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PubMed2001

Survival of Fuji IX ART fillings in permanent teeth of primary school children in Tanzania.

OBJECTIVE: To evaluate the clinical performance of atraumatic restorative treatment (ART) fillings using Fuji IX as a filling material in field conditions. DESIGN: Longitudinal study of the ART fillings in permanent teeth of primary school children aged eight to fifteen years. SETTING: Primary schools in Morogoro municipality, Tanzania. SUBJECTS AND METHODS: Standard 3 and 4 children in five primary schools randomly selected from a list of 36 primary schools of Morogoro municipality were examined for dental caries and periodontal conditions. All 296 carious lesions that were indicated for restoration were treated using ART approach according to the instructions given in the manual for ART approach for the control of dental caries. Essential measurements for treated teeth and cavity were taken. The cavities were filled with Fuji IX glass ionomer cement as per manufacturer's instructions. After one year, 238 restorations were evaluated using the criteria for evaluating ART restorations. MAIN OUTCOME MEASURE: Clinical appearance of the surface of the restorations. RESULTS: Ninety four per cent of the restorations evaluated were rated as good and intact, while 1.7% were rated as having slight defects that needed no repair, giving a one year survival rate of 96.1%. Mean working time was 14.5 minutes. CONCLUSIONS AND RECOMMENDATIONS: The one-year survival rate of 96.1% is high enough to recommend wide use of ART in Tanzania. Town and municipal councils should be encouraged to adopt ART in their school oral health programmes.

Adolescent↗

PubMedDate not supplied

The role of the school-based occupational therapist in secondary education transition planning: a pilot survey study.

OBJECTIVE: The purpose of this study was to investigate school-based occupational therapists' knowledge of transition planning, their degree of participation in assessment and intervention of students requiring transition services, and to identify potential barriers limiting therapists' participation in transition services. METHOD: Using survey methods, a questionnaire was mailed to a random sample of therapists listed as members of the School System Special Interest Section of the American Occupational Therapy Association. Eighty therapists from all geographical regions within the continental United States and who identified themselves as working with students 13-21 years of age in an educational setting, participated in the study. The response rate was 20%. RESULTS: The majority of participants reported that they understood the terminology associated with the Individuals with Disabilities Education Act (IDEA) of 1990 and the 1997 IDEA amendments definitions of transition planning at the secondary level, but were less likely to apply that knowledge to the transition planning process. The majority of therapists reported minimal participation in secondary education transition planning assessment and intervention for students with disabilities. Most respondents believed that they were not contributing to the transition planning process in a manner that maximized their skills, and identified several barriers that they believed hindered greater participation. CONCLUSION: This pilot study suggests that occupational therapists may not be participating in transition services to their fullest potential. While the low response rate in this study precludes generalization, this information is important to guide further study as well as to shape efforts to increase occupational therapy's role in this important service area within school-based practice.

Adolescent↗

PubMed2002

Work-schedule characteristics and reported musculoskeletal disorders of registered nurses.

OBJECTIVES: The relationship between a combination of demanding work-schedule characteristics and reported musculoskeletal disorders of the neck, shoulders, and back was examined. METHODS: A probability sample of 1163 nurses, randomly selected from the list of actively licensed nurses in two states of the United States, served as the sample for this cross-sectional study. Data were collected via an anonymous survey mailed to the participants' homes from October 1999 through February 2000. RESULTS: Four of the nine work-schedule characteristics (working full-time, >8 hours/day, 2-4 weekends/month, and other than day shift) were significantly related to musculoskeletal disorders in one or more body sites. When a work-schedule index was created by summing the nine characteristics, a demanding schedule was significantly associated with musculoskeletal disorders in the neck [odds ratio (OR) 1.10, 95% confidence interval (95% CI) 1.00-1.21], shoulder (OR 1.12, 95% CI 1.01-1.23), and back (OR 1.16, 95% CI 1.06-1.27). Adjustment for psychological and physical job demands reduced the odds ratios slightly and therefore suggested that some of the association between musculoskeletal disorders and schedule was due to increased exposure to these job demands. Working "long hours" (>12 hours/day, >40 hours/week) and "off hours" (weekends and "other than day shifts") were associated with a 50-170% increase in the age-adjusted odds ratio for musculoskeletal disorders in the three body sites. CONCLUSIONS: The findings of this study suggest that preventing musculoskeletal disorders requires system-level approaches to scheduling that reduce the time of exposure to demanding work conditions and promote healthful work-rest patterns.

