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A follow-up study of juvenile rheumatoid arthritis into adulthood.

AIM OF THE STUDY: To study the clinical profile of various subtypes of juvenile rheumatoid arthritis (JRA) in adulthood and analyse the outcome of the disease in terms of functional status, educational achievement, growth abnormalities, radiological progression and activity of the disease. METHODS: From a group of 150 JRA cases, 26 adult patients were included in the study. All of them were under follow up since the onset of disease in childhood. Clinical data at the onset were obtained from old medical documents. Detailed clinical and laboratory assessment of all cases were done. RESULTS: There were 10 oligoarticular, 13 polyarticular and three systemic onset cases. Mean age of onset of disease was 11.7 +/- 3.39 years (range 2-15). Mean duration of follow up was 11.4 +/- 4.46 years range (6-22). Twenty-one patients had active disease. Ninety percent of oligoarthritis group were in class 1 status whereas none of the systemic onset JRA cases were in class I. Micrognathia, short stiff neck and short stature were noticed among polyarticular and systemic onset JRA. Seventy percent of oligoarthritis group developed inflammatory low back ache. Bony ankylosis of tarsal and carpal bones were seen in eight cases. CONCLUSION: In our study there is a male predominance in JRA. Pauciarticular (oligoarthritis) JRA occurring in older boys had the best functional outcome. Growth abnormalities and radiological changes were more common in polyarticular and systemic onset JRA.

Activities of Daily Living↗

Premature childbirth: social and behavioural risks in Singapore.

The associations of social and behavioural factors on preterm birth in Singapore were studied using hospital maternity records of 20,723 consecutive singleton births between January 1986 and November 1991. The overall proportion of preterm births was 3.6%, the rates for the Chinese, Malay and Indian groups being 3.2%, 3.8% and 4.9% respectively. Teenage mothers were at a higher risk of preterm labour compared to women aged 20-29 years. The incidence of preterm labour decreased with increasing educational status. Preterm births were six times more likely in women who had no antenatal care. Women who had three or more previous births were at a higher risk, while those who had one or two previous births were at a lower risk compared to women who had none.

Adult↗

Educational attainment and HIV-1 infection in developing countries: a systematic review.

OBJECTIVES: To assess whether educational status is associated with HIV-1 infection in developing countries by conducting a systematic review of published literature. METHODS: Articles were identified through electronic databases and hand searching key journals. Studies containing appropriately analysed individual level data on the association between educational attainment and HIV-1 status in general population groups were included. RESULTS: Twenty-seven articles with appropriately analysed results from general population groups in developing countries were identified, providing information on only six countries. Large studies in four areas in Africa showed an increased risk of HIV-1 infection among the more educated, whilst among 21-year-old Thai army conscripts, longer duration of schooling was strongly protective against HIV infection. The association between education and schooling in Africa was stronger in rural areas and in older cohorts, but was similar in men and women. Serial prevalence studies showed little change in the association between schooling and HIV over time in Tanzania, but greater decreases in HIV prevalence among the more educated in Uganda, Zambia and Thailand. CONCLUSIONS: In Africa, higher educational attainment is often associated with a greater risk of HIV infection. However, the pattern of new HIV infections may be changing towards a greater burden among less educated groups. In Thailand those with more schooling remain at lower risk of HIV infection.

Adult↗

Is extracurricular participation associated with beneficial outcomes? Concurrent and longitudinal relations.

The authors examined the relations between participation in a range of high school extracurricular contexts and developmental outcomes in adolescence and young adulthood among an economically diverse sample of African American and European American youths. In general, when some prior self-selection factors were controlled, 11th graders' participation in school clubs and organized sports was associated with concurrent indicators of academic and psychological adjustment and with drug and alcohol use. In addition, participation in 11th grade school clubs and prosocial activities was associated with educational status and civic engagement at 1 year after high school. A few of the concurrent and longitudinal relations between activity participation and development were moderated by race and gender. Finally, breadth of participation, or number of activity contexts, was associated with positive academic, psychological, and behavioral outcomes.

Adaptation, Psychological↗

Rehabilitation of young adults during renal replacement therapy in Europe. 2. Schooling, employment, and social situation.

