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1.
Background
Evidence from a number of countries in Europe and North America point towards the secular declining trend in menarcheal age with considerable spatial variations over the past two centuries. Similar trends were reported in several developing countries from Asia, Africa and Latin America. However, data corroborating any secular trend in the menarcheal age of the Indian population remained sparse and inadequately verified.Methods
We examined secular trends, regional heterogeneity and association of socioeconomic, anthropometric and contextual factors with menarcheal age among ever-married women (15–49 years) in India. Using the pseudo cohort data approach, we fit multiple linear regression models to estimate secular trends in menarcheal age of 91394 ever-married women using the Indian Human Development Survey.Results
The mean age at menarche among Indian women was 13.76 years (95 % CI: 13.75, 13.77) in 2005. It declined by three months from 13.83 years (95% CI: 13.81, 13.85) among women born prior to 1955–1964, to nearly 13.62 years (95% CI: 13.58, 13.67) among women born during late 1985–1989. However, these aggregate national figures mask extensive spatial heterogeneity as mean age at menarche varied from 15.0 years in Himachal Pradesh during 1955–1964 (95% CI: 14.89–15.11) to about 12.1 years in Assam (95% CI: 11.63–12.56) during 1985–1989.Conclusion
The regression analysis established a reduction of nearly one month per decade, suggesting a secular decline in age at menarche among Indian women. Notably, the menarcheal age was significantly associated with the area of residence, geographic region, linguistic groups, educational attainment, wealth status, caste and religious affiliations among Indian women. 相似文献2.
Henk Talma Yvonne Sch?nbeck Paula van Dommelen Boudewijn Bakker Stef van Buuren Remy A. HiraSing 《PloS one》2013,8(4)
Aim
To assess and compare the secular trend in age at menarche in Dutch girls (1955–2009) and girls from Turkish and Moroccan descent living in the Netherlands (1997–2009).Methods
Data on growth and maturation were collected in 20,867 children of Dutch, Turkish and Moroccan descent in 2009 by trained health care professionals. Girls, 9 years and older, of Dutch (n = 2138), Turkish (n = 282), and Moroccan (n = 295) descent were asked whether they had experienced their first period. We compared median menarcheal age in 2009 with data from the previous Dutch Nationwide Growth Studies in 1955, 1965, 1980 and 1997. Age specific body mass index (BMI) z-scores were calculated to assess differences in BMI between pre- and postmenarcheal girls in different age groups.Results
Median age at menarche in Dutch girls, decreased significantly from 13.66 years in 1955 to 13.15 years in 1997 and 13.05 years in 2009. Compared to Dutch girls there is a larger decrease in median age of menarche in girls of Turkish and Moroccan descent between 1997 and 2009. In Turkish girls age at menarche decreased from 12.80 to 12.50 years and in Moroccan girls from 12.90 to 12.60 years. Thirty-three percent of Turkish girls younger than 12 years start menstruating in primary school. BMI-SDS is significantly higher in postmenarcheal girls than in premenarcheal girls irrespective of age.Conclusion
There is a continuing secular trend in earlier age at menarche in Dutch girls. An even faster decrease in age at menarche is observed in girls of Turkish and Moroccan descent in the Netherlands. 相似文献3.
Background
Adolescence is a critical stage for bone accrual. It is also decisive for the establishment of behaviors such as smoking and alcohol drinking.Objective
To quantify the short- and long-term associations between smoking and drinking initiation and bone mineral density in adolescent girls.Methods
We used prospective data from 731 girls identified in public and private schools in Porto, Portugal. Evaluations were conducted when participants were 13 and 17 years old. Bone mineral density (BMD) was measured at the forearm by dual-energy X-ray absorptiometry and weight, height and fat-free mass were measured. Pubertal development status was estimated using menarche age. Self-administered questionnaires were used to collect data on smoking and alcohol drinking, physical exercise and calcium and vitamin D intakes. BMD in early and late adolescence was analyzed as a continuous or dichotomous (Z-score cutoff: −1.0) variable. Associations were calculated using linear or logistic regression.Results
Over one quarter of these girls had tried smoking by 13, while 59% had drunk alcoholic beverages and 20% had experienced both behaviors by that age. Lower mean BMD at 17 years of age was observed in girls who had ever smoked by 13, as well as in those who reported drinking at that age. There were no significant cross-sectional associations between experience and frequency of smoking or drinking and BMD at 13 years of age. However, we observed significant associations between BMD z-score<−1 in late adolescence and having ever smoked by 13, after adjustment for menarche age and sports practice, (OR = 1.92; 95% CI: 1.21, 3.05) and with ever smoking and drinking in the same period (OR = 2.33; 95% CI: 1.36, 4.00).Conclusion
Our study adds prospective evidence to the role of early initiation of smoking and alcohol drinking as relevant markers of lower bone mineral density in late adolescence. 相似文献4.
