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PubMed2001

Socioeconomic, demographic, occupational, and health factors associated with participation in a long-term epidemiologic survey: a prospective study of the French GAZEL cohort and its target population.

The purpose of this paper is to examine personal and health factors, both at the beginning of the study and thereafter, associated with participation in the GAZEL cohort, set up in 1989 in a large French company. The authors used logistic regression to analyze the associations between participation and data available for both participants (n = 20,093) and nonparticipants (n = 24,829). Higher participation was associated with male sex, marriage, children, managerial status, and residence in particular regions. Among men, lower participation was associated with sick leave in the year before recruitment and afterwards. During follow-up, participation was negatively associated with several groups of diseases, especially those associated with alcohol consumption. The risk of upper respiratory and digestive tract and lung cancer during follow-up was higher among nonparticipants. The same phenomenon occurred among women, but less markedly, for cancers of the breast and genital organs. During follow-up, mortality among men was higher among nonparticipants, especially for alcohol-related diseases. The association among women was less strong. Among men, but not among women, diseases caused by alcohol, smoking, or dangerous behavior were the primary reason for the health differences observed between participants and nonparticipants. Overall, the most important determinants of participation were cultural factors and lifestyle behaviors.

Absenteeism↗
PubMed2002

Studies of impact on physical fitness and working capacity of patients with advanced Schistosomiasis japonica in Susong County, Anhui Province.

To assess the impact level on physical fitness and working capacity in patients with advanced Schistosomiasis japonica, a field study was carried out. According to the records of patients with advanced schistosomiasis in Susong County, Anhui Province, 48 advanced cases without other serious chronic diseases from endemic areas in two townships and 56 healthy individuals from non-endemic area, served as control group with matched ages between 40 and 70 years and matched sex were investigated with questionnaire, anthropometric measure and hemoglobin level. The impairment level of the liver was measured by ultrasonography and physical fitness was measured by the Step test in the case and control groups. All situations including lifestyle, working, socio-economic status and residing environment was similar in the case and control groups. Average height and weight was significantly lower in the case group than in the control group (height = 156.29 and 159.41 cm; weight = 50.72 and 53.92 kg; respectively, all P < 0.05). Thirteen individuals (28.3%) in the case group had moderate reduction of working capacity or even unable to work, but only seven (12.7%) individuals in the control group had moderate reduction of working capacity and all in the control group were able to work (P < 0.01). In the past 1 year, the average working days lost was 4.11 days in the case group and 0.86 day in the control group (P < 0.01). Both groups differed significantly in symptoms of abdominal pain, diarrhea and weakness (all P < 0.05). Twenty-one cases (43.8%) had grade II impairment of the liver and eight cases (16.7%) had grade III impairment of the liver in the case group, whereas seven individuals (12.7%) had grade II impairment of the liver in the control group (P < 0.01), as assessed by ultrasound. The hemoglobin levels and the power of gripping in the case group were significantly lower than those in the control group (Hb = 111.06 and 122.27 g/l; grip = 303.83 and 344.20 N, respectively, all P < 0.01). Physical fitness scores showed the control group (score: 71.84) was significantly fitter than the case group (score: 61.09, P < 0.01). Compared with the control group, the physical fitness of the case group reduced by 15%. The results showed that physical fitness and working capacity were reduced in advanced cases. Although most of the cases were treated and had reached a status of 'clinical cure', the impact on physical fitness and working capacity still existed.

Adult↗
PubMed2005

[The prevalence of osteoporosis and associated health care use in women 45 years and older in Germany. Results of the first German Telephone Health Survey 2003].

