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PubMed2003

Obesity and health-related quality of life: a cross-sectional analysis of the US population.

OBJECTIVE: To examine the relationship between body mass index (BMI) and health-related quality-of-life (HRQL), in the presence of dietary controls and/or exercise in a national sample in the United States. METHODS: BMI and its association with HRQL domains (physical, mental and activity limitations) were examined using the Centers' for Disease Control and Prevention's 2000 Behavioral Risk Factor Surveillence System (BRFSS) data, after adjusting for various sociodemographic factors, self-reported health-status, and diet/exercise behavior. RESULTS: Based on World Health Organization's (WHO) classification of obesity, the study sample (N=182 372) included approximately 43.7% nonoverweight, 36% overweight, 14% obese, and 7% severely obese respondents. Exercise and dietary modifications were used by 17.5% of overweight, 15.2% of obese, and 12.5% of severely obese individuals. Logistic regression results using nonoverweight BMI as the reference category showed that severely obese (OR=1.87, 95% CI 1.64-2.12) and obese (OR=1.21, 95% CI 1.09-1.33) were more likely to experience greater than 14 unhealthy days affecting the physical health domain. Severely obese (OR=1.41, 95% CI 1.26-1.59) and obese (OR=1.17, 95% CI 1.07-1.28) were also more likely to experience greater than 14 unhealthy days affecting the mental health domain. Similarly, severely obese (OR=1.73, 95% CI 1.50-1.99) and obese (OR=1.22, 95% CI 1.08-1.37) were more likely to experience greater than 14 days with activity limitations. Exercise and dietary controls were associated with better HRQL across all three domains. CONCLUSION: The study highlights the relationship between BMI and HRQL in the United States. The study also underlines the positive correlation of exercise and dietary modifications with HRQL.

Analysis of Variance↗

PubMed2002

Cross-sectional analysis of intimacy, passion, and commitment: testing the assumptions of the triangular theory of love.

Using data from two previous studies, the current study tested the assumptions in the Triangular Theory of Love about changes in intimacy, passion, and commitment over time. Using a cross-sectional design, the study examined differences in the three components among 446 romantically involved individuals who were either casually dating, exclusively dating, engaged, or married. In support for the assumptions in the Triangular Theory specifically, analyses indicated significant negative partial correlations between intimacy and relationship length as well as between passion and relationship length. The correlation between commitment and relationship length was significant and positive. One-way analysis of variance of relational stage gave similar results. Reported intimacy and passion scores were lowest for participants who were casually dating, higher for participants who were engaged, and lower for married participants. Reported commitment scores increased from casually dating participants to the married participants.

Adolescent↗

PubMed1993

The importance of physical fitness versus physical activity for coronary artery disease risk factors: a cross-sectional analysis.

Numerous epidemiological investigations have shown that low physical fitness and low physical activity are related to the incidence of coronary artery disease (CAD). Most studies, however, have not examined both variables concurrently to determine which has the strongest association with CAD risk. The purpose of this investigation was to cross-sectionally examine the relationships among physical fitness, physical activity, and risk factors for CAD. Male law enforcement officers (N = 412) from the City of Austin, Texas, were subjects for this study. Physical fitness, physical activity, and risk factors for CAD were assessed through health screenings and from data collected as part of an annual physical fitness assessment. Multivariate analysis of covariance revealed that physical fitness, but not physical activity, was related to several single CAD risk factors. Percent body fat, smoking habits, and Type A behavior score were negatively related to physical fitness level, and high density lipoprotein (HDL) cholesterol was positively related to physical fitness level. Univariate analysis of variance found both physical fitness and physical activity to be significantly related to a composite CAD risk score. Low physical fitness and low physical activity were associated with a high CAD risk score. These data suggest that physical activity must be sufficient to influence physical fitness before statistically significant risk-reducing benefits on single CAD risk factors are obtained, although minimal engagement in weekly vigorous activity provides a significant benefit for the composite CAD risk score. It is plausible, however, that physical fitness is a stronger measure than physical activity and optimally characterizes the relationship among physical activity and CAD risk factors.

Adult↗

PubMed2025

Integrative oral and gut microbiome profiling highlights microbial correlates of complications in type 1 diabetes: a cross-sectional analysis.

