Geographic Region Of Residence Research Articles

Predictors of high-risk alcohol consumption in young offenders on community orders: Policy and treatment implications.

The present study examined the relationship between a set of individual and contextual variables and high-risk alcohol use among young offenders placed on community orders in New South Wales, Australia. Participants (n = 777) were compared on a set of factors known to be strong predictors of high-risk alcohol use among adolescents. The authors assessed the strength of the relationship between gender, age, ethnicity, geographical region of residence, school attendance, father absence, history of childhood trauma, and the presence of severe conduct disorder on weekly levels of alcohol use. Living in rural locations, not currently attending school, being female, and not having been raised with a biological father present were associated with significantly increased odds of alcohol abuse. Father absence was a more important risk factor for rural young offenders, but school dropout was associated with more hazardous drinking among young offenders in urban areas. Accordingly, the authors suggest family-focused intervention programs for young offenders living in rural areas and school-based programs for vulnerable young people living in urban areas, although programs should consider including both factors for both groups if feasible and warranted.

Dietary Vitamin D Intake and Cancers of the Colon and Rectum: A Case-Control Study in Italy

Epidemiologic evidence indicates that vitamin D is inversely associated with risk of colon or rectal cancer or both. Using data from a case-control study conducted in Italy between 1992 and 1996, we examined the relation between dietary intake of vitamin D and colon and rectal cancer risk. The study population comprised patients with incident colon cancer (n = 1,225) or rectal cancer (n = 728) and 4,154 hospital controls. Odds ratios (OR) and 95% confidence intervals (CI) according to deciles of vitamin D intake were estimated by multiple logistic regression. In addition, we adjusted for intensity of sunlight exposure through stratification by geographic region of residence, and we computed ORs separately by anatomic subsite within the colon. Adjusted ORs for colon cancer were seen to decrease after the 5th decile of vitamin D intake and reached 0.69 (95% CI = 0.50–0.96) for the 9th and 10th deciles, reflecting a statistically significant inverse trend. The inverse association appeared to be somewhat more pronounced for the proximal than the distal colon and was similar among strata of geographic region and calcium intake. Rectal cancer was unrelated to vitamin D intake in this population. In conclusion, we observed an inverse association between dietary vitamin D intake and colon cancer risk among those with the highest intake levels, which was somewhat unexpected given that these levels were still substantially below the levels considered optimal for colon cancer prevention.

Attitudes toward Participation in Research, New Treatments, and Medication Side Effects among Multiple Myeloma and Myelodysplastic Syndrome Patients - The Patient Registries at Slone: Myeloma & MDS.

Background: Exploration of multiple myeloma (MM) and myelodysplastic syndrome (MDS) patients' attitudes toward participation in research, newly approved treatments, and potential treatment side effects can guide efforts to increase both participation in research and acceptance of treatments among diverse patient subgroups.Methods: The Patient Registries at Slone: Myeloma & MDS are national disease-based observational registries conducted by Boston University. All patients diagnosed with these diseases within 4 months of enrollment are eligible for inclusion. Subjects enroll by mail or over the Internet; information on treatment, clinical events, quality of life, and attitudes toward research participation, new treatments, and possible side effects is obtained by questionnaire at baseline and at six-month intervals. We reviewed answers to attitudinal questions obtained from baseline questionnaires completed by 104 MM and 126 MDS patients enrolled between June 2006 and June 2007 (residing in 40 states). We also calculated a composite “side effect concern” score based on the answers to 11 questions on specific side effects.Results: Most patients reported willingness to participate in clinical trials (81% MM; 86% MDS) and to consider a new treatment that had benefited some patients, but for which side effects were not yet known (81% MM; 87% MDS). Differences among subgroups categorized according to age, geographic region of residence, education, or race were small. Thirteen percent, 65%, and 22% reported they were very, somewhat, and not at all willing, respectively, to try a new, potentially beneficial treatment that could also rarely cause death. Approximately 75% of patients reported they would be very concerned about serious infection as a treatment side effect, and 36% and 29%, respectively, reported they would be very concerned about vomiting and fever. Most patients reported lower levels of concern about other possible side effects. Median side effect concern scores were 14 for both MM and MDS patients (range 1–24 for MM and 0–24 for MDS). The median score was 14 for both those willing and those not willing to participate in research. The median was 15.5 for those not at all willing to try a new treatment compared to 12.5 for those very willing to try such treatment (p=0.02). Scores did not vary appreciably by age, geographic region of residence, education, race, or history of any of 6 diseases. MDS patients who reported having undergone treatment for their disease had a median score of 13 compared to 16 for those who reported no treatment (p=0.03); among MM patients, the medians were similar for those with and without prior treatment.Conclusion: MM and MDS patients in a large national registry largely indicate a willingness to participate in research and consider newly-approved treatments. Most patients reported concerns about possible side effects of treatment; higher levels of concern were associated with less willingness to try a new treatment, but were not associated with willingness to participate in research.

Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS

We evaluated the utilization and potential benefits of recombinant human growth hormone (rhGH) in children with chronic kidney disease (CKD) and following renal transplantation in a large patient cohort. We queried the chronic renal insufficiency (CRI), dialysis, and transplant registries of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) to characterize the frequency of rhGH utilization, factors related to its usage, and the relationship between rhGH usage and catch-up growth. Data from 6,505, 5,122, and 4,478 CRI, dialysis, and transplant patients, respectively, was evaluated. Percentage utilization of rhGH 2 years after registry entry was 22%, 33%, and 3% in children with a height standard deviation score (SDS)<-1 and age<17 years (termed candidate group) in CRI, dialysis, and transplant patients, respectively. Multivariate logistic regression analysis showed that the likelihood of using rhGH was significantly correlated with age, gender, geographical region of residence and height category within the candidate group (p<0.01). The use of rhGH was associated with catch-up growth in 27%, 11%, and 25% of candidate CRI, dialysis, and transplant patients, respectively. In the candidate group, percentage catch-up growth was highest in children who were Tanner stage 1-2, who comprised 19.4%, 7.1%, and 25.5% of the CRI, dialysis, and transplant patients, respectively. Using multiple regression analysis, the estimated impact of rhGH on final adult height (age>19 years) was 0.80, 0.50, and 0.19 SDS, in CRI, dialysis, and transplant patients, respectively. Thus, rhGH can improve height gain in some children with CKD. The use of rhGH appears to be most effective in prepubertal children with CRI.

Suicide Attempts and Associated Factors in Newfoundland and Labrador, 1998–2000

This study examined the epidemiology and associated factors for suicide attempts requiring hospitalization in the province of Newfoundland and Labrador. We extracted data from the provincial hospital separation database. Outcome measures included incidence rates (IRs) of suicide attempts by age, sex, and geographical region of residence. We also analyzed sociodemographic data to determine associated factors. A total of 978 patients who were hospitalized owing to suicide attempts were identified for 1998-2000, giving an overall IR of 68.7 per 100,000 person-years (P-Y). The age-specific rate for people aged 15 to 19 years was much greater, at 143.0 per 100,000 P-Y. The overall female-to-male ratio was 1.3, with an attempted suicide rate of 76.1 per 100,000 P-Y for female patients and 60.3 per 100,000 P-Y for male patients (P = 0.001). Labrador (210.2 per 100,000 P-Y), a region with a high Aboriginal population, had a higher rate of suicide attempts, compared with the island portion of the province (59.0 per 100,000 P-Y) (P < 0.001). More than 70% of hospitalizations were associated with psychiatric diagnosis. Poisoning was the most frequent method of attempting suicide. Higher IRs of suicide attempts were found among people who were divorced or separated and among those who were less educated (P < 0.001). Suicide attempt represents a significant public health concern in the province, particularly in Labrador. An increased risk of suicide attempts was associated with single status, female sex, younger age (teen or young adult), and low educational level during the index attempt. Further research is needed to explicate these findings and increase our understanding of attempted suicide.

