The fall of marital fertility in nineteenth-century France: exemplar or exception? (Part I).
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Population projections generally use the component method which consists in adapting sample size by age and sex from mortality, fertility and migration hypotheses. This exercise is not always aimed a providing projection data, but may also serve to analyze factors changing in the population. Comparatively long-term demographic forecasts, particularly for mortality, can be made due to the major inertia of demographic phenomena. However, the quality of such predictions depends on the quality of knowledge of past evolution in the demographic factors and on the capacity to forecast their future evolution.
BACKGROUND: Job characteristics may constitute a barrier to return-to-work (RTW) after compensated disabling low back pain (LBP). This study examines the impact of psychosocial job factors on time to RTW separately during the acute and subacute/chronic disability phases. METHODS: This is a retrospective cohort study of 433 LBP workers' compensation claimants with 1-4 years of follow-up. The association of psychosocial job factors with duration of work disability was estimated with Cox regression models, adjusting for injury history and severity, physical workload, and demographic and employment factors. RESULTS: High physical and psychological job demands and low supervisory support are each associated with about 20% lower RTW rates during all disability phases. High job control, especially control over work and rest periods, is associated with over 30% higher RTW rates, but only during the subacute/chronic disability phase starting 30 days after injury. Job satisfaction and coworker support are unrelated to time to RTW. CONCLUSIONS: Duration of work disability is associated with psychosocial job factors independent of injury severity and physical workload. The impact of these risk factors changes significantly over the course of disability.
OBJECTIVES: The study was designed to determine how pregnancy affects lipid and lipoprotein profiles among women living in a typical suburban commercial community in Africa, and to highlight the consequences of such changes. STUDY DESIGN: Lipid and lipoprotein levels and coronary heart disease (CHD) risk predictor index [High density lipoprotein-cholesterol (HDLC)/Total cholesterol (TC)] were evaluated in 27 African pregnant and 17 non-pregnant women of the same age and demographic profiles. RESULTS: Total cholesterol and low density lipoprotein-cholesterol (LDLC) levels increased, while HDLC level and HDLC/TC ratio decreased in the pregnant women. CONCLUSIONS: These findings suggest that African women are more prone to hyperlipidemia during normal pregnancy. The consequences of the adverse lipid and lipoprotein changes as seen in the pregnant women, on the fetal development and welfare should be explored in further studies. In general, these results have added to our understanding and knowledge of the numerous factors that could cause abnormal lipid and lipoprotein levels in African women.
BACKGROUND: Health behavior theories suggest that occurrence of heart attack or stroke in an immediate family member should increase one's perceived susceptibility to these conditions, which might lead to improved risk factor behavior and control. METHODS: Changes in measures of smoking, physical activity, lipids/lipoproteins, body weight, and blood pressure were investigated over two consecutive 5-year follow-up periods among 3950 participants (aged 18 to 30 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, who either did or did not have an immediate family member experience a heart attack or stroke. Recruitment and examinations for Years 0, 5, and 10 took place in 1985-1986, 1990-1991, and 1995-1996, respectively. RESULTS: After adjustment for baseline demographics and risk factors, young adults who experienced a change in family history of heart attack or stroke over a 5-year period were no more likely than those who did not to quit smoking, or to experience more positive changes in weight, physical activity, LDL cholesterol, HDL cholesterol, triglycerides, or systolic or diastolic blood pressure. These findings persisted among the few study participants with one or more established risk factors at baseline. CONCLUSIONS: The occurrence of a heart attack or stroke in an immediate family member does not appear to lead to self-initiated, sustained change in modifiable risk factors in young adults. Since family history of heart attack and stroke is associated with known risk factors and is an independent risk factor for incident development of these conditions, interventions should be developed and tested to motivate sustained risk-factor control following occurrence of a severe vascular event in a family member.
