Trend Χ2 Research Articles

Mortality trends from 2003 to 2009 among adolescents and young adults in rural Western Kenya using a health and demographic surveillance system.

BackgroundTargeted global efforts to improve survival of young adults need information on mortality trends; contributions from health and demographic surveillance system (HDSS) are required.Methods and FindingsThis study aimed to explore changing trends in deaths among adolescents (15–19 years) and young adults (20–24 years), using census and verbal autopsy data in rural western Kenya using a HDSS. Mid-year population estimates were used to generate all-cause mortality rates per 100,000 population by age and gender, by communicable (CD) and non-communicable disease (NCD) causes. Linear trends from 2003 to 2009 were examined. In 2003, all-cause mortality rates of adolescents and young adults were 403 and 1,613 per 100,000 population, respectively, among females; and 217 and 716 per 100,000, respectively, among males. CD mortality rates among females and males 15–24 years were 500 and 191 per 100,000 (relative risk [RR] 2.6; 95% confidence intervals [CI] 1.7–4.0; p<0.001). NCD mortality rates in same aged females and males were similar (141 and 128 per 100,000, respectively; p = 0.76). By 2009, young adult female all-cause mortality rates fell 53% (χ2 for linear trend 30.4; p<0.001) and 61.5% among adolescent females (χ2 for linear trend 11.9; p<0.001). No significant CD mortality reductions occurred among males or for NCD mortality in either gender. By 2009, all-cause, CD, and NCD mortality rates were not significantly different between males and females, and among males, injuries equalled HIV as the top cause of death.ConclusionsThis study found significant reductions in adolescent and young adult female mortality rates, evidencing the effects of targeted public health programmes, however, all-cause and CD mortality rates among females remain alarmingly high. These data underscore the need to strengthen programmes and target strategies to reach both males and females, and to promote NCD as well as CD initiatives to reduce the mortality burden amongst both gender.

Incidence of Serious Injuries Due to Physical Abuse in the United States: 1997 to 2009

Although US child protective services data showed a 55% decrease in the national incidence of substantiated physical abuse from 1992 to 2009, no study has tracked the occurrence of serious injuries due to physical abuse. This study examined changes in the incidence of serious injuries due to physical abuse in hospitalized children from 1997 to 2009. The Kids' Inpatient Database, a sample of discharges from hospitals in the United States, includes International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and external cause of injury codes; it was prepared every 3 years from 1997 to 2009. Cases of serious physical abuse (eg, abusive head injury) were identified by using injury codes (800-959) and codes for abuse (995.50, 0.54, 0.55, and 0.59), selected assault codes (E960-966, 968), or perpetrator of abuse (E967). The weighted number of hospitalizations due to serious physical abuse was used to calculate the national incidence, and χ(2) for linear trend compared over time the incidence for children <18 years and <1 year of age. The incidence per 100,000 children <18 years of age increased 4.9%: 6.1 (95% confidence interval = 5.4-6.8) for 1997, 6.0 (5.2-6.7) for 2000, 6.0 (5.3-6.7) for 2003, 6.1 (5.3-6.8) for 2006, and 6.4 (5.7-7.2) for 2009 (P < .01). The incidence for children <1 year of age increased 10.9% (P < .05). Over 12 years, when substantiated physical abuse was declining, there was a small increase in the incidence of serious physical abuse in children <18 and <1 year of age.

Population attributable risk estimates for risk factors associated with hypertension in an Indian population

Little evidence exists regarding the magnitude of contribution of risk factors associated with hypertension in India. Determination of potentially modifiable risk factors is necessary to focus prevention strategies. Age-matched case-control study. A total of 350 hypertensive cases and 350 controls of both sexes in the age group 20-65 years. Hypertension was defined according to JNC VII criteria. Adjusted odds ratio (OR) and population attributable risk percentage (PAR %) for hypertension were calculated. In multivariate analysis, tobacco users (either tobacco chewing/smoking or both) (adjusted OR 5.1, 95% CI 3.6-7.3), tobacco chewing (adjusted OR 3.2, 95% CI 2.2-4.6), smoking (adjusted OR 2.9, 95% CI 1.9-4.4), and alcohol consumption (adjusted OR 1.5, 95% CI 1.1-2.2) was the strongest determinants of hypertension. A dose-response relation was found between the number of cigarettes smoked per day (χ2 for trend = 26.07; p < 0.0001) and the amount of alcohol consumption per day (χ2 for trend = 24.26; p < 0.0001) and the risk of hypertension. PARs were 70.3% (95% CI 63.0-77.5) for tobacco use, 45.3% (95% CI 37.1-53.4) for tobacco chewing, 31.5% (95% CI 21.3-40.9) for smoking, and 33.6% (95% CI 22.9-44.4) for alcohol consumption. Our results indicate that incident hypertension cases are largely attributable to the habit of tobacco use and alcohol consumption. Therefore, changing these selected lifestyle factors needs to be prioritized as a major strategy for reducing incidence of hypertension in our population.

