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Type A behaviour and life-events.

Our aim was to study the relationship between Type A behaviour and the occurrence of life-events in a large sample (n = 1003) of men aged 35-54. Over the whole sample, Type As reported more events during the past 12 months than Type Bs. This difference was found in the total score and in self-initiated life-events, but not in other-initiated ones. The results were similar even if those who reported chronic illness or a severe attack of chest pain were excluded. The relationship varied, however, by age as well as by marital and occupational status.

Adult↗

An arc of unpaired "hinge bases" facilitates information exchange among functional centers of the ribosome.

Information must be shared and functions coordinated among the spatially distinct functional centers of the ribosome. To address these issues, a yeast-based genetic system enabling generation of stable strains expressing only mutant forms of rRNA was devised. The B1a bridge (helix 38) has been implicated in the subtle modulation of numerous ribosomal functions. Base-specific mutations were introduced into helix 38 at sites affecting the B1a bridge and where it contacts the aminoacyl-tRNA (aa-tRNA) D-loop. Both sets of mutants promoted increased affinities for aa-tRNA but had different effects in their responses to two A-site-specific drugs and on suppression nonsense codons. Structural analyses revealed an arc of nucleotides in 25S rRNA that link the B1a bridge, the peptidyltransferase center, the GTPase-associated center, and the sarcin/ricin loop. We propose that a series of regularly spaced "hinge bases" provide fulcrums around which rigid helices can reorient themselves depending on the occupancy status of the A-site.

Base Sequence↗

Cognitive development in low risk preterm infants at 3-4 years of life.

BACKGROUND: Major neurological handicaps and neuropsychological disturbances are more common in ex-preterm children than their counterparts born at term. OBJECTIVE: To establish in a prospective study whether a characteristic neuropsychological profile exists in ex-preterm children who do not exhibit neurodevelopmental deficits on routine clinical examination. METHODS: Thirty intellectually normal children born preterm (30-34 weeks gestation) without major neurological disabilities and a control group of term children matched for age, sex, and parental educational and occupational status were assessed at 3-4 years of age to obtain a complete neuropsychological profile. Intellectual ability, language comprehension and expression, perceptual and visual motor function, working memory, and attention and behavioural problems were investigated. RESULTS: Even in the absence of major neurological signs, children born preterm achieved lower mean scores than controls on the Stanford-Binet intelligence scale (110.8 v 121, p<0.001), visual perception test (33.8 v 42.7, p<0.001), visual motor integration test (42.6 v 47.4, p = 0.049), memory for location test (8.4 v 9.5, p = 0.007), sustained attention test (41.6 v 51.5, p = 0.009), and the picture vocabulary test (33.3 v 44.7, p = 0.021). CONCLUSIONS: Neuropsychological abnormalities can be detected early in childhood in apparently normal ex-preterm children and are consistent with a growing body of evidence that prematurity may be associated with long term neuropsychological morbidity in childhood and adolescence.

Attention↗

Paediatric manpower.

Two investigations of paediatric manpower in England, Wales, and Northern Ireland were carried out, each using a different method. The first survey located registrars and senior registrars and checked on their occupational status 3 years later in order to see which ones had been promoted. Loss factors--such as emigration, retirement for personal reasons, part-time training, or transfer to general practice, community paediatrics, or other medical specialties--were examined closely. The second survey was a cross-sectional analysis of the entire paediatric establishment. It examined in particular the distribution of consultants and registrars. Using figures from survey 2 and loss factors from survey 1, a model of the paediatric career structure could be constructed. This showed that the present career pyramid would be unable to absorb the current number of registrars in training. There is an urgent need for a comprehensive registration scheme for registrars, especially those with honorary contracts, who are not currently included in official records. Paediatrics is unique in having a high proportion of women for whom there is little opportunity of reconciling career aspirations with family commitments.

Career Mobility↗

A prospective study of smoking during pregnancy and SIDS.