Cross-Sectional Studies↗

PubMed1991

Variability in classification of consultations by content-based descriptors.

OBJECTIVE: To determine the reliability with which general practitioners use content-based descriptors of consultations. Our hypothesis was that there would be considerable variety in the opinion of general practitioners on the classification of consultations by descriptors. DESIGN: General practitioners in Newcastle, New South Wales, assessed videotaped consultations and the written consultation records by 12 general practitioners. SETTING: The medical faculty of the University of Newcastle and the general practitioners' own homes and offices. PARTICIPANTS: Twelve general practitioner participants were selected from consultation tapes recorded in 1983 by the Primary Care Research Group at the University of Newcastle. Thirty-nine observer general practitioners were randomly selected from a list of general practitioners practising in the Newcastle area maintained by the Hunter Postgraduate Medical Institute. Those whose videotapes had been selected were excluded. RESULTS: There were high levels of variation between assessments made from the original records and from viewing the tapes. Doctors varied greatly in their use of the descriptors. This variation included estimation of the duration of consultations and of the individual components of the consultation (history, physical examination, problems dealt with). No systematic relationships were found between any characteristics of the doctors and their ratings of consultations. CONCLUSIONS: There is potential for enormous variation in the use of content-based descriptors currently available in Australia. Observer general practitioners tended to underestimate the content of the consultations and overestimate the duration. It would be inappropriate to use the general practitioner patient record for audit of the content or difficulty of a consultation.

Adult↗

PubMed1998

Ethnic and sex bias in primary care screening tests for alcohol use disorders.

BACKGROUND: The use of self-report screening tests for alcohol use disorders in the primary care setting has been advocated. OBJECTIVE: To test for ethnic and sex bias in three self-report screening tests for alcohol use disorders in a primary care population. DESIGN: Cross-sectional study with patients randomly selected from appointment lists. SETTING: University-based family practice clinic. PATIENTS: Probability sample of 1333 adult family practice patients stratified by sex and ethnicity. MEASUREMENTS: Patients completed 1) a diagnostic interview to determine the presence of a current alcohol use disorder and 2) three screening tests: the CAGE questionnaire, the Self-Administered Alcoholism Screening Test (SAAST), and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: The areas under the receiver-operating characteristic (ROC) curves for the CAGE questionnaire and the SAAST ranged from 0.61 to 0.88 and were particularly poor for African-American men and Mexican-American women. For the AUDIT, the area under the ROC curves was greater than 0.90 for each patient subgroup. The sensitivity of the CAGE questionnaire and the SAAST at standard cut-points was lowest for Mexican-American women (0.21 and 0.13, respectively). Positive likelihood ratios for the AUDIT were similar to or higher than those for the other screening tests, whereas negative likelihood ratios were lowest for the AUDIT (<0.33), indicating the superiority of this test in ruling out a disorder. CONCLUSIONS: A marked inconsistency in the accuracy of common self-report screening tests for alcohol use disorders was found when these tests were used in a single clinical site with male and female family practice patients of different ethnic backgrounds. The AUDIT does not seem to be affected by ethnic and sex bias.

Adolescent↗

PubMed1999

[Cross cultural adaptation of a health related quality of life measurement: the Spanish version of the COOP/WONCA cartoons].

OBJECTIVES: Cross-cultural adaptation to Castilian Spanish of the original COOP/WONCA charts questionnaire and its validation for use in Spain. DESIGN: Descriptive crossover study. SETTING: Primary Care. PATIENTS: Pilot test with a consecutive sample of 63 patients from a medical list. The final version was administered to a random sample of 475 patients from five medical lists of two urban Health Centres. MEASUREMENTS AND MAIN RESULTS: The adaptation was based on the method of translations and independent back-translations by bilingual persons, from the original version of the instrument and performance of the pilot test. The conceptual equivalence between the final version and the original questionnaire was satisfactory in 8 of the 9 items. Mean scores of the semantic and syntactic equivalences were high and equally satisfactory. Cronbach's alpha was above 0.7 for 6, 7 and 9 items. Spearman's correlation coefficients between two administrations of the questionnaire, separated by 15 days, scored between 0.52 and 0.72. The factorial analysis of 6, 7 and 9 items revealed a unifactorial structure. All the load values ranged between 0.5 and 0.8 except item 5. CONCLUSIONS: The adaptation of the COOP/WONCA charts questionnaire finished with an instrument apparently equivalent to the original and with acceptable reliability and validity. However, other basic characteristics such as sensitivity to changes need to be explored, and aspects of construct validity examined more closely.

