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PubMed2006

Body size and risk of renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Previous studies suggest that obesity is related to increased risk of renal cell carcinoma (RCC); however, only a few studies report on measures of central vs. peripheral adiposity. We examined the association between anthropometric measures, including waist and hip circumference and RCC risk among 348,550 men and women free of cancer at baseline from 8 countries of the European Prospective Investigation into Cancer and Nutrition (EPIC). During 6.0 years of follow-up we identified 287 incident cases of RCC. Relative risks were calculated using Cox regression, stratified by age and study center and adjusted for smoking status, education, alcohol consumption, physical activity, menopausal status, and hormone replacement therapy use. Among women, an increased risk of RCC was conferred by body weight (relative risk [RR] in highest vs. lowest quintile = 2.13; 95% confidence interval [CI] = 1.16-3.90; p-trend = 0.003), body mass index (BMI) (RR = 2.25; 95% CI = 1.14-4.44; p-trend = 0.009), and waist (RR = 1.67; 95% CI = 0.94-2.98; p-trend = 0.003) and hip circumference (RR = 2.30; 95% CI = 1.22-4.34; p-trend = 0.01); however, waist and hip circumference were no longer significant after controlling for body weight. Among men, hip circumference (RR = 0.44; 95% CI = 0.20-0.98; p-trend = 0.03) was related significantly to decreased RCC risk only after accounting for body weight. Height was not related significantly to RCC risk. Our findings suggest that obesity is related to increased risk of RCC irrespective of fat distribution among women, whereas low hip circumference is related to increased RCC risk among men. Our data give further credence to public health efforts aiming to reduce the prevalence of obesity to prevent RCC, in addition to other chronic diseases.

Body Composition↗

PubMed2000

Impact of infant feeding practices on the risk of mother to child transmission of HIV-1 in Zimbabwe.

OBJECTIVE: To determine the magnitude of the contribution of infant feeding practices on the risk of mother to child transmission (MTCT) of the HIV-1 infection. METHODOLOGY: Prospective data from birth until 24 months of age on 236 infants born to HIV-positive mothers in Harare, Zimbabwe was analysed for this study. However, because only a small proportion of infants (2.1%) were HIV-1 polymerase chain reaction (PCR) tested shortly after birth, the PCR results for infants at birth were not incorporated into our analyses. The contribution of infant feeding practices on the risk of MTCT of HIV-1 was assessed using Cox Proportional Hazards Regression Models. RESULTS: The incidence of HIV-1 through MTCT was greatest among breastfed (8.33 per 100 child-months) and mixed fed (8.64 per 100 child-months) infants by 3 months. After adjustment for maternal age, marital status, education and infant antibody HIV-1 status, the cumulative relative risk of MTCT of HIV-1 was 4.19 (95% confidence interval (CI) 3.44, 5.09) among breastfed and 1.10 (95% CI 0.97, 1. 25) among mixed fed infants. The overall MTCT rate of HIV-1 in this study was 40.3%. CONCLUSIONS: Breastfed infants had the greatest cumulative relative risk of MTCT of HIV-1, followed by mixed fed infants, with the highest incidences occurring within the first 3 months.

Adolescent↗

PubMed2004

Adherence to the Mediterranean dietary pattern among the population of the Balearic Islands.

The aim of the present study was to assess the prevalence of the Mediterranean dietary pattern (MDP) in the population of the Balearic Islands and socio-demographic and lifestyle factors that might determine adherence to the MDP. A cross-sectional nutritional survey was carried out in the Balearic Islands between 1999 and 2000. A random sample (n 1200) of the adult population (16-65 years) was interviewed. Dietary questionnaires incorporating questions related to socio-economic status, education level, lifestyle factors and health status were utilised. Dietary habits were assessed by means of two 24 h recalls, and a quantitative food-frequency questionnaire. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high MUFA:saturated fatty acids ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables, and fish consumption, and low consumption of meat and milk. Then, socio-demographic, lifestyle and health status variables that could determine a higher or lower adherence were assessed. Adherence to the MDP among the population of the Balearic Islands was found to be 43.1 (sd 5.8)%, and was similar in all socio-demographic and lifestyle groups, with some differences according to age, sex and physical status. There was an increase in the percentage of adherence with age, which was greater in males than in females. A more physically active lifestyle was associated with a higher adherence to the MDP. The promotion of the Mediterranean lifestyle, including the MDP and greater physical activity, should be reinforced in the population of the Balearic Islands and especially in the younger generations.

