Association Of Factors Research Articles

Factors associated with breast cancer detection method in California women: an analysis of California Health Interview Survey data.

Breast cancer mortality has significantly declined in the U.S. due in part to effective clinical screening methods. However, previous studies have found many women first detect their breast cancers through means other than their providers. Given that detection method has been shown to be an important prognostic factor, we examined the association between breast cancer detection method and various demographic and health-related factors in a representative sample of female breast cancer patients aged 40 + in California. We analyzed data from the 2009 and 2011-2012 California Health Interview Survey. Weighted percentages of breast cancer patients by detection method were calculated. A multivariable logistic regression model was used to quantify each factor's association with the likelihood of having a patient-detected versus clinically detected breast cancer using odds ratios (ORs) and 95% confidence intervals (CIs). 36% of female breast cancer patients first detected their cancer themselves. Compared to U.S.-born women, those who had spent 40% or less of their lifetime in the U.S. were more than twice as likely to report their breast cancer being patient-detected versus clinically detected (OR = 2.27, 95% CI 1.06-4.86, p = 0.035). Rural women were also more likely to report a patient-detected breast cancer than urban women (OR = 1.51, 95% CI 1.01-2.11, p = 0.044). Recent immigrants and those residing in rural areas were more likely to report self-detecting their breast cancer. Given the persistent disparities with regard to breast cancer mortality, particularly among underserved communities, strategies addressing barriers to screening uptake in these populations may be warranted.

Factors associated with early-stage lung cancer diagnosis (ESLCD) in Brazil, 2013-2019: A multivariable analysis.

e20091 Background: Lung cancer has the highest mortality rate among the leading deadly cancers worldwide. Despite improvements in tobacco cessation and treatment over the years, disparities in access to care, timely diagnosis, and proper treatment remain prevalent. This study aims to identify the factors associated (FA) with Early-Stage Lung Cancer Diagnosis (ESLCD) in Brazil. Methods: This retrospective cohort study includes individuals diagnosed with lung cancer from January 2013 to December 2019, registered in the Brazilian hospital-based Cancer Registry (HBCR). Descriptive and bivariate analysis was performed, and T-tests and Chi-square were used to compare early vs late-stage groups. Multivariable backward stepwise logistic regression identified FA with ESLCD at a 95% confidence interval (CI). Results: The study was conducted with data on 86,558 individuals registered in the HBCR; 56.6% were men, 64 years old on average, and 54.8% were white. We found a high percentage of patients without education information (23.9%), and 70% had completed high school. As for behavioral characteristics, only 20% of the patients had never smoked; the others were current smokers (40%) or former smokers (40%). Almost half of the patients were from the Southeast region of Brazil (44.6%), 27% from the South, 19.9% from the Northeast, 3.9% from the North and 3.9% from the Midwest. The vast majority of the individuals were diagnosed at a late stage (85.6%), while 14.4% were ESLCD. In the bivariate analysis, being less than 65 years old, being female, white, never smoking, having a college degree, and living in the south or southeast regions were associated with ESLCD. In the final multivariable model the Factors Associated with ESLCD were having less than 65 years (OR=1.28 [95% CI: 1.22-1.34]), of the female gender (OR=1.26 [95% CI: 1.22-1.32]), having education greater than a college degree (OR=1.49 [95% CI: 1.38-1.61]), and living on the southeast (OR=1.22 [95% CI: 1.15-1.30]); and in the south region (OR=1.21 [95% CI: 1.18-1.32]); which are the wealthiest regions in the country. Conclusions: The education level was the most decisive factor associated with ESLCD. Geographic location played an important role in ESLCD, indicating issues related to wealth and access to health services. Improving access to lung cancer diagnosis, especially for vulnerable populations, can reduce disparities in the rates of early-stage diagnosis and improve overall survival. [Table: see text]

Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review

ObjectivesThe aim of this review was to identify the potential intrinsic and extrinsic risk factors (RFs), associated factors (AFs) and consequences of developing calcaneal apophysitis (CA).DesignSystematic review.Data sourcesCochrane Library, Embase,...

Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals: A Scientific Statement From the American Heart Association.

Cardiovascular disease is the leading cause of pregnancy-related death in the United States. American Indian and Alaska Native individuals have some of the highest maternal death and morbidity rates. Data on the causes of cardiovascular disease-related death in American Indian and Alaska Native individuals are limited, and there are several challenges and opportunities to improve maternal cardiovascular health in this population. This scientific statement provides an overview of the current status of cardiovascular health among American Indian and Alaska Native birthing individuals and causes of maternal death and morbidity and describes a stepwise multidisciplinary framework for addressing cardiovascular disease and cerebrovascular disease during the preconception, pregnancy, and postpartum time frame. This scientific statement highlights the American Heart Association's factors for cardiovascular health assessment known collectively as Life's Essential 8 as they pertain to American Indian and Alaska Native birthing individuals. It summarizes the impact of substance use, adverse mental health conditions, and lifestyle and cardiovascular disease risk factors, as well as the cascading effects of institutional and structural racism and the historical trauma faced by American Indian and Alaska Native individuals. It recognizes the possible impact of systematic acts of colonization and dominance on their social determinants of health, ultimately translating into worse health care outcomes. It focuses on the underreporting of American Indian and Alaska Native disaggregated data in pregnancy and postpartum outcomes and the importance of engaging key stakeholders, designing culturally appropriate care, building trust among communities and health care professionals, and expanding the American Indian and Alaska Native workforce in biomedical research and health care settings to optimize the cardiovascular health of American Indian and Alaska Native birthing individuals.

Lower Limb Assessment Related to Vascularity: A Simple Bedside Enabler.

The lower limb is a vulnerable area of the body and often subjected to minor or major trauma. In the presence of underlying systemic disease, especially with comorbidities related to arterial blood supply and simple venous backflow compromise, traumatic injury may trigger an acute lower limb skin injury to become a chronic ulcer.1 Regardless of the cause of skin breakdown, the majority of chronic lower limb wounds often have an underlying venous etiology2 that can be managed successfully with compression therapy.3 However, not all leg wounds present in the same way nor should they be treated equally. The subtle presence of arterial compromise in a predominantly venous etiology may change the appearance of the wound, the pain experience of the patient, and patient adherence to the treatment protocol (mixed venous-arterial etiology).4 Equally challenging may be lower limb edema in the limb of a person with arterial insufficiency who is not eligible for full compression therapy (mixed arterial-venous etiology).5 These mixed clinical presentations often have subtle differences and, if those are missed, clinical outcomes may not be achieved. The importance of interprofessional team involvement in managing challenging wounds that do not heal at the expected rate cannot be emphasized enough.6 Accordingly, the aim of this bedside enabler is to help clinicians recognize different clinical presentations of lower limb ulcers and assessment markers (Table 1). Recognizing these nuances in day-to-day clinical practice will promote correct initiation of adapted intervention protocols, leading to improved patient outcomes. The Table in this Practice Points column includes markers associated with blood flow etiologies of venous, arterial, mixed arterial-venous, mixed venous-arterial, and the combined neuroischemic diabetic foot.Table 1: FACTORS ASSOCIATED WITH DIFFERENT UNDERLYING ETIOLOGIES IN LOWER LIMB WOUNDSBy empowering clinicians to use multiple markers associated with lower leg and ischemic-related foot ulcers, early detection of complex lower limb ulcers with potential healing difficulties can be established from the outset. Clinicians should prioritize the correction of underlying etiologies and form an interprofessional team centered around the patient. Appropriate interventions should be initiated as needed, such as correction of arterial blood supply, smoking cessation, edema control, and weight loss, as well as metabolic control of blood glucose in persons with diabetes. Astute clinical assessment promotes timely wound treatment, lowering cost while improving patient quality of life.