Introduction
Gallstone disease (GSD) and its complications are major public health issues globally. Although many community-based studies had addressed the risk factors for GSD, little is known about GSD prevalence and risk factors among Taiwanese vegetarians.Methods
This study included 1721 vegetarians who completed a questionnaire detailing their demographics, medical history, and life-styles. GSD was ascertained by ultrasonography or surgical history of cholecystectomy for GSD. The predictive probability of GSD for male and female vegetarians was estimated from the fitted model.Results
The prevalence of GSD was 8.2% for both male and female vegetarians. The risk of GSD is similar in men and women across all age groups, and increases steadily with increasing age. For male vegetarians, age (OR: 1.04; 95% CI: 1.00–1.08) and serum total bilirubin level (OR: 2.35; 95% CI: 1.31–4.22) predict risk for GSD. For female vegetarians, age (OR: 1.03; 95% CI: 1.01–1.05), BMI (OR: 1.07; 95% CI: 1.01–1.13), and alcohol consumption (OR: 7.85; 95% CI: 1.83–33.73) are associated with GSD. GSD is not associated with type of vegetarian diet, duration of vegetarianism, low education level, physical inactivity, diabetes, coronary artery disease, cerebral vascular accident, chronic renal failure, hepatitis C virus infection, and lipid abnormalities. GSD is also not associated with age at menarche, postmenopausal status, and multiparity in female vegetarians.Conclusions
Risk factors useful for predicting GSD in vegetarians are (1) age and total bilirubin level in men, and (2) age, BMI, and alcohol consumption in women. Many previously identified risk factors for general population does not seem to apply to Taiwanese vegetarians. 相似文献5.
Jianduan Zhang John H. Himes Yuan Guo Jingxiong Jiang Liu Yang Qiaozhen Lu Haiyan Ruan Shuhua Shi 《PloS one》2013,8(6)
Objectives
To investigate the early determinants of overweight and obesity status at age two years.Methods
A total of 1098 healthy neonates (563 boys and 535 girls) were involved in this community-based prospective study in China. Data on body weight and length were collected at birth, the 3rd and 24th month. A self-administered questionnaire was used to collect data on social demography and feeding patterns of children, etc. Three multivariable logistic regression models were employed to make various comparisons of weight status, i.e., model 1 (obesity vs. non-obesity), model 2 (combined overweight and obesity vs. normal weight, and model 3 (obesity, overweight and normal weight).Results
Prevalences of overweight/obesity (95th >BMI ≥85th p and BMI ≥95th p, referring to WHO BMI standards) at 2 years of age are 15.8%/11.2% for boys and 12.9%/9.0% for girls, respectively. Being born with macrosomia (OR: 1.80–1.88), relatively greater BMI increment in the first 3 months (OR: 1.15–1.16) and bottle emptying by encouragement at age two (OR: 1.30–1.57) were found in all three models to be significant risk factors for higher BMI status at 2 years. Pre-pregnancy maternal BMI (OR: 1.09–1.12), paternal BMI (OR: 1.06), and mixed breastfeeding (OR: 1.54–1.57) or formula feeding (OR: 1.90–1.93) in the first month were identified as significant in models 2 and 3. Child-initiated bottle emptying at age two was observed to increase the risk of obesity by 1.31 times but only in model 1.Conclusion
Fetal and early postnatal growth and feeding pattern appear to have significant impacts on early childhood overweight and obesity status independent of parental BMI. Policy-based and multidisciplinary approaches to promote breastfeeding and enhancement of feeding skills of care takers may be promising intervention strategies. 相似文献6.