BACKGROUND/OBJECTIVE: Chronic vascular complications are the primary threat in long-standing type 1 diabetes (T1D) patients. We examined the associations between oral-gut microbiome dysbiosis and these complications, offering novel insights into therapeutic strategies and underlying mechanisms. METHODS: This cross-sectional study enrolled 75 T1D participants (disease duration ≥ 10 years) and 43 healthy controls who underwent comprehensive clinical assessment, including blood glucose, lipid profile, and complication-related examinations. Fecal and oral rinse samples were collected for shotgun metagenomic sequencing. T1D participants were stratified by the presence of microvascular (retinopathy, nephropathy, or neuropathy) or macrovascular complications separately. Microbial differences across groups were assessed. RESULTS: Significant differences in oral and gut microbiota compositions were observed between T1D participants with and without complications (both microvascular and macrovascular). A core set of 26 gut and 8 oral microbial species was specifically associated with vascular complications. Butyrate-producing gut bacteria (Blautia wexlerae, Anaerobutyricum hallii, Roseburia inulinivorans, A. soehngenii) and specific oral Neisseria species were enriched in T1D without complications individuals, suggesting protective effects against complications. Mediation analysis indicated associations consistent with partial mediation between certain microbial species and the relationships of glycemic control or insulin resistance (HbA1c, glucose risk index, estimated glucose disposal rate) with complication risk. Moreover, potential oral-gut microbiome interconnections were implicated in complication development. Finally, classification models integrating both oral and gut microbial features significantly outperformed models based on either site alone in distinguishing T1D patients with complications. CONCLUSIONS: Distinct oral and gut microbiome features are associated with chronic vascular complications in T1D. These findings highlight the potential of microbiome-targeted strategies for understanding and preventing T1D-related complications.

Humans↗

PubMed2002

A cross-sectional analysis of work-related outcomes in adults with asthma.

BACKGROUND: Asthma is a disease with physical symptoms that can impair a person's functioning to the point of interfering with school, work, and social activities. OBJECTIVE: Describe how disease (asthma) and patient characteristics affect perceived work performance and absenteeism. METHODS: Using a cross-sectional study design, 369 adults with asthma from a managed care organization responded to a mailed questionnaire which included a perceived work performance scale (WPS) and an item assessing absenteeism. Analysis consisted of psychometric testing of the scale (internal consistency and construct validity); trend observation of influence of perceived and symptom-derived severity on WPS and absenteeism distribution; and regression analysis to examine the relationship between patient/disease characteristics and the work-related outcomes. RESULTS: The mean WPS score was 88.0 +/- 16.2 (of a possible 100), with a Cronbach's alpha of 0.79. Most respondents (84.7%) did not miss any work in the previous 4 weeks. WPS scores declined and the percentage of respondent absenteeism increased as perceived and symptom-derived severity worsened. The regression model for WPS produced an adjusted R2 of 0.32 and included the number of other illnesses, health beliefs, race, income, and perceived and symptom-derived asthma severity. The regression model for absenteeism included number of other illnesses, race, health beliefs, and symptom-derived severity. Perceived work performance and absenteeism are outcomes measures that are distinctive and complementary. CONCLUSIONS: Disease severity, race, income, and health beliefs also contribute and should be considered in health services research related to asthma.

Absenteeism↗

PubMed1991

A cross-sectional analysis of aspartate aminotransferase in human gingival crevicular fluid.

Previous investigation has shown that the concentration of aspartate aminotransferase (AST), an established serum marker for cardiac and liver damage in humans, is significantly elevated in samples of gingival crevicular fluid (GCF) from ligated teeth in beagle dogs. This paper reports on a cross-sectional study of the relationships between AST in GCF and clinical indices of human periodontal disease in 60 patients with mild to moderate adult periodontitis. AST standardized to a 30-second collection interval (AST30) showed substantial (multiple regression R2 = 0.61) association with summary indices of patient disease status, modest association (partial R2 = 0.22) with tooth disease status within patient, and weaker (partial R2 = 0.12) but statistically significant association with site-to-site variation in disease at the same tooth. AST concentration showed modest (R2 = 0.30) between-patient relationship with clinical indices, but no clinically significant relationship with these indices between sites within patients, suggesting a rough proportionality between accumulated enzyme and GCF volume at sites with varying stages of disease. The relationship between GCF volume and probing depth also appears central to interpretation of enzyme assays. Clinical measures of past periodontitis and current inflammatory disease are cross-sectionally related to variation in AST30, across patients and sites within the same patient. Considerable residual variation, especially elevated AST30 in the absence of clear signs of disease, may result from varying levels of current disease activity, not reflected in clinical measures.