Cross-Cultural Comparison↗

PubMed1999

Postal urine specimens: are they a feasible method for genital chlamydial infection screening?

BACKGROUND: A United Kingdom (UK) screening programme for Chlamydia trachomatis has recently been announced. Pilot projects involving the opportunistic testing of women attending health facilities are due to commence in several sites. There is a danger that this approach will fail to obtain adequate population coverage. The alternative--true systematic population screening--is generally assumed to be unfeasible. Studies in Denmark using postal urine specimens have challenged this assumption. No such studies have been reported from the UK. AIM: To assess the potential of urine specimens sent by post as the basis for a UK population screening strategy for genital chlamydial infection. METHOD: Two hundred patients (100 men, 100 women) aged 18 to 45 years were randomly sampled from the list of one urban group practice. Subjects were mailed an explanatory letter, a urine sample container, a sexual lifestyle questionnaire, and a prepaid return envelope. Non-responders were contacted by telephone; persistent non-responders were visited at home. Samples were tested for Chlamydia by DNA amplification and enzyme immunoassay. RESULTS: Sixty-four (32%) subjects were no longer living at their GP registered address. Of the remaining 136, 126 (93%) responded to the survey and 113 (83%) accepted the request for a urine sample and completed a questionnaire. Acceptance rates were similar for men and women and across age groups. Four samples (3%) were Chlamydia positive. CONCLUSION: Home mailed urine specimen collection in conjunction with a self-completed postal questionnaire is feasible. This could provide a viable basis both for determining population Chlamydia prevalence and for a UK Chlamydia population screening strategy. Overall cost effectiveness of such a strategy will depend on the cost of the test used. Comparative performance characteristics of the different currently available tests in this setting have yet to be fully determined.

Adolescent↗

PubMed1999

Exposure to power-frequency magnetic fields and the risk of childhood cancer. UK Childhood Cancer Study Investigators.

BACKGROUND: Previous studies have suggested an association between exposure to power-frequency electromagnetic fields (EMF) and the development of childhood malignant disease, especially leukaemia and tumours of the central nervous system. We investigated the relation between all childhood cancer and exposure to power-frequency magnetic fields. METHODS: The UK Childhood Cancer Study was a population case-control study covering the whole of England, Wales, and Scotland. All children with a confirmed malignant disorder were potentially eligible. For each case, we matched two controls on date of birth and sex, randomly chosen from the list of the Family Health Services Authority in England and Wales or Health Board in Scotland. In the main study, 3838 cases and 7629 controls were interviewed. The EMF part of the study included only one control per case, and household EMF measurements and school measurements where relevant were taken on 2226 matched pairs. These measurements, adjusted for historical line load and appliance fields, were used to estimate average exposure in the year before the date of diagnosis, or an equivalent date for controls. Analyses were by conditional logistic regression, incorporating a census-derived deprivation index used as a measure of socioeconomic status. FINDINGS: For children with mean exposures of more than 0.2 microT compared with children with mean exposures of less than 0-1 microT, the adjusted odds ratios were 0.92 (95% CI 0.47-1.79) for acute lymphoblastic leukaemia, 0.90 (0.49-1.63) for all leukaemia, 0.46 (0.11-1.86) for central-nervous-system tumours, 0.97 (0.46-2.05) for other malignant disease, and 0.87 (0.56-1.35) for all malignant disease combined. Higher exposures (>0.4 microT) were recorded for only 17 (<0.4%) individuals (eight cases, nine controls). INTERPRETATION: This study provides no evidence that exposure to magnetic fields associated with the electricity supply in the UK increases risks for childhood leukaemia, cancers of the central nervous system, or any other childhood cancer.

Adolescent↗

PubMed2000

[Prevalence and intensity of smoking among adult urban population of Tiumen': data of population mail questionnaire survey].