Purpose
To examine the association between female reproductive factors and age-related macular degeneration (AMD) in postmenopausal women.Design
Nationwide population-based cross-sectional study.Methods
A nationally representative dataset acquired from the 2010–2012 Korea National Health and Nutrition Examination Survey was analyzed. The dataset involved information for 4,377 postmenopausal women aged ≥50 years with a fundus photograph evaluable for AMD in either eye. All participants were interviewed using standardized questionnaires to determine reproductive factors including menstruation, pregnancy, parity, lactation, and hormonal use. The association between reproductive factors and each type of AMD was investigated.Results
The mean age of the study participants was 63.1±0.2 years. Mean ages at menarche and menopause were 16.1±0.0 and 49.2±0.1 years, respectively. The overall prevalence rates of early and late AMD were 11.2% (95% confidence interval [CI], 10.1–12.5) and 0.8% (95% CI, 0.5–1.2), respectively. When adjusted for age, neither smoking nor alcohol use was associated with the presence of any AMD or late AMD. Multivariate logistic regression analysis revealed age (OR, 1.12 per 1 year), duration of lactation (OR, 0.91 per 6 months), and duration of use of oral contraceptive pills (OCP) (OR, 1.10 per 6 months) as associated factors for late AMD. The other variables did not yield a significant correlation with the risk of any AMD or late AMD.Conclusion
After controlling for confounders, a longer duration of lactation appeared to protect against the development of late AMD. A longer duration of OCP use was associated with a higher risk of late AMD. 相似文献7.
Zaida Herrador Luis Sordo Endalamaw Gadisa Javier Moreno Javier Nieto Agustín Benito Abraham Aseffa Carmen Ca?avate Estefania Custodio 《PloS one》2014,9(9)
Introduction
Little information is available on malnutrition-related factors among school-aged children ≥5 years in Ethiopia. This study describes the prevalence of stunting and thinness and their related factors in Libo Kemkem and Fogera, Amhara Regional State and assesses differences between urban and rural areas.Methods
In this cross-sectional study, anthropometrics and individual and household characteristics data were collected from 886 children. Height-for-age z-score for stunting and body-mass-index-for-age z-score for thinness were computed. Dietary data were collected through a 24-hour recall. Bivariate and backward stepwise multivariable statistical methods were employed to assess malnutrition-associated factors in rural and urban communities.Results
The prevalence of stunting among school-aged children was 42.7% in rural areas and 29.2% in urban areas, while the corresponding figures for thinness were 21.6% and 20.8%. Age differences were significant in both strata. In the rural setting, fever in the previous 2 weeks (OR: 1.62; 95% CI: 1.23–2.32), consumption of food from animal sources (OR: 0.51; 95% CI: 0.29–0.91) and consumption of the family''s own cattle products (OR: 0.50; 95% CI: 0.27–0.93), among others factors were significantly associated with stunting, while in the urban setting, only age (OR: 4.62; 95% CI: 2.09–10.21) and years of schooling of the person in charge of food preparation were significant (OR: 0.88; 95% CI: 0.79–0.97). Thinness was statistically associated with number of children living in the house (OR: 1.28; 95% CI: 1.03–1.60) and family rice cultivation (OR: 0.64; 95% CI: 0.41–0.99) in the rural setting, and with consumption of food from animal sources (OR: 0.26; 95% CI: 0.10–0.67) and literacy of head of household (OR: 0.24; 95% CI: 0.09–0.65) in the urban setting.Conclusion
The prevalence of stunting was significantly higher in rural areas, whereas no significant differences were observed for thinness. Various factors were associated with one or both types of malnutrition, and varied by type of setting. To effectively tackle malnutrition, nutritional programs should be oriented to local needs. 相似文献8.