The prevalence of osteoporosis and associated factors were assessed among women 45 years and older as part of the first nationwide German Telephone Health Survey (GSTel03). A total of 14.2% of women reported that a doctor had ever diagnosed them with osteoporosis. Among these about, 15% also reported a physician-diagnosed fragility fracture, the fracture question was restricted to the subgroup of women with osteoporosis. Point estimates of overall osteoporosis prevalence increased significantly across 10-year age bands from 4% in the lowest to 30% in the highest age group. There was no significant association of osteoporosis with socioeconomic status or residence in former East vs West Germany; however, osteoporosis was significantly overrepresented among women with a migration background in comparison to women born in Germany (age-adjusted odds ratio: 1.68; 95% CI: 1.07-2.63). In age-adjusted logistic regression models, osteoporosis was significantly related to physician-diagnosed arthritis or rheumatoid arthritis, significant stature loss (>5 cm) compared to height at age 25 years, postmenopausal hormone therapy, lower ratings of subjective health as well as increased utilization of health care services. No significant association was observed with body mass index computed from self-reported height and weight. In conclusion, despite methodological limitations, these population-based, representative data support the observation that osteoporosis is a prevalent and serious health problem among older women and reflect the considerable variability with regard to diagnosis and management of this condition. Studies evaluating quality of care as well as monitoring of disease endpoints and risk factors based on representative samples of the population are needed.

Adult↗
PubMed1990

Two neglected categories of immigrants to Canada: temporary immigrants and returning Canadians.

Results are presented from an attempt to improve Canadian statistics on international migration so as to comply with U.N. guidelines by including data on long-term residents with temporary status and Canadian citizens and permanent residents returning from abroad. "The estimation procedures involve extensive operations on three Canadian administrative data systems: the Visitors Immigration Data System of Employment and Immigration Canada; the Family Allowances Files of Health and Welfare Canada; and the Customs and Excise Files of Revenue Canada. These data are used to produce the number of immigrants in both of the neglected categories, as well as to calculate the geographic (origin and destination) and demographic (sex, age, marital status) structures of these groups. Results of the analysis of estimates for the period 1982-1988 show that, due to their size and characteristics, both of these neglected categories of immigrants constitute a significant part of immigration to Canada, and their importance has and will continue to increase over time."

Americas↗
PubMed2001

Folate status in women of childbearing age residing in Southern California after folic acid fortification.

OBJECTIVE: The purpose of this study was to investigate folate status in healthy, nonpregnant women (18 to 45 years) following folic acid (FA) fortification of the food supply. DESIGN: This was a cross-sectional study design in which a fasting blood sample was obtained from socio-economically advantaged (n=85) and disadvantaged (n=50) women residing in Southern California who had not consumed supplemental FA within the past 12 months. Serum folate (SF), red cell folate (RCF) and plasma homocysteine (tHcy) concentrations were measured and methylene tetrahydrofolate reductase (MTHFR) genotype (C677T) was determined. RESULTS: SF and RCF concentrations (mean+/-SD) for socio-economically advantaged (54+/-18, 1387+/-329 nmol/L, respectively) and disadvantaged women (41+/-18, 1172+/-342 nmol/L, respectively) greatly exceeded the levels deemed acceptable for SF (> or = 13.6 nmol/L) and RCF (> or = 362 nmol/L). Moreover, 95% of socio-economically advantaged women and 78% of disadvantaged women achieved RCF concentrations > or = 906 nmol/L, which are associated with very low risk of neural tube defects (NTD). Plasma tHcy concentrations for both socio-economically advantaged (5.2+/-1.6 micromol/L) and disadvantaged women (6.1+/-1.6 micromol/L) were within the lower limit of normal range and indicative of adequate folate status. For the combined groups (n=135), the frequency of the C/C, C/T and T/T genotype was 56.0, 37.3 and 6.7%, respectively. MTHFR genotype was not associated with SF, RCF or tHcy. CONCLUSIONS: These data suggest that women of childbearing age are achieving positive folate balance and RCF concentrations associated with reduced risk of NTD following FA fortification of the food supply.

Adolescent↗
PubMed2004

Less affluent area of residence and lesser-insured status predict an increased risk of death or myocardial infarction after angiographic diagnosis of coronary disease.