AIM: To estimate prevalence and intensity of smoking among adult Tyumen citizens by mail questionnaire survey. MATERIALS AND METHODS: A representative sample of adult population of Tyumen (central district) was randomly selected using the list of the electors. The questioning covered a total of 3200 citizens (8 groups per 400 age- and sex-matched subjects). The response reached 71.5%. Smoking in the population was studied in three aspects: prevalence, intensity and passive smoking. RESULTS: Overall prevalence of smoking was not great (28.8%), but smoking was frequent in women, especially young, was intensive in males of all the age groups. The number of smokers who had quit smoking was small. Passive smoking at jobs was prevalent. CONCLUSION: The data of the survey indicate difficulties of social adaptation for the studied population who fall under risk to develop cardiovascular diseases.

Adult↗

PubMed1999

[Survey among chest physicians regarding the diagnosis and management of asthma].

A survey on asthma management was conducted in 300 chest physicians randomized from a national list. Diagnosis procedures, methods for recognizing life-threatening asthma attacks and patient education about his or her disease were reviewed. Ninety-eight responses were obtained (32.7% of the questionnaires mailed). 71% of the responders were specialized in respiratory medicine (RM), 12% in RM + Internal Medicine (IM), 6% in RM + Allergy (A), 5% in A, 4% in IM, and 2% in IM + A. As a diagnostic test, immediate response to bronchodilator was seldom used and a trial course of oral steroids was even less used. Blood eosinophilia and specific IgE RAST were frequently used and more than in other compared countries in spite of its doubtfulness for the diagnosis of asthma. Severity of asthma attack was assessed less than in other countries in relation to symptoms, lack of response to inhaled bronchodilators and with practically no use of any objective method for the assessment of airways obstruction (PEFR). The latter was seldom employed for chronic control of the disease. The assessment of the correct technique of metered dose inhaler or dry powder inhaler use was rarely done. Only the questions referred to patient education about their disease, teaching about the difference between relieving (bronchodilator) and anti-inflammatory treatment, communication to the patient about the severity of his or her disease and the frequency of giving a written action plan in case of severe asthma attacks qualified equal or better than countries that always qualified well. These responses, together with other data of the literature, makes us suspect, as is common in these audits, that the interviewed person sometimes replies what he or she should do, but not necessarily what he or she does.

Argentina↗

PubMed2000

Early-life physical activity and postmenopausal breast cancer: effect of body size and weight change.

It is not yet known whether early-life physical activity reduces the risk of developing breast cancer. Subgroup analyses according to menopausal status and body mass may help clarify this association. Data from a population-based case-control study of female residents of Wisconsin, Massachusetts, Maine, and New Hampshire were used to examine associations between body mass and breast cancer risk. Cases (n = 4614) were identified by each state's tumor registry; controls (n = 5817) were randomly selected from population lists. Frequency of participation in strenuous physical activity when 14-22 years of age, weight at age 18 and 5 years before interview, height, and other factors were ascertained through structured telephone interviews. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed using logistic regression. Reductions in postmenopausal breast cancer risk associated with strenuous physical activity were greatest for women in the fourth quartile of body mass index at age 18; the OR for women with the highest activity frequency on average (> or =once/day) was 0.45 (95% CI = 0.26-0.79). Associations with frequency of activity also varied by weight change. Compared to women with no activity and little adult weight gain, frequent physical activity was associated with reduced postmenopausal breast cancer risk in women who had lost weight since age 18 (OR = 0.19, 95% CI = 0.05-0.70) or had gained little or modest amounts of weight (weight gain: first tertile, OR = 0.36, 95% CI = 0.05-0.85; second tertile, OR = 0.31, 95% CI = 0.14-0.66). Weighted MET score analyses yielded similar but less inverse results. These findings suggest that the reduced risk of postmenopausal breast cancer associated with frequent, early-life physical activity may be greatest in women who, over the adult years, either lost weight or gained only modest amounts.

Adolescent↗

PubMed2001

[The preprosthetic preparation of the endodontically treated abutment tooth. Post and core technique: a questionnaire analysis].