The educational status, employment rate and social situation were studied in 617 patients between 21 and 35 years of age who started renal replacement therapy (RRT) as children. The data were derived from a special questionnaire concerning disability and rehabilitation sent to dialysis and transplant centres reporting to the EDTA Registry. Fifty-six percent of patients completed secondary school and one in three went on to vocational training. Eleven percent of patients attended university, and 16% were reported to have gone to a special school for the handicapped. Up to one-third of patients who attended different school types failed to complete their education. There were notable geographical differences in schooling and in employment. Fifty-six percent of all patients were employed. Lack of schooling was considered to be a major reason for unemployment. Sixty-one percent of patients with disabilities and 34% without disabilities were receiving invalidity payments. The place of residence of these patients aged 21-35 was usually the parental home. Compared to the general population of similar age, only a few patients were married (13.5% of the total study group) and 8% had children. In summary, the present report shows that the major factors influencing rehabilitation on RRT are the presence of disabilities, the method of treatment, geographical factors, duration of RRT, and the underlying primary renal disease.

Adolescent↗

Medico-social profile of male teenager STD patients attending a clinic in Pune.

A study of 250 male teenager STD cases was carried out to determine the association between certain medicosocial factors e.g. age, type of infection, educational status, source of infection, knowledge about mode of acquiring infection and prophylaxis etc. Salient findings of the study such as gonorrhoea being the commonest type of STD, curiosity being the main reason for first sexual exposure and prostitutes being the major source of infection have been highlighted in this communication.

Adolescent↗

Influence of psychological and clinical factors on postoperative pain and narcotic consumption.

Demographic, psychological and clinical factors influencing postoperative pain and narcotic analgesic requirements in 162 patients undergoing elective operations under general anesthesia were studied. Eysencks Personality Questionnaire, Foulds Hostility Questionnaire, Zung's Anxiety-Depression (self-rating) Scales and the 43 Item Life Events Inventory by Holmes and Rahe were used. Clinical correlates such as surgical department, outcome of the operation, patient's knowledge of the diagnosis, were studied. Using multiple regression analysis the following results were obtained: postoperative pain levels increase with higher score of extroverted hostility (p = 0.038), abdominal surgery (p = 0.004), longer stay at hospital postoperatively (p = 0.15) and higher educational status (p = 0.13). Postoperative narcotic requirements increase with increased postoperative pain levels (p = 0.039) and preoccupation with pain postoperatively (p = 0.025), preoperative analgesic drug use (p = 0.017), abdominal surgery (p = 0.009) and longer stay at hospital preoperatively (p = 0.016). Also the department in which the patients were hospitalized influenced narcotic consumption.

Abdomen↗

Distribution and biosocial correlations of blood pressure levels in Johannesburg blacks.

Blood pressures were measured in a sample of Johannesburg Blacks consisting of 5 018 men and 5 028 women attending the local Labour Bureau. Blood pressure levels correlated positively with age and body mass and were higher in males than females when weight was taken into account. Hypertension was common in both sexes and at most ages; in the 4th decade about one-third of men and women had phase 4 diastolic pressures greater than 90 mmHg. Correlations of blood pressure with a number of social variables were generally unimpressive. There was some evidence that blood pressure was inversely related to educational status and was higher in young adults who (a) lived apart from their families compared with those who lived in family units, and (b) grew up in a rural area and then migrated to Johannesburg compared with those who had lived in Johannesburg all their lives.

Adolescent↗

A review of articles published in Aviation, Space, and Environmental Medicine, 1975-94.

Aviation, Space, and Environmental Medicine, the official journal of the Aerospace Medical Association, is dedicated to serving and supporting all who work to solve the problems of living and working in hazardous environments on, above, and beneath the earth and sea. This study examines and analyzes the characteristics of authors and their articles published in Aviation, Space, and Environmental Medicine over a 20-y period, from 1975-94. There were 3562 articles meeting inclusion criteria published during this period. Articles were analyzed for article length, number of authors per article, country and institution of origin, main topic, and educational preparation of authors. The majority of articles originated in the United States (68%), followed by England (7%), Canada (5%), France (3%), Israel (2%), and Russia/USSR (2%). The number of different countries contributing articles increased from 26 countries in the first 5 yr to 35 countries in the last 5 yr. The content has remained relatively uniform, with the most frequent topics being aviation medicine, aerospace physiology, environmental medicine, and space medicine. The most infrequent topics were health promotion and wellness, occupational health, and aerospace nursing. Over 85% of articles in which the educational status of authors was known were written by authors with a doctorate degree. Most primary authors possessed a doctor of medicine (38%) degree, doctor of philosophy (37%) degree, or both (5%). This analysis can provide insight into the history and future of aerospace and environmental medicine and physiology, since the contents of the Journal clearly reflect the interests of individuals working in these fields.