Adolescent↗

PubMed1998

Education and the risk of physical disability and mortality among men and women aged 65 to 84: the Italian Longitudinal Study on Aging.

BACKGROUND: Most studies report that people with higher education enjoy better health and longer life. Although it is well known that most risk factors are more common among individuals with a lower level of education, the underlying mechanism of this association is not fully understood. The objective of this study was to assess the association between education, disability, and mortality. METHODS: We analyzed data on 1,817 men and 1,643 women, aged 65-84 years, to assess the association of educational level with physical disability and mortality adjusting for age, sex, smoking habit, occupation, and major chronic conditions. RESULTS: The association between educational level and disability was characterized by a dose-response effect, with the relative odds significantly decreased by about 30%, 60%, and 79% in those with 4 or 5, 6 to 8, and more than 8 years of education, compared to those with 3 or less years of education. Death rates were lower among persons with 4 or more years of education compared to those with less education. However, after adjusting for disability status, education was no longer associated with mortality (RR=0.97, CI=0.65-1.43). CONCLUSIONS: The strong association of low education with disability found in this study may explain the inverse association with mortality reported in previous studies. Disability, indeed, seems to be the mediator between education and mortality and might be due to the higher severity level of diseases, leading to death, in the lower educated group.

Aged↗

PubMed2000

Alcohol intake and mortality: findings from the National Health Interview Surveys (1988 and 1990).

The authors used prospective data from two supplemental studies of the National Health Interview Survey, the 1988 Alcohol Supplement and the 1990 Health Promotion and Disease Prevention Supplement, to examine the relation between alcohol intake and mortality. Their study included 17,821 men and 25,874 women aged 40 years or older at baseline; during an average of 6 years of follow-up, 5,540 deaths occurred. The alcohol-mortality relation was U-shaped for men and J-shaped for women. On the basis of categorical analyses adjusted for age, race, smoking, and baseline diseases, men who drank 2 drinks per day had a significantly lower risk of death compared with abstainers (relative risk = 0.60, 95% confidence interval (CI): 0.45, 0.82). The relative risk was 0.75 (95% CI: 0.55, 1.03) after further adjustment for marital status, education, and self-perceived health status. For women, the corresponding relative risks were 0.69 (95% CI: 0.61, 0.78) and 0.79 (95% CI: 0.70, 0.90) for those who drank less than 1 drink per day. When drinking category was considered as an ordinal variable and fitted with a quadratic function in the Cox model, the estimated optimal alcohol intake was approximately less than 1 to 1 drink per day for men and lifetime infrequent to less than 1 drink per day for women. Data from these representative US cohorts demonstrated that less than 2 drinks per day for men and less than 1 drink per day for women are associated with the lowest all-cause mortality.

Alcohol Drinking↗

PubMed2004

Hormone replacement therapy and lung cancer risk: a case-control analysis.

