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PubMed1997

Risk factors of early menopause in two generations of gainfully employed French women.

OBJECTIVES: Numerous studies have been focused on the detection of factors which can act on the age of menopause. Little is known about the factors related to the occurrence of an early menopause. Some factors such as occupational work factors and generational effects have not been taken into account as yet. METHODS: We examined the risk factors of early natural menopause (before age 45) in a large random sample of gainfully employed French women born in the years 1938 (n = 1743) and 1943 (n = 1959). The subjects were selected from files of an occupational physician. A woman was considered to be post-menopausal when at least 12 consecutive months had passed without menstruation at the time of the survey. Subjects were questioned and examined during their annual visit by the occupational physician. Occupational history, working conditions, living conditions, smoking habits and reproductive history were explored. RESULTS: The prevalence of early natural menopause, before age 45, was higher in the generation of 1938 (5.3%) than in that of 1943 (3.3%) with P < 0.01. After multivariate regressions, significant relationships existed statistically between the occurrence of early natural menopause and marital status, educational level, age at first childbirth and breast-feeding of children. CONCLUSIONS: Our results show important generation effects. There was no evidence of a significant relationship between early natural menopause at 45 years of age and factors relative to heavy physical work conditions.

Adult↗
PubMed1996

Characteristics of subjects with a high frequency of emergency visits for asthma.

The determinants of frequent visits to the emergency department (ED) for asthma were evaluated in 30 patients who made 2 or more ED visits for asthma (mean, 3.1; range, 2 to 9) over a period of 1 year. They were matched for age, sex, and medication with a control group of asthmatic patients who had made no ED visits within the same period. Evaluation included measurements of expiratory flows (baseline FEV1; PEFR 4 times daily for 3 weeks), airway responsiveness to methacholine, perception of induced bronchoconstriction, and questionnaires on quality of life and knowledge of asthma and its management. In comparison with the control group, the study group showed a trend toward inferior socioeconomic status, education level, and technical abilities (eg, inhaler use). Both groups had similar baseline FEV1, reversibility of airflow obstruction, methacholine-induced changes in expiratory flows, and perception of bronchoconstriction. Diurnal variation in PEFR was slightly increased in the study group. Absenteeism from work or school was higher in the study group but quality of life score was similar to controls. Patients with frequent ED visits showed significantly lesser knowledge of asthma control criteria, as well as an overall trend toward reduced asthma management knowledge and skills. In conclusion, in addition to the previously reported undertreatment of asthma, other factors such as insufficient asthma management knowledge and skills may contribute to frequent ED visits for asthma.

Adolescent↗
PubMed1996

Relationships among illness uncertainty, stress, coping, and emotional well-being at entry into a clinical drug trial.

The purpose of this cross-sectional study was to examine the relationships among illness uncertainty, stress, coping, and emotional well-being at the time of entry into a clinical drug trial. Hopefulness and mood state were included as indicators of emotional well-being. The sample included 59 clients who participated in a 2-year trial using methotrexate for progressive multiple sclerosis. Results indicated that ambulation status, education, perceived stress, and illness uncertainty were the best correlates of emotional well-being. The results suggest that clients entering a drug trial with high levels of illness uncertainty and stress are likely to experience mood disturbances and feel less hopeful about treatment effectiveness. This information may be used as a foundation for developing nursing interventions designed to foster emotional well-being at the time of entry into drug trials.

Adaptation, Psychological↗
PubMed1998

Beyond black, white and Hispanic: race, ethnic origin and drinking patterns in the United States.

