to ensure healthy children.

Body Image↗

Palmar eczema: a pathogenetic role for acetylsalicylic acid, contraceptives and smoking?

A statistical study of the relationship between vesicular palmar eczema and various clinical variables was carried out. Vesicular palmar eczema was found in 153 cases (38%), thereof 113 females (76%). Ninety-two percent of all found cases could be regarded as pompholyx. Three new pathogenetic factors were suggested in the vesicular palmar eczema: use of acetylsalicylic acid (Aspirin), contraceptives and smoking. Furthermore, the relationship between pompholyx and contact allergy to nickel was confirmed. No correlation to atopy was found. However, both atopy and sex were found to constitute certain risk factors. The study was based on information from 425 consecutively patch tested patients (74% females) from our local database DALUK.

Adult↗

Active life among the elderly in the United States: multistate life-table estimates and population projections.

Calculations of multistate life expectancy not only measure how long a population may live beyond a certain age, but also what fractions of this continuing lifetime will be spent in an independent or dependent status. Many Americans aged 70 and over are leading long, active lives; large numbers of individuals who become dependent, moreover, do so temporarily and return to independent status. Men and women have disparate total and active life expectancies, however, reflecting differential survival patterns and varying rates of transition among statuses. Policy makers must consider the increased size of the future elderly population, and changes in its age composition and functional status, when planning relevant health services.

Activities of Daily Living↗