PURPOSE: To date, there are few published data regarding the use of hormone replacement therapy (HRT) and lung cancer risk. Therefore, we analyzed data regarding HRT use from a large case-control study designed to study genetic susceptibility to lung cancer to determine whether HRT affected risk of lung cancer. EXPERIMENTAL DESIGN: In a secondary analysis, we compared self-reported HRT use among 499 women with lung cancer and 519 healthy age-matched controls. RESULTS: HRT use was associated with an overall reduced risk of 34% [odds ratio (OR), 0.66; 95% confidence interval (CI), 0.51-0.89] of lung cancer, after adjusting for age, ethnicity, smoking status, education, body mass index, and menopausal status. The use of estrogen replacement therapy alone was associated with a 35% reduction in lung cancer risk (OR, 0.65; 95% CI, 0.47-0.89) and the use of combination therapy (estrogen and progestin) was associated with a 39% reduction in lung cancer risk (OR, 0.61; 95% CI, 0.40-0.92). HRT use was also associated with a statistically significantly reduced risk of lung cancer in current smokers (OR, 0.59; 95% CI, 0.38-0.92), but the risk estimates were not statistically significant in never (OR, 0.72; 95% CI, 0.37-1.40) or former smokers (OR, 0.73; 95% CI, 0.46-1.15). In addition, as the cigarette pack-years increased among ever smokers, the protective effect diminished, so that light smokers appeared to benefit the most from HRT use. Decreased lung cancer risks were also evident when the data were stratified by age, ethnicity, and body mass index. The joint effects of HRT use and mutagen sensitivity suggest that HRT use modifies lung cancer risk for genetically susceptible women. HRT use was also associated with a lower risk of death and improved survival compared with the women not taking HRT. To provide a possible biological mechanism to explain our findings, we compared plasma levels of insulin-like growth factor I in users and nonusers, and demonstrated that HRT use was associated with statistically significantly lower insulin-like growth factor I levels for both cases and controls compared with non-HRT users. CONCLUSIONS: These data suggest an association of HRT use with a decrease in lung cancer risk. However, there are several limitations to this secondary analysis, requiring that the data be viewed with caution, and confirmation is required in well-designed hypothesis driven studies. The biological role of HRT in lung cancer remains understudied, and only extensive research can yield new insights into the mechanisms underlying a protective effect of HRT for lung cancer.

Age Distribution↗

PubMed2005

Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults.

OBJECTIVES: We sought to determine whether, among older adults (>65 years), a perception that their basic needs are not being met increased mortality risk and whether this risk varied by race/ethnicity. METHODS: We used Cox proportional hazards modeling to estimate the effect of perceived inadequacy in having one's basic needs (adequacy of income, quality of housing, and neighborhood safety) met on 10-year mortality rates. RESULTS: After control for age, gender, race/ethnicity, marital status, education, income, and cognitive and functional status at baseline, perceived inadequacy in having one's basic needs met was shown to be a significant predictor of mortality (P<.0001), but no significant differences by race/ethnicity were observed. CONCLUSIONS: Perceived inadequacy in having one's basic needs met predicted mortality during a 10-year follow-up among community-dwelling elderly persons.

Activities of Daily Living↗

PubMed2003

Performance evaluation of quality improvement team in an anesthesiology department.

BACKGROUND: In health care community, quality improvement pathway has always been treated as critical index to control cost, improve efficiency and promote service quality, particularly in the last decade. From theoretical standpoint, clinical practice as well as research data, quality improvement team has been demonstrated to play an important role in the adaptation to the changing health environment and enhancement of the competition through the improvement process. The purpose of this study was to explore members' job satisfaction, morale, organizational commitment and inventory management through quality improvement team intervention in a department of anesthesiology. METHODS: This study was of a quasi-experimental and longitudinal design. The subjects involved 45 nurse anesthetists (the experiment group, intervention of quality improvement team) and 50 operation room nurses (control group) in a general hospital. The quality improvement team had been initiated and implemented pursuant to the quality improvement process for 8 months. GEEs (Generalized Estimating Equations) model was used to examine the differences in job satisfaction, morale, organizational commitment, and the inventory management was also examined between two groups. RESULTS: After control of all variables, except education background, such as age, marital status, education, position and nursing experience, a natural growth effect was observed on quality improvement team. The results revealed that the experimental group showed significant positive effects on both job satisfaction and organizational commitment after the intervention. The morale scale did not differ significantly between two groups. In the inventory management, the experimental group successfully decreased the monthly consumable materials stock with a descending rate of 24.8%, while in the control group, the inventory was increased 16.9% in the basal stock instead. CONCLUSIONS: As other previous reports did, the present study also demonstrated that intervention of the quality improvement team improves the nurse anesthetists' job satisfaction, such as promotion of autonomy, organizational policy and positive member interaction. Moreover, it improves work efficiency, service quality as well as control of the stock inventory.