Chun-Yan Li Bo Song Ying-Yan Wang Hua Meng Shi-Bin Guo Li-Na Liu Hai-Chen Lv Qi-Jun Wu 《PloS one》2013,8(6)
Background
Various observational studies have focused on the relationship between menarcheal age and the risk of colorectal cancer (CRC). However, the association is still controversial because of inconsistent results. Therefore, we performed a meta-analysis to assess this issue from epidemiological studies.Methods
After a literature search in MEDLINE, EMBASE, and Web of Science for studies of menarcheal age and CRC risk published through the end of January 2013, we pooled the relative risks (RRs) from included studies using a fixed- or random-effects model and performed heterogeneity and publication bias analyses. All statistical tests were two-sided.Results
Eleven case-control and 11 cohort studies were eligible for inclusion in our analysis. The random-effects pooled RR for oldest versus youngest menarcheal age was 0.95 [95% confidence intervals (CIs) = 0.85–1.06], with significant heterogeneity (Q = 61.03, P<0.001, I 2 = 65.6%). When separately analyzed, case-control (RR = 0.95, 95% CI = 0.75–1.21) and cohort studies (RR = 0.97, 95% CI = 0.90–1.04) yielded similar results. Moreover, similar results were also observed among the subgroup analyses by study quality, population, exposure assessment, anatomic cancer site, subsite of colon cancer, and several potential important confounders and risk factors. There was no evidence of publication bias and significant heterogeneity between subgroups detected by meta-regression analyses.Conclusions
Findings from this meta-analysis demonstrated that menarcheal age was not associated with the risk of CRC in humans. Further studies are warranted to stratify results by the subsite of colon cancer and menopause status in the future. 相似文献9.
Background
Missed appointments are associated with an increased risk of hospitalization and mortality. Despite its widespread prevalence, little data exists regarding factors related to appointment non-adherence among hypertensive African-Americans.Objective
To investigate factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension.Design and Participants
A cross-sectional survey of 185 African-Americans admitted to an urban medical center in Maryland, with severe, poorly controlled hypertension from 1999–2004. Categorical and continuous variables were compared using chi-square and t-tests. Adjusted multivariable logistic regression was used to assess correlates of appointment non-adherence.Main Outcome Measures
Appointment non-adherence was the primary outcome and was defined as patient-report of missing greater than 3 appointments out of 10 during their lifetime.Results
Twenty percent of participants (n = 37) reported missing more than 30% of their appointments. Patient characteristics independently associated with a higher odds of appointment non-adherence included not finishing high school (Odds ratio [OR] = 3.23 95% confidence interval [CI] (1.33–7.69), hypertension knowledge ([OR] = 1.20 95% CI: 1.01–1.42), lack of insurance ([OR] = 6.02 95% CI: 1.83–19.88), insurance with no medication coverage ([OR] = 5.08 95% CI: 1.05–24.63), cost of discharge medications ([OR] = 1.20 95% CI: 1.01–1.42), belief that anti-hypertensive medications do not work ([OR] = 3.67 95% CI: 1.16–11.7), experience of side effects ([OR] = 3.63 95% CI: 1.24–10.62), medication non-adherence ([OR] = 11.31 95% CI: 3.87–33.10). Substance abuse was not associated with appointment non-adherence ([OR] = 1.05 95% CI: 0.43–2.57).Conclusions
Appointment non-adherence among African-Americans with poorly controlled hypertension was associated with many markers of inadequate access to healthcare, knowledge, attitudes and beliefs. 相似文献10.
Ana Paula Silva Marília Greco Maria Arlene Fausto Dirceu B. Greco Mariangela Carneiro 《PloS one》2014,9(10)
Background
There has recently been an increase in HIV infection rates among men who have sex with men (MSM). This study aimed at investigating risk factors associated with incident HIV infection in a MSM cohort–Project Horizonte, Belo Horizonte, Minas Gerais, Brazil.Methodology
This is a nested case-control study in an ongoing open cohort of homosexual and bisexual men, carried out in 1994–2010, during which 1,085 volunteers were enrolled. Each HIV seroconverted volunteer (case) was compared with three randomly selected HIV negative controls, matched by admission date and age (±3 years). During follow-up, 93 volunteers seroconverted and were compared with 279 controls.Principal Findings
The risk factors associated with HIV seroconversion were: contact with partner’s blood during sexual relations (OR 3.7; 95% CI 1.2–11.6), attendance at gay saunas in search for sexual partners (OR 2.6; 95% CI 1.3–5.4), occasional intake of alcohol when flirting and engaging in sexual activity (OR 2.5; 95% CI 1.3–5.1), inconsistent use of condoms in receptive anal sex (OR 2.4; 95% CI 1.1–5.4), little interest to look up information about AIDS (OR 2.6; 95% CI 1.0–6.7) particularly in newspapers (OR 3.4; 95% CI 1.4–8.1).Conclusions
This study shows that MSM are still engaging in risk behavior, such as unprotected anal intercourse, despite taking part in a cohort study on various preventive measures. New preventive strategies in touch with the epidemic’s development and the specificities of this particular population are needed. 相似文献11.
