Predicting contraceptive use in Bangladesh: a logistic regression analysis

Family planning knowledge, attitude and practice surveys typically assess respondents' reproductive attitudes and intentions to use contraception. Longitudinal observation of individual respondents nevertheless shows that such questions are not strongly predictive of subsequent behaviour. This study examines 3 years' data which show that a set of such responses to questions are nevertheless substantially superior in predicting behaviour than any single indicator. Thus statistical techniques which bring into account the apparent multidimensionality of contraceptive motivation can greatly improve upon the estimation of future practice of family planning in a population.     

Horse Husbandry and Preventive Health Practices in Australia: An Online Survey of Horse Guardians

Little is known about the horse health management practices of Australian horse caregivers (owners). This article presents findings from a convenience sample of 505 horse owners who participated in an online survey. No large-scale welfare issues were identified, but there were some areas of potential concern, including owners who did not regularly deworm their horses (4%), a lack of strategic parasite control (3.1%), and a lack of regular dental care (11%). Several participants did not have their horse’s hooves regularly shod or trimmed (2%), and 14% had an unqualified person maintain their horse’s hooves. One in five owners (19%) did not vaccinate their horses against tetanus. The findings are discussed in relation to current Australian horse health guidelines and traditional sources of horse health information, together with recommendations for providing horse owners with relevant information in relevant forms.     

Longitudinal study of obesity in the National Survey of Health and Development.

In a nationally representative cohort of 5362 children born in one week in March 1946 weights and heights were recorded at 6, 7, 11, 14, 20, and 26 years. Overweight was defined as a weight that exceeded the standard weight for height, age, and sex by more than 20% (relative weight greater than 120%). The prevalence of overweight was 1.7% and 2.9% in boys and girls respectively at 6 years; 2.0% and 3.8% at 7 years; 6.4% and 9.6% at 11 years; 6.5% and 9.6% at 14 years; 5.4% and 6.5% at 20 years; and 12.3% and 11.2% at 26 years. The risk of being overweight in adulthood was related to the degree of overweight in childhood and was about four in 10 for overweight 7-year-olds. Analysis of the data in the reverse direction showed that 7% and 13% respectively of 26-year-old overweight men and women had been overweight at the age of 7. These results suggest that there is no optimal age during childhood for the prediction of overweight in adult life and that excessive weight gain may begin at any time. Overweight children are more likely to remain overweight than their contemporaries of normal weight are to become overweight.     

Return of fertility after use of the injectable contraceptive Depo Provera: up-dated data analysis

796 Thai women who stopped using the long-acting injectable contraceptive depot medroxyprogesterone acetate (DMPA, Depo Povera), 437 women who stopped using oral contraceptives and 125 women who had an IUD removed to have a planned pregnancy, were followed up to ascertain the delay to conception after the end of contraception and to determine the proportion of women who did not conceive in the 4 years after discontinuation. The median delay to conception was 5.5 months plus the estimated duration of the effect of the last injection of DMPA, 3 months for oral contraceptives and 4.5 months after discontinuing the IUD. The proportion of women who did not conceive within 9 months after discontinuation of DMPA is similar to that of ex-IUD users, and by 3 years to that of the ex-pill sample. There is no evidence to suggest that prolonged use of DMPA increases the delay to conception. The return of fertility among never pregnant ex-users resembled that of ever pregnant ex-users. There were comparable proportons of live births among ex-DMPA users and ex-pill users and both of these showed higher proportions of live-births than ex-IUD users. There was no evidence to suggest that previous use of DMPA had any significant adverse effect on the outcome of pregnancy of the subsequent births. This study did not show any association between infertility and the previous use of DMPA or other contraceptives.     

The Association Between Sleep Duration and General and Abdominal Obesity in Koreans: Data From the Korean National Health and Nutrition Examination Survey, 2001 and 2005

This study aimed to investigate the association between self‐reported sleep duration and general and abdominal obesity in Korean adults. A total of 8,717 adults aged 20–65 years from the Korean National Health and Nutrition Examination Survey (KNHANES) 2001 and 2005 were included. General obesity was defined as BMI ≥25 kg/m² and abdominal obesity as waist circumference ≥90 cm in men and ≥85 cm in women. To control for sociodemographic and lifestyle factors and comorbidities, multivariable logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of general and abdominal obesity across the following sleep duration categories: ≤5, 6, 7, 8, and ≥9 h/day. Mean sleep duration (±s.d.) was 6.9 ± 1.3 h. Those sleeping ≤5 h/day had the highest BMI and waist circumference compared with those sleeping 7, 8, or ≥9 h/day (P < 0.05 for all comparisons). After controlling for sociodemographic and lifestyle factors, the adjusted ORs (95% CIs) associated with sleeping ≤5 h/day (vs. 7 h/day) were 1.25 (1.06–1.48) for general obesity and 1.24 (1.03–1.48) for abdominal obesity. Further adjustment for hypertension and diabetes mellitus did not significantly affect the associations. These data suggest that short sleep duration is significantly associated with a modest increase in general and abdominal obesity in Korean adults.     