Adult↗

PubMed2005

Factors contributing to maternal mortality in north-central Nigeria: a seventeen-year review.

Maternal mortality ratio in Nigeria is one of the highest in the world. This paper reports a facility based study in north-central Nigeria to determine the magnitude, trends, causes and characteristics of maternal deaths before and after the launch of the Safe Motherhood Initiative in Nigeria, with a view to suggesting strategic interventions to reduce these deaths. The records of all deliveries and case files of all women who died during pregnancy and childbirth between January 1, 1985 and December 31, 2001, in the maternity unit of Jos University Teaching Hospital, Jos, Nigeria, were reviewed. Data collected were analysed for socio-biological variables including age, booking status, educational level, parity, ethnic group, marital status, mode of delivery, duration of hospital stay before death occurred, cause (s) of maternal deaths. There were 38,768 deliveries and 267 maternal deaths during the period under review, giving a maternal mortality ratio (MMR) of 740/ 100,000 total deliveries. The trend fluctuated between 450 in 1990 and 1,010/100.000 deliveries in 1994. The mean age of maternal death was 26.4 (SD 8.1) years. The greatest risk of MMR was among young teenagers (> 15 years) and older women (< 40 years). Parity-specific maternal mortality ratio was highest in the grand multiparous women. Unbooked as well as illiterate women were associated with very high maternal mortality ratio. The Hausa - Fulani ethnic group contributed the largest number (44%) by tribe to maternal mortality in our study. The major direct causes of deaths were haemorrhage (34.6%), sepsis (28.3%), eclampsia (23.6%) and unsafe abortion (9.6%). The most common indirect causes of death were hepatitis (18.6%), anaesthetic death (14.6%), anaemia in pregnancy (14.6%), meningitis (12.0%), HIV/AIDS (10.6%) and acute renal failure (8.0%). Seventy-nine percent of the maternal deaths occurred within 24 hours of admission. Most of the deaths were preventable. A regional-specific programme should be planned to reduce the deplorably high maternal mortality in north-central Nigeria.

Adolescent↗

PubMed1991

Societal opinions on the eruption of deciduous maxillary central incisors before the mandibular ones in Nigeria.

This paper reports perceptions and beliefs about babies who erupt upper deciduous teeth before the lower in two rural Yoruba communities. 96.5% of respondents expected that the lower incisors should erupt first. The majority (70.4%) believed the eruption of upper teeth before the lower to be a sign of an evil child. This observation was, however, related to educational status and age. The higher the educational level of the respondents, the higher the proportion of respondents who viewed the occurrence as a mere individual variation. Similarly, the older people tended to view the eruption of upper deciduous teeth before the lower as evidence of an evil child. The need for an educational package directed at similar populations in order to reduce anxiety related to this human variation is stressed. It is suggested that a transcultural approach be taken to cater for the child and family welfare in a situation where societal pressure is high.

Child, Preschool↗

PubMedDate not supplied

Predictors of hospital postdischarge infant mortality: implications for high-risk infant follow-up efforts.

The association between maternal/infant characteristics and postdischarge mortality was determined for 19,573 infants from a single regional perinatal center. Postdischarge mortality was not associated with infant sex or ethnicity, mother's marital status, education, method of delivery, or income status. Mortality risk was statistically increased for infants who were neonatal intensive care unit graduates, of low birth weight, preterm, or small for gestational age. Infants who were either of low birth weight, neonatal intensive care unit graduates, or preterm represented 38% of hospital discharges and 64% of postdischarge deaths. Mortality odds for low-birth-weight infants exceeded that of neonatal intensive care unit graduates or preterm infants. Within these high-risk groups, mortality was further increased for infants with pulmonary interstitial emphysema, patent ductus arteriosus, bronchopulmonary dysplasia, hyaline membrane disease, apnea, or intraventricular hemorrhage III/IV. There were no postdischarge deaths among infants with meconium aspiration, persistent fetal circulation, or necrotizing enterocolitis. Partitioning infant mortality attributable to a single tertiary center suggested that 73.5% of the deaths occurred in infants who were continuously hospitalized from birth; 1.7% of the deaths occurred after discharge in infants who had lethal anomalies and were not expected to survive; 9.0% of the deaths occurred after discharge in infants without a selected risk factor; and 15.8% of the deaths occurred after discharge in infants with at least one high-risk characteristic.