B-PO05-033 PACEMAKER IMPLANTATION AFTER SELECTIVE ALCOHOL SEPTAL ABLATION

Complete heart block (CHB) with permanent pacemaker (PPM) placement is a known risk of alcohol septal ablation (ASA) for hypertrophic cardiomyopathy. Historically, the incidence has been around 10% in all-comer populations. However, rates of 25% are reported in centers that selectively target older, higher risk patients (pts). Understanding predictors of CHB in this evolving cohort is important. Report baseline characteristics, associated factors (AF) of PPM placement, longer-term pacing need following ASA in a high-volume HCM center. 94 consecutive pts underwent ASA from 2/2017 to 12/2020. 25 were excluded due to prior septal reduction or device. Criteria for PPM included persistent post-ASA CHB >24 hours, recurrent pacing due to 2nd degree HB/ transient CHB >24 hours. 69 pts (mean age 65.7 ± 11 years, females 53.6%) were included. 19 (27.5%) required PPM prior to discharge, 6 (31.5%) of whom were prohibitive surgical risk for myectomy (20.3% PPM rate in pts not at prohibitive surgical risk). All had reduction in peak provoked gradient (pre-procedure mean 149.8 mm Hg vs. post-procedure mean 10.5 mmHg, p<0.01) and improved NYHA class. Comparison of baseline clinical, ECG, and procedural characteristics (e.g., peak troponin and gradient reduction) yielded no AF of PPM implantation, with exception of intraprocedural CHB (OR 12.4, 95% CI 3.4 - 45.3, p<0.0001). Post procedure PR prolongation >50 ms (OR 6.1, 95% CI 1.5 - 24.5, p = 0.01), first-degree AV block with RBBB and LAFB (OR 6.1, 95% CI 1.5 - 24.5, p = 0.01) and change in QRS axis >700 (OR 5.3, 95% CI 1.4 - 18.9, p= 0.01) was also associated with PPM. At 1 month, 16 pts (84.2%) required >1% RV pacing (mean 59.2%) suggesting appropriateness of PPM implantation. At 3 months 10 pts (52.6%) required pacing (mean 52.4%) indicating some late recovery. No procedural factors were associated with PPM following ASA with exception of intraprocedural CHB. Daily ECGs identified dynamic abnormalities associated with PPM. Short term follow up suggests PPM criteria are appropriate, with longer term follow up showing some recovery. As higher risk cohorts are targeted for ASA, PPM risk factors of long term pacing will be vital.

Weight Gain After 20 Years of Age is Associated with Unfavorable Lifestyle and Increased Prevalence of Metabolic Disorders.

PurposeIt is unclear what kind of modifiable lifestyle factors are associated with long-time weight gain in adulthood. To clarify the lifestyle behavior related to body weight gain since the age of 20 years, we explored the lifestyle risk factor, independently associated with excessive weight gain after 20 years of age as compared to those in subjects with a stable weight, with matching of age, gender, and the current body mass index (BMI).Patients and MethodsFrom baseline data of a general population-based cohort study, we designed a cross-sectional analysis collecting individual data of medical health check-ups and a questionnaire related to lifestyle, including amount of sleep, frequency of eating breakfast, average times per day engaged in walking and sitting in the prior year, and smoking habits. These data were compared between the subjects with weight gain ≥10kg (n=3601) and <10kg (n=3601) after age 20, matched by a propensity score model which included current BMI, age and gender. We used multivariable logistic regressions to assess the lifestyle factor’s association with high weight gain.ResultsParticipants who gained ≥10 kg were significantly more likely to sleep <5 hours or ≥9 hours per night, skip breakfast, engage in walking <1 hour per day, and sit ≥5 hours per day than those who gained <10kg. Multivariable logistic regressions analyses showed that, with adjusting for potential confounder, the lifestyles with the positive association with high weight gain were skipping breakfast (OR 1.252; 95% CI 1.053–1.489, vs regularly), long sleeping duration (9 hours/day≤ OR 1.613; 95% CI 1.018–2.557 vs 5≤-<7 hours/day), and former smoker (OR 1.163; 95% CI 1.008–1.343 vs never smoker), while walking duration was negatively associated with high weight gain. Furthermore, despite similar current BMI, participants with weight gain ≥10kg had significantly higher values for waist circumference, blood pressure, HbA1c, LDL-C, triglycerides, and hepatic enzyme levels than those with weight gain <10kg. Similarly, the prevalence rates of hypertension, dyslipidemia, metabolic syndrome (MetS), and former smoker were higher in the participants with weight gain ≥10kg.ConclusionMajor weight gain after 20 years of age was associated with unfavorable lifestyle factors and greater waist circumference, possibly leading to elevated risk for MetS and other non-communicable diseases. These findings highlight the importance of maintaining both weight at age 20 and a favorable lifestyle throughout adulthood.