Oriol Vall Mario Gomez-Culebras Carme Puig Ernesto Rodriguez-Carrasco Arelis Gomez Baltazar Lizzeth Canchucaja Xavier Joya Oscar Garcia-Algar 《PloS one》2014,9(1)
Introduction
The use of p,p′-dichlorodiphenyltrichloroethane (DDT) has been banned since the late 1970s due to its toxicity. However, its long half-life makes it persistent in the environment and, consequently, almost everyone has DDT residues in the body. Human milk constitutes an ideal non-conventional matrix to investigate environmental chronic exposure to organochlorine compounds (OCs) residues. The study aimed to identify potential population risk factors of exposure to DDT due to the proximity to countries where it is still used.Methods
Seventy-two consecutive lactating women were prospectively included in Tenerife, Canary Islands (Spain). A validated questionnaire was used to obtain socioeconomic, demographics data, and daily habits during pregnancy. DDT levels in breast milk were measured by gas chromatography with-electron capture detector (GC-ECD). Anthropometrics measurements in newborns were obtained.Results
Thirty-four out of 72 (47.2%) of the analysed milk samples presented detectable levels of DDT (mean: 0.92 ng/g), ranging between 0.08 to 16.96 ng/g. The socio-demographic variables did not significantly differ between detectable DDT and non-detectable DDT groups. We found positive association between DDT levels and vegetables (OR (95%CI): 1.23 (1.01–1.50)) and poultry meat (OR (95%CI): 2.05 (1.16–3.60)) consumption, and also between the presence of DDT in breast milk and gestational age (OR (95%CI): 0.59 (0.40–0.90)).Conclusions
DDT is present in breast milk of women at the time of delivery. Residual levels and the spread from countries still using DDT explain DDT detection from vegetables and from animal origin food. The presence of this compound in breast milk represents a pre- and postnatal exposure hazard for foetuses and infants due to chronic bioaccumulation and poor elimination, with possible deleterious effects on health. This data should be used to raise awareness of the risks of OCs exposure and to help establish health policies in order to avoid its use worldwide and thus, to prevent its propagation. 相似文献12.
Objective
To determine the physical activity level and factors influencing physical activity among pregnant urban Chinese women.Methods
This prospective cross-sectional study enrolled 1056 pregnant women (18–44 years of age) in Tianjin, China. Their socio-demographic characteristics were recorded, and the Pregnancy Physical Activity Questionnaire was used to assess their physical activity during pregnancy. The data were analyzed by multinomial logistic regression with adjustment for potential confounders.Results
Median total energy expenditure of pregnant women in each of the three trimesters ranged from 18.50 to 21.90 metabolic equivalents of task (METs) h/day. They expended 1.76–1.85 MET h/day on moderate and vigorous activities and 0.11 MET h/day on exercise. Only 117 of the women (11.1%) met the international guideline for physical activity in pregnancy (≥150 min moderate intensity exercise per week). The most frequent reason given for not being more physically active was the fear of miscarriage. Higher education level (OR: 4.11, 95% CI: 1.59–10.62), habitual exercise before pregnancy (OR: 2.14, 95% CI: 1.39–3.28), and husbands who exercised regularly (OR: 2.21, 95% CI: 1.33–3.67) significantly increased the odds of meeting the guideline (p<0.001). A low pre gravid body mass index (OR: 0.42, 95% CI: 0.20–0.87) significantly decreased the odds (p<0.001).Conclusions
Few urban Chinese pregnant women met the recommended physical activity guideline. They also expended little energy exercising. Future interventions should be based on the clinic environment and targeting family members as well as the subjects. All pregnant women should be targeted, not just those in high-risk groups. 相似文献13.