Cause of Death↗

PubMed1996

Screening for smokers in four Sydney teaching hospitals.

BACKGROUND: Cardiovascular disease is a major cause of death and a reason for hospital admissions. The hospital stay is a window of opportunity to assist smokers to quit. METHODS: Patients from selected wards in four teaching hospitals in Sydney, Australia were screened using a self-completed general health questionnaire. The questionnaire included questions on demographic variables, tobacco and alcohol consumption, attitudes towards tobacco and alcohol use, and a measure of readiness to charge high-risk lifestyle behaviors, based on that proposed by Prochaska and DiClemente [1]. RESULTS: The total number of screening questionnaires completed was 2,815: 78% men and 22% women. The average age of the sample was 44 years, 48% were married or living in a de facto relationship whilst 35% never married, with the rest widowed, separated or divorced. A total of 877 (31%) patients reported smoking: 33% of men and 24% of women screened. Predictors of smoking were sex, age, marital status, education level and socio-economic status. A significant association was found between excessive drinking and smoking. Among the smoking patients, 157 (18%) planned no change in smoking (precontemplation), 379 (43%) were ambivalent about smoking (contemplation), and 334 (38%) were serious about quitting. CONCLUSION: As about one third of patients in hospital are smokers, the hospital is an ideal setting for the delivery of brief interventions by a range of health personnel at the patients bedside. The use of a detection instrument measuring levels of intake and readiness to change tobacco use is described, as a practical method for targeting patients in hospital who are at risk or have already developed cigarette-related diseases, such as cardiovascular disease.

Adolescent↗

PubMed1988

[A prospective analysis of fertility based on the Willis model].

"In this article, Willis' micro-economic model of fertility is tested with data obtained from the 1982 Netherlands Fertility Survey of the Netherlands Central Bureau of Statistics." This model enables a prospective as well as a retrospective analysis of fertility and helps analyze the impact of husband's and wife's educational status on fertility. The probability of couples having three or more children is shown to be higher when both partners have had only a primary education or when both have had a university-level education. (SUMMARY IN ENG)

Birth Rate↗

PubMed1999

Assessment of glycaemic control in stable type 2 black South African diabetics attending a peri-urban clinic.

Glycaemic control was assessed in type 2 black diabetics attending the diabetic clinic at a peri-urban hospital. Baseline glycosylated haemoglobin levels were measured and a subsequent estimation was carried out in those patients who attended a follow-up consultation to see whether current recommended targets for glycosylated haemoglobin levels were being attained. Out of 708 patients, mean age 56.3 years, 14.7% were insulin treated and 85.3% were non-insulin-treated. Target values of HbA1c < 7% were achieved in only 20.1% (142) of patients. Although mean glycosylated haemoglobin levels were significantly higher in females (p = 0.03), the proportion of poorly controlled diabetics was similar in the two sexes. Patients whose HbA1c levels fell within the target values had diabetes of significantly shorter duration than those exhibiting poor control (5.0 + 0.2 vs 7.03 + 0.5 years). Obesity was present in 562 patients (79.4%). Target values were only achieved in 16.4% of non-obese and 21% of obese diabetics, with mean glycosylated haemoglobin levels being significantly higher (p < 0.05) in the former group (10.3 + 0.4% vs 9.5 + 0.2%). Similar results were observed with respect to type of treatment, with only 14.4% of insulin-treated and 21% of non-insulin-treated diabetics achieving target values. The follow-up HbA1c estimation did not show any difference in the glycaemic control status of patients, with only 19.9% of them achieving the target values. Dietary advice (though minimal) seemed to have no impact on the metabolic control of our patients. These results suggest that glycaemic control was poor irrespective of sex, duration, BMI, educational status, dietary advice and type of treatment with recommended target values not being achieved in the majority of patients. Behavioural changes through health educational programmes need to be instituted with both patient and medical personnel being motivated to take this process forward.