Thrombomodulin Ala455Val Polymorphism and the risk of cerebral infarction in a biracial population: the Stroke Prevention in Young Women Study

BackgroundThe genes encoding proteins in the thrombomodulin-protein C pathway are promising candidate genes for stroke susceptibility because of their importance in thrombosis regulation and inflammatory response. Several published studies have shown that the Ala455Val thrombomodulin polymorphism is associated with ischemic heart disease, but none has examined the association with stroke. Using data from the Stroke Prevention in Young Women Study, we sought to determine the association between the Ala455Val thrombomodulin polymorphism and the occurrence of ischemic stroke in young women.MethodsAll 59 hospitals in the greater Baltimore-Washington area participated in a population-based case-control study of stroke in young women. We compared 141 cases of first ischemic stroke (44% black) among women 15 to 44 years of age with 210 control subjects (35% black) who were identified by random digit dialing and frequency matched to the cases by age and geographical region of residence. Data on historical risk factors were collected by standardized interview. Genotyping of the thrombomodulin Ala455Val polymorphism was performed by pyrosequencing.ResultsThe A allele (frequency = 0.85) was associated with stroke under the recessive model. After adjustment for age, race, cigarette smoking, hypertension, and diabetes, the AA genotype, compared with the AV and VV genotypes combined, was significantly associated with stroke (odds ratio 1.9, 95% CI 1.1–3.3). The AA genotype was more common among black than white control subjects (81% versus 68%) but there was no significant interaction between the risk genotype and race (adjusted odds ratio 2.7 for blacks and 1.6 for whites). A secondary analysis removing all probable (n = 16) and possible (n = 15) cardioembolic strokes demonstrated an increased association (odds ratio 2.2, 95% CI 1.2–4.2).ConclusionsAmong women aged 15 to 44 years, the AA genotype is more prevalent among blacks than whites and is associated with increased risk of early onset ischemic stroke. Removing strokes potentially related to cardioembolic phenomena increased this association. Further studies are needed to determine whether this polymorphism is functionally related to thrombomodulin expression or whether the association is due to population stratification or linkage to a nearby functional polymorphism.

Marriage or Cohabitation: A Competing Risks Analysis of First-Partnership Formation among the 1958 British Birth Cohort

Summary A discrete time competing risks hazards model is used to analyse entry into first partnership among men and women born in Britain in 1958. Using a life-course approach we identify family background and current life experiences which affect the timing and type of first-partnership formation. Education is a key factor influencing the age of entry into first partnership and whether or not the respondent will experience pregnancy before forming the partnership. Religiosity, experience of parental separation and the geographical region of residence are more important in affecting the decision to cohabit rather than to marry directly. The analyses highlight the importance of transitions in other domains such as leaving the parental home in encouraging cohabitation.

Factors associated with the crash risk of adult bicyclists

This article evaluates the factors associated with the crash risk of adult bicyclists. A logistic regression analysis was used to determine and quantify risk factors, controlling simultaneously for a number of rider characteristics and bicycle use patterns. The analysis was based on data from a national survey of over 3,000 adult bicyclists, age 18 and older. The survey gathered information on the characteristics and use patterns of the bicyclists, and whether they had crashed or fallen from their bicycles during the preceding year. The results of the analysis show that the bicycle crash risk is systematically related to a rider's age, riding distances, riding surface, bicycle type, and geographical region of residence.

Extent and variation of omeprazole prescribing in an elderly population of Ontario.