Associated Factors for Falls, Recurrent Falls, and Injurious Falls in Aged Men Living in Taiwan Veterans Homes

The information exploring the falls, recurrent falls, and injurious falls simultaneously in a large scale of aged people was limited. This study investigated the prevalence and frequency of falls and identified the associated factors of fall among aged Chinese men. A cross-sectional study was carried out in four veteran homes in eastern Taiwan from 2009 to 2010. The investigated sample consisted of 940 elderly men. A questionnaire was used for collecting demographic background, comorbid medical conditions, and fall characteristics. Depression status was evaluated by the Geriatric Depression Scale-Short Form. The prevalence of fall and recurrent falls were 17.2 % and 6.9%, respectively. The injury rate after falls was 51.9%.The advanced age [odds ratio (OR): 1.04; confidence interval (CI): 1.01–1.07), depression status (OR: 1.05; CI: 1.01–1.10), stroke (OR: 2.16; CI: 1.18–3.96), gouty arthritis (OR: 1.96; CI: 1.36–2.81), and cataract (OR: 1.48; CI: 1.03–2.15) were independent variables associated with falls. We also found that the greater the number of variables, the higher the risk of falling (χ2 for linear trend = 31.98, d.f.= 4, p < 0.001). Furthermore, depression was the only independent variable for predicting recurrent falls (OR: 1.22; CI: 1.12–1.32). However, no variable was found to be capable of predicting injurious falls. This study demonstrated that the advanced age, depression status, stroke, gouty arthritis, and cataract are independent variables for predicting falls; depression is the only clinical factor capable of predicting the recurrent falls. These variables were potential targets for effective prevention of falls.