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BACKGROUND: Vasectomy is a reliable and widely accepted method of contraception, but there is some uncertainty and few data about a possible long-term adverse effect on health. METHODS: We examined the relation between vasectomy and mortality rates from cardiovascular disease, cancer, and all causes in a retrospective cohort of husbands of members of the Nurses' Health Study. In 1989 we obtained data by questionnaire on 14,607 men who had undergone vasectomy as of 1976 and 14,607 men who had not. RESULTS: Among the men who were free of cancer at the start of the study, 1052 died: 446 of cardiovascular disease, 341 of cancer, and 265 of other causes. Vasectomy was associated with reductions in mortality from all causes (age-adjusted relative risk, 0.85; 95 percent confidence interval, 0.76 to 0.96) and mortality from cardiovascular disease (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.92). Vasectomy was unrelated to mortality from all forms of cancer (relative risk, 1.01; 95 percent confidence interval, 0.82 to 1.25). Among men who had a vasectomy at least 20 years earlier, the procedure had no relation to mortality from all causes (relative risk, 1.11; 95 percent confidence interval, 0.92 to 1.33) or that from cardiovascular disease (relative risk, 0.85; 95 percent confidence interval, 0.63 to 1.16). However, mortality from cancer was increased in men who had a vasectomy at least 20 years earlier (relative risk, 1.44; 95 percent confidence interval, 1.07 to 1.92). The excess risk of cancer in these men was due primarily to lung cancer. None of the observed associations were confounded by smoking habits, body-mass index, alcohol consumption, or educational level. CONCLUSIONS: Vasectomy is not associated with an increase in overall mortality or mortality from cardiovascular disease. Our study also found no increase in overall mortality from cancer after vasectomy, but there was an apparent increase in the risk of cancer 20 or more years after vasectomy that requires further study.
OBJECTIVES: The purpose of this study was to analyse the determinants and consequences of the nutrition transition in Chile and describe the related health promotion policies. DESIGN AND SETTING: This is a descriptive, population-based study including data on demographic, diet, nutrition and biomedical related variables. Data came from the Food and Agriculture Organization (FAO), the National Institute of Statistics (INE), the Ministries of Planning, Health and Education surveillance systems, and national surveys. RESULTS: As malnutrition decreased during the 1980s, obesity increased rapidly in all age groups. In adults, currently about 25% of women are obese (body mass index >30 kg m(-2)); particularly those from low socio-economic levels. Among preschoolers, obesity is now 10% while in 6-year-old children it is 17.5% (weight/height greater than two standard deviations (>2SD) of the World Health Organization reference). Nutritional risk factors are prevalent, diet is changing to a 'Western diet' with an increasing fat consumption, and sedentarianism is constant in all groups. High blood pressure (>140/90) is greater than 10% in adults. Diabetes is increasing in urban areas, including in the indigenous population, and more than 40% of adults have a cholesterol level of more than 200 mg ml(-1). CONCLUSIONS: Promotion of healthy lifestyles is the main strategy to cope with this situation, particularly changing behaviour in food habits, physical activity and psychosocial factors. Changes in lifestyles will not only allow the prolonged life expectancy to be of better quality, but also will favour a decrease in the morbidity and mortality from chronic diseases, mainly cardiovascular diseases.