This study used data on 42,862 U.S. adults, including 18,352 past-year drinkers, to describe differentials by race and national origin in U.S. drinking patterns. Age-sex standardized estimates were presented within 21 categories of ethnic origin for whites and within five categories each for individuals of black and other races. Of the three racial groups, whites were the most likely to drink, but blacks had the highest volume of intake and frequency of heavy drinking. Differences by ethnic origin within racial categories were as marked as differentials between races. Compared to whites of European origin, those of Hispanic and native American origin were less likely to drink but consumed more alcohol on days when they drank. Whites of Southern and Eastern European origin drank proportionately more wine and demonstrated more moderate drinking patterns (lower intake per drinking day and/or less frequent heavy drinking) than those of Northern or Central European origin. Hispanics of Caribbean origin were less prone to heavy drinking than other white Hispanics; similarly, blacks from the English-speaking Caribbean showed more moderate drinking patterns than other blacks. Individuals of Asian origin, in particular those of non-Japanese origin, had the most moderate drinking patterns within the category of other race. Although the black/white differentials in volume of intake and frequency of heavy drinking disappeared after adjusting for marital status, education and income, most of the differences by ethnic origin retained their statistical significance if not their original magnitudes. These findings indicate that cultural forces exert a strong effect on drinking behavior. Differences among European whites with respect to prevalence of drinking, beverage preference and frequency of heavy drinking suggest that the association between ethnic origin and drinking behavior may persist even after many generations of presumed acculturation.

Acculturation↗
PubMed2002

The association between schizophrenia and cancer: a population-based mortality study.

BACKGROUND: For most of this century there has been speculation that persons diagnosed with schizophrenia have a reduced incidence of cancer. OBJECTIVE: To determine if a history of cancer was more common in persons diagnosed with schizophrenia when compared with the general population, controlling for known risk and demographic factors. DESIGN: We used the 1986 National Mortality Followback Survey (NMFS) which sampled 1% of all deaths in the US from that year. Data were obtained from death certificates and records of hospitalizations in the last year of life. Additional health and demographic data were obtained through interviews with decedents' families and other informants. We compared persons diagnosed with schizophrenia (n=130) to individuals without schizophrenia (n=18,603) and used logistic regression to determine the odds ratio for the occurrence of cancer in persons diagnosed with schizophrenia. Adjustment for age at death was done to correct for the fact that persons diagnosed with schizophrenia die on average 10 years younger than the general population. MAIN OUTCOME MEASURE: A diagnosis of cancer on a hospital record or the death certificate. RESULTS: The unadjusted odds ratio for cancer among individuals with schizophrenia was 0.62 (95% confidence interval (CI) 0.40-0.96). After controlling for age, race, gender, marital status, education, net worth, smoking, and hospitalization in the year before death, we determined that the odds ratio for the diagnosis of cancer in persons with schizophrenia was 0.59 (95% CI 0.38-0.93). CONCLUSION: In this population-based study, we demonstrated a reduced risk of cancer among persons diagnosed with schizophrenia.

Case-Control Studies↗
PubMed2000

[Adolescents and ambulatory care: results from a national survey of young people 15 to 20 years of age in Switzerland].

UNLABELLED: In industrialized countries, statistics on health services exhibit a low level of health care use by adolescents, despite the fact that their needs have been widely described. OBJECTIVES: To assess ambulatory health care use by 15-20-year-old teenagers in Switzerland. METHOD: Nine thousand, two hundred and sixty-eight adolescents responded to the self-administered questionnaire distributed in secondary schools and vocational classes for the Swiss Adolescent Health Survey. Questions about visits to general practitioners, specialists and gynecologists, reasons for visit, the availability of a regular health care provider and a confidential health care resource were analysed. RESULTS: Within the previous 12 months, 87.6% of the girls and 75.3% of the boys reported having seen a physician. General practitioners were visited more frequently than specialists. The contact with a specialist was the only one to be related to socio-demographic variables: a lower proportion of reported visits to a specialist was related to apprenticeship, low educational status of parents or rural living area. Thirty-nine percent of the girls reported having seen a gynecologist during the previous 12 months. Two adolescents out of three reported having a personal doctor, and one out of two declared being aware of a confidential health care resource. Girls reported a larger number of reasons for visits than boys: chronic conditions, fatigue, headache and depressive symptoms were the most often cited in a list of ten reasons. Among the subjects who declared a health concern (sleep disturbances, eating disorders, depressive symptoms, smoking or alcohol-related problems) and a need for help, less than 10% declared having seen a health care provider for this reason, even if more than 70% reported contact with a physician within the last 12 months. CONCLUSION: These results show that most adolescents, especially girls, reported recent use of medical services, but did not discuss their health concerns with the doctor. Training should be improved to give better knowledge and counseling skills to health professionals, in order to allow them to address adolescents' health needs.