The goal of the questionnaire was to determine the materials and methods that general dentists in Switzerland at present use for the treatment of non-vital abutment teeth. Questionnaires were sent to 1000 dentists from a computer generated random sample of the list of members of the SSO (Swiss Dental Society). The return ratio was 36%. The responses provided information on the current philosophies and prevailing techniques used to restore endodontically treated abutment teeth. Most of the answering dentists believed it was necessary to stabilize a root treated tooth with a post. The preferred restoration in anterior teeth was the cast post and core, while composite resin build-up with a prefabricated post was predominantly made for posterior teeth. Conical or combined cylindrical-conical posts, which had a sand-blasted surface, were predominantly used. Most of the answering dentists strove to stabilize the remaining tooth structure by circular enclosure of the tooth structure by the later crown (ferrule effect). Zinc phosphate cement was still preferred for cementation of metal posts and ceramic posts were most often fixed with the help of the acid etching technique. The most frequently described failures were retention loss or root fractures.

Acid Etching, Dental↗

PubMedDate not supplied

Risk factors of malaria in the fringes of an evergreen monsoon forest of Arunachal Pradesh.

BACKGROUND: The forested hilly and foothill regions of north-east India are highly endemic for malaria and have a distinct epidemiological pattern. Nearly half the reported cases of malaria are from these areas. A knowledge of the risk factors in this eco-geographic entity may be helpful in formulating a specific control strategy. Hence, we conducted a community-based epidemiological study in a hilly, forested terrain of Arunachal Pradesh and examined different socio-demographic factors to identify those predisposing to the occurrence of malaria, especially Plasmodium falciparum infection, in such areas. METHODS: Four epidemiological surveys were carried out during 1997 in 7 villages located at the fringes of a forest (total population: 1177) under Nompong Primary Health Centre of Changlang district, Arunachal Pradesh. Blood slides were collected randomly from the inhabitants, irrespective of their fever status, ensuring at least 50% coverage. One hundred and thirty-four microscopically confirmed Plasmodium falciparum cases were identified and 536 controls were randomly selected from the list of uninfected inhabitants. Relevant socio-demographic information was obtained from both cases and controls. The data were analysed by simple and multiple logistic regression using the unconditional maximum likelihood method. RESULTS: Factors which were found to be strongly associated with Plasmodium falciparum malaria on univariate analysis were age, ethnicity, village of residence and accessibility to the nearest health care facility. However, in multiple regression analysis, after controlling for the effects of confounding variables, the only risk factor identified was accessibility to the nearest health care facility (adjusted odds ratio: 4.5; 95% CI: 1.8-11.3; p < 0.0001 for those at a distance of 2-8 km and adjusted odds ratio: 11.1; 95% CI: 4.1-30.0; p < 0.0001 for those > 8 km away). CONCLUSION: Distance, particularly non-motorable distance, from the place of residence to the nearest health care facility was a major risk factor for malaria in this hilly forested terrain. This indicates the need for special efforts to detect cases early and institute treatment promptly in such areas of the north-eastern region, so as to reduce the morbidity and mortality of malaria.

Adolescent↗

PubMed2001

A study of Maryland dental hygienists' perceptions regarding self-assessment.

PURPOSE: This research applied the Theory of Reasoned Action to study dental hygienists' perceptions about self-assessment (SA). This theory suggests that individuals are likely to exhibit a given behavior, i.e., self-assessment, when they view it positively and when they believe that important others think they should perform it. Using the Theory of Reasoned Action model, the study addressed the following research questions: What are dental hygienists' beliefs, attitudes, motivations, and intentions regarding SA? Respondents were asked if they actually self-assess when providing dental hygiene services and if they felt they had adequate time to do so. The study also examined correlations between socio-demographic variables (i.e., initial year of licensure, educational level, practice characteristics, and professional membership) and self-assessment intention and behavior. METHODS: A self-administered survey was mailed to 200 dental hygienists randomly selected from a list of all currently licensed dental hygienists in Maryland. Data analysis included descriptive statistics, correlations to predict intention and behavior, and analyses of differences related to socio-demographic variables. RESULTS: A total of 119 usable surveys were returned after one mailing, achieving a 59.5% response rate. The demographic data indicated that the respondents were a representative sample, with 66% holding associate degrees, 30% baccalaureate degrees, and 3% masters' degrees. Respondents' attitudes toward SA and intention to perform SA were strongly positive (X = 2.7, 2.6 respectively, on a Likert Scale ranging from -3 to +3) and, as the Theory of Reasoned Action suggests, attitude was strongly associated with intention (r = .6673). However, in contrast to the Theory, intention was weakly associated with behavior (r = .3721). Only one socio-demographic variable correlated with SA intention or self-reported behavior. Subjects who worked 20 hours per week or more were significantly more likely to self-assess when providing dental hygiene care than those who worked less than 20 hours per week (p < .01, .0089). A majority of respondents (76%) reported that they consistently perform SA and felt they had adequate time to do so. Respondents seemed to be motivated by perceived benefits of SA rather than by social pressure to perform it. CONCLUSION: Dental hygienists in this study appear to value self-assessment, use it when they provide patient care, and believe they have the time to do it. The extent and scope of their SA behaviors were not investigated. As SA is an integral component of quality assurance, application of well-developed self-assessment strategies in both educational and practice settings may benefit both dental hygienists and the public they serve.

