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PubMed2005

The epidemiology of malaria in Bolifamba, a rural community on the eastern slopes of Mount Cameroon: seasonal variation in the parasitological indices of transmission.

The prevalences of malarial parasitaemia, fever, splenomegaly and anaemia and the levels of parasitaemia were investigated, through part of one wet season (in 2001) and the following dry season (in 2002), in 2157 subjects in the village of Bolifamba, in south-western Cameroon. Overall, 55.9% of the villagers checked in the wet season but only 49.5% of those examined in the dry season were found smear-positive for malaria (P<0.0001). Rainfall was found to be significantly associated with the mean level of parasitaemia (P=0.001). The prevalences of fever (40.3% v. 19.6%), splenomegaly (37.4% v. 4.0%) and marked splenomegaly (i.e. a Hackett's score of 2 or higher; 25.8% v. 2.4%) were all significantly higher in the wet season than in the dry (P<0.0001 for each). No seasonal difference was observed, however, in the prevalence of anaemia. Parasitaemia, fever, splenomegaly and anaemia were all significantly more common in the young children investigated (i.e. those aged < 5 years) than in the older subjects. When the data were subjected to a multiple logistic regression, age-group, anaemia, fever, and month of examination were all found to be significantly associated with the presence of malarial parasitaemia. The results of this large-scale study, the first of its kind in the Buea district of Cameroon, indicate the intense transmission of malarial parasites in rural Bolifamba, with young children at greatest risk. The data collected provide a useful 'base line' for an ongoing study to assess the immune status of the residents of Bolifamba.

Adolescent↗

PubMed2006

Wealth and sexual behaviour among men in Cameroon.

BACKGROUND: The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon. METHODS: We analysed data from 4409 sexually active men aged 15-59 years who participated in the Cameroon DHS using logistic regression models, and have reported odds ratios (OR) with confidence intervals (CI). RESULTS: When we controlled for the potential confounding effects of marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32-0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12-1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60-2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16-0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10-3.56) and had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02-3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services. CONCLUSION: Wealthy men in Cameroon are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and are less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society.

Journal Article↗

PubMed2005

Comparing strategies for United States veterans' mortality ascertainment.

BACKGROUND: We aimed to determine optimal strategies for complete mortality ascertainment comparing death certificates and United States (US) Veterans Administration (VA) records. METHODS: We constructed a cohort of California veterans who died in fiscal year (FY) 2000 and used VA services the year before death. We determined decedent status using California death certificates linked to VA utilization data and the VA Beneficiary Identification and Records Locator System (BIRLS) death file. We compared the characteristics of decedents who would not have been identified by either single source (e.g., VA BIRLS alone or California death certificates alone) with the rest of the cohort. RESULTS: A total of 8,813 veteran decedents were identified from both VA decedent files and death certificates. Of all decedents, 5,698 / 8,813 (65%) veterans were identified in both source files, but 2,426 / 8,813 (28%) decedents were not identified in VA BIRLS, and 689 / 8,813 (8%) were not identified in death certificates. Compared to the rest of the cohort, decedents whose mortality status was ascertained through either single source differed by race / ethnicity, marital status, and California residence. Clinically, veterans identified from either single source had less comorbidity and were less likely to have been users of VA inpatient or long term care, but equally or more likely to have been users of VA outpatient services. CONCLUSION: As single sources, VA decedent files and death certificates each provided an incomplete record, and death ascertainment was improved by using both source files. Potential bias may vary depending on analytic interest.

Journal Article↗

PubMed2002

How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials.

PURPOSE: We chose to examine the impact of socioeconomic factors on accrual to National Cancer Institute (NCI)-sponsored cancer treatment trials. PATIENTS AND METHODS: We estimated the geographic and demographic cancer burden in the United States and then identified 24,332 patients accrued to NCI-sponsored cancer treatment trials during a 12-month period. Next, we examined accrual by age, sex, geographic residence, health insurance status, health maintenance organization market penetration, several proxy measures of socioeconomic status, the availability of an oncologist, and the presence of a hospital with an approved multidisciplinary cancer program. RESULTS: Pediatric patients were accrued to clinical trials at high levels, whereas after adolescence, only a small percentage of cancer patients were enrolled onto clinical trials. There were few differences by sex. Black males as well as Asian-American and Hispanic adults were accrued to clinical trials at lower rates than white cancer patients of the same age. Overall, the highest observed accrual was in suburban counties. Compared with the United States population, patients enrolled onto clinical trials were significantly less likely to be uninsured and more like to have Medicare health insurance. Geographic areas with higher socioeconomic levels had higher levels of clinical trial accruals. The number of oncologists and the presence of approved cancer programs both were significantly associated with increased accrual to clinical trials. CONCLUSION: We must work to increase the number of adults who enroll onto trials, especially among the elderly. Ongoing partnership with professional societies may be an effective approach to strengthen accrual to clinical trials.