Adolescent↗
PubMed2002

Systematic errors in middle-aged women's estimates of energy intake: comparing three self-report measures to total energy expenditure from doubly labeled water.

PURPOSE: To evaluate energy intake (EI) derived from a food frequency questionnaire (FFQ), seven-day dietary recall (7DDR), and seven 24-hour dietary recall interviews (24HR) for reporting errors associated with social desirability and social approval. METHODS: The FFQ and 7DDR were administered once before and once after a 14-day metabolic period during which total energy expenditure was determined using the doubly labeled water method (TEE(dlw)). Seven 24HR were conducted over the 14-day period. Data obtained from 80 healthy women (mean age = 49.1 years) were fit to linear regression models in which the EI estimates were the dependent variables and estimates of social desirability and social approval traits, body mass index [weight (kg)/ height (m)(2)], and TEE(dlw) were fit as independent variables. RESULTS: indicated that in college-educated women there was an underestimate associated with social desirability on the FFQ (-42.24 kcal/day/point on the social desirability scale; 95% CI:-75.48, -9.00). For college-educated women with an average social desirability score ( approximately 17 points) this would equal an underestimate of 507 kcal/day compared to women with the minimum score (4 points). The 7DDR was associated with a differential effect of social approval when comparing by education; i.e., there was a difference of 36.35 kcal/day/point between the two groups (-14.69 in women with >/=college and 21.66 in women with <college) (95% CI: 10.25, 62.45). CONCLUSIONS: Social desirability and social approval distort energy intake estimates from structured questionnaires, in a manner that appears to vary by educational status. Results observed have important implications for subject recruitment, data collection, and for methods of detection and control of biases in epidemiologic studies.

Adult↗
PubMed1999

Correlates of missed appointments in orofacial injury patients.

OBJECTIVE: The purposes of this study were to compare the sociodemographic and health-related characteristics of orofacial injury patients who miss appointments with those of patients who do not and to determine which patient characteristics best predict missed-appointment behaviors (e.g., the number of missed clinic visits). STUDY DESIGN: A total of 190 patients (134 African American and 56 Hispanic) treated for mandible fractures at the King/Drew Medical Center, Los Angeles, participated in a prospective study involving structured interviews at 4 points (denoted recalls 1-4) over a 6-month period. To be included in the study, patients were required to have attended recall 1. Most patients in the study sample were male, more than 32 years of age, unmarried, and unemployed; most had completed high school; and most had sustained their injuries as a result of assault. RESULTS: Only 22% of the patients attended all 4 recall clinic appointments. However, 42% completed 3 recall visits, and 69% completed 2 recall visits. Patients who missed appointments were more likely to be African American than Hispanic and more likely to be unemployed than employed. There was a significant negative association between perceived social support and missed appointments (r = -0.18, P = .01). Patients who missed more appointments perceived themselves to have less social support than those who missed fewer or no appointments. The data revealed no associations between missed appointment behavior and age, gender, marital status, or education. None of the health-related variables investigated were associated with missed appointments. Multiple regression analysis confirmed that race, unemployment, and perceived social support were the best predictors of missed appointments. CONCLUSIONS: Social variables have a greater impact than health variables in predicting missed-appointment behavior. Unemployed African American patients are at the greatest risk for missing recall clinic appointments; however, this finding is independent of health insurance. Accessing and enlisting patients' social networks to support follow-up medical care has potential for improving appointment-keeping behavior and should be further examined.

Adult↗
PubMed2000

Severity and associated risk factors in adult asthma patients in Turkey.