Attitude of Health Personnel↗

PubMed2001

[Cancer of the prostate in France: results of the survey CCAFU-FRANCIM].

OBJECTIVE: The management, diagnosis and treatment of prostate cancer (PC) in the general population are poorly defined in France. The objective of this survey was to analyse the diagnostic and therapeutic modalities of prostate cancer in 1995, on the basis of a population derived from 4 French cancer registries. MATERIAL AND METHOD: A sample of 803 PCs diagnosed in 1995 were selected at random from the cases listed in the 4 registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis by questionnaire concerned the modalities of diagnosis, clinical tumour stage and the treatment performed. Clinical stage (TNM 1992) was submitted to centralized coding. Logistic regression was used to quantify the various practices, taking into account the patient's age, PSA level and clinical stage. The probability of receiving each treatment modality was studied by using the same clinical determinants. RESULTS: The mean age of the patients was 71.6 years (range: 46-94). The clinical stage was T1 or T2 in 60% of cases, T3 or T4 in 14% of cases and N+ or M+ in 17% of cases. PSA (median: 18.2 ng/ml) was assayed in 92.4% of cases. The diagnosis was established by biopsy in 63% of cases and by endoscopic resection (TURP) in 32% (5% unknown). The main treatments were: radical prostatectomy (RP): 21.9%, radiotherapy: 19.4%, endocrine therapy: 33%, isolated TURP: 16.3%, conservative management: 6% and unspecified treatment: 5.6% of cases. 31% of cases received combinations of various treatment modalities. RP was performed more frequently in patients over the age of 60 years, for T2 tumours (OR: 3.3) and for 4 < PSA < 20 ng/ml. Radiotherapy tended to be reserved for older patients with T3-T4 tumours and 20 < PSA < 50 ng/ml. The frequency of endocrine therapy increased with age and PSA (> 50 ng/ml). The frequency of TURP and surveillance also increased with age, decreased with high PSA and essentially concerned T1 tumours. CONCLUSION: PC was diagnosed relatively early in France in 1995 with clinically localized tumours in 60% of cases. In this survey, 94% of patients received treatment during the year following diagnosis, with 40% of curative treatments and 31% of combined treatments.

Aged↗

PubMed2002

Postmenopausal estrogen and progestin use in relation to breast cancer risk.

Epidemiological evidence now consistently supports a modest increase in breast cancer risk among women using postmenopausal hormones, usually estrogens. Less is known regarding how the addition of progestin affects breast cancer risk. The objective of this study was to investigate the type and duration of postmenopausal therapy and breast cancer risk. We performed a multicenter population-based case-control study set in Massachusetts, New Hampshire, and Wisconsin. The subjects were 5298 postmenopausal women (age range, 50-79 years) with a new diagnosis of invasive breast cancer from statewide tumor registries. For comparison, 5571 controls were randomly selected from population lists. Participants completed a structured telephone interview covering hormone use and breast cancer risk factors. Multivariable regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). The RR for breast cancer increased with longer durations of hormone use, about 2%/year for estrogen alone (RR, 1.02; 95% CI, 1.01-1.03) and 4%/year for estrogen-progestin use (RR, 1.04; 95% CI, 1.01-1.08). Estrogen-progestin use that was both recent and long term (>5 years in duration) was more strongly associated with breast cancer risk (RR, 1.57; 95% CI, 1.15-2.14) than similar use of estrogen alone (RR, 1.39; 95% CI, 1.17-1.65). In estrogen-progestin users, risks were similar for sequential and continuous use regimens but perhaps stronger for lobular than ductal breast cancer. Use of progestin alone was associated with a doubling of risk (RR, 2.09; 95% CI, 1.07-4.07 for ever use versus nonuse). Estrogen-progestin use, both sequential and continuous, appears to be more strongly associated with risk of breast cancer than use of estrogen alone.