General psychopathology factor and borderline personality disorder: Evidence for substantial overlap from two nationally representative surveys of U.S. adults.

A general psychopathology factor reflects an underlying liability for a wide range of mental disorders. There is suggestive evidence that borderline personality disorder (BPD) may be strongly associated with the general psychopathology factor, but there are no detailed data on the degree of overlap between the general psychopathology factor and BPD or its individual symptoms. This study examined the overlap between the general psychopathology factor and BPD using cross-sectional survey data from two nationally representative samples of U.S. adults, the National Comorbidity Survey Replication (N = 5,692) and the National Comorbidity Survey follow-up (N = 5,001). Structural equation modeling was used to fit a bifactor general psychopathology model and to examine the general psychopathology factor's associations with (a) a series of Clusters A, B, and C personality disorder symptoms including BPD symptoms and (b) a latent BPD. Results showed that the shared variance between the general psychopathology factor and a latent BPD was 56% in the National Comorbidity Survey Replication and 71% in the National Comorbidity Survey follow-up. The correlation between the general factor and BPD could be set to unity without worsening model fit, suggesting that BPD closely reflects a general liability to psychopathology. The affective features of BPD were particularly strongly associated with the general psychopathology factor. Findings are discussed with respect to the nosology of BPD and the treatment of mental disorders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluation of the Bidirectional Relations of Perceived Physical Fatigability and Physical Activity on Slower Gait Speed.

Lower physical activity levels and greater fatigability contribute independently to slower gait speed in older adults. To fully understand the bidirectional relations between physical activity and fatigability, and to inform potential intervention strategies, we examined whether physical activity or fatigability explains more of the other factor's association on slower gait speed. Two generations (probands and offspring) of older adults (N = 2079, mean age 73.0 ± 10.0 years, 54.2% women, 99.7% White) enrolled in the Long Life Family Study were assessed at Visit 2 (2014-2017). Self-reported physical activity was measured with the Framingham Physical Activity Index and perceived physical fatigability using the Pittsburgh Fatigability Scale. Statistical mediation analyses were conducted separately by generation with linear mixed-effect models accounting for family relatedness and adjusted for demographics, health conditions, and field center. Greater perceived physical fatigability explained the association of lower physical activity on slower gait speed via a 22.5% attenuation of the direct association (95% confidence interval [CI]: 15.0%-35.2%) for the probands and 39.5% (95% CI: 22.8%-62.6%) for the offspring. Whereas lower physical activity explained the association of greater perceived fatigability on slower gait speed via a 22.5% attenuation of the direct association (95% CI: 13.4%-32.8%) for the probands and 6.7% (95% CI: 3.8%-15.4%) for the offspring. Our findings suggest that the impact of greater perceived physical fatigability on the association between lower physical activity and slower gait speed differs between younger-old and middle-to-oldest-old adults, indicating perceived physical fatigability as a potential mediator in the disablement pathway.

Association Factor for Identifying Linear and Nonlinear Correlations in Noisy Conditions.