BACKGROUND: The prevalence of asthma of varying severity and associated risk factors are unknown in Turkey. OBJECTIVE: The study investigated the distribution of asthma severity, the factors having roles in asthma severity, and the relationship between serum eosinophil cationic protein (ECP) levels and disease severity. METHODS: Three hundred patients with asthma (73 male, 227 female) were enrolled in the study. The patients were surveyed for their smoking habits, educational levels, household incomes, asthma duration, occupations, and accompanying diseases. ECP levels were also determined in certain patients representing different disease severities (n: 76) and in a control group (n: 9). RESULTS: Patients were classified as mild intermittent (n: 14, 5%), mild persistent (n: 220, 73%), moderate (n: 44, 15%), and severe asthma (n: 22, 7%). Cigarette consumption and educational status were similar in all groups. A longer duration of disease and an older population predominated in patients with moderate and severe asthma. Analgesic sensitivity was seen in 7%, 10%, 6%, and 31% of mild intermittent, mild persistent, moderate and severe asthma patients, respectively, with the highest ratio in severe asthma (P < .05). Nasal polyps were significantly higher in severe asthmatics. Atopy was diagnosed in 85%, 57%, 56% and 10% of mild intermittent, mild persistent, moderate and severe asthma patients, respectively. ECP levels were significantly higher in moderate and severe asthma patients. CONCLUSIONS: Mild asthma was the most common clinical presentation and was associated with atopy. The factors associated with severe asthma included prolonged asthma duration, advanced age, nonatopy, analgesic intolerance and nasal polyps. ECP levels also reflected disease severity.

Adolescent↗
PubMed2003

Seroprevalence and risk factors for human T-cell lymphotropic virus (HTLV-I) infection among ethnically and geographically diverse Peruvian women.

OBJECTIVE: To assess the seroprevalence and risk factors for HTLV-I infection in Peruvian women. METHODS: Five hundred and sixty-eight healthy women >20 years of age from three Peruvian regions were randomly selected and screened for HTLV-I. ELISA-reactive sera were confirmed via immunofluorescence assay, recombinant immunoblot assay, Western blot, and PCR. Women from Huanta (n=303), an Andean city inhabited by indigenous Quechuans, El Carmen (n=132), a primarily African-American coastal town, and Lima (n=133), with its Mestizo population, were selected. RESULTS: HTLV-I antibodies were present in 2.5% (14/568) of women (1.3% in Huanta, 3.8% in El Carmen, and 3.8% in Lima); 2.5%, 2.7% and 2.6% of Quechuans, Mestizas and African-Americans, respectively, were infected. History of a blood transfusion (P <0.00002), chronic scabies (P <0.02), having a relative with leukemia (P <0.04), age +/- 38 years (P <0.03), young age at first intercourse (P <0.04), lifetime partners >4 (P <0.04), educational status (P <0.02) and >4 pregnancies (P <0.03) were significantly associated with infection. CONCLUSIONS: HTLV-I is endemic among asymptomatic Peruvian women. Parenteral, vertical and heterosexual transmission are associated with infection.

Adult↗
PubMed2003

Snoring and the metabolic syndrome in women.

OBJECTIVE: The main objective was to examine the association between metabolic syndrome, snoring and sleep quality among women. METHODS: The study sample comprised healthy women (30-65 years) from the greater Stockholm area. Snoring and sleep quality were measured by the Karolinska Sleep Questionnaire. The metabolic syndrome was defined as the presence of two or more of the following components: (1) fasting serum glucose level > or =7.0 mmol/L; (2) arterial blood pressure > or =140/90 mmHg; (3) fasting serum triglycerides > or =1.7 mmol/L and/or HDL cholesterol <1.05 mmol/L; and (4) obesity (waist-to-hip ratio >0.85 and/or BMI > or =28 kg/m2). RESULTS: After adjustment for age, the risk ratio of metabolic syndrome among snorers as compared to non-snorers was 4.50 (95% CI: 1.71-11.86; p=0.002). This association persisted after controlling for menopausal status, educational level, smoking, fatigue and exercise habits. Poor sleep quality showed a trend (OR: 3.31; 95% CI: 0.89-12.21; p=0.073) towards an increased risk for metabolic syndrome, but this did not reach statistical significance. CONCLUSIONS: Snoring may be a strong predictor for metabolic syndrome in middle-aged women. These findings show that snoring women are not only at increased risk for individual risk factors associated with cardiovascular disease and type 2 diabetes, but also for metabolic syndrome.