Yanzhen Cheng Hua Zhang Rongping Chen Fan Yang Wei Li Lishu Chen Shaoda Lin Ganxiong Liang Dehong Cai Hong Chen 《PloS one》2014,9(7)
Background
Type 2 diabetes is often accompanied by altered cardiometabolic risk profiles, including abdominal obesity, hypertension, and dyslipidaemia. The association of altered cardiometabolic risk profiles with chronic complications of diabetes is not well investigated.Methods
We recruited 2954 type 2 diabetes patients with a body mass index ≥25 kg/m2 who visited the diabetes clinics of 62 hospitals in 21 cities in Guangdong province of China from August 2011 to March 2012. Demographic characteristics, personal and family medical histories, and data on chronic complications of diabetes were collected. Clinical examinations and laboratory assessment were conducted.Results
Abdominal obesity was found in 91.6% of the study population, elevated blood pressure in 78.3%; elevated serum triacylglycerols in 57.8%, and reduced serum HDL-C in 55.9%. Among the cardiometabolic risk factors, elevated blood pressure was significantly associated with almost all the chronic complications of diabetes. After adjusting for age, gender, duration of diabetes, and HbA1c, elevated blood pressure was significantly associated with diabetic retinopathy (OR 1.63, 95% CI: 1.22–2.19), diabetic nephropathy (OR 3.16, 95% CI: 2.25–4.46), cardiovascular disease (OR 2.71, 95% CI: 1.70–4.32), and stroke (OR 1.90, 95% CI: 1.15–3.12). Abdominal adiposity was significantly associated with diabetic nephropathy (OR 1.39, 95% CI: 1.11–1.74). Elevated triacylglycerols was significantly associated with diabetic retinopathy (OR 1.29, 95% CI: 1.05–1.58) and diabetic nephropathy (OR 1.30, 95% CI: 1.05–1.58). Reduced HDL-C was significantly associated with stroke (OR 1.41, 95% CI: 1.05–1.88).Conclusions
Altered cardiometabolic risk profiles, and elevated blood pressure in particular, were significantly associated with chronic complications in overweight and obese patients with type 2 diabetes. Future studies on the prevention of chronic complications of diabetes might make lowering blood pressure a primary target. 相似文献14.
Cheng-Chih Huang Wei-Ting Lee Sen-Tien Tsai Chun-Yen Ou Hung-I Lo Tung-Yiu Wong Sheen-Yie Fang Ken-Chung Chen Jehn-Shyun Huang Jiunn-Liang Wu Chia-Jui Yen Wei-Ting Hsueh Yuan-Hua Wu Ming-Wei Yang Forn-Chia Lin Jang-Yang Chang Kwang-Yu Chang Shang-Yin Wu Jenn-Ren Hsiao Chen-Lin Lin Yi-Hui Wang Ya-Ling Weng Han-Chien Yang Jeffrey S. Chang 《PloS one》2014,9(5)
Background
The current study evaluated the association between tea consumption and head and neck cancer (HNC) in Taiwan, where tea is a major agricultural product and a popular beverage.Methods
Interviews regarding tea consumption (frequency, duration, and types) were conducted with 396 HNC cases and 413 controls. Unconditional logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of HNC risk associated with tea drinking, adjusted for sex, age, education, cigarette smoking, betel quid chewing, and alcohol drinking.Results
A reduced HNC risk associated with tea drinking (OR for every cup per day = 0.96, 95% CI: 0.93–0.99; OR for ≧5 cups per day = 0.60, 95% CI: 0.39–0.94) was observed. The association was especially significant for pharyngeal cancer (OR for every cup per day = 0.93, 95% CI: 0.88–0.98; OR for ≧5 cups per day = 0.32, 95% CI: 0.16–0.66). A significant inverse association between HNC and tea consumption was observed particularly for green tea.Conclusions
This study suggests that tea drinking may reduce the risk of HNC. The anticancer property of tea, if proven, may offer a natural chemopreventive measure to reduce the occurrence of HNC. 相似文献15.