To determine the extent of omeprazole prescribing in the senior population of Ontario over a 1-year period; the variation in omeprazole prescribing for this population according to age group, gender, and geographic region: and the extent of inappropriate prescribing of omeprazole for this population. Retrospective drug utilization review of prescription drug insurance claims. The Ontario Drug Benefit (ODB) program claims database. The following outcomes were measured: the proportion of seniors in Ontario who received a prescription for omeprazole from April 1, 1992 to March 31, 1993: effects of age group, gender, and geographic region of residence on omeprazole prescribing; and the extent of inappropriate omeprazole prescribing according to the ODB criteria for use. Prescribing of omeprazole was defined as inappropriate if a first-line antiulcer drug (i.e., histamine2-receptor antagonist) was not prescribed within 1-6 months of the first prescription claim for omeprazole. A total of 29,936 seniors in Ontario received omeprazole from April 1, 1992 to March 31, 1993 (2.53 recipients per 100 eligible population). The age-gender group most frequently prescribed omeprazole was women 65-74 years, followed by women and men 75 years or older, and then men 65-74 years. Omeprazole prescribing varied widely among the 48 provincial counties (range of 1.66 recipients per 100 eligible population to 4.52 recipients per 100 population, p < 0.001). There was no evidence of a clustering effect in omeprazole prescribing at the county level. Prescribing of omeprazole was considered to be inappropriate for 80.5% of recipients. This study demonstrated the ineffectiveness of the ODB limited-use program in controlling omeprazole prescribing. Further study should be done to examine determinants of variation in prescribing by geographic region.

Trends in heterosexually acquired AIDS in the United States, 1988 through 1995.

We used national AIDS surveillance data to characterize trends in the numbers and proportions of heterosexually acquired AIDS cases diagnosed from January 1988 through December 1995 among adults and adolescents. We adjusted for expansion of the 1993 AIDS surveillance case definition and for delays in reporting, and we redistributed cases initially reported without risk. The chi-square test for linear trend was used to analyze trends at the p < 0.01 level by half-year of diagnosis and by sex, age, race or ethnicity, geographic region of residence at diagnosis, and partner's HIV exposure risk. From 1988 through 1995, heterosexual contact accounted for 10% of all AIDS cases. Heterosexual contact increased the most rapidly of all HIV exposure modes, with increases found among men and women in all age groups; among blacks, whites, and Hispanics: and among persons living in all geographic regions of the country. Blacks and Hispanics accounted for 75% of all persons reported with AIDS attributed to heterosexual contact. Although heterosexual contact with an injection drug user (IDU) accounted for most cases until 1993, cases increased most rapidly among persons reporting heterosexual contact with an HIV-infected partner whose risk was not specified. Findings suggest continued growth of the heterosexual AIDS epidemic. Because of the disproportionate and increasing number of heterosexually acquired AIDS cases among blacks and Hispanics, black and Hispanic communities at risk for HIV infection should be considered a high priority for prevention and education programs specifically targeting heterosexually active adolescents and adults. Epidemiologic and behavioral research and prevention program evaluation are urgent public health priorities to better control and prevent the further spread of HIV among heterosexually active adults and adolescents.

Pediatric critical care nurses' knowledge of cardiac dysrhythmias

To describe pediatric critical care nurses' knowledge of dysrhythmias in critically ill pediatric patients and relate this knowledge level to certain demographic variables (education, nursing experience, certification, supplemental training, area of employment and geographic region of residence). A descriptive survey. American Association of Critical-Care Nurses' 19 geographic regions of the United States. Of 1000 questionnaires mailed to pediatric critical care nurses who were members of the American Association of Critical-Care Nurses in 1991, 356 responses were received (a response rate of 36%). A criterion-referenced, self-administered test regarding pediatric dysrhythmias and a demographic sheet randomly mailed to 1000 pediatric critical care nurses. Test results were analyzed and compared with demographic variables. The mean total test score was 66%. Significantly higher total test scores and selected subtest scores were demonstrated in relationship to the following variables: increased age; certification in pediatric advanced life support, advanced cardiac life support or adult critical care; increased years of adult critical care experience; advanced dysrhythmia courses and dysrhythmia self-study; and perceived knowledge level above that of the advanced beginner. Pediatric critical care nurses' overall knowledge of dysrhythmias was low. Knowledge strengths included recognition of basic and life-threatening dysrhythmias and calculation of basic ECG measurements. Knowledge deficits included importance of sinus bradycardia in the neonate, appropriate intervention for life-threatening dysrhythmias and calculation of an irregular heart rate. These deficits should be considered when planning continuing education programs for pediatric critical care nurses.