Adult↗
PubMed2005

Developmental dyscalculia: a prospective six-year follow-up.

To determine the natural history of developmental dyscalculia (DC) and factors impacting on its prognosis, we performed a prospective six-year longitudinal study. One hundred and forty children of normal intelligence diagnosed with DC in the fifth grade of elementary school were re-examined for dyscalculia three and six years later, in eighth (n=123) and eleventh (n=104; 41 males, 63 females) grades respectively. Mean age of the children in fifth grade was 11 years 1 month (SD 4 months), in eighth grade 14 years 2 months (SD 1 month), and in eleventh grade 17 years 2 months (SD 5 months). The assessment included standardized arithmetic, reading and writing tests, behavioural rating scales, information on socioeconomic status, educational interventions, and familial learning problems. Participants in eleventh grade were recategorized as having DC if their score on the arithmetic test was not more than the fifth centile for grade. At the six-year follow-up, 99/104 (95%) children diagnosed with dyscalculia in fifth grade were still performing poorly in arithmetic, scoring within the lowest quartile for their grade, and 42/104 (40%) were recategorized with DC. Chronicity of DC was associated with severity of the dyscalculia in fifth grade (p<0.05), lower IQ (p<0.01), inattention (p<0.01), and writing problems (p<0.01). Thus, DC is an enduring specific learning difficulty, persisting into late adolescence in almost half of affected individuals.

Adolescent↗
PubMed1989

Determinants of breast-feeding and post-partum amenorrhoea in Orissa.

A life table analysis is made of the duration of breast-feeding and post-partum amenorrhoea in Orissa, India, taking one variable at a time using data from a baseline survey of fertility and mortality (BSFM) conducted on the lines of the World Fertility Survey. Then a multivariate (proportional hazard) analysis showed that socioeconomic factors including residence, caste status and education influence the breast-feeding and post-partum amenorrhoea periods. There was no effect of maternal age on the length of breast-feeding, but mean length of post-partum amenorrhoea varied with age. The durations of breast-feeding and post-partum amenorrhoea are strongly related.

Amenorrhea↗
PubMed1996

Sociodemographic risk factors associated with low birthweight in United Arab Emirates.

This case-control study was undertaken to determine sociodemographic risk factors for low birth weight in Al-Ain (United Arab Emirates) over a 12-month period in 1992-93. A total of 3485 live births occurred of which 293 (8.4%) were low birth weight. The risk factors considered were mother's occupation, house conditions, place of residence (urban or rural), maternal smoking habits, antenatal care, availability of help in the home, maternal BMI and educational status. Multiple logistic regression analysis showed that mother's occupation, maternal smoking, antenatal care, and lack of help in the home were associated with increased risk of low birth weight.

Adolescent↗
PubMed1990

A comparison of anorexia nervosa and affective psychosis in young females.

In a retrospective case note study, 73 young females with anorexia nervosa were compared with 88 young females with affective psychosis. These groups of patients did not differ in terms of place of residence, birth order or social class. They differed very significantly, however, in terms of age at onset of symptoms, marital status, educational attainments and in the pattern of family histories of psychiatric illness. It is concluded that anorexics and young females with affective disorders are two quite distinct groups of patients.

Adolescent↗
PubMed2003

Association between psychotic disorder and urban place of birth is not mediated by obstetric complications or childhood socio-economic position: a cohort study.