Buruli Ulcer in Gabon, 2001–2010

To the Editor: Worldwide, Buruli ulcer is the third most common mycobacterial infection, following only tuberculosis and leprosy (1,2). It has been identified in 30 countries, including 12 African countries (1–3). For Gabon, the first report of a case consistent with Buruli ulcer was published in 1961 (4). The patient was a European woman who sought care at a hospital in Lambarene for a painless upper arm nodule, which evolved into a plaque and then an extensive ulcer. The only other Buruli ulcer reports available for Gabon are a case report from 1968 and a case-series report from 1986 (5,6). We report data for Buruli ulcer in this sub-Saharan African country for 2001–2010, including prevalence within a hospital population and clinical presentation of the cases. These data can be used to assess long-term developments in the number of cases of Buruli ulcer in this region. In Gabon, the major focus of Buruli ulcer is the area around Lambarene (population ≈25,000), the capital of Moyen Ogooue Province (population ≈35,000). It is located near the equator in the central African rainforest. Lambarene lies near the confluence of 2 major rivers, Ogooue and Ngounie, and is the starting point for one of the largest river deltas in Africa. Numerous lakes are present throughout the region. The Albert Schweitzer Hospital in Lambarene serves the entire province. At this hospital, Buruli ulcer is diagnosed on the basis of clinical presentation. In addition, tissue samples are sent to the Prince Leopold Institute of Tropical Medicine in Belgium for PCR analysis. All cases are treated surgically, and since 2006, patients have received rifampin and streptomycin as well. Since 2007, patient information has been recorded on a BU-02 form, designed by the World Health Organization to register and report cases of Buruli ulcer (1). We reviewed cases of Buruli ulcer at the Albert Schweitzer Hospital. We checked the hospital registry and patient records from 2001 through 2010 to identify probable cases of Buruli ulcer on the basis of clinical appearance and response to treatment. We also gathered information from BU-02 forms from 2007 through 2010. During 2001–2010, the number of patients admitted to surgical wards because of suspected Buruli ulcer ranged from 5 to 40 per year (average 25 patients/year) (Figure). Despite moderate variability from year to year, the number of cases over the years increased (χ2 for trend, p = 0.003), which could be associated with increased awareness of the disease. The variability was not caused by changes in the number of patients hospitalized. Figure Number (line) and prevalence (in parentheses) of Buruli ulcer cases, Gabon, 2001–2010. During 2007–2010, detailed clinical information from BU-02 forms was available for 77 patients. PCR results were available for 57 patients and confirmed the diagnosis for 39. Patient ages ranged from 2 to 72 years; 40 (52%) patients were 5 cm. The lesions were located on the lower arm for 41 (53%) patients, upper arm for 28 (36%) patients, chest and/or back for 7 (9%) patients, and perineal region for 1 (1%) patient. Depending on the type of lesion, the length of hospitalization ranged from 1 to 352 days (median 31 days). The longest hospitalization was almost 1 year; the patient was a child who had severe lesions and lived in conditions in which adequate wound care and follow-up after hospital discharge were unlikely. In Gabon, the available data on Buruli ulcer come mainly from surgical wards in areas where prevalence is high. A national survey of hospital registration data in 2005 detected 3 cases in Ngounie Province in southern Gabon and 5 cases in Woleu-Ntem Province in northern Gabon. All cases are thought to have been acquired locally, thus establishing the existence of 2 previously unknown foci (U. Ateba Ngoa et al., unpub. data). Buruli ulcer has a strong economic effect on the community and health facilities. For example, in 2010, management of the disease at the Albert Schweitzer Hospital cost an estimated 554–1,660 euros per person, not including drug costs (7). In 2009, African countries where Buruli ulcer is endemic, including Gabon, signed the Cotonou Declaration (8). According to this declaration, these countries have committed themselves to fight Buruli ulcer by several measures, including assessing the magnitude of the disease and conducting surveillance.

OC-057 10 Years on from the improving outcomes guidance—development of a tertiary pancreatic cancer unit

IntroductionIn 2001 the National Institute for Clinical Excellence (NICE) published guidance on best practice for cancer services entitled Improving Outcomes Guidance (IOG). These guidelines specified centralisation, increased patient volume (>200...

Titering of 2009 pandemic H1N1 influenza virus hemagglutinin inhibition antibody in nonvaccinated pregnant women in Shiraz, Southern Iran

Influenza may cause severe complications for pregnant women. In this study antibody response against 2009 H1N1 influenza virus in pregnant women was investigated. This seroprevalance cross sectional and questionnaire based study was conducted using a convenient sampling method. Blood samples of pregnant women were checked for antibodies against 2009 H1N1 influenza virus using hemagglutination inhibition assay. An antibody titer level of ≥ 1:40 dilution was considered as the protective level. 167 (43.60%) of 383 pregnant women who participated in this study had protective antibody levels against this virus. 62 (35.63%) of 3rd trimester, 79 (46.74%) of 2nd trimester, and 21(52.50%) of 1st trimester pregnant women were immune respectively (χ2for trend = 8.20, p < 0.004). Lack of protective antibody level was significantly seen more in pregnant women of 3rd trimester of pregnancy (OR = 2.37, CI = 1.09–5.18). Pregnant women with higher education (OR = 1.67, CI = 1.02–2.73) and those with history of anemia (OR = 2.09, CI = 1.18–3.68) had more immunity. Older women (OR = 0.95, CI = 0.91–0.99) and those with history of psychological diseases (OR = 0.19, CI = 0.05–0.70) had less immunity. Vaccination of pregnant women, especially those who are in the higher trimesters of pregnancy, older, or less educated, against the 2009 H1N1 influenza virus should be continued.