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This paper describes the life-style and behavioral correlates of change in coronary heart disease risk factors measured eight years apart in the young adult offspring of the Framingham Heart Study cohort. Changes in total cholesterol, lipoprotein cholesterols (high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol), and blood pressure were observed longitudinally in 397 men and 497 women who were aged 20-29 years at entry into the study. Stepwise multiple linear regression procedures were used to identify characteristics and their changes that were significantly associated with risk factor changes in each sex. The attribute most strongly and consistently related to lipoprotein and blood pressure changes in both sexes was change in body mass index (p less than or equal to 0.01 or p less than or equal to 0.001). In addition to weight gain, increases in alcohol consumption in men (p less than or equal to 0.001) and beginning oral contraceptive use in women (p less than or equal to 0.01) were associated with increases in blood pressure over the study period. Weight loss, stopping or decreasing cigarette consumption (p less than or equal to 0.01), increasing alcohol intake (p less than or equal to 0.01), and, in women, discontinuing oral contraceptive use (p less than or equal to 0.01) also were independently related to improvements in lipoprotein profiles during follow-up. After adjustment for all life-style correlates of risk factor change, simple self-assessments of physical activity or activity change were negatively associated with changes in VLDL cholesterol (p less than or equal to 0.01) and the total cholesterol/HDL cholesterol ratio (p less than or equal to 0.05) in men and positively associated with changes in HDL cholesterol (p less than or equal to 0.05) in women. Sociodemographic and behavioral characteristics that made a further independent contribution to increases in the total cholesterol/HDL cholesterol ratio in men were blue-collar occupation and trait Type A behavior pattern (p less than or equal to 0.05). Unexplained, but provocative, results of this study included the associations of interim vasectomy with increases in total cholesterol in men (p less than or equal to 0.05) and of number of livebirths with decreases in total cholesterol and HDL cholesterol in women (p less than or equal to 0.01). These findings are among the first to offer prospective evidence which suggests that habits and behaviors during young adulthood have a substantial effect on lipid and lipoprotein profiles in men and women.(ABSTRACT TRUNCATED AT 400 WORDS)
Studies suggest that hysterectomy and tubal sterilization may alter the function of the remaining ovaries. Conceivably, this effect could alter breast cancer risk. To investigate whether these surgeries affect breast cancer risk, the authors analyzed data collected between December 1, 1980, and April 30, 1983, in a population-based, case-control study of women aged 20-54 years, the Cancer and Steroid Hormone Study. Compared with never-sterilized women, women with hysterectomy and no remaining ovaries had a decreased risk of breast cancer (relative risk (RR) = 0.7, 95% confidence interval (CI) = 0.6-0.8). Risk was lowest in women who had their surgery before age 40 years or 15 or more years in the past; surgery at an early age provided greater protection than surgery in the distant past. Hysterectomy with one or two remaining ovaries was also inversely associated with breast cancer risk (RR = 0.8, 95% CI = 0.7-0.9), but no relation was found with age at surgery or time since surgery. Women with tubal sterilization had a slightly increased risk of breast cancer, which was of borderline statistical significance (RR = 1.2, 95% CI = 1.0-1.3). However, no relation was found with age at surgery or time since surgery. The data suggest that hysterectomy with bilateral oophorectomy decreases the breast cancer risk in women aged less than 55 years, possibly by curtailing ovarian function at a critical period. However, neither hysterectomy without bilateral oophorectomy nor tubal sterilization appears to substantially alter breast cancer risk in women of this age.
OBJECTIVES: This study was done to assess changes in obesity and risk factors for cardiovascular disease (CVD) in Black and White children from 1975 through 1990. METHODS: A cross-sectional study of body composition and CVD risk factors conducted in a school district as part of the Lipid Research Clinics (LRC) Program Prevalence Study (1973-1975) was compared with a later study (1989-1990) conducted in the same school district, which remained demographically stable. The studies included 1456 third- and fifth-grade students and 300 LRC subjects within the same age ranges. RESULTS: Students in the 1989-1990 study had a significantly higher mean body mass index (BMI), total blood cholesterol concentration, and systolic and diastolic blood pressures and marginally higher resting heart rates than those in the earlier study. The prevalence of obesity increased from 12.5% to 25.3%, and of hypercholesterolemia from 8.0% to 14.8%. Black females had the largest increase in BMI and resting heart rate and the highest prevalence of elevated total cholesterol in the 1989-1990 study. CONCLUSIONS: The results of this study suggest a secular trend toward increased obesity in children and portend the potential development of a public health problem that could reverse the recent decline in morbidity from CVD.
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