PURPOSE: Low socioeconomic status (SES) predicts coronary artery disease (CAD) onset, but its value among patients with CAD is uncertain. Geographic measures (e.g., residential neighborhood) may predict risk, but this requires further evaluation. METHODS: A cohort of 3410 patients with significant, angiographically-defined CAD (> or =1 lesion of > or =70% stenosis) joined a registry during the period between 1993 and 2000 and was followed for 6.7 years (median 3.7 years). A geographic SES measure-residential economic status (RES)-and insurance type were examined for association with mortality or myocardial infarction (MI). RESULTS: In Cox regression adjusting for 17 covariates, lower RES quartile was associated with increased death/MI (p-trend<0.001), death (p-trend=0.001), and MI (p-trend=0.07). First RES quartile (vs. fourth) predicted death/MI (hazard ratio [HR]=1.32, 95% confidence interval [CI]=1.07-1.62, p=0.01) and death (HR=1.46, CI=1.12-1.91, p=0.006), but not MI (HR=1.18, p=0.31). Compared with private insurance, self-pay (HR=1.88, p=0.053), charity care (HR=1.71, p<0.001), and Medicaid (HR=1.43, p=0.24), but not Medicare (HR=0.95, p=0.68), were associated with death/MI. CONCLUSIONS: Both geographic (RES) and economic (insurance) measures of SES independently predicted risk of death/MI in a large population with angiographically-defined CAD. This suggests that SES remains a significant predictor of health outcomes after CAD has developed, and that geographic measures of SES deserve further evaluation.

Adult↗
PubMed2003

[Concentrations of selected bioelements and toxic metals and their influence on health status of children and youth residing in Szczecin].

This study was performed in 174 children (59 boys and 115 girls) residing in Szczecin. The objective was to measure the concentrations of heavy metals--lead and cadmium--and some bioelements--magnesium, zinc, copper, calcium, and iron--and to establish relationships between concentrations of elements in serum, erythrocytes, and hair. Mean concentrations of lead in serum and erythrocytes were 0.003 micromol/L (0.07 microg/dL) and 0.96 micromol/L (2.0 microg/dL), respectively (Table 1). Mean concentrations of cadmium in serum and erythrocytes were 0.006 micromol/L (0.07 microg/dL) and 0.02 micromol/L (0.21 microg/dL), respectively (Table 4). In both cases, the maximum allowable concentrations were not exceeded. In hair, the concentrations exceeded the maximum allowable concentration, reaching 0.006 micromol/g dry mass (1.2 microg/g d.m.) for lead and 0.0008 micromol/g d.m. (0.1 microg/g d.m.) for cadmium (Table 3). A positive correlation was found between the concentration of lead in erythrocytes and hair (r = 0.37, p < 0.000001). Concentrations of magnesium in serum and erythrocytes were below the normal range, but were within norm in hair. Mean concentrations of total magnesium in serum, erythrocytes, and hair were 0.69 mmol/L (1.7 mg/dL), 1.6 mmol/L (3.9 mg/dL), and 0.9 micromol/g d.m. (21.5 microg/g d.m.(, respectively (Table 4). 35 children with hypomagnesemia and elevated concentrations of lead and cadmium were placed on magnesium supplementation with Laktomag B6 preparation. This led to significant reduction in the concentrations of lead and cadmium in erythrocytes and hair. Mean concentration of lead diminished from 0.28 micromol/L (5.8 microg/dL) to 0.17 micromol/L (3.6 microg/dL) (p < 0.03) in erythrocytes and from 0.014 micromol/g d.m. (2.9 microg/g d.m.) to 0.007 micromol/g d.m. (1.5 microg/g d.m.) (p < 0.001) (table 5). Mean concentration of cadmium diminished from 0.02 micromol/L (0.23 microg/dL) to 0.015 micromol/L (0.17 microg/dL) in erythrocytes (p < 0.002) and from 0.009 micromol/g d.m. (0.1 microg/g d.m.) to 0.0009 micromol/g d.m. (0.01 microg/g d.m.) in hair (p < 0.02) (Table 6). Magnesium supplementation caused a significant increase in ionized magnesium in serum and and insignificant increase in erythrocytes and hair. No correlations were found in the examined children between hypomagnesemia, elevated levels of lead and cadmium in blood and hair, and health status.