Adolescent↗

PubMed2000

Plant sterols and risk of stomach cancer: a case-control study in Uruguay.

In 1997-1999, 120 incident and histologically verified cases of stomach cancer were frequency matched on age, gender, residence, and urban/rural status with 360 controls to study the role of diet in gastric cancer in Uruguay. We focused on the role of plant sterols (beta-sitosterol, campesterol, stigmasterol, and total plant sterols) after controlling for major confounders. Total phytosterols were associated with a strong inverse relationship with stomach cancer (odds ratio of stomach cancer for total phytosterol intake in the highest tertile = 0.33, 95% confidence interval = 0.17-0.65). Joint exposure to high intake of total phytosterol and alpha-carotene was also inversely associated with gastric cancer risk (odds ratio = 0.09, 95% confidence interval = 0.02-0.32). High intake of total plant sterols explained most of the attenuation in risk of gastric cancer associated with vegetable and fruit intakes.

Adult↗

PubMed2000

Vegetables, fruits, related dietary antioxidants, and risk of squamous cell carcinoma of the esophagus: a case-control study in Uruguay.

In 1998-1999, a case-control study on esophageal cancer was conducted in Uruguay. For this purpose, 111 cases with squamous cell carcinoma of the esophagus and 444 controls with conditions unrelated to tobacco smoking, alcohol drinking, or recent changes in the diet were frequency matched on age, gender, residence, and urban/rural status. Vegetables and, more markedly, fruits were associated with strong reductions in risk. On the other hand, 12 of 15 dietary antioxidants displayed significant inverse associations with esophageal cancer risk. The strongest effect was observed for high intake of beta-cryptoxanthin (odds ratio = 0.16, 95% confidence interval = 0.08-0.36). Also, alpha-carotene, lycopene, and beta-sitosterol were associated with significant reductions in risk. Most antioxidants lost their effect when they were further adjusted for a term for all vegetables and fruits. beta-Carotene showed an increased risk with high intakes. On the other hand, vegetables and fruits remained as significant variables after adjustment for each antioxidant, suggesting that other substances or other mechanisms could explain this effect.

Aged↗

PubMed2005

Dietary patterns and risk of cancer of the oral cavity and pharynx in Uruguay.

From 1995 to 2002, a case-control study on food groups and risk of cancer of the oral cavity and pharynx was conducted in Montevideo, Uruguay. Two hundred thirty cases were frequency-matched to 460 controls on age, residence, and urban/rural status. The study was restricted to men. The relationship between foods and risk of oral and pharyngeal squamous cell carcinoma was examined through: 1) individual food group analysis, 2) factor analysis, and 3) determination of empirical scores. The results were similar. Factor analysis generated 2 patterns, which were labeled as "stew" and "vegetables and fruits." The stew pattern loaded positively on boiled meat, cooked vegetables, potato, and sweet potato. This pattern was directly associated with risk of oral and pharyngeal cancer [odds ratio (OR), 3.75; 95% confidence interval (CI), 1.99-7.06; P value for trend=0.0002]. The vegetables and fruits factor loaded positively on raw vegetables, citrus fruits, other fruits, liver, fish, and desserts. This pattern was inversely associated with risk of oropharyngeal carcinoma (OR, 0.34; 95% CI, 0.18-0.64; P value for trend=0.0008). Joint effects of high intake of risk foods and low intake of protective foods were associated with a risk of 12.0 (95% CI, 4.1-34.6). Our study confirms the important role of dietary factors in oral and pharyngeal cancer risk and suggests that the analysis of dietary patterns is a powerful tool to investigate the links between nutrition and cancer.