The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey

Background

Most knowledge of fibromyalgia comes from the clinical setting, where healthcare-seeking behavior and selection issues influence study results. The characteristics of fibromyalgia in the general population have not been studied in detail.

Methods

We developed and tested surrogate study specific criteria for fibromyalgia in rheumatology practices using variables from the US National Health Interview Survey (NHIS) and the modification (for surveys) of the 2010 American College of Rheumatology (ACR) preliminary fibromyalgia criteria. The surrogate criteria were applied to the 2012 NHIS and identified persons who satisfied criteria from symptom data. The NHIS weighted sample of 8446 persons represents 225.7 million US adults.

Results

Fibromyalgia was identified in 1.75% (95% CI 1.42, 2.07), or 3.94 million persons. However, 73% of identified cases self-reported a physician’s diagnosis other than fibromyalgia. Identified cases had high levels of self-reported pain, non-pain symptoms, comorbidity, psychological distress, medical costs, Social Security and work disability. Caseness was associated with gender, education, ethnicity, citizenship and unhealthy behaviors. Demographics, behaviors, and comorbidity were predictive of case status. Examination of the surrogate polysymptomatic distress scale (PSD) of the 2010 ACR criteria found fibromyalgia symptoms extending through the full length of the scale.

Conclusions

Persons identified with criteria-based fibromyalgia have severe symptoms, but most (73%) have not received a clinical diagnosis of fibromyalgia. The association of fibromyalgia-like symptoms over the full length of the PSD scale with physiological as well as mental stressors suggests PSD may be a universal response variable rather than one restricted to fibromyalgia.     

Biomarkers of Exposure to Polycyclic Aromatic Hydrocarbons and Cognitive Function among Elderly in the United States (National Health and Nutrition Examination Survey: 2001-2002)

Recent studies report a link between common environmental exposures, such as particulate matter air pollution and tobacco smoke, and decline in cognitive function. The purpose of this study was to assess the association between exposure to polycyclic aromatic hydrocarbons (PAHs), a selected group of chemicals present in particulate matter and tobacco smoke, and measures of cognitive performance among elderly in the general population. This cross-sectional analysis involved data from 454 individuals aged 60 years and older from the 2001–2002 National Health and Nutrition Examination Survey. The association between PAH exposures (as measured by urinary biomarkers) and cognitive function (digit symbol substitution test (DSST)) was assessed using multiple linear regression analyses. After adjusting for age, socio-economic status and diabetes we observed a negative association between urinary 1-hydroxypyrene, the gold standard of PAH exposure biomarkers, and DSST score. A one percent increase in urinary 1-hydroxypyrene resulted in approximately a 1.8 percent poorer performance on the digit symbol substitution test. Our findings are consistent with previous publications and further suggest that PAHs, at least in part may be responsible for the adverse cognitive effects linked to tobacco smoke and particulate matter air pollution.     

A Delphi Survey and Analysis of Expert Perspectives on One Health in Australia

One Health (OH) is an interdisciplinary approach aiming to achieve optimal health for humans, animals and their environments. Case reports and systematic reviews of success are emerging; however, discussion of barriers and enablers of cross-sectoral collaboration are rare. A four-phase mixed-method Delphi survey of Australian human and animal health practitioners and policymakers (n = 52) explored areas of consensus and disagreement over: (1) the operational definition of OH; (2) potential for cross-sectoral collaboration; and (3) key priorities for shaping the development of an OH response to significantly elevated zoonotic disease risk. Participants agreed OH is essential for effective infectious disease prevention and control, and on key priorities for outbreak responses, but disagreed over definitions and the relative priority of animal health and welfare and economic considerations. Strong support emerged among Australian experts for an OH approach. There was also recognition of the need to ensure cross-sectoral differences are addressed.     