Adolescent↗
PubMed1987

The mortality in an age cohort followed from birth to age 70.

The Study of Men Born in 1913 is a prospective population study of cardiovascular diseases in Gothenburg, Sweden, that started in 1963. To describe survival curves and mortality pattern, all boy-children born alive in 1913 in the city of Gothenburg, were identified. This birth cohort was followed from birth to age 70 for residence, vital status and cause of death. At the age of 50 years, 25% of the birth cohort were dead and at age 70, 43% had died. The high infant mortality and the great impact of infectious diseases in the beginning of this century is illustrated. The death rate for the cohort was almost identical to national figures for men in the same age group. Men who migrated from Gothenburg had a death rate very similar to those who stayed. It can therefore be concluded that the men in the Study of Men Born in 1913 is a representative sample not only of men in Gothenburg but also of men in Sweden as far as mortality is concerned. Special attention was paid to death from otitis media complications, congestive heart failure, and diabetes. Few persons died from these diseases before age 50 when the prospective study started and therefore did not influence the study of the natural history for these conditions to any great extent. Otitis media infections might be studied retrospectively from this age.

Aged↗
PubMed2004

Clinical characteristics of young-onset hypertension-implications for different genders.

BACKGROUND: Hypertension may develop early, before the age of 40 years, in both genders, so-called young-onset hypertension. The clinical characteristics of young-onset hypertension have not been well defined. METHODS: The personal history and clinical characteristics were evaluated in a series of patients with young-onset hypertension. With the individual-matching, case-controlled design, patients were initially matched for age, gender and residence with the first control (C1) group in either 2:1 or 1:1 fashion. They were then additionally matched for body mass index (BMI) with the second control (C2) group in 1:1 fashion. To elucidate the possible difference between genders, all the comparisons were conducted in males and females separately. RESULTS: A total of 82 consecutive patients, 56 males and 26 females, with young-onset hypertension were included. Compared with the 148 subjects in C1 group, hypertensive patients were relatively highly educated and had less alcohol drinking in either gender. BMI (25.10+/-0.49 vs. 22.34+/-0.31 kg/m(2), P<0.001) and serum triglyceride level (153.35+/-10.71 vs. 98.76+/-5.12 mg/dl, P<0.001) were significantly increased in male patients, while serum uric acid (5.74+/-0.34 vs. 4.78+/-0.17 mg/dl, P=0.006) and triglyceride level (121.39+/-12.71 vs. 76.58+/-4.88 mg/dl, P=0.002) were increased in female ones. Compared to that in C2 group, serum triglyceride level was still increased in patients of either gender. Interestingly, serum cholesterol level in female patients was lower than that in either C1 or C2 group. Further, serum triglyceride level was significantly correlated to BMI, serum cholesterol and glucose level in male patients but only to serum uric acid level in female ones. CONCLUSIONS: Clinical characteristics of young-onset hypertension were unique and different by gender. Though consistently increased in patients of either gender, serum triglyceride level was correlated to BMI, serum cholesterol and glucose level only in males, suggesting the gender-specific presence of metabolic syndrome in young-onset hypertension.

Adult↗
PubMed1998

Nutritional potassium status of healthy adult males residing in the rural northeast Thailand.