AIMS: To study the association between smoking during pregnancy and sudden infant death syndrome (SIDS) using prospectively collected data, making it possible to account for a number of potential confounders. DESIGN: Prospective follow up study (n = 24 986). RESULTS: The overall rate of SIDS was 0.80 per 1000 live births (n = 20). Children of smokers had more than three times the risk of SIDS compared with children of non-smokers (OR = 3.5; 95% CI 1.4-8.7), and the risk of SIDS increased with the number of cigarettes smoked per day (p < 0.05). Adjustment for parity, alcohol, and caffeine intake during pregnancy, maternal height and weight before pregnancy, years of school, occupational status, marital status, and number of antenatal care visits did not change the results. Adjustment for mother's age marginally reduced the risk of SIDS associated with smoking (OR = 3.0; 95% CI 1.2-7.3). CONCLUSIONS: Given the prospective nature of the study, the number of deaths is small; however, if our results reflect a true association between smoking during pregnancy and SIDS, approximately 30-40% of all cases of SIDS could be avoided if all pregnant women stopped smoking in a population with 30% pregnant smokers. Our study adds to earlier evidence for an association between smoking during pregnancy and SIDS. The strengths of the study are the possibility to adjust for a number of potential confounders and the fact that information about smoking habits during pregnancy was prospectively collected.

Adolescent↗

Childbearing and risk of cataract in young women: an epidemiological study in central India.

BACKGROUND/AIMS: Observations in central India, over a period of more than a decade, suggested that the frequency of sight restoring cataract surgery was substantially higher in women of childbearing age compared to men of the same age. Formal surveys in the subcontinent of India have confirmed a higher prevalence of cataract in women. The present study was conducted to explore possible effects of childbearing and associated adverse factors on cataract risk. METHODS: A case-control study design was used. Cases were mothers aged 35-45 with bilateral "senile" cataract. Controls were mothers of the same age but with clear lenses, attending the hospital services with other, mostly minor, complaints. RESULTS: A significant association was found between childbearing and risk of sight impairing cataract in mothers. Having more than three babies doubled the risk (adjusted odds ratio 2.0, p=0.012), and the risk increased by an estimated 20% for each additional birth. The birth effect was independent of age, socioeconomic status (occupation and income level), body mass index, and multiple episodes of severe dehydration, all regarded as putative risk factors for cataract. CONCLUSIONS: Having more than three babies may substantially increase the risk of sight impairing cataract in mothers of childbearing age in central India. The findings open new research challenges to identify cataract risk factors to which mothers may be exposed during pregnancy and childbirth, particularly under poor socioeconomic conditions.

Adult↗

Assessment of need for coordinated approach in families with victims of head injury.

Forty two men with severe head injury, and 41 with minor head injury, together with their families, were assessed at home after the injury. Despite significant impairment with respect to physical symptoms, personality difficulties, and occupational status in severely injured patients after one year, there was a very poor uptake of hospital rehabilitation facilities. In addition, patients' relatives showed significant psychosocial impairment throughout this period. There is a need for a specialist to coordinate rehabilitation services for patients with head injury and their relatives and, in particular, to integrate physical and psychological aspects of management with a multidisciplinary team approach. Although this task will require specialist hospital teams for future development, at present general practitioners have some specialised knowledge that would enable them to coordinate rehabilitation.

Aftercare↗

Sudden infant death syndrome: links with infant care practices.

OBJECTIVES: To investigate infant care practices in a small ethnic minority population within Britain that might suggest possible factors contributing to the low incidence of the sudden infant death syndrome in Asian populations. DESIGN: Ethnographic interviewing, a qualitative comparative method drawn from social anthropology. SETTING: Central Cardiff. SUBJECTS: Non-random sample of 60 mothers of Bangladeshi or Welsh ethnic origin and working or middle class occupational status, who had infants under one year old. None of the families interviewed had experienced a sudden infant death. RESULTS: Broad cultural contrasts emerged as a series of themes from the interview data: living patterns, family networks, sleeping patterns, and concepts of time and dependence. CONCLUSION: Bangladeshi infants were cared for in a consistently rich sensory environment; Welsh infants, in contrast, were more likely to experience alternating periods of high and low sensory input. Long periods of lone quiet sleep may be one factor that contributes to a higher rate of sudden deaths in white than in Asian infants.