Aerospace Medicine↗

Risk factors for overdose mortality: a case-control study within a cohort of intravenous drug users.

Overdose mortality is the major adverse health effect of drug injection. The potential determinants of overdose death are poorly understood; the aim of this study was to investigate risk factors for overdose mortality among intravenous drug users (IVDU). A cohort of 4200 IVDU attending methadone treatment centres in Rome during the period 1980-1988, was enrolled. Data were collected from clinical records. Vital status and cause of death were ascertained as of 31 December 1988. A matched case-control analysis within the cohort was performed to identify risk factors of death from overdose. All overdose deaths were included as cases and four controls, matched on year of birth and sex, were selected for each case from among the cohort members still alive at the time of death of the corresponding case. In all, 81 deaths from overdose were identified as cases and compared with 324 controls. A high risk of overdose death occurred among subjects who left treatment compared with those still in treatment (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.82-6.90). The OR was particularly elevated in the first 12 months after drop-out compared with those retained in treatment (OR = 7.98, 95% CI: 3.40-18.73). The risk of overdose death was higher for unmarried compared with married people (OR = 2.48, 95% CI: 1.31-4.68); a higher risk of overdose death was also associated with lower educational status and younger age at first drug use, but such association was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗

Human papillomavirus infection and invasive cervical cancer in Paraguay.

HPV types 16 and 18 have been categorized as human carcinogens based on their strong associations with cervical cancer in previous case-control studies. Recent IARC studies in the Philippines, Thailand and Morocco show strong associations between invasive cervical cancer and less common HPV types, including HPV 31, 33, 45, 51, 52 and 58. We present results of a further IARC case-control study conducted in Asunción, Paraguay, to examine the association between specific HPV types and invasive cervical cancer as well as risk factors other than HPV. One-hundred thirteen incident histologically confirmed invasive cervical cancer cases and 91 age-matched hospital controls were recruited. A standardized questionnaire was administered to investigate known and suspected risk factors for cervical cancer. For HPV status determination, cervical biopsy specimens from case subjects and exfoliated cervical cells from control subjects were obtained. HPV DNA was ascertained using a GP5+/6+ PCR-based assay capable of detecting more than 33 HPV types. Overall HPV prevalence was 97% in the cervical cancer cases and 20% in the control subjects. As a single infection, HPV 16 was the predominant type with a prevalence of 48% among case subjects and 5.5% among control subjects. Significant associations with the risk of cervical cancer were detected as follows: any HPV type (OR = 114; 95% CI: 36-361); HPV 16 (OR = 910); HPV 18 (infinite OR); HPV 31 (OR = 110); HPV 33 (OR = 261); HPV 45 (OR = 129); and HPV 58 (OR = 36). In the multivariate model, risk factors other than HPV significantly associated with cervical cancer risk were a higher number of lifetime sexual partners, lower educational status and never having had a Pap smear. Strong associations were found between invasive cervical cancer and specific HPV types 16, 18, 31, 33, 45 and 58.

Adolescent↗

Breastfeeding effects on intelligence quotient in 4- and 11-year-old children.