Sixteen villages from rural areas of 8 provinces in the northeastern region of Thailand were randomly selected as study sites. Data on potassium (K) contents in 24-hour urine and serum samples of 93 healthy adult volunteer males aged 20-50 years old were completely collected and covered all 3 seasons of the year. The method of direct weighing of food was used to assess K intake in 13 subjects. K loss through sweat during working (9 hours) in the field was measured in 14 subjects by soaking their worn-clothes in distilled water after which K contents were measured by the flame photometry method. The results showed that the means urinary K excretion of 93 subjects were less than that of the cut-off value for normal (> or = 30 mmol/day) in all seasons of which 76.71%, 90.71% and 81.02% of the urine were categorized as hypokaliuria in the hot, rainy and cold seasons, respectively. In the case of serum K of these subjects, though the mean values were within a normal limit (> or = 3.5 mmol/l), 36.56%, 34.41% and 29.03% of the serum were classified as hypokalemia in the hot, rainy and cold seasons, respectively. In the assessment of K intake, it was clearly demonstrated that the values in all 3 seasons were much lower than that of the estimated safe and adequate daily dietary intake (ESADI) of K for the westerners (1975-5625 mg/day), i.e., the means of intake in the hot, rainy and cold seasons were only 807 +/- 172, 877 +/- 257 and 902 +/- 227 mg/day, respectively. Furthermore, K loss through sweat in the cold and the hot seasons were as high as a third (7.4 +/- 2.4 mmol/day) and a half (11.5 +/- 1.6 mmol/day), respectively, of the urinary excretion. Though the total body K contents were not evaluated in this study, our results suggest rural people in the northeast region of Thailand may be in a state of K deficiency. The severity is probably worsened in the hot season as seen from the tendency of decrease in serum K levels among 650 renal stone formers and 260 blood donors in this season.

Adult↗
PubMed1998

Severe dental fluorosis in a Tanzanian population consuming water with negligible fluoride concentration.

OBJECTIVES: To identify risk factors for dental fluorosis that cannot be explained by drinking water fluoride concentration alone. METHODS: Two hundred eighty-four Tanzanian children ages 9 to 19 (mean 14.0+/-SD 1.69), who were lifetime residents at differing altitudes (Chanika, 100 m; Rundugai, 840 m; and Kibosho, 1,463 m; Sites 1, 2, and 3 respectively) were examined for dental fluorosis and caries. They were interviewed about their food habits, environmental characteristics and use of a fluoride-containing food tenderizer known locally as magadi. Meal, urine, water and magadi samples supplied by the participants were analyzed for fluoride content. Urine samples were also analyzed for creatinine concentration. Four magadi samples from Sites 1 and 3 were analyzed for complete element composition. RESULTS: Of the 13 water samples from Site 2, 10 contained > or =4 mg/L F, ranging from 1.26 to 12.36 mg/L with a mean+/-SD of 5.72+/-4.71 mg/L. Sites 1 and 3 had negligible water fluoride of 0.05+/-0.05 and 0.18+/-0.32 mg/L respectively. Mean TFI fluorosis scores (range 0-9) for Site 2 were high: 4.44+/-1.68. In Sites 1 and 3, which both had negligible water fluoride, fluorosis scores varied dramatically: Site 1 mean maximum TFI was 0.01+/-0.07 and Site 3 TFI was 4.39+/-1.52. Mean DMFS was 1.39+/-2.45, 0.15+/-0.73 and 0.19+/-0.61 at Sites 1, 2, and 3, respectively. There were no restorations present. Urinary fluoride values were 0.52+/-0.70, 4.34+/-7.62, and 1.43+/-1.80 mg/L F at Sites 1, 2, and 3, respectively. Mean urinary fluoride values at Site 3 were within the normal urinary fluoride reference value range in spite of pervasive severe pitting fluorosis. Meal and magadi analyses revealed widely varied fluoride concentrations. Concentrations ranged from 0.01 to 22.04 mg/L F for meals and from 189 to 83211 mg/L F for magadi. Complete element analysis revealed the presence of aluminum, iron, magnesium, manganese, strontium and titanium in four magadi samples. There were much higher concentrations of these elements in samples from Site 3, which was at the highest altitude and had severe enamel disturbances in spite of negligible water fluoride concentration. An analysis of covariance model supported the research hypothesis that the three communities differed significantly in mean fluorosis scores (P<0.0001). Controlling for urinary fluoride concentration and urinary fluoride:urinary creatinine ratio, location appeared to significantly affect fluorosis severity. Urinary fluoride:urinary creatinine ratio had a stronger correlation than urinary fluoride concentration with mean TFI fluorosis scores (r=0.43 vs r= 0.25). CONCLUSIONS: The severity of enamel disturbances at Site 3 (1463 m) was not consistent with the low fluoride concentration in drinking water, and was more severe than would be expected from the subjects' normal urinary fluoride values. Location, fluoride in magadi, other elements found in magadi, and malnutrition are variables which may be contributing to the severity of dental enamel disturbances occurring in Site 3. Altitude was a variable which differentiated the locations.