Adult↗

PubMed1996

Monitoring human exposure to 2-hydroxyethylating carcinogens.

It is known that human hemoglobin contains low levels of N-terminal N-(2-hydroxyethyl)valine. Possible sources of this modified amino acid are exposure to ethylene oxide or other 2-hydroxy-ethylating agents. Although such processes are likely to occur endogenously, the exogenous contribution to the adduct formation is unclear. In order to explore the latter, we have analyzed N-(2-hydroxyethyl)valine in the globin of 49 pregnant women and evaluated the effect of smoking status, area of residence, and glutathione S-transferase M1 genotype on adduct levels. Transplacental transfer of hydroxyethylating agents was also studied by the analysis of umbilical cord hemoglobin. The adduct levels in smokers were significantly higher than those in nonsmokers. The adduct levels in umbilical cord blood globin were quantitatively related to those in maternal blood (maternal:fetal ratio 2.7 in smokers and 2.8 in nonsmokers). In the nonsmokers, there was no statistically significant difference in the adduct level between the urban and rural areas, but the level in suburbia tended to be lower than that in the rural area. In the combined smoker and nonsmoker groups, there was no effect of the glutathione S-transferase M1 genotype on levels of N-(2-hydroxyethyl)valine.

Adult↗

PubMedDate not supplied

The relationship of life stressors and maternal depression to pediatric asthma morbidity in a subspecialty practice.

OBJECTIVE: To examine the relationships among demographic characteristics, caregiver life stressors, and depressive symptoms of mothers and their children's asthma morbidity. SETTING: Three pediatric asthma subspecialty programs, 2 in the inner city and 1 in the suburbs. DESIGN: Cross-sectional census sample of caregivers of children with asthma: interviews mostly with mothers (N = 123) regarding their children's asthma symptoms and health care utilization. Information collected on demographics and caregivers' own recent life stressors and depressive symptoms. SUBJECTS: Caregivers of children ages 18 months to 12 years with asthma at their subspecialty visit. MEASURES: Structured interviews: a survey instrument prepared for this study and standardized instruments for depression (Center for Epidemiologic Studies--Depression) and life stressors (Crisis in Family Systems). RESULTS: A total of 32% of respondents' children had high asthma morbidity, 28% intermediate, and 40% low. Caregiver life stressors and depression and the children's sex showed the strongest relationships to asthma morbidity in a model that also included race, residence, and Medicaid status. Children were more likely to have high morbidity if they had caregivers with more depressive symptoms and negative life stressors and if they were female. CONCLUSIONS: Respondents experienced many life stressors and symptoms of depression while managing their children's illness. Caregivers' lives may affect their children's asthma morbidity, offering empirical evidence for the potential value of targeted case management for children in subspecialty care.

Analysis of Variance↗

PubMed2004

A comparison of community and physician explanatory models of AIDS in Mexico and the United States.

The goal of this research was to explore differences between lay and professional explanatory models both within and between two countries. We test which effect is stronger, country of residence or professional/lay status, in determining similarities and differences of explanatory models of AIDS. Interviews conducted in Guadalajara, Jalisco (Mexico) and the Edinburg-McAllen area of south Texas (United States) elicited explanatory models of AIDS. Two pairs of samples were interviewed: a physician and community sample in Mexico and a physician and community sample in the United States. Comparisons of the explanatory models indicated that there was a shared core model of AIDS across all four samples, but that physicians' models were more similar to those of lay people in their own communities than either was to samples across the border.

Acquired Immunodeficiency Syndrome↗

PubMed2006

[Risk factors for cancer of the uterine cervix in Propriá, Sergipe, Brazil].

Cervical cancer is highly incident in poor regions of developing countries. It is related to lifestyle factors that lead to human papillomavirus (HPV) infection. The aim of the study was to assess which factors are important in the development of HPV infection and consequent cervical cancer in the community of Propriá, Sergipe, Brazil. To analyze the risk factors related to cervical cancer, a case-control study was performed, matching cases and controls for age, place of residence, and socioeconomic status. Twenty cases of carcinoma of the uterine cervix and 80 controls were identified. Cases had more pregnancies and a higher proportion of women who had not done Pap smears. Women in the two groups lived with promiscuous partners, had deficient knowledge about cervical cancer and its risk factors, and were predominantly illiterate. We concluded that in the community of Propriá, multiple pregnancies and failure to have Pap smears were associated with the occurrence of cervical cancer.