BACKGROUND: Although urban place of birth has been identified as a risk factor for schizophrenia, the extent to which this association is mediated by socially patterned risk factors such as obstetric complications and childhood socio-economic position is unclear. The diagnostic specificity of the association within the clinical psychotic syndromes is also unclear. METHOD: A population cohort of 696025 males and females, born in Sweden between 1973 and 1980 and with linked birth and socio-economic data was followed up from age 16 for up to 9.8 years. Hospitalized cases of schizophrenia and other non-affective psychosis were identified from the Swedish Inpatient Discharge Register. We examined associations of these disorders with a three-level measure of urbanicity of birthplace before and after controlling for measures of foetal nutrition, obstetric complications and level of maternal education. RESULTS: Urban compared to rural birthplace was associated both with increased risk of adult onset schizophrenia (hazard ratio 1.34, CI 0.91-1.96) and other non-affective psychoses (hazard ratio 1.63, CI 1.18-2.26). None of these associations was greatly affected by adjustment for obstetric complications or maternal educational level. In the group of other non-affective psychoses urban-rural differences in disease risk were strongest among those born in the winter months. CONCLUSION: Urbanization of birthplace is associated with increased risk of non-affective psychosis but this is not confined to narrowly defined cases. The magnitude of the association in Sweden is lower than that reported in other studies. Causal factors underlying this association appear to operate independently of risks associated with obstetric complications and parental educational status.

Adolescent↗
PubMed1997

Long-term morbidity associated with delayed treatment of first admission schizophrenic patients: a re-analysis of the Camarillo State Hospital data.

BACKGROUND: The authors examined data from a follow-up study of first admission schizophrenic patients treated with and without antipsychotic medications, who were discharged from the hospital within 6 months. It was predicted that patients who did not require antipsychotic medications for discharge would have a more favourable long-term outcome. METHODS: The subjects were part of the Camarillo State Hospital study conducted by May and colleagues in the late 1950s and early 1960s. Patients had been randomly assigned to treatment with and without antipsychotic medications. The number of rehospitalization days and total prescribed chlorpromazine equivalents were calculated for each patient for the 2 years following discharge. In order to assess patients' continuing ability to function, 11 patients from each group who met DSM-IV criteria for schizophrenia were matched for age, educational status at first admission, race, and gender; their Global Assessment of Functioning Scale (GAF) score was estimated across a period of 6-7 years following discharge. RESULTS: During the second year following discharge, patients initially treated with antipsychotic medications required fewer rehospitalization days than the initially non-medicated patients. Furthermore, 6-7 years following initial discharge, those patients initially treated with medications were functioning at a higher level, as measured by GAF scores, than patients not initially treated with antipsychotic medications. CONCLUSIONS: The results of this study suggest that, at least for this subgroup of patients, early treatment with antipsychotic medications both decreases the immediate morbidity associated with schizophrenia, and prevents detrimental changes possibly related to prolonged untreated psychosis.

Adolescent↗
PubMed1997

The determinants of parenting: an epidemiological, multi-informant, retrospective study.

BACKGROUND: To understand the relationship between parenting and psychopathology in offspring, it is critical to clarify the determinants of parenting behaviour itself. METHODS: A 16-item version of the Parental Bonding Instrument (PBI) was administered to parents of epidemiologically sampled adult female-female twin pairs, who reported on the parenting they provided to their twins, and to the twins themselves who reported on the parenting they and their co-twin had received (N = 828 twin families). Using a mixed-model regression, we examined the impact on parenting, as retrospectively reported by parents and twins, of six variable domains: demographic factors, family characteristics, parental symptoms and personality, parental psychopathology, child vulnerability and childhood temperament. RESULTS: The PBI yielded three factors: warmth (W), protectiveness (P) and authoritarianism (A). W was most strongly predicted by parental personality and psychopathology, parental marital quality, and child temperament. P and A were both most strongly predicted by parental educational level and religious fundamentalism. In addition, P was predicted by neurotic/anxious traits in both parent and child. For a number of variables that predicted W, the strength of the association was stronger when twins were reporting than when parents were reporting. CONCLUSIONS: Parenting is a complex, multi-determined set of behaviours that is influenced by parental personality, psychopathology, values and marital quality and by a range of child characteristics. W appears to be strongly influenced by parental and childhood temperament and vulnerability to psychiatric illness while P and A are more strongly influenced by 'sociological' factors such as religious affiliation and educational status.

Adolescent↗