Adolescent↗
PubMed1992

Misconceptions about cancer among Latinos and Anglos.

OBJECTIVE: To collect information regarding knowledge about and attitudes toward cancer in a sample of adult health plan members, self-identified as Latino or Anglo. DESIGN: Cross-sectional survey. SETTING: Prepaid health plan. RESPONDENTS: A random sample of 844 Latinos (mean age, 50.5 years) and 510 Anglos (51.8 years) completed the interview. MAIN OUTCOME MEASURES AND RESULTS: Latinos were significantly more likely than Anglos to think that sugar substitutes (58% vs 42%), bruises from being hit (53% vs 34%), microwave ovens (47% vs 23%), eating pork (31% vs 11%), eating spicy foods (15% vs 8%), breast-feeding (14% vs 6%), and antibiotics (32% vs 12%) could cause cancer (P < .001 for each). Compared with Anglos, Latinos more often misidentified constant dizziness (39% vs 25%) and arthralgias (35% vs 20%) as being symptoms of cancer. A higher proportion of Latinos believed that having cancer is like getting a death sentence (46% vs 26%), that cancer is God's punishment (7% vs 2%), that there is very little one can do to prevent getting cancer (26% vs 18%), that it is uncomfortable to touch someone with cancer (13% vs 8%), and that they would rather not know if they had incurable cancer (35% vs 23%; P < .001 for each). Latino ethnicity was a significant predictor of these knowledge and attitude items in multivariate logistic regression models adjusted for sex, education, age, employment, marital status, county of residence, and self-perceived health status. CONCLUSIONS: We conclude that misconceptions about cancer are more prevalent among Latinos than Anglos and that selected attitudes about cancer among Latinos fit a cultural theme of fatalismo. These data can enable development of culturally appropriate cancer control interventions for Latinos.

Adult↗
PubMed1999

Trends in incidence and treatment for ductal carcinoma in situ in Hispanic, American Indian, and non-Hispanic white women in New Mexico, 1973-1994.

BACKGROUND: Incidence rates of ductal carcinoma in situ (DCIS) breast carcinoma and the use of breast-conserving surgery (BCS) for its treatment show substantial geographic and ethnic variations nationwide. To the authors' knowledge, few studies have investigated incidence rates and treatment patterns in Hispanics and American Indians. METHODS: The authors used data from the population-based New Mexico Tumor Registry to describe trends in DCIS incidence rates between 1973-1994 and investigate patient and physician characteristics related to BCS in a multiethnic population between 1985-1994. Multiple logistic regression was used to evaluate patient and physician factors related to receiving BCS. RESULTS: Incidence rates for DCIS in Hispanics were approximately 50% lower compared with non-Hispanic whites. American Indians had the lowest incidence rate. Beginning in 1985, incidence rates for Hispanics and non-Hispanic whites showed a 21% annual increase. Between 1990-1994, incidence rates in American Indians increased more than twofold. BCS increased 5.8% per year between 1985-1994, with 50% of Hispanic and non-Hispanic white patients treated with BCS in 1994. The strongest factor associated with receiving BCS was geographic location of treatment (P < 0.001). The odds of receiving BCS were 5.8 times higher in the northern third of the state compared with the southern third. No significant variation in BCS was found by ethnicity, rural/urban residency, socioeconomic status, or physician characteristics. CONCLUSIONS: Incidence rates for DCIS increased substantially in all three ethnic groups. The use of BCS was associated most strongly with the location of treatment, most likely reflecting differences in physician practices and treatment recommendations. Further research is needed to investigate the increasing incidence rates of DCIS and the determinants of BCS for the treatment of DCIS.