Thomas Niederkrotenthaler Erin M. Parker Fernando Ovalle Rebecca E. Noe Jeneita Bell Likang Xu Melissa A. Morrison Caitlin E. Mertzlufft David E. Sugerman 《PloS one》2013,8(12)
Objectives
We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011.Methods
We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls.Results
Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10–23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04–0.40), bathrooms (OR, 0.22; 95% CI: 0.06–0.78), hallways (OR, 0.31; 95% CI: 0.11–0.90) and closets (OR, 0.25; 95% CI: 0.07–0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09–0.49), television (aOR, 0.45; 95% CI: 0.24–0.83), and sirens (aOR, 0.50; 95% CI: 0.30–0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events.Conclusions
Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available. 相似文献16.
Background
The relationship between passive smoking exposure (PSE) and breast cancer risk is of major interest.Objective
To evaluate the relationship between PSE from partners and breast cancer risk stratified by hormone-receptor (HR) status in Chinese urban women population.Design
Hospital-based matched case control study.Setting
Chinese urban breast cancer patients without current or previous active smoking history in China Medical University 1st Hospital, Liaoning Province, China between Jan 2009 and Nov 2009.Patients
Each breast cancer patient was matched 1∶1 with healthy controls by gender and age (±2 years) from the same hospital.Measurements
The authors used unconditional logistic regression analyses to estimate odds ratio for women with PSE from partners and breast cancer risk.Results
312 pairs were included in the study. Women who endured PSE had significantly increased risk of breast cancer (adjusted OR: 1.46; 95% CI: 1.05–2.03; P = 0.027), comparing with unexposed women. Women who exposed to >5 cigarettes/day also had significant increased risk (adjusted OR: 1.99; 95% CI: 1.28–3.10; P = 0.002), as were women exposed to passive smoke for 16–25 years (adjusted OR: 1.87 95% CI: 1.22–2.86; P = 0.004), and those exposed to > 4 pack-years (adjusted OR: 1.71 95% CI: 1.17–2.50; P = 0.004). Similar trends were significant for estrogen receptor (ER)/progesterone receptor (PR) double positive subgroup(adjusted OR: 1.71; 2.20; 1.99; 1.92, respectively), but not for ER+/PR−, ER−/PR+, or ER−/PR− subgroups.Limitations
limitations of the hospital-based retrospective study, lack of information on entire lifetime PSE and low statistical power.Conclusions
Our findings provide further evidence that PSE from partners contributes to increased risk of breast cancer, especially for ER/PR double positive breast cancer, in Chinese urban women. 相似文献17.
Martin Floer Erwin Biecker Rüdiger Fitzlaff Hermann R?ming Detlev Ameis Achim Heinecke Steffen Kunsch Volker Ellenrieder Philipp Str?bel Michael Schepke Tobias Meister 《PloS one》2014,9(12)
Objectives
The Endocuff is a device mounted on the tip of the colonoscope to help flatten the colonic folds during withdrawal. This study aimed to compare the adenoma detection rates between Endocuff-assisted (EC) colonoscopy and standard colonoscopy (SC).Methods
This randomized prospective multicenter trial was conducted at four academic endoscopy units in Germany. Participants: 500 patients (235 males, median age 64[IQR 54–73]) for colon adenoma detection purposes were included in the study. All patients were either allocated to EC or SC. The primary outcome measure was the determination of the adenoma detection rates (ADR).Results
The ADR significantly increased with the use of the Endocuff compared to standard colonoscopy (35.4%[95% confidence interval{CI} 29–41%] vs. 20.7%[95%CI 15–26%], p<0.0001). Significantly more sessile polyps were detected by EC. Overall procedure time and withdrawal time did not differ. Caecal and ileum intubation rates were similar. No major adverse events occurred in both groups. In multivariate analysis, age (odds ratio [OR] 1.03; 95%[CI] 1.01–1.05), male sex (OR 1.74; 95%CI 1.10–2.73), withdrawal time (OR 1.16; 95%CI 1.05–1.30), procedure time (OR 1.07; 95%CI 1.04–1.10), colon cleanliness (OR 0.60; 95%CI 0.39–0.94) and use of Endocuff (OR 2.09; 95%CI 1.34–3.27) were independent predictors of adenoma detection rates.Conclusions
EC increases the adenoma detection rate by 14.7%(95%CI 6.9–22.5%). EC is safe, effective, easy to handle and might reduce colorectal interval carcinomas.Trial Registration
ClinicalTrials.gov . NCT02034929相似文献18.