Adult↗

PubMed1980

The influence of smoking habits and body weight on vital capacity and FEV1 in male Air Force personnel: a longitudinal and cross-sectional analysis.

Vital capacity (VC) and forced expiratory volume in one second (FEV1) measured in 7,123 men during annual or biennial medical examination were analyzed as a function of age (A), weight (W), and standing height (H). The subjects were grouped according to their smoking habits. A cross-sectional and longitudinal study was performed. Vital capacity and FEV1 were found to increase with age during the first 22 to 23 yr; thereafter, a steady decline was observed, more pronounced in smokers than in nonsmokers. In both longitudinal and cross-sectional surveys, body weight influenced the values of VC and FEV1. An increase of weight tended to be accompanied by an increase in VC and FEV1 in the younger, taller, and lighter subjects. This effect lessened and even reversed with increasing age and weight, decreasing height, and heavier smoking (in the longitudinal study). The influence of height on VC and FEV1 appeared to depend markedly on the weight of the subjects.

Adolescent↗

PubMed1998

Longitudinal and cross-sectional analysis of cytotoxic T lymphocyte responses and their relationship to vertical human immunodeficiency virus transmission. ARIEL Project Investigators.

The ARIEL Project for the Prevention of HIV Transmission from Mother to Infant was established to evaluate virologic and immunologic parameters during vertical transmission. To determine the strength and breadth of the cytotoxic T lymphocyte (CTL) response and its correlation with human immunodeficiency virus (HIV) transmission, a cross-sectional study was done of 31 HIV-infected pregnant women, of whom 15 transmitted and 16 did not transmit HIV to their infants. The precursor frequencies of CTL specific for HIV-1 gag, pol, nef, and env from 5 different isolates of the clade B of HIV-1 were determined by limiting dilution analysis. Results showed that variable levels of HIV-specific CTL response were present in HIV-infected pregnant women during and after pregnancy. In addition, CTL precursor frequencies specific for pol and nef were higher during pregnancy in nontransmitters than in transmitters. Thus, CTL responding to different HIV antigens may not be contributing equally to the prevention of vertical transmission.

Adult↗

PubMed1983

Male sexual development in the monkey. II. Cross-sectional analysis of pulsatile hypothalamic-pituitary secretion in castrated males.

Pulsatile secretion of serum gonadotropins was studied in 16 castrated monkeys from 4 weeks of age through adult life. Animals were castrated at various ages from birth through adult life. Although some studies of the gonadotropin-secretory patterns were longitudinal in nature, most comparisons were cross-sectional. On the basis of our observations, we have arbitrarily grouped the animals into 4 developmental ages: postnatal (less than 7 months), prepubertal or juvenile (7-27 months), pubertal (28-59 months), and adult (greater than or equal to 60 months). In carrying out these studies, blood was withdrawn at 15-min intervals over 24 h without anesthesia using a mobile vest and tether assembly to support an indwelling catheter. GnRH challenge tests were done on 1 or more occasions on all animals. Plasma samples were analyzed for concentrations of FSH and LH by established RIAs and an in vitro bioassay for LH. During the frequent sampling period (24 h for all except postnatal animals), the amplitude of gonadotropin pulses was greatest in adult animals followed by postnatal and pubertal monkeys. During pubertal development, there was a marked increase in the magnitude of gonadotropin pulses, and remarkedly, there was a substantial increase in the LH bioassay: RIA (greater than 5:1) by adult life. GnRH challenge tests of gonadotropins correlated with these observations. Time series analysis was applied to the data for objective statistical characterization of cyclic patterns. Our findings can be summarized: 1) during pubertal maturation there is a change in amplitude but not frequency of gonadotropin pulses, 2) pubertal development of the hypothalamic-pituitary axis advances in the absence of gonadal feedback, and 3) there is a significant increase in the LH bioassay: RIA during pubertal development. We conclude that the castrate monkey is a valuable adjunct to direct clinical investigations of the mechanisms controlling human sexual development.

Age Factors↗

PubMed2003

Global intellectual impairment does not accelerate with age in patients with schizophrenia: a cross-sectional analysis.