Bangladesh↗

Female medical leadership: cross sectional study.

OBJECTIVE: To assess the relation between male and female medical leadership. DESIGN: Cross sectional study on predictive factors for female medical leadership with data on sex, age, specialty, and occupational status of Norwegian physicians. SETTING: Oslo, Norway. SUBJECTS: 13 844 non-retired Norwegian physicians. MAIN OUTCOME MEASURE: Medical leaders, defined as physicians holding a leading position in hospital medicine, public health, academic medicine, or private health care. RESULTS: 14.6% (95% confidence interval 14.0% to 15.4%) of the men were leaders compared with 5.1% (4.4% to 5.9%) of the women. Adjusted for age men had a higher estimated probability of leadership in all categories of age and job, the highest being in academic medicine with 0.57 (0.42 to 0.72) for men aged over 54 years compared with 0.39 (0.21 to 0.63) for women in the same category. Among female hospital physicians there was a positive relation between the proportion of women in their specialty and the probability of leadership. CONCLUSION: Women do not reach senior positions as easily as men. Medical specialties with high proportions of women have more female leaders.

Adult↗

Socioeconomic position in childhood and adult cardiovascular risk factors, vascular structure, and function: cardiovascular risk in young Finns study.

OBJECTIVE: To examine the association of childhood socioeconomic position (SEP) with adult cardiovascular risk factors, vascular structure, and vascular function in a contemporary population of young adults. DESIGN: Population based prospective cohort study with baseline assessment in 1980. SETTING: Finland. PARTICIPANTS: 856 men and 1066 women whose childhood SEP was determined by parental occupational status (manual, lower non-manual, upper non-manual) at age 3-18 years. MAIN OUTCOME MEASURES: Cardiovascular risk factors, carotid artery intima-media thickness, and brachial artery flow mediated vasodilatation, assessed at age 24-39 years. RESULTS: After adjustment for age and adult SEP, systolic pressure was 2.3 mm Hg higher (p = 0.0002), high density lipoprotein (HDL) cholesterol 0.03 mmol/l lower (p = 0.02), and insulin resistance score (homeostasis model assessment index) 0.12 units greater (p = 0.05) among men; and systolic pressure was 1.3 mm Hg higher (p = 0.02), diastolic pressure 1.1 mm Hg higher (p = 0.01), and height 1.1 cm lower (p < 0.0001) among women for each step down the childhood SEP hierarchy. Lower childhood SEP was associated with a 20% increase in the odds of having a waist circumference > 102 cm in men and > 88 cm in women (overall p = 0.05). Childhood SEP was not associated with intima-media thickness, flow mediated vasodilatation, the metabolic syndrome, low density lipoprotein cholesterol, triglycerides, body mass index, alcohol consumption, or smoking. CONCLUSIONS: Among adults under 40, low childhood SEP predicted higher blood pressure and central obesity and, among men, unfavourable HDL cholesterol and insulin resistance, independent of current SEP. No independent effects were found on adult vascular structure, vascular function, or health related behaviours at this life stage.

Adolescent↗

Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004-2005.

OBJECTIVE: To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health. Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves. PARTICIPANTS: Swedish population-based sample of 17 362 men and 20 037 women. RESULTS: Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7 (95% confidence interval (CI) 2.5 to 3.0) times the odds for self-rated poor oral health, whereas odds related to severe SDI were 6.8 (95% CI 6.2 to 7.5). The corresponding values among women were 2.3 (95% CI 2.1 to 2.5) and 6.8 (95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7-9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden. CONCLUSIONS: Results call for urgent public health interventions to increase equitable access to dental care services.

Adolescent↗

Parity and obesity.