Background: In data analysis and machine learning, we often need to identify and quantify the correlation between variables. Although Pearson’s correlation coefficient has been widely used, its value is reliable only for linear relationships and Distance correlation was introduced to address this shortcoming. Methods: Distance correlation can identify linear and nonlinear correlations. However, its performance drops in noisy conditions. In this paper, we introduce the Association Factor (AF) as a robust method for identification and quantification of linear and nonlinear associations in noisy conditions. Results: To test the performance of the proposed Association Factor, we modeled several simulations of linear and nonlinear relationships in different noise conditions and computed Pearson’s correlation, Distance correlation, and the proposed Association Factor. Conclusion: Our results show that the proposed method is robust in two ways. First, it can identify both linear and nonlinear associations. Second, the proposed Association Factor is reliable in both noiseless and noisy conditions.

FACTORS ASSOCIATED WITH MOBILITY APPREHENSION IN AMPUTEES

INTRODUCTION&#x0D; Studies report that after lower-limb amputation, patients have high levels of pain in the form of chronic low back pain, residual limb pain, and phantom pain leading to restrictions in functional activity1. Patients with high levels of pain and disability may develop avoidance behaviors. Vlaeyen et al. presents the fear-avoidance model, which suggests that after an injury there are two pathways a patient will take based on their interpretation of acute pain 2. Pain that is perceived as non-threatening leads to the patient’s recovery and return to normal activities of daily life. Pain that is perceived as threatening, or pain catastrophizing, causes anxiety and induces mobility apprehension which leads to avoidance behaviors. Avoidance behaviors may then lead to greater pain, depression, and disability3 . Factors described in the literature that are related to mobility apprehension were measured in a sample of lower limb amputees. The purpose was to determine which of pain intensity, interference, and catastrophizing lead to increased mobility apprehension.&#x0D; Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32040/24454&#x0D; How to cite: Mathis S.L. FACTORS ASSOCIATED WITH MOBILITY APPREHENSION IN AMPUTEES. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32040 &#x0D; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. &#x0D; http://www.aopanet.org/&#x0D;

Synovitis and the risk of knee osteoarthritis: the MOST Study

To identify the independent relation of synovitis with incident radiographic knee osteoarthritis (OA) after adjusting for other structural factors known to cause synovitis. We examined MRIs from knees that developed incident radiographic OA from the Multicenter Osteoarthritis Study (MOST) and compared these case knees with controls that did not develop OA. We examined baseline MRIs for knees developing OA at any time up to 84 months follow-up. We scored lesions in cartilage, meniscus, bone marrow and synovitis. Synovitis scores were summed (0-9) across three regions, suprapatellar, infrapatellar and intercondylar region, each of which was scored 0-3. After bivariate analyses examining each factor's association with incidence, we carried out multivariable regression analyses adjusting for age, sex, BMI, alignment and cartilage and meniscal damage. We studied 239 case and 731 control knees. In bivariate analyses, cartilage lesions, meniscal damage, synovitis and bone marrow lesions were all risk factors for OA. After multivariable analyses, synovitis was associated with incident OA. A higher synovitis score increased the risk of incident OA (adjusted OR per unit increase 1.1; (95% CI 1.0, 1.2, P = .02)), but increased risk was associated only with synovitis scores of ≥3 (adjusted OR 1.6; 95% CI 1.2, 2.1, P = .003). Synovitis, especially when there is a substantial volume within the knee, is an independent cause of OA.

High HIV incidence among men who have sex with men attending a community-based voluntary counselling and testing service in Barcelona, Spain: results from the ITACA cohort

ObjectivesTo identify the HIV incidence and its associated factors (AFs) of the ITACA, a community-based cohort of HIV-negative men who have sex with men (MSM) established in Barcelona, Spain from...

The emergence of cardiometabolic disease risk in Chinese children and adults: consequences of changes in diet, physical activity and obesity.