Age Distribution↗

PubMed2003

[Survey of the practice of cervical ripening and labor induction in France].

OBJECTIVES: Labor induction is a widespread medical practice in France. The medical or obstetric indications for induction as well as the protocols used probably vary from one maternity to another. The objective of this national survey was to describe current medical practices and procedures in France, regarding labor induction and cervical ripening, eight years after the national consensus on labor induction management. A second objective was to assess mothers' opinion on the induction of their labor/level of satisfaction on their childbirth experience. MATERIALS AND METHODS: The sample of maternities was randomly extracted from a list published by the French Ministry of Health. Sampling was performed according to maternity size, geography, and private vs public. Medical information was collected on consecutive labor induction cases in each maternity. Mother's opinions were estimated through a score based on the validated Labour Agentry Scale. RESULTS: Within the 38 maternities included, 21 (55.3%) were public, and 17 (44.7%) private. 1192 women were included in this study and 1090 (91.4%) answered the questionnaire on level of satisfaction. Global rate of elective induction (no medical or obstetric indication) was 24.8% (n=295). Prostaglandins are almost as widely used as oxytocin (45.8% and 47.7% of total labor inductions, respectively). Mostly used methods of delivering prostaglandin are intravaginal (27.1%), controlled-release pessaries (10.2%) and intracervical (8.1%). Among the elective inductions, an important rate of unfavorable cervix was found (n=81, 27.5%) as well as a quite high level of use of prostaglandins (n=51, 17.3%). The statistically independent criteria linked to a high satisfaction score are an older age (OR=1.58; CI 95% [1.80-3.33]), an elective induction (OR=2.44; IC 95% [1.80-3.33]) and a favorable cervix (OR=1.47; [1.08-1.98]). CONCLUSION: The use of prostaglandins in labor induction and cervical ripening is now widespread in France. This technique is not always used in accordance with available scientific data. These results should lead health professionals to set up an evaluation process for their practices, when these are not based on clear scientific evidence.

Adult↗

PubMed1992

Use of host factors to identify people at high risk for cutaneous malignant melanoma .

OBJECTIVE: To determine which host characteristics are risk factors for cutaneous malignant melanoma in order to aim prevention and early detection programs at people at high risk. DESIGN: Case-control study. SETTING: Southern Ontario. SUBJECTS: The 583 case subjects were aged 20 to 69 years and had had malignant melanoma newly diagnosed between Oct. 1, 1984, and Sept. 30, 1986. The 608 control subjects were randomly selected from a list of residents in the study area and were stratum matched for age, sex and municipality. INTERVENTION: Through in-person interviews the interviewer ascertained exposure to putative external risk factors and assessed skin colour and number of nevi on the arm, and the subject reported his or her natural hair colour at age 20 years, eye colour, skin reaction to repeated sun exposure, and freckle and whole-body nevus densities. RESULTS: Although all the host factors mentioned were significantly associated with melanoma risk when considered separately, only hair colour, skin reaction to repeated sun exposure, and self-reported freckle and nevus densities remained significant after backward logistic regression analysis. The odds ratio for melanoma was estimated to be 10.7 in people who had many nevi compared with those who had none (95% confidence interval [CI] 6.6 to 17.4), 4.0 in people who had red hair compared with those who had black hair (95% CI 1.9 to 8.2), 1.9 in people who had many freckles compared with those who had none or few (95% CI 1.3 to 2.8) and 1.4 respectively in people who burned and had a subsequent increase in tan and those who burned and had no increase in tan after repeated sun exposure compared with those who did not burn [corrected]. CONCLUSIONS: Four risk factors for malignant melanoma have been identified. Prospective evaluation of their predictive value should be done. In the meantime, however, these factors should be used to identify people apparently at high risk for malignant melanoma, who can then be targeted for early detection and prevention programs.

Adult↗