Determinants of menstrual bleeding patterns among women using natural and hormonal methods of contraception I. Regional variations

Records of the occurrence of vaginal bleeding were obtained from women using either a natural method of contraception or one of four types of hormonal contraceptive. The relationships between their bleeding patterns and a number of demographic variables were examined, with the aim of identifying subgroups of women who, if they used a particular hormonal method of contraception, would be likely to suffer more or less disruption to their bleeding pattern than the ‘norm’. Within contraceptive method, bleeding patterns were more closely related to the woman's geographical region of residence than to any other factor. Some of the differences between regions were consistent across contraceptive methods. European women tended to have more bleeding/spotting days than women in other regions; Latin American women had relatively short episodes and long bleeding-free intervals, whether they were using the ovulation method, combined pills or a vaginal ring. Other differences were method-specific. Women using combined pills in India or Pakistan had fewer spotting episodes than women using the same method elsewhere; those using progestogen-only pills had more. Regional variations In bleeding patterns were particularly marked among women using DMPA, and increased over time: by their fourth injection interval, 25% of European women had amenorrhea, as compared with 72% of subjects in North Africa. These findings need to be confirmed by carefully controlled studies of menstrual bleeding patterns and their acceptability in various ethnic groups. The results would be valuable in counselling new contraceptive acceptors, and could eventually guide the choice of methods for introduction into national family planning programmes.

Determinants of menstrual bleeding patterns among women using natural and hormonal methods of contraception II. The influence of individual characteristics

Menstrual diary records were obtained from women using either a natural method of contraception, a combined or progestogen-only oral contraceptive, a vaginal ring, or a long-acting injectable (DMPA). Within each method group, multiple regression analysis was used to examine the relationships between the subjects' bleeding patterns and their age, age at menarche, ponderal index, obstetric and contraceptive history and ethnic origin. The influence of ethnic origin was described in the preceding paper. Among combined pill users, increasing age was associated with more frequent spotting episodes. In both the untreated and combined pill groups, women with a higher ponderal index had less variable bleeding-free intervals; in the vaginal ring and DMPA groups, the more obese women had shorter bleeding/spotting episodes and longer bleeding-free intervals. Among combined oral contraceptive users, the most influential variable was the time since the end of the woman's last pregnancy: subjects who had been more recently pregnant had longer, less predictable episodes and shorter intervals. Previous oral contraceptive use was associated with more predictable bleeding patterns among women currently using either type of oral pill. In the vaginal ring and DMPA groups, subjects whose last pregnancy had ended in abortion had more bleeding/spotting days and episodes than those who had had a live birth. As reported previously, bleeding patterns were more closely related to the woman's geographical region of residence than to any other factor. The associations found with other individual characteristics were often inconsistent or difficult to interpret. A number of variables which could potentially influence menstrual bleeding patterns, such as nutritional status, were not measured and therefore could not be included in the analysis. However, contraceptive method and ethnic origin may be predominant influences, overriding any other factor.

Demographic Factors in Opiate Addiction among Mexican-Americans

V ARIOUS empirical studies have established the neceissity for considering sex, race, culture, and the geographic region of residence when describing any population of addicts. Bates (1) and Chambers and associates (2) have provided des-criptions of Negro addicts. Ball (3), Ball and Snarr (4), and Ball and Pabon (5) have described Puerto Rican addicts. Ball and Lau (6) provided a description of the Chinese addict. Southern white addicts have been the subject of extensive inquiry by O'Donnell (7-9) and O'Donnell and associates (10). Glaser (11) and (Chambers and associates (12) have described female addicts, while Ball and associates (13) and Ellingwood and associates (14) have compared male addicts with female. Noticeably ab,sent, however, is any definitive description of the Mexican-American opiate addict.