Parity was found to be closely related to adiposity and prevalence of obesity in a population sample of 17 688 non-pregnant women aged 25-84. The women took part in multiphasic screening examinations in various parts of Finland in 1966-72. The relationship between parity and obesity was independent of other factors such as +geographical area, region, marital status, occupation, smoking habits, or incapacity for work. Pregnant women were considered to be an important target population for nutritional education.

Adolescent↗

Smoking and drinking habits before and during pregnancy in Spanish women.

STUDY OBJECTIVE: To investigate possible changes in smoking and drinking habits during pregnancy and to elucidate the sociodemographic factors associated with these changes in Spanish women. DESIGN: A cross-sectional survey. PARTICIPANTS AND SETTING: A total of 1004 pregnant women of between 12 and 18 weeks of gestation who were attending the antenatal clinic of the main regional hospital of Valencia (Spain) during 1989 were studied. All participants completed the study and only one eligible woman refused to participate when approached. MEASUREMENTS AND MAIN RESULTS: Information was obtained by structured questionnaire (Euromac questionnaire), which included items on age, educational level, marital status, occupation, parity, previous and present smoking habits, and previous and present alcohol consumption. Women were asked about the consumption of cigarettes and alcohol for a typical week before they knew they were pregnant, and details of current consumption were obtained for the week before the interview. The number of drinks taken per week was later converted to the amount of absolute alcohol (in g). Sixty per cent of the women smoked and 72% drank alcohol before pregnancy. Forty eight per cent of smokers stopped smoking and 37% of drinkers stopped drinking alcohol during pregnancy. No sociodemographic factor showed an independent association with either smoking or drinking cessation. Only the number of cigarettes and the amount of alcohol consumed before pregnancy were identified as significant independent predictors for stopping. CONCLUSIONS: Pregnant Spanish women seemed to stop smoking at about three times the rate found in Spanish women in the reproductive years. The sociodemographic variables usually associated with stopping smoking could not account for the high rate of quitting in these Spanish women, a rate higher than that in women from other developed countries. The high prevalence of smoking before pregnancy might explain not only the high rate of stopping smoking but also the absence of a well defined profile of "quitters". In our study, high levels of alcohol consumption were limited to a small group of pregnant women, and preventive efforts should be focused on this group.

Adolescent↗

Asymptomatic hyperglycaemia and major ischaemic heart disease events in Britain.

OBJECTIVE: To examine the association between non-fasting serum glucose concentrations and major ischaemic heart disease (IHD) events (fatal and non-fatal myocardial infarction). DESIGN: A prospective study. SUBJECTS: A population based sample of 7735 middle aged British men. Known diabetics, men with a glucose concentration > or = 11.1 mmol/l at screening, and hypertensive patients taking regular medication were excluded from the analysis. With exclusions (n = 509) and missing glucose values (n = 49), there were 7177 men available for analysis. MAIN OUTCOME MEASURES: Major IHD events (fatal and non-fatal myocardial infarction) during 9.5 years follow up on all men. RESULTS: There were 505 major IHD events, 222 fatal and 283 non-fatal, in the 7177 men studied. There was a non-linear relation between the glucose concentration and the risk (per 1000 men per year) of all major IHD events and fatal IHD events, with the excess risk in the upper quintile of the glucose distribution (> or = 6.1 mmol/l). The unadjusted relative risks (RR) in the upper glucose concentration quintile compared with the first to the fourth quintiles combined were 1.4 (95% CI 1.1, 1.7) for all events and 1.3 (95% CI 1.0, 1.7) for fatal events. Adjustment for age, smoking, occupational status, body mass index, physical activity, systolic blood pressure, total and high density lipoprotein cholesterol, and triglyceride concentrations had a minimal effect on these relative risk estimates. This non-linear relationship between the serum glucose concentration and the risk of a major IHD event was observed in men with no evidence of IHD at screening (n = 5518) but not in men with IHD (n = 1659). In the former group, the RR (adjusted for major coronary risk factors) for all major IHD events in the upper quintile relative to the lower quintiles combined was 1.5 (95% CI 1.2, 2.0) and for fatal IHD events was 1.8 (95% CI 1.1, 2.6). CONCLUSION: These data suggest that asymptomatic hyperglycaemia is an independent risk factor for major IHD events.