Analysis of Variance↗

PubMed1989

A comparison of Turkish and Anglo-American normative data on the Wechsler Memory Scale.

This study compared the performance of 200 Turkish adults, divided by educational status and age (20-39; 40-59), with published data based upon similar-aged American and British normative samples. Results highlighted the major influence of educational background in determining performance on the WMS and the implications of this effect in interpreting normative performance.

Adult↗

PubMed1976

The relationship of education to blood pressure: findings on 40,000 employed Chicagoans.

The relationship of education to both actual blood pressure and the prevalence of high blood pressure, based on a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 95 mm Hg or greater, was analyzed among 27,033 men and women, white and black, age 25-44 and 45-64, from the Chicago Heart Association Detection Project in Industry. The educational status of each individual was categorized as not a high school graduate, high school graduate, some college, or college graduate. A statistically significant inverse association between education and high blood pressure was present in all groups of whites. This association could not be "accounted for" by differences in age, relative weight, and heart rate among the educational strata. Controlling for these variables did, however, lessen the association. Among black males a significant inverse association between education level and blood pressure was found for the younger group. For the older black males there was a clear inverse association although with the small numbers it did not achieve statistical significance. For black females there was no clear association.

Adult↗

PubMedDate not supplied

Disclosure of cancer diagnosis to patients and their relatives in Turkey: views of accompanying persons and influential factors in reaching those views.

AIMS AND BACKGROUND: In Turkey, it is a common belief that most family members of patients with cancer would not want them to be informed of a diagnosis of cancer. Our aim was to evaluate the attitudes and opinions of people accompanying cancer patients, regarding cancer diagnosis disclosure. METHODS: In a cross-sectional study 270 caregivers accompanying cancer patients during outpatient chemotherapy sessions were asked to fill in a questionnaire to determine their opinions regarding whether the diagnosis of cancer should be disclosed to the patients and their relatives or not. Timing of telling the diagnosis and from whom it should be learned were queried as well. Possible influential factors for the answers were analyzed with the chi-square test. RESULTS: Of the 270 accompanying persons, 130 (48.2%) said that the patients should be informed of the diagnosis, whereas a greater number (236, 87.4%) believed that the patient's relatives should be informed. Being younger than 40 years old (P = 0.0005), being unmarried (P = 0.002), having a higher educational status (P = 0.0001) and having passed less than four months since the diagnosis (P = 0.005) positively affected opinions regarding telling the truth to the patient. Higher education (P = 0.012) and high monthly income (P = 0.002) positively affected opinions regarding disclosing a diagnosis of cancer to the patient's relatives. CONCLUSION: As a result, in a survey of caregivers' points of view, more than half of the accompanying persons did not agree with disclosing a cancer diagnosis to patients, whereas the majority agreed with disclosing it to the relatives, and educational level seemed to be the major influential factor.

Adolescent↗

PubMed1991

Australian patterns of tobacco smoking in 1989.

OBJECTIVE: To estimate the national prevalence of smoking. DESIGN: A total of 4820 adults aged 16 years and over (2364 men, 2456 women) were surveyed throughout Australia in 1989 by a large market research company. SETTING: Interviews were conducted in the participants' homes. RESULTS: Overall, 30.2% of men and 27.0% of women were current smokers; 29.8% of men and 19.3% of women were past smokers. The mean daily consumption of factory-made cigarettes among male smokers was 22 and among female smokers 18.9. Taking into account the published tar content of the brand smoked, it was estimated that the average daily exposure to tobacco tar for men was 204 mg and for women 157 mg. Occupational and educational status were inversely related to the prevalence of smoking. The most popular packet size was 25 (preferred by 48% of smokers) and those in lower occupational and educational categories were more likely to purchase cigarettes in large packet sizes. CONCLUSIONS: Comparison with an earlier series of studies commenced in 1974 showed that the national prevalence of smoking among adults has continued to fall, particularly among men.

Adolescent↗