Neuropsychological studies show impairment in intellectual functions in schizophrenia patients. It is still unclear, however, whether intelligence scores decline progressively during the illness as compared to healthy subjects' scores. Longitudinal studies conducted so far have been restricted to relatively short time spans. The aim of this study is to investigate whether changes in intelligence scores accelerate with age in schizophrenia patients. In a cross-sectional design, performance of four subtests of the Wechsler Adult Intelligence Scale (WAIS) was analyzed in 112 schizophrenia patients and compared to that of 70 healthy subjects, across an age span of 40 years (16-56 years). A linear regression analysis was performed. A main effect on the total ratio score of the four tests was demonstrated between the two groups. No main effect of age and no interaction effect of age with group for the total ratio score were found. The results confirm that there is global intellectual impairment in schizophrenia patients at the onset of illness but no age-accelerated decline and are consistent with the neurodevelopmental hypothesis of schizophrenia.

Adolescent↗

PubMed1978

A longitudinal and cross-sectional analysis of the growth of the postnatal cranial base angle.

Radiographs of 32 children, 16 girls and 16 boys, taken at 1 month, 3 months, 9 months, and once a year until 5 years 9 months were selected from the Denver Series. The cranial base deflection was measured by five sets of angles. A cross-sectional evaluation revealed a significant decrease in angle size by all methods of measurement by 9 months of age. Little change was noted after 1 year, 9 months, indicating that studies beginning after 2 years would not find this decrease. All individuals followed a pattern of reduction between 1 month and 9 months with variable changes at 3 months. Choice of landmark affected the degree and timing of the observed change but not the overall pattern. Differences in measuring techniques evaluated the mean degree of deflection to range from -6.9 degrees to -13.8 degrees.

Cephalometry↗

PubMed1997

Do ethnic differences in dietary cation intake explain ethnic differences in hypertension prevalence? Results from a cross-sectional analysis.

PURPOSE: To better understand how the magnitude of the association between ethnicity and hypertension is affected by ethnic differences in dietary cation intake, we describe differences in dietary cation intakes and prevalence of hypertension across four ethnic groups (African-Americans, European-Americans, Mexican-Americans, and Puerto Ricans). We also assess the cross-sectional association between: (i) hypertension and self-reported dietary intakes of sodium, potassium, and calcium for each ethnic group; and (ii) ethnicity and hypertension before and after adjustment for dietary cation intakes. METHODS: Data from the Second National Health and Nutrition Examination Survey (1976-1980) and the Hispanic Health and Nutrition Examination Survey (1982-1984) were analyzed. Multiple logistic regression was used to estimate odds ratio (OR) for hypertension for each ethnic group, with adjustment for age, body mass index (BMI), and diabetes status. Comparisons were made to assess whether the magnitude for the ethnicity ORs changed when the three nutrient variables were entered into the model. RESULTS: Mexican-American and Puerto Rican men and women showed clinically and statistically significantly higher mean intakes of the three cations than did African-American men and women, who reported clinically and statistically significantly lower mean intakes of sodium, potassium, and calcium than did European-American men and women. Mean dietary intakes of potassium and calcium were higher for normotensives than for hypertensives among all ethnic groups, except African-American and Mexican-American women. In multivariate modeling, stark differences in ORs for hypertension persisted across ethnic groups despite inclusion of the nutrient variables. CONCLUSION: In this cross-sectional study, adjustment for dietary cation intakes did not alter the magnitude of the ethnic differences in prevalence of hypertension.

Adult↗

PubMed2026

Long-acting reversible contraception, condom use and sexually transmitted infections in developing countries: a multi-country serial cross-sectional analysis using demographic and health surveys.