Adult↗

Socioeconomic variations in hysterectomy: evidence from a linkage study of the Finnish hospital discharge register and population census.

STUDY OBJECTIVE: To explore variations in rates for hysterectomy in relation to social class, education, and family income. DESIGN: Retrospective analysis of the 1988 Finnish hospital discharge register linked individually to the 1987 population census. SETTING: Finland. PARTICIPANTS: All women living in Finland aged 35 and over were the denominator population. The numerators were the 8663 women who underwent hysterectomy in 1988. MAIN RESULTS: The overall rate for hysterectomy was 63.5/10,000 women aged 35 and over. There was a marked positive correlation between disposable family income and hysterectomy rates even after age, hospital catchment area, education, and occupational status were adjusted for. However, no linear trend for overall hysterectomy rates was observed in relation to social class or education. Procedures due to myomas, accounting for 48% of all hysterectomies, were more frequent among women of high socioeconomic status according to all socioeconomic indicators. Larger proportions of hysterectomies for myoma were also performed in patients in private hospitals and in pay beds in public hospitals than in women in worse off groups. CONCLUSIONS: Unlike the findings in earlier studies from other countries, there was a positive correlation between income and hysterectomy rates as a result of the high numbers of hysterectomies performed to treat myoma in the well off women. The findings are discussed in terms of socioeconomic differences in the use of private gynaecological services, and factors, such as parity and use of hormonal replacement therapy, that affect the growth of myomas.

Adult↗

Cerebellar calcification and lead.

In elderly subjects who were brought up in a known high lead environment in Queensland, Australia, childhood residence and occupational status provide circumstantial evidence of a relationship between excessive lead intake and cerebellar calcification as seen on computed tomography. This supports experimental and neuropathological studies demonstrating an association between exposure to lead and perivascular cerebellar calcification.

Basal Ganglia Diseases↗

Conservatively treated patients with cerebral arteriovenous malformation: mental and physical outcome.

Twenty five patients with conservatively treated cerebral arteriovenous malformation were followed up for a mean of 10.6 years after diagnosis. The follow up included neuropsychological examination. Bleeding did not occur after the time of diagnosis. Three patients had moderate to severe neurological deficits, five had moderate to severe intellectual impairment. Nineteen had an unaffected occupational status. It is concluded that the outcome in conservatively treated patients may be no worse than in surgically treated patients.

Adolescent↗

Road traffic noise and hypertension.

BACKGROUND: It has been suggested that noise exposure increases the risk of hypertension. Road traffic is the dominant source of community noise exposure. OBJECTIVE: To study the association between exposure to residential road traffic noise and hypertension in an urban municipality. METHODS: The study population comprised randomly selected subjects aged 19-80 years. A postal questionnaire provided information on individual characteristics, including diagnosis of hypertension. The response rate was 77%, resulting in a study population of 667 subjects. The outdoor equivalent traffic noise level (Leq 24 h) at the residence of each individual was determined using noise-dispersion models and manual noise assessments. The individual noise exposure was classified in units of 5 dB(A), from <45 dB(A) to >65 dB(A). RESULTS: The odds ratio (OR) for hypertension adjusted for age, smoking, occupational status and house type was 1.38 (95% confidence interval (CI) 1.06 to 1.80) per 5 dB(A) increase in noise exposure. The association seemed stronger among women (OR 1.71; 95% CI 1.17 to 2.50) and among those who had lived at the address for >10 years (OR 1.93; 95% CI 1.29 to 2.83). Analyses of categorical exposure variables suggested an exposure-response relationship. The strongest association between exposure to traffic noise and hypertension was found among those with the least expected misclassification of true individual exposure, as indicated by not having triple-glazed windows, living in an old house and having the bedroom window facing a street (OR 2.47; 95% CI 1.38 to 4.43). CONCLUSION: The results of our study suggest an association between exposure to residential road traffic noise and hypertension.

Adult↗