Derk L. Arts Stefan Visscher Wim Opstelten Joke C. Korevaar Ameen Abu-Hanna Henk C. P. M. van Weert 《PloS one》2013,8(7)
Objective
To determine adequacy of antithrombotic treatment in patients with non-valvular atrial fibrillation. To determine risk factors for under- and over-treatment.Design
Retrospective, cross-sectional study of electronic health records from 36 general practitioners in 2008.Setting
General practice in the Netherlands.Subjects
Primary care physicians (n = 36) and patients (n = 981) aged 65 years and over.Main Outcome Measures
Rates of adequate, under and over-treatment, risk factors for under and over-treatment.Results
Of the 981 included patients with a mean of age 78, 18% received no antithrombotic treatment (under-treatment), 13% received antiplatelet drugs and 69% received oral anticoagulation (OAC). Further, 43% of the included patients were treated adequately, 26% were under-treated, and 31% were over-treated. Patients with a previous ischaemic stroke were at high risk for under-treatment (OR 2.4, CI 1.6–3.5), whereas those with contraindications for OAC were at high risk for over-treatment (OR 37.0, CI 18.1–79.9). Age over 75 (OR 0.2, CI: 0.1–0.3]), diabetes (OR 0.1, CI: 0.1–0.3), heart failure (OR 0.2, CI: 0.1–0.3), hypertension (OR 0.1, CI: 0.1–0.2) and previous ischaemic stroke (OR 0.04, CI: 0.02–0.11) protected against over-treatment.Conclusions
In general practice, CHADS2-criteria are being used, but the antithrombotic treatment of patients with atrial fibrillation frequently deviates from guidelines on this topic. Patients with previous stroke are at high risk of not being prescribed OAC. Contraindications for OAC, however, seem to be frequently overlooked. 相似文献19.
Maria Melchior évelyne Touchette Elena Prokofyeva Aude Chollet Eric Fombonne Gulizar Elidemir Cédric Galéra 《PloS one》2014,9(12)
Background
Common negative events can precipitate the onset of internalizing symptoms. We studied whether their occurrence in childhood is associated with mental health trajectories over the course of development.Methods
Using data from the TEMPO study, a French community-based cohort study of youths, we studied the association between negative events in 1991 (when participants were aged 4–16 years) and internalizing symptoms, assessed by the ASEBA family of instruments in 1991, 1999, and 2009 (n = 1503). Participants'' trajectories of internalizing symptoms were estimated with semi-parametric regression methods (PROC TRAJ). Data were analyzed using multinomial regression models controlled for participants'' sex, age, parental family status, socio-economic position, and parental history of depression.Results
Negative childhood events were associated with an increased likelihood of concurrent internalizing symptoms which sometimes persisted into adulthood (multivariate ORs associated with > = 3 negative events respectively: high and decreasing internalizing symptoms: 5.54, 95% CI: 3.20–9.58; persistently high internalizing symptoms: 8.94, 95% CI: 2.82–28.31). Specific negative events most strongly associated with youths'' persistent internalizing symptoms included: school difficulties (multivariate OR: 5.31, 95% CI: 2.24–12.59), parental stress (multivariate OR: 4.69, 95% CI: 2.02–10.87), serious illness/health problems (multivariate OR: 4.13, 95% CI: 1.76–9.70), and social isolation (multivariate OR: 2.24, 95% CI: 1.00–5.08).Conclusions
Common negative events can contribute to the onset of children''s lasting psychological difficulties. 相似文献20.
《PloS one》2014,9(1)