INTRODUCTION: Unintended pregnancy and sexually transmitted infections (STIs) are major public health issues in developing countries. While long-acting reversible contraception (LARC) effectively prevents unintended pregnancy, there is limited evidence from large multinational studies on its association with condom use and STI-related outcomes. This study aimed to investigate the association between LARC use, condom use and STIs among women in developing countries. METHODS: This serial cross-sectional study extracted data from Demographic and Health Surveys (DHS), a series of nationally representative household surveys conducted in developing countries. The analysis included women aged 15 to 49 years, with data on contraceptive methods and demographics. Generalised linear mixed effect models (GLMMs) were used to estimate adjusted prevalence ratios (aPRs) for condom use and self-reported STI-related outcomes, comparing LARC users with both non-LARC users and oral contraceptive users. Subgroup analyses were conducted at the individual level and at the country level. RESULTS: Data from 2 171 884 women across 31 countries were analysed. Overall, the prevalence of self-reported STI-related outcomes was 7.4%, 3.9% of participants used LARC, and 7.5% of participants reported consistent condom use. LARC users were significantly less likely to use condoms compared with non-LARC users (aPR=0.40, 95% CI 0.30 to 0.53) and compared with oral contraceptive users (aPR=0.61, 95% CI 0.48 to 0.78). LARC use was associated with a higher prevalence of STI-related outcomes compared with non-LARC users (aPR=1.19, 95% CI 1.10 to 1.28) and compared with oral contraceptives users (aPR=1.14, 95% CI 1.05 to 1.24). Associations were stronger in low-Human Development Index (HDI) countries, especially among younger women (15-19 years), but were not significant in high-HDI countries. Country-level heterogeneity was observed. CONCLUSIONS: LARC use is associated with reduced condom use and higher self-reported STI prevalence, particularly among younger women and in lower HDI developing countries. These findings support integrating STI prevention into LARC services and promoting dual-method use to prevent both unintended pregnancies and STIs.

Humans↗

PubMed2006

Gender differences in health care use among the elderly population in areas of Norway and Finland. A cross-sectional analysis based on the HUNT study and the FINRISK Senior Survey.

BACKGROUND: The aim of the study was to examine gender differences in the self-reported use of health care services by the elderly in rural and metropolitan areas of two Nordic countries with slightly different health care systems: Finland and Norway. METHODS: Population based, cross-sectional surveys conducted in Nord-Tröndelag Norway (1995-97) and in rural and metropolitan areas of Finland (1997) were employed. In the Norwegian data, a total of 7,919 individuals, aged 65-74 years old were included, and the Finnish data included 1,500 individuals. The outcome variables comprised whether participants had visited a general practitioner or a specialist, or had received hospital care or physiotherapy during the past 12 months. Gender differences in the use of health care services were analysed by multiple logistic regression, controlling for health status and socio-demographic characteristics. RESULTS: In Norway, elderly women visited a specialist or were hospitalised less often than men. In Finland, elderly women used all health care services except hospital care more often than men. In Norway, less frequent use of specialist care by women was not associated with self-reported health or chronic diseases. CONCLUSION: The findings revealed differences in self-reported use of secondary care among different genders in areas of Norway and Finland.

Aged↗

PubMed2006

A cross-sectional analysis of acute hepatitis B virus reported to the Vancouver Coastal Health Authority from 2000 to 2003.

BACKGROUND: Acute hepatitis B virus (HBV) transmission remains a significant public health problem despite effective vaccination and prophylaxis strategies. Vancouver, British Columbia, has a large ethnic community from endemic areas, which may further impact on the epidemiology of acute HBV. A cross-sectional study of factors associated with acute HBV cases reported to the Vancouver Coastal Health Authority (Vancouver, British Columbia) from 2000 to 2003 is reported. METHODS: New seropositive cases of hepatitis B surface antigen were reported to the Vancouver Coastal Health Authority Office of Communicable Disease Control. Patients meeting both clinical and laboratory criteria for acute HBV were interviewed by telephone for demographic and risk behaviour information. Risk behaviours within the last six months before disease onset were ranked on efficiency of transmission in a mutually exclusive risk category. RESULTS: There were 78 patients of identified acute HBV in Vancouver from 2000 to 2003. The overall incidence rate was 3.38 per 100,000 person years. Outside of Canada, Asia was the most common place of birth (29.5%). The three most frequently identified risk factors were men who have sex with men (21.9%), heterosexual activity with two or more partners (14.0%) and intravenous drug use (14.0%). Sexual contact with an HBV carrier was identified in 9.4% of patients. CONCLUSIONS: Sexual transmission is a major mode in the spread of HBV in Vancouver. Existing public education, surveillance and vaccination strategies for HBV need to be strengthened to address those engaging in risky behaviours.

Acute Disease↗

PubMed2005

International nurse recruitment and NHS vacancies: a cross-sectional analysis.