Adolescent↗
PubMed2001

Cervical screening behavior of women with atypical squamous cells of undetermined significance (ASCUS).

Expectant follow-up based on early repeat Papanicolaou (Pap) smear(s) is the most commonly recommended management of patients with atypical squamous cells of undetermined significance (ASCUS). In a cervical cytology laboratory in northern Italy, a retrospective study of 1,087 ASCUS patients aged 25-64 was conducted. The primary aim was to assess the actual probability of early repeat Pap smear and associated factors. Univariate comparisons were based on the actuarial method. Multivariate associations were evaluated by Cox regression analysis. The cumulative probability of early repeat Pap smear was 0.11 at 6 mo, 0.29 at 12 mo, and 0.41 at 24 mo, with a multivariate association with screening sector (relative hazard, 3.0 for public offices and 2.8 for private offices vs. organized screening) and previous Pap smear history. Laboratory recommendation, patient age, place of birth, place of residence, marital status, and occupation exerted no independent effect. In conclusion, the probability of early repeat Pap smear was poor and independent of demographic and social factors. The frequency of follow-up failures emerged as a major problem with ASCUS management.

Adult↗
PubMed1987

A study of risk factors of vaginal colonization with group B streptococci in pregnancy.

Two hundred pregnant women were screened for vaginal Group B Streptococci carriage just before delivery. Fifty non-pregnant women were also examined. Vaginal colonization rate of pregnant women and of non-pregnant women was identical (12% in both groups). None of the personal and social characteristics investigated (age, profession, residence, marital status and education) were associated with higher or lower colonization rates. However the influence of the number of previous pregnancies proved to be significant, as pregnant women with 2 or more previous pregnancies tended to be more frequently colonized than primigravidae or secundigravidae women. These findings are discussed in relation to the possible reservoir of the microorganisms and the route of infection.

Adult↗
PubMed1994

Age-related differences in breast cancer treatment.