Brazil↗

PubMed2003

Neighborhood-based differences in physical activity: an environment scale evaluation.

OBJECTIVES: This study evaluated a neighborhood environment survey and compared the physical activity and weight status of the residents in 2 neighborhoods. METHODS: On 2 occasions, 107 adults from neighborhoods with differing "walkability" were selected to complete a survey on their neighborhood environment. Physical activity was assessed by self-report and by accelerometer; height and weight were assessed by self-report. RESULTS: Neighborhood environment characteristics had moderate to high test-retest reliabilities. Residents of high-walkability neighborhoods reported higher residential density, land use mix, street connectivity, aesthetics, and safety. They had more than 70 more minutes of physical activity and had lower obesity prevalence (adjusted for individual demographics) than did residents of low-walkability neighborhoods. CONCLUSIONS: The reliability and validity of self-reported neighborhood environment subscales were supported. Neighborhood environment was associated with physical activity and overweight prevalence.

Adult↗

PubMed2003

GM-CSF and dendritic cells in allergic airway inflammation: basic mechanisms and prospects for therapeutic intervention.

The interaction between dendritic cells (DC) and naïve T cells is the first step in the evolution of an immune response, either tolerogenic or inflammatory. Therefore, the status of DC residing at mucosal sites, such as the airway, has a definitive impact on the character of the ensuing immune response. In the absence of pathogenic stimulation, DC serve to regulate immunological homeostasis in the lung; the generation of Th2-associated (allergic) inflammatory responses, which are directed at presumably innocuous antigens, represent a deviation from normal DC function. The dysregulation of DC phenotype leading to the development of allergy might be programmed by genetic pedigree, or might be induced by factors released in the airway. One potential candidate, GM-CSF, is abundant in the allergic airway and can condition DC to propagate Th2 responses. Moreover, that allergens, alone or in combination with other factors, can spontaneously induce GM-CSF production in the airway thus present a compelling etiological argument for the role of GM-CSF in allergic sensitization. The interplay between DC and mediators present in the allergic airway is likely critical to the establishment of allergic airway inflammation. Understanding these interactions may, therefore, afford insight into prospective therapeutic interventions to circumvent, and even reverse the allergic diathesis.

Animals↗

PubMed2001

Effect of inapplicable items in the factor structure of the Spanish version of the Ways of Coping Questionnaire.

The aim of this work was to examine how the presence of inapplicable items might change the factor structure of the 1984 Ways of Coping Questionnaire by Lazarus and Folkman. The Spanish version of the Ways of Coping Questionnaire was administered to 156 subjects with university degrees. The 95 women and 61 men whose ages were from 18 and 45 years (M = 27.8, SD = 12.1) were of middle socioeconomic status. All were residents of Buenos Aires. To study whether relevant items modify the factor structure of the Ways of Coping Questionnaire, two factor analyses were carried out, one with items rated as not relevant (Item Mean) and the other with the same items rated as not chosen. In both factor analyses, principal axes method and oblimin rotation were performed, and five factors were considered. Congruence indexes were performed. Analysis showed that not choosing an item because it does not coincide with one's behavior or ideas is not the same as not selecting that item because it does not apply to the current threatening situation. Lack of discrimination between situations when analyzing data leads to a distorted interpretation of the way in which the subject actually behaves or copes with the situation.

Adaptation, Psychological↗

PubMed1993

Breast cancer in Denmark. Incidence, risk factors, and characteristics of survival.