BACKGROUND: Foreign-trained nurse recruits exceeded the number of new British-trained recruits on the UK nurse register for the first time in 2001. As the nursing shortage continues, health care service providers rely increasingly on overseas nurses to fill the void. Which areas benefit the most? And where would the NHS be without them? METHODS: Using cross-sectional data from the 2004 Nursing and Midwifery Council register, nurse resident postcodes are mapped to Strategic Health Authorities to see where foreign recruits locate and how they affect nurse shortages throughout the UK. RESULTS: Areas with the highest vacancy rates also have the highest representation of foreign recruits, with 24% of foreign-trained nurses in the UK residing in the London area and another 16% in the SouthEast (comparable numbers for British-trained nurses are 11% and 13%, respectively). Without foreign recruitment, vacancy rates could be up to five times higher (three times higher if only Filipino recruits remained). CONCLUSION: The UK heavily relies on foreign recruitment to fill vacancies, without which the staffing crisis would be far worse, particularly in high vacancy areas.

Journal Article↗

PubMed2005

The ill child in the emergency department and the accompanying people: a cross-sectional analysis.

OBJECTIVE: The objective of this study is to investigate relationship between the number of the family members visiting the emergency department with pediatric patients and patient characteristics such as age, insurance status, traumatic complaint, whether event was acute or not, and to estimate number of family members who had any time off from their work among this group. METHOD: A prospective cross-sectional study was performed using a questionnaire which included demographic characteristics, number of family members, number of family members who were taking hours off from work. In the 15-day period (1-15 August 2003), all persons who accompanied the children to the university-based PED (annual volume: 18,000) were asked to participate in the study. RESULTS: A total of 575 persons accompanied the 300 children seen in PED (1.92 persons per child). Number of persons accompanying the children was found to be inversely related to age (Pearson correlation, P = 0.000). Seventy-nine children (32.1%) of those with acute complaints had family members who took time off from their work, whereas 29 (53.70%) of those with chronic illnesses had such family members (P = 0.003). The mean number of family members of children who had been referred from another healthcare institution was 2.06 +/- 0.77, whereas the mean number of family members of patients who presented directly to the PED was 1.85 +/- 0.63 (P = 0.013). The mean number of family members of patients who had insurance for their child and those who do not have were 1.84 +/- 0.66 and 2.06 +/- 0.71, respectively, (P = 0.001). CONCLUSIONS: Numbers of family members were positively associated with a history of referral to another institution for the same reason, and inversely related to the parents' age and insurance status.

Adolescent↗

PubMed2006

Cross-sectional analysis of oncogenic HPV viral load and cervical intraepithelial neoplasia.

In human papillomavirus (HPV)-associated carcinogenesis, HPV infection characteristics such as viral load may play an important role in lesion development. The purpose of this study was to determine the association between quantitative assessment of oncogenic HPV viral load, and abnormal cytology among women residing along the United States-Mexico border. A cross-sectional study of 2,319 women was conducted between 1997 and 1998. Viral load of oncogenic HPV types (16, 18, 31, 39, 45, 51, 52, and 58) was measured among 173 HPV (+) women using quantitative real-time PCR. Overall, HPV 16, 31, 52 and 58 showed the highest viral load. Single type infection had higher viral loads compared to multiple type infections. HPV viral load declined significantly (p = 0.04) with age. No significant association was observed with other known HPV risk factors such as oral contraceptive use, parity, sexual and STD history. Viral load was independently associated with degree of cervical lesions. An adjusted odds ratio (AOR) of 4.7 for the association between increasing total viral load and Atypical Squamous Cells of Undetermined Significance (ASCUS)/Atypical Glandular Cells of Undetermined Significance (AGUS) was observed (p for trend <0.01). Increased risk of low-grade SIL was observed with higher viral load compared with HPV negative women (AOR = 47.7 for total viral load; AOR = 37.1 for HPV viral load not including HPV16, and AOR = 25.9 for HPV16 viral load). Likewise, increased risk of high-grade SIL with higher viral loads was observed (AOR = 58.4 for high total viral load compared with HPV negative women, AOR = 58.1 for HPV viral load not including HPV16, and AOR = 69.8 for HPV16 high viral load). Results from this study suggest a dose-response relationship between increasing oncogenic HPV viral load and risk of LSIL and HSIL.

Adolescent↗