OBJECTIVE: A study of preterm children found an IQ advantage among those who were breastfed as infants after controlling for maternal social class and educational status. However, this advantage needs to be examined in light of other maternal characteristics, such as maternal IQ and parenting skills, which were not measured in that study and which have been found to be related to breastfeeding. METHODOLOGY: IQ was assessed in 323 children at 4 years of age on the McCarthy Scales of Children's Abilities and the Peabody Picture Vocabulary Test-Revised and in 280 children on the Wechsler Intelligence Test for Children-Revised at 11 years of age. RESULTS: Children who were breastfed in infancy had significantly higher scores on IQ tests at both ages, even after adjusting for social class and education, confirming the earlier findings and extending them to a predominantly full-term sample. However, the effect of breastfeeding was no longer significant after adjusting for maternal IQ assessed on the Peabody Picture Vocabulary Test-Revised and for parenting skills assessed on the Home Observation for Measurement of the Environment. Significant relations between breastfeeding and Woodcock Reading Achievement scores at 11 years were also reduced to nonsignificant levels after the inclusion of maternal IQ and the Home Observation for Measurement of the Environment. CONCLUSIONS: These findings suggest that the observed advantage of breastfeeding on IQ is related to genetic and socioenvironmental factors rather than to the nutritional benefits of breastfeeding on neurodevelopment. They should not be interpreted as detracting from the medical benefits associated with breastfeeding.

Bottle Feeding↗

A comparative study of alcohol-related problems among a group of university students and a group of clerks in the National Capital District, Papua New Guinea.

This article reports a comparative study of alcohol-related problems in two groups of Papua New Guinean youth. The first group consists of 25 undergraduate students of the University of Papua New Guinea. The second group consists of 25 staff members of the Post and Telecommunications Corporation (PTC). The research subjects in both groups were selected at random. The instrument used for the study is the Brief (10 item questions) Michigan Alcoholism Screening Test (MAST). Demographic data including age, sex, educational status, marital status and province of origin were also collected using a purpose designed questionnaire. The data collected were analyzed and compared between the two groups using chi-square statistical analysis. The findings and results point to the following conclusions: (a) Alcohol-related problems are more common among the clerks than among the students, but the differences are not statistically significant; (b) alcohol-related health problems (medical and neuropsychiatric complications) were not reported in the study sample; and (c) further surveys on larger samples using the Brief MAST were recommended for early detection of alcohol-related problems. The results could form a basis for future alcohol education programmes.

Administrative Personnel↗

Breastfeeding and verbal ability of 3-year-olds in a multicity sample.

OBJECTIVES: Our goal was to analyze the effect of maternal verbal ability and education on the association between breastfeeding and children's cognitive functioning. First, we hypothesized that maternal verbal abilities account for a large portion of the association between breastfeeding and child verbal abilities. Second, we hypothesized that after adjusting for maternal verbal abilities, a positive effect of breastfeeding will be most evident among highly educated mothers, because these mothers may have more opportunity to engage in cognitively stimulating parenting than do mothers with less education. PATIENTS AND METHODS: With data on 1645 American-born mothers participating in a longitudinal birth cohort study, we used linear regression to determine the influence of breastfeeding for at least 1 month on the Peabody Picture Vocabulary Test-Third Edition scores of 3-year-old children. Models were adjusted for an extensive set of demographic characteristics, including mother's Peabody Picture Vocabulary Test and the Home Observation for Measurement of the Environment score. Mothers were categorized into 1 of 3 educational-status groups: no high school diploma, high school diploma, and some post-secondary education. RESULTS: In unadjusted mean comparisons, breastfed children had Peabody Picture Vocabulary Test scores that were 6.6 points higher than children who were not breastfed. After adjusting for demographic characteristics and maternal verbal ability, the coefficient dropped to 1.72. Among mothers with education beyond high school, the children's Peabody Picture Vocabulary Test scores in adjusted models were 2.2 points higher for breastfed children. Among mothers with a high school diploma or less, there were no significant differences in the children's Peabody Picture Vocabulary Test scores by breastfeeding status. These results were consistent in white, black, and Hispanic children. CONCLUSIONS: Maternal Peabody Picture Vocabulary Test scores mediate much of the association between breastfeeding and child verbal abilities. The beneficial effects of breastfeeding on children's cognition may emerge only when breastfeeding is done in conjunction with other positive parenting behaviors. The advantageous effects of breastfeeding do not seem to be solely attributable to the superior nutrient content of breast milk.

Adolescent↗

Urinary stone disease in Turkey: an updated epidemiological study.