Seroprevalence of Helicobacter pylori infection in chagasic and nonchagasic patients from the same geographical region of Brazil

In this study, we evaluated the seroprevalence of Helicobacter pylori infection among chagasic and non-chagasic subjects as well as among the subgroups of chagasic patients with the indeterminate, cardiac, digestive, and cardiodigestive clinical forms. The evaluated subjects were from the Triângulo Mineiro region, Minas Gerais, Brazil. Chagasic patients showed positive reactions to the conventional serological tests used and were classified according to the clinical form of their disease. Immunoglobulin G antibodies specific to H. pylori were measured using a commercial enzyme-linked immunosorbent assay kit. The overall H. pylori prevalence was 77.1% (239/310) in chagasic and 69.1% (168/243) in non-chagasic patients. This difference was statistically significant even after adjustment for age and sex (odds ratio = 1.57; 95% confidence interval, 1.02-2.42; p = 0.04) in multivariate analysis. The prevalence of infection increased with age in the non-chagasic group (p = 0.007, χ² for trend), but not in the chagasic group (p = 0.15, χ² for trend). H. pylori infection was not associated with digestive or other clinical forms of Chagas disease (p = 0.27). Our findings demonstrate that chagasic patients have a higher prevalence of H. pylori compared to non-chagasic subjects; a similar prevalence was found among the diverse clinical forms of the disease. The factors contributing to the frequent co-infection with H. pylori and Trypanosoma cruzi as well as its effects on the clinical outcome deserve further study.

Breast cancer stage at diagnosis and area-based socioeconomic status: a multicenter 10-year retrospective clinical epidemiological study in China

BackgroundAlthough socioeconomic status (SES) has been focused on as a key determinant of cancer stage at diagosis in western countries, there has been no systemic study on the relationship of SES and breast cancer stage at diagnosis in China.MethodsThe medical charts of 4,211 eligible breast cancer patients from 7 areas across China who were diagnosed between 1999 and 2008 were reviewed. Four area-based socioeconomic indicators were used to calculate area-based SES by cluster analysis. The associations between area-based SES and stage at diagnosis were analyzed by trend chi-square tests. Binary logistic regression was performed to estimate odds ratios for individual demographic characteristics' effects on cancer stages, stratified by area-based SES.ResultsThe individual demographic and pathologic characteristics of breast cancer cases were significantly different among the seven areas studied. More breast cancer cases in low SES areas (25.5%) were diagnosed later (stages III & IV) than those in high (20.4%) or highest (14.8%) SES areas (χ2 for trend = 80.79, P < 0.001). When area-based SES is controlled for, in high SES areas, cases with less education were more likely to be diagnosed at later stages compared with more educated cases. In low SES areas, working women appeared to be diagnosed at earlier breast cancer stages than were homemakers (OR: 0.18-0.26).ConclusionsIn China, women in low SES areas are more likely to be diagnosed at later breast cancer stages than those in high SES areas.

Frequency and multiplicity of human papillomavirus infection in HIV-1 positive women in Italy

BackgroundNatural history of HPV infection is altered in HIV positive women, with increased risk of cervical dysplasia. Limited data are available about the influence of HPV genotypes and HPV multiple infections on cervical disease in HIV positive women. ObjectivesWe determined HPV genotype prevalence in cervical samples from 553 HIV-infected women attending the gynaecological service at “L. Spallanzani” Hospital. Association of HPV multiple infections with cervical abnormalities was investigated. Study designMY09/MY11 consensus primers were used to detect HPV-DNA; HPV typing was performed by RFLP. A commercial array based kit was used to define unresolved RFLP patterns. ResultsHPV was detected in 244/553 (44.1%) patients, correlating with low CD4 counts (p<0.001) and age (p=0.001). Multiple HPV types were observed in 44.4% of cases, more frequently involving HR than LR HPV (OR=12.8, p<0.00001). Multiple HPV infections were associated with low CD4 counts (OR=3.8 in CD4<200 vs CD4≥500cells/mm3). Dyskaryosis was associated with decreased CD4 counts (≥500 vs 200–499 vs <200cells/mm3, χ2 for trend, p=0.001) and with HPV types multiplicity (1 vs 2–3 vs ≥4, χ2 for trend, p<0.00001). Notably, in 3 H-SIL cases only LR types were detected (HPV62, n=2; HPV81, n=1). ConclusionsMultiple HPV infections, often involving HR types, are frequent in HIV-infected women. Association between multiple HPV infection, low CD4 count and cytological abnormalities supports the interplay of virological and immunological factors in cervical cancer pathogenesis. Assessment of multiple HPV infections might gain importance in cervical cancer screening, particularly in patients with predisposing factors like immuno-suppression.