Strong secular declines in physical activity, increased fat and salt intake, and increased obesity, especially abdominal obesity, mark China's recent nutrition transition. The China Health and Nutrition 2009 Survey collected anthropometry, blood pressure and fasting blood samples from more than 9,000 individuals ≥ 7 years of age. We focus on elevated blood pressure and plasma markers of diabetes, inflammation and dyslipidemia. We used international definitions of cardiometabolic risk and estimated age- and sex-specific prevalence ratios for each outcome for high waist circumference or overweight. We used logistic regression to assess each risk factor's association with diet, physical activity, overweight and abdominal obesity. Cardiometabolic risk prevalence was high in all age groups Prevalence ratios for most risk factors were nearly doubled for overweight or high waist circumference groups. Prevalence ratios were higher in younger than older adults. Low physical activity consistently predicted higher cardiometabolic risk across most outcomes and age-sex groups. The co-occurrence of overweight and high waist circumference was highly predictive of dyslipidemia, elevated glycated haemoglobin and diabetes. High prevalence of cardiometabolic risk factors and their strong association with weight status and abdominal obesity in young adults portend increases in cardiometabolic morbidity and mortality. Early interventions will be required to reverse trends.

M531 WEIGHT GAIN IN PREGNANCY AND ASSOCIATED FACTORS: A SAMPLE OF PREGNANT WOMEN IN THE CITY OF RIO DE JANEIRO

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S702-S702 Poster presentations M531 WEIGHT GAIN IN PREGNANCY AND ASSOCIATED FACTORS: A SAMPLE OF PREGNANT WOMEN IN THE CITY OF RIO DE JANEIRO A.C.S. Amaral, A.C.S. AmaralSearch for more papers by this authorM.M. Theme, M.M. ThemeSearch for more papers by this author A.C.S. Amaral, A.C.S. AmaralSearch for more papers by this authorM.M. Theme, M.M. ThemeSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61719-6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S702-S702 RelatedInformation

Comparison of skin prick allergy test in urban and rural children

Background Children who grow up in rural areas have a lower incidence of atopy and other allergic manifestations than children in urban areas. Several recent studies have suggested that agricultural exposure may protect children from developing asthma and atopy, but these findings are inconsistent.Objective To examine an association between living in rural or urban areas and skin prick allergy test results in children and to detennine associated risk factors for atopy.Methods We conducted a cross-sectional study in Karo district (rural) and Medan (urban) in October-December 2009. We enrolled primary school children who had a history of atopy in their families. Skin prick testing was done on the volar side of the forearm and included eight aero-allergens: house dust mites, house dust, cotton, chicken feathers, cat dander, cockroaches, mould, and pollen. We analyzed the folloMng risk factors forassociation Mth atopy: tobacco smoke, pets, livestock exposure, and having older sibling(s).Results We recruited 49 children from the Karo district and 52 children from the city of Medan. There were significant associations between living in an urban area and positive skin prick test results for house dust mites and house dust compared to living in a rural area (P=0.04, 95% CI: 1.11 to 5.91; P=0.04, 95% CI: 1.13 to 12.45, respectively). The reverse was true for cockroach allergens (P=0.02, 95% CI: 0.16 to 0.81). Tobacco smoke and livestock exposure were associated Mth negative skin prick test results in rural children (P=O.03, 95% CI: 0.03 to 0.81 and P=0.002, 95% CI: 0.02 to 0.42, respectively). Multivariate analysis revealed that lack of livestock exposure was the major risk factor associated Mth any positive skin prick test results in rural children (P=0.004; 95% CI ; 0.02 to 0.49).Conclusion There were differing associations between living in rural and urban areas to various skin prick test results in children. Lack of livestock exposure was the risk factor associated with positive skin prick test results in rural children.