Hepatitis C virus screening trends: A 2016 update of the National Health Interview Survey

Background50% of liver cancer is caused by hepatitis C virus (HCV). Baby boomers are at increased risk and are recommended for one-time HCV screening. However, <13% of baby boomers were screened in 2015.Materials and methodsWe are updating a previous study using 2013–2015 NHIS data to examine HCV screening prevalence by birth cohort, with 2016 data. We used logistic regression to evaluate whether HCV screening prevalence changed over time, stratified by birth cohort.Results and discussionThe sample consisted of 132,742 participants from 2013–2016. Screening increased in baby boomers from 11.9 to 14.1%. Odds of HCV screening for baby boomers was significantly associated with age, gender, race/ethnicity, and other variables and increased significantly with each subsequent year (aOR = 1.21, aOR = 1.33, aOR = 1.42, consecutively). While HCV screening is increasing over time, there is still room for improvement and future interventions should focus on increasing HCV screening among groups demonstrating significantly lower screening prevalence.     

Determinants of contraceptive use in Nepal

This 1981 study is the 1st of its kind in Nepal. Analysis using a logit-linear model showed that contraceptive use in Nepal depends on many factors. Women aged 35-49 are 3 times more likely than women aged 15-24 to use contraceptives. Women with 4 or more children are 8 times more likely to use contraceptives than women with 1 or no children, and 2.5 times more likely than women with 2 or 3 children. The use of contraceptives is greatest among women whose offspring includes more sons than daughters, and least among women whose offspring are all daughters. Women who desire no more children are 5 to 6 times more likely to use contraceptives than women who desire more children. Women who have discussed desired family size with their husbands are more than 4 times more likely to use contraceptives than women lacking this type of communication. Women with some schooling are twice as likely to use contraceptives as women with no schooling. Contraceptive use is higher among women who do nonfarm work than farm work, and higher still among women who do not work. Urban women were almost twice as likely to use contraceptives as rural women. Women with less than 1 hour access to a family planning service outlet were 2 to 3 times more likely to use contraceptives than women whose access to these facilities was greater than 1 hour. The number of previous child losses per woman had no significant effect in contraceptive use. Conclusions are based on analysis of data from the Nepal Contraceptive Prevalence Survey, 1981.     

Patient Referral Patterns and the Spread of Hospital-Acquired Infections through National Health Care Networks

Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2004 to measure the connectedness between hospitals. This allowed us to reconstruct the network of hospitals in the Netherlands. We used mathematical models to assess the effect of different patient referral patterns on the potential spread of hospital-acquired infections between hospitals, and between categories of hospitals (University medical centers, top clinical hospitals and general hospitals). University hospitals have a higher number of shared patients than teaching or general hospitals, and are therefore more likely to be among the first to receive colonized patients. Moreover, as the network is directional towards university hospitals, they have a higher prevalence, even when infection control measures are equally effective in all hospitals. Patient referral patterns have a profound effect on the spread of health care-associated infections like hospital-acquired MRSA. The MRSA prevalence therefore differs between hospitals with the position of each hospital within the health care network. Any comparison of MRSA rates between hospitals, as a benchmark for hospital hygiene, should therefore take the position of a hospital within the network into account.     

Prevalence of Diabetes in the Republic of Ireland: Results from the National Health Survey (SLAN) 2007

Background

Current estimates of diabetes prevalence in the Republic of Ireland (RoI) are based on UK epidemiological studies. This study uses Irish data to describe the prevalence of doctor-diagnosed diabetes amongst all adults aged 18+ years and undiagnosed diabetes amongst those aged 45+ years.

Methods

The survey of lifestyle attitudes and nutrition (SLAN) 2007 is based on a nationally representative sample of Irish adults aged 18+ years (n = 10,364). Self-reported doctor-diagnosed diabetes was recorded for respondents in the full sample. Diabetes medication use, measured height and weight, and non-fasting blood samples were variously recorded in sub-samples of younger (n = 967) and older (n = 1,207) respondents.

Results

The prevalence of doctor-diagnosed diabetes amongst adults aged 18+ years was 3.5% (95% CI 3.1% - 3.9%). After adjustment for other explanatory variables; the risk of self-reported doctor-diagnosed diabetes was significantly related to age (p < 0.0001), employment status (p = 0.0003) and obesity (p = 0.0003). Amongst adults aged 45+ years, the prevalence of doctor-diagnosed diabetes was 8.9% (95% CI 7.3% -10.5%) and undiagnosed diabetes was 2.8% (95% CI 1.4% - 4.1%). This represented 31.2% of diabetes cases in this age group.

Conclusion

Notwithstanding methodological differences, these prevalence estimates are consistent with those in the UK and France. However, the percentage of undiagnosed cases amongst adults aged 45+ years appears to be higher in the RoI. Increased efforts to improve early detection and population level interventions to address adverse diet and lifestyle factors are urgently needed.