In a nationwide survey conducted in 14 provinces on 1,500 individuals, an overall prevalence of 14.8% and an incidence of 2.2% for the year 1989 are found for urinary stone disease in Turkey. The male:female ratio was 1.5:1. The prevalence showed a geographical distribution with higher figures in southern and south-eastern parts of the country. Low socioeconomic and educational status were associated with a higher prevalence rate, while there was no significant difference between people living in rural areas or in cities. Similarly, occupation had no significant impact on the incidence of urinary stone disease. Urolithiasis is a severe problem in Turkey and more detailed epidemiological studies are needed to enlighten the pathogenetic factors of stone formation and its geographical variations.

Adolescent↗

Socioeconomic distribution of smoking in a population of 10,529 New Zealanders.

AIMS: This study aimed to investigate the associations of several smoking variables with socioeconomic status. METHODS: Cross-sectional analyses of data about smoking behaviour and socioeconomic status (education, occupation and neighbourhood income) were performed using baseline data from the Fletcher Challenge-University of Auckland Heart and Health Study (10,529 participants). RESULTS: After adjustment for age and sex, lower educational level was associated with: (1) higher frequency of ever having smoked (65% of participants who had attended secondary school for fewer than two years, versus 43% of participants who had attended university; 2p < 0.0001); (2) lower likelihood of having quit (46% versus 71%; 2p < 0.0001); (3) higher likelihood of being a current smoker (35% versus 12%; 2p < 0.0001); (4) higher tobacco consumption per smoker (13 manufactured cigarettes/day versus 8 manufactured cigarettes/day; 2p < 0.0001); and (5) higher tobacco consumption per participant (1980 cigarette-equivalents/year versus 450 cigarette-equivalents/year; 2p < 0.0001). Similar, but shallower, associations of these smoking variables were observed with occupation and neighbourhood income (with the exception that tobacco consumption per smoker was not associated with neighbourhood income). The socioeconomic gradients of tobacco consumption per study participant with all three socioeconomic indicators were particularly steep among younger participants, men and Maori. CONCLUSIONS: Participants of low socioeconomic status consumed a disproportionately large amount of tobacco. Policies that prevent smoking initiation and promote smoking cessation in low socioeconomic groups are therefore needed. These should include targeting of mass media messages to low socioeconomic groups, public subsidisation of nicotine replacement therapy and higher taxes on tobacco.

Adult↗

Hajj-associated acute respiratory infection among hajjis from Riyadh.

A prospective cohort study was conducted to estimate the incidence of acute respiratory infections (ARI) among hajjis registered at primary health care centres of Riyadh. Out of 1027 hajjis, 39.8% developed symptoms of ARI. The incidence of ARI was not statistically significantly associated with age, sex, educational status or smoking. The risk of illness was significantly higher among diabetics, hajjis who stayed longer in the hajj area and who prayed at Namera mosque. Use of a facemask by men, but not use of a facecover by women, was a significant protective factor against ARI.

Acute Disease↗

A birth cohort analysis of the smoking epidemic in West Germany.

STUDY OBJECTIVE: The aim was to provide insights in the spread of the smoking epidemic and eventual progress against cigarette smoking in West Germany. DESIGN: This was a retrospective birth cohort analysis based on a cross sectional national survey. SETTING: The survey was conducted in 1987 by the Ministry of Youth, Family and Health in order to identify priorities for health policy and promotion. The target population were all residents of German nationality above the age of 14 years. STUDY POPULATION: 1721 men and women of the birth cohorts 1911-20, 1921-30, 1931-40, 1941-50, 1951-60, and 1961-70 were included in this analysis (65.7% overall response rate). MEASUREMENTS AND MAIN RESULTS: The participants were asked for their detailed life time history of cigarette smoking in a personal interview. This information was used to calculate and plot historical smoker prevalences by sex, level of school education, birth cohort, and calendar year after correcting for differential survival of smokers and non-smokers. In men, smoking prevalences increased slowly from birth cohort to birth cohort and reached a maximum of more than 70% in the 1941-50 cohort in the early 1970s. While smoker prevalences were considerably lower in the two youngest birth cohorts among better educated men, no major changes were observed in men with lower educational status. The rise of the smoking epidemic in women seems to have levelled off only very recently. CONCLUSIONS: In contrast to other countries with more powerful antismoking campaigns, no major progress in the fight against cigarette smoking has so far been made in West Germany. Major public health efforts are badly needed to limit the epidemic of smoking attributable diseases in this country.

Adolescent↗