Factorial and Construct Validity of the Revised Short Form Integrative Psychotherapy Alliance Scales for Family, Couple, and Individual Therapy

The Integrative Psychotherapy Alliance model brought an interpersonal and systemic perspective to bear on theory, research, and practice on the psychotherapeutic alliance. Questions have been raised about the independence of the theoretical factors in the model and their operationalization in the Individual, Couple, and Family Therapy Alliance Scales. This paper presents results of a confirmatory factor analysis of the scales that delineated at least three distinct interpersonal factors as well as shorter versions of the three scales to facilitate their use in research and practice. The paper also presents the results of a study testing each factor's association with client retention and progress over the first eight sessions in individual and couple therapy. At least two of the interpersonal factors were uniquely associated with progress in individual and couple functioning. Implications of the results for theory, research, practice, and training in individual, couple, and family therapy are elaborated.

Fatores associados à hipertensão arterial e níveis pressóricos encontrados entre adolescentes trabalhadores

O objetivo deste trabalho foi identificar fatores associados (FA) à hipertensão arterial e verificar níveis pressóricos de adolescentes trabalhadores. Foram entrevistados 193 adolescentes, sendo 135 homens e 58 mulheres, entre 16 e 18 anos. Após cinco minutos sentados, mediu-se a circunferência braquial e determinou-se a pressão arterial (PA), usando manguito de largura correta (MLC) e padrão (MLP). Os valores obtidos foram relacionados aos FA encontrados. As médias pressóricas, considerando todos os adolescentes, foram 105,2/60,9 mmHg (MLC) e 101,0/57,9 (MLP-p&lt;0,05). Dentre os FA encontrados, apenas a cor e a ingestão de bebidas alcoólicas foram associadas ao aumento da PA. O uso do MLC permitiu a detecção de maior número de hipertensos e limítrofes que o uso do MLP. Todos apresentaram FA. Pode-se concluir que há vários FA com hipertensão arterial nessa população, alguns deles já causando elevação da PA. Estudos como este deveriam ser realizados freqüentemente entre adolescentes, pois seus níveis pressóricos podem pre-dizer hipertensão na fase adulta.

Primary prevention of prematurity mediated by genital infection/inflammation: Critical factors associated with improved outcomes

INFLAMMATION: CRITICAL FACTORS ASSOCIATED WITH IMPROVED OUTCOMES JAMES MCGREGOR, JANICE FRENCH, OZLEM EQUILS, University of Southern California, Obstetrics/Gynecology, Los Angeles, California, Los Angeles Best Baby Network, Santa Monica, California, University of California at Los Angeles, Pediatrics, Los Angeles, California OBJECTIVE: Examine selected, prospective controlled trials for factors associated with successful primary prevention of preterm birth (PTB) mediated by ascending reproductive tract infection/inflammation (RTI) and/or BV. Background: Second trimester, late miscarriage (LM), and !35 week PTB are etiologically associated with RTIs and other potentially remediable conditions. However, timing, treatments, and populations likely to benefit require clarification. STUDY DESIGN: Controlled trials among asymptomatic women which evaluated PTB and related outcomes were analyzed. Study design and factors were evaluated for positive/negative effects. RESULTS: Ten studies met evaluation criteria. Four critical factors associated with .50 reduction in PTB were identified: A) Early (!20 weeks) screening and treatment (including test of cure [TOC]) of affected mothers (BV, STIs) (4/4). B) Clindamycin (oral or topical) treatment for BV when given early in gestation (3/3). C) Comprehensive ‘‘screen and treat’’ Study designs in which prevalent RTIs were systematically identified and treated beginning !20 weeks gestation (3/3). D) Relevent genotypic/phenotypic-environment interactions are more common among African-American and black women of differing racial and geographic origins. Benefits of treatment are largest in populations at increased risk and late treatments are ineffective. CONCLUSION: Controlled trials evaluating primary prevention of prematurity !35 weeks and/or LM demonstrated consistent, biologically plausible and clinically applicable determinants associated with reduced prematurity !34 weeks. 1) Early gestation screening and treatment followed by TOC; 2) Use of clindamycin for treatment of BV early in pregnancy; 3) Comprehensive screening and treatment of prevalent RTIs andBV.African-American and other blackwomen demonstrate differential benefits compared to comparator women. These findings can inform research design and medical care strategies designed to prevent PTB/pPROM etiologically linked to infection/inflammation.