In Denmark, incidence of female breast cancer remained constant from 1943 to around 1960, whereafter a steady increase has occurred, the level today being about 50% higher than in 1960. No equivalent rise has been observed for breast cancer mortality. Influence of hormonal and dietary factors on breast cancer risk and survival was evaluated in a combined population-based case-control and follow-up study, including 2,445 women, aged less than 70 years, diagnosed with breast cancer in Denmark between 1 March 1983 and 31 August 1984, identified from the files of the nation-wide clinical trial of the Danish Breast Cancer Co-operative Group (DBCG) and the Danish Cancer Registry. The control group was an age-stratified random sample of the general female population, selected from the Central Population Register. Data on risk factors were collected by self-administered questionnaires. Clinical and pathological tumour characteristics derived from DBCG. The case-control analysis confirmed an overall increased risk of breast cancer associated with urban residence, high social status, nulliparity, early age at menarche, late age at natural menopause, hormonal replacement therapy, high dietary fat intake, and high alcohol consumption in a subgroup. It failed to detect an association with age at first childbirth, oral contraceptives, smoking, intake of vegetables, tea, coffee, and sweeteners. Survival was determined by tumour size, skin invasion, number of positive lymph nodes, and grade. There was no relation between survival and reproductive or hormonal factors, dietary variables, alcohol consumption, or smoking. However, a complex relationship may exist between survival and body mass index.

Adult↗

PubMedDate not supplied

Assessing the risk factors for suicidal thoughts at a nontraditional commuter school.

The sample of students completing the National College Health Assessment (NCHA) Survey at the University of Utah differs from the national reference group for the NCHA 2003 in age, employment, residence, and marital status. The purpose of this study is to determine if the defining characteristics of a commuter school increase the risk for suicidal thoughts. During the fall semester of 2004, the University of Utah implemented a randomized electronic survey assessing the student body's health status in several areas. The authors compared 88 respondents who endorsed seriously considered suicide in the previous 12 months were with the remaining 954 respondents to identify discriminating variables. Those students who seriously considered suicide more likely lived off campus, indicated they were emotionally abused, were in only fair health, experienced being assaulted, experienced unwanted sexual touching, or were not heterosexual. Students who were employed were significantly less likely to consider suicide.

Adolescent↗

PubMed2003

Life span of people who died from cardiovascular diseases in Siberia: a comparative study of two populations.

OBJECTIVES: To assess associations between mean age at death from cardiovascular disease (myocardial infarction, acute heart failure, ischemic heart disease and stroke) and sex, education, socio-professional status, marital status, region of residence at birth, month and season of birth and of death in dependence of climatic conditions. DESIGN: A retrospective analysis of death certificates in two Siberian cities from 1971 to 1978 (Novosibirsk, south-western Siberia) and from 1968 to 1985 (Mirny, western Yakutia). METHODS: Analysis of variance, test for seasonality. RESULTS: A remarkable effect of birthplace on longevity was observed in Novosibirsk. West Russia-born decedents were older than their cause-of-death-matched counterparts born in Siberia. In this city, men died at younger age in spring months compared to the rest of the year. In Mirny, an extreme northern town with a very harsh climate, the life span depended on the duration of living in this region prior to death. CONCLUSION: There was some difference among cardiovascular diagnoses and between the two cities. However, overall, the results offer some support for theories suggesting that early "imprinting" is responsible for the association between life span and region/season of birth.

Adult↗

PubMed2002

Effect of differing immunization policies on circulating measles antibody levels in US and Canadian children.

OBJECTIVE: To examine the effect of differing age-at-immunization policies on measles antibody levels in US children immunized at the age of 15 months compared with Canadian children immunized at the age of 12 months. SUBJECTS AND METHODS: Healthy, volunteer US and Canadian children aged 6 to 11 years who had been immunized with a single dose of the measles vaccine were enrolled from 1991 to 1993. Measles antibody was measured with a whole-virus, measles-specific IgG enzyme-linked immunoassay. Age, race, sex, country of residence, general health status, age at time of measles immunization, and time from immunization to sampling were recorded. RESULTS: Of the 1052 children enrolled in the study, US children (n=719) had a significantly higher measles seroprevalence (87%) compared with Canadian children (n=333) (76%; P<.001). After adjustment for time from immunization and age at immunization, the differences in seropositive rates were no longer significant (odds ratio [OR], 1.53; 95% confidence interval, 0.87-2.69; P=.15). We found a significant dose-response relationship between age at the time of immunization and the odds of being seropositive after immunization, with ORs varying from 1 with immunization at 13 months or younger to 2.30 with immunization at 16 months of age (P=.01). CONCLUSIONS: The current US policy of immunizing with the first dose of measles at the age of 12 months may be less effective than a policy of immunizing at 12 to 15 months of age. These findings may be highly significant as we move toward an era in which measles exposure may be rare and policies are developed to eradicate measles.

Age Factors↗