BACKGROUND: More than half of the cases of breast cancer treated in the United States occur in women over age 65. This study investigates age-related differences in breast cancer therapy. METHODS: A retrospective review of all women with primary operable invasive breast cancer treated at the University of Michigan Breast Care Center over a 30-month period showed a total of 77 older patients aged > or = 65 years (median, 71; oldest patient, 92) for whom full information was available regarding comorbidity, tumor stage and histology, and details of surgery, radiation, and chemohormonal therapy and complications. Fifty-one similar younger patients aged 55-64 years (median, 59) were identified for comparison. Patients were classified as either having received standard treatment or non-standard treatment. Standard therapy was prospectively defined as follows: local/regional--lumpectomy and axillary lymph node dissection plus radiation therapy or modified radical mastectomy; systemic--chemotherapy and/or tamoxifen for stage II disease. A comorbidity score calculated for each patient assigned one point each for nursing home residence, nonambulatory status, recent surgery, and each medical problem requiring drug therapy. RESULTS: When overall treatment (local/regional plus systemic) was assessed, proportionately fewer older patients (55 of 77 versus 47 of 51; p < 0.01) received standard treatment. Fewer older than younger patients (62 of 77 versus 50 of 51; p < 0.01) received surgical therapy that included an axillary dissection. A smaller proportion of older patients received radiation therapy following lumpectomy and axillary lymph node dissection (26 of 29 versus 19 of 19; N.S.). Overall, only 59 of 77 older patients versus 50 of 51 younger patients (p < 0.001) received standard local/regional care. Similar proportions of younger and older patients (19 of 22 and 24 of 30, respectively) received standard systemic therapy for stage II breast cancer, but older patients were less likely to receive chemotherapy than younger patients (7% versus 50%; p < 0.001). Treatment-related complications were not age-related but were more frequent in patients receiving standard treatment than in patients receiving nonstandard treatment (45 of 102 versus two of 26; p < 0.001). Comorbidity score correlated with the use of nonstandard therapy but not with age. The scores for both older and younger patients receiving overall standard treatment were 0.8 versus 1.5 and 1.4, respectively, in patients receiving nonstandard treatment. Interestingly, explanations for decisions to deviate from standard treatment guidelines were often not identified. Comorbidity was explicitly noted in only one of four younger patients who received nonstandard treatment therapy. In 22 older patients who received nonstandard treatment, comorbidity was cited in eight cases, patient age was cited in six cases, and patient choice was cited in four cases. Follow-up (median, 34 months) did not show that disease-free or overall survival differences were related to age or to treatment (standard versus nonstandard). CONCLUSIONS: These data demonstrate age-related variations in breast cancer treatment in a multidisciplinary breast care unit. Lower complication rates and equivalent short-term outcomes in women who received nonstandard therapy suggest good clinical judgment may have played a role in these differences. Although age-related patient preferences and comorbidity are relevant, the age-related attitudes of caregivers must also be taken into account to fully explain these variations.

Age Factors↗
PubMed1984

Hepatitis viruses in southern Taiwan--mass survey of 2985 inhabitants.

A survey of 2985 apparently healthy Taiwanese in southern Taiwan revealed a high prevalence (18.2%) of hepatitis B surface antigen (HBsAg). It was significantly higher in males (22.3%) than in females (13.6%), but no correlation with family origin, socioeconomic status or residence was established. About one-third of the breeding female HBsAg carriers were HBeAg-positive, and these may be an important source in the spread of HBV. Subtyping of HBsAg in 63 subjects showed adw to be dominant in this area, and 8 subjects with suspicious results had overlapping heterotypic HBV's (7 adwr and 1 adyw) in addition to 2 subjects in which coexistence of HBsAg and anti-HBs was recognized. The association between HBsAg positivity and serum transaminase elevation was significant, especially in the older groups who had a higher abnormal rate. Hepatitis A virus infection was serious too, with nearly 100% of people above 20 years of age being anti-HA antibody positive.

Adolescent↗
PubMed2006

Core features of repeated suicidal behaviour: a long-term follow-up after suicide attempts in a low-suicide-incidence population.

BACKGROUND: The aim of this article was to study repeated suicidal behaviour in a low-incidence population to elucidate robust risk factors. METHODS: A cohort of first-ever suicide attempters from 1960 to 1982 on the Faroe Islands was followed up for a minimum of 20 years. The cohort was initially characterized in psychiatric and social terms. RESULTS: The incidence of suicidal behaviour for the cohort years (age 15 years and older) was 37.9 per 100,000 per year (95% confidence interval 31.5-45.1). It was associated, as expected, with gender, age, residence, marital status, occupation, diagnosis, previous psychiatric admission, alcohol intoxication and the method and planning of the act. Factors of the index episode predicting repetition at 5 years were gestures and alcohol intoxication and at 20 years were physical methods, suicide letter and alcohol intoxication. CONCLUSIONS: Alcohol intoxication and the level of determination behind the suicide attempt emerge as targets for prevention. Alcohol intoxication at the initial episode seems to be a strong long-term as well as short-term risk factor.

Adolescent↗