Public Health and the Risk Factor: A History of an Uneven Medical Revolution (review)

Reviewed by: Public Health and the Risk Factor: A History of an Uneven Medical Revolution Neil A. Holtzman William G. Rothstein . Public Health and the Risk Factor: A History of an Uneven Medical Revolution. Rochester Studies in Medical History. Rochester, N.Y.: University of Rochester Press, 2003. xiii + 466 pp. Tables. $95.00; £70.00 (1-58046-127-1). Risk factors can be reduced or removed by interventions in populations, individuals, or both. In this study, William Rothstein first traces the use of the concept of the risk factor (not the name) to improve population health from the seventeenth century through the first half of the twentieth; surprisingly, he does not cite the work of Thomas McKeown or his recent critics.1 Then he deals with the extrapolation of risk factors in populations to risk factors in individuals. Quoting Claude Bernard, he points out one problem: "'an average description [of the risk factor for a group] will never be matched in nature,' inasmuch as each case differs from the average. . . .' 'In my opinion statistics [risk factor data] can never yield scientific truth'" (p. 19). Another reason why risk factor data may fail is that despite a risk factor's association with disease, it may not be causally related. In this regard, Rothstein cogently notes that the decline of premature deaths due to coronary heart disease (CHD) began before campaigns to reduce putative personal risk factors (as well as changes in the medical care of CHD) became widespread. He does not discuss the relation of socio-economic status (SES) to the decline, although he documents low SES in the second half of the twentieth century as a risk factor for CHD. Readers are left wondering what was going on. One possibility, not discussed by Rothstein, is the much poorer SES of the cohort born during the Great Depression and World War II than of previous or subsequent cohorts: they comprised the middle-aged population (45-60 years) between 1975 and 1990, and it was in this cohort that the decline in CHD mortality occurred. According to Rothstein, the risk factor was invented by life insurance companies when they realized that instead of denying insurance to anyone who was not healthy, "they should have graded the risks of the applicants and adjusted the premiums to the level of risk" (p. 61). With the sale of inexpensive "industrial" life insurance (which paid for little more than burials) to millions of workers, the major life insurance companies had sufficiently large numbers of policyholders in the first decades of the twentieth century to grade risk fairly accurately. As Rothstein describes, census and vital statistics data go back much further, but their lack of completeness and accuracy were drawbacks. Moreover, not until the second half of the nineteenth century did census data include occupation and other social factors. Rothstein nicely describes the different meanings of "statistics" over the past centuries. He does not describe how statisticians estimate whether associations [End Page 927] are due to chance by techniques such as chi-square or t-test; this will be a relief to some readers, but a shortcoming to others. He discusses problems of small and large sample sizes, pointing out: "Statistical tests are designed to attach great weight to the size of the samples, so that very large samples make trivial differences statistically significant" (p. 366). Surprisingly, he seldom considers magnitude of risk in terms of odds ratios. Instead, he emphasizes correlations between mortality rates and putative risk factors, a much cruder measure. Moreover, society's interest has shifted from the relation of risk factors to mortality to their relation to disease onset. The emphasis throughout the book is on mortality. Despite its weaknesses, this is a highly readable and informative book. Neil A. Holtzman Johns Hopkins University School of Medicine and Bloomberg School of Public Health Footnotes 1. Thomas McKeown, The Role of Medicine: Dream, Mirage, or Nemesis? (Princeton: Princeton University Press, 2003), p. 207; James Colgrove, "The McKeown Thesis: A Historical Controversy and Its Enduring Influence," Amer. J. Publ. Health, 2002, 92: 725-29; Simon Szreter, "Rethinking McKeown: The Relationship between Public Health and Social Change," ibid., pp. 722-25. Copyright © 2004 The Johns Hopkins...