Prevalence of Helicobacter pylori, cytomegalovirus, and Chlamydia pneumoniae immunoglobulin seropositivity in coronary artery disease patients and normal individuals in North Indian population

BackgroundIn present day atherosclerosis is perceived as a chronic inflammatory vascular condition and infectious diseases are believed to contribute to its pathophysiology. In this context, the microorganisms which are believed to play a role in the pathophysiology include Chlamydia pneumoniae, cytomegalovirus (CMV), and Helicobacter pylori. MethodA case control study (retrospective) was conducted over a two-year period. The study population was divided into two groups with 200 individuals in each group. The first group comprised cases of coronary artery disease (CAD) and the second comprised healthy controls selected from the general population after matching for age and sex. Enzyme-linked immunosorbent assay (ELISA) was done for immunoglobulin (IgG) antibodies to H. pylori, C. pneumonia, and CMV. They were also evaluated for conventional risk factors including hypertension, diabetes, obesity, and dyslipidaemia. Epi Info™ version 6 six software was used for analysis of data. Odds ratio, χ2 for trend and multiple logistic regression analysis were used to find out statistically significant results. ResultsSeropositivity for H. pylori was present in 119 patients of CAD (59.5%) but it was present in only 76 controls (38%) (P = 0.001). There was a statistically significant association between seropositivity for H. pylori and CAD. There was no statistically significant association between C. pneumoniae and CMV seropositivity with CAD. Multiple logistic regression analysis was done with CAD as the outcome (dependent variable). The predictor covariates (independent) variables were seropositivity to H. pylori, C. pneumoniae, and CMV, hypertension, obesity, diabetes, and dyslipidaemia. It was found that seropositivity to H. pylori, hypertension, obesity, and dyslipidaemia were significant risk factors for CAD. ConclusionOur study shows an association between IgG antibody response to H. pylori and CAD. Multiple logistic regression analysis showed that this association was retained even on comparison with the other risk factors.

Aplastic anemia: A common hematological abnormality among peripheral pancytopenia

Background:Aplastic anemia is a well-recognized form of marrow failure. The incidence of aplastic anemia is subjected to wide variation. Most cases are acquired and immune-mediated but there are also inherited forms.Aim:The study was conducted to assess the magnitude of the problem, morphological changes and determinants of aplastic anemia in North Bengal.Materials and Methods:A cross-sectional study had been conducted for a period of one year among 5 to 70 years age group. Initially complete blood count followed by bone marrow examination was done for diagnosis.Results:Out of 48 cases, 38 (79.17%) had hypocellular diagnosed as aplastic anemia, 5 (10.42%) each had normocellular and hypercellular bone marrow. Histopathology shows that 30 (78.95%) cases had increased iron stores in bone marrow and 8 (21.05%) cases had decreased iron stores. Subjects less than 20 years of age mostly (31.58%) suffered from non-severe disease in contrast to subjects in higher age groups who had severe or very severe disease, though the trend was not significantly different (χ2 for linear trend 0.171, P > 0.05).Conclusion:The study shows aplastic anemia is a common hematological abnormality among peripheral pancytopenia in North Bengal region where males were affected more than females.

Tuberculosis and HIV co-infection in healthcare workers in England and Wales, 1999–2005

This study used linked national tuberculosis (TB) and HIV surveillance data to investigate recent trends and factors associated with HIV co-infection (TB-HIV) in healthcare workers (HCWs) with TB in England and Wales. Methods applied were the χ2 trend test and logistic regression. Overall 14% (231/1627) of HCWs with TB were co-infected with HIV, increasing from 8% in 1999 to 14% in 2005 (P<0·001). Most (78%) HCWs were non-UK born and 74% of these developed TB ⩾2 years post-entry. Being born in Sub-Saharan Africa was an independent predictor for TB-HIV, especially for female HCWs (odds ratio 66·5, 95% confidence interval 16·3-271·1), who also had a lower median CD4 count than other co-infected women (106/mm3, interquartile range 40-200, P<0·01). Voluntary HIV testing of new HCWs should be encouraged as an opportunity for early diagnosis. Post-entry, a high index of clinical suspicion for TB in those most at risk remains important.

Excessive Weight Gain in Term Twin Pregnancies

To estimate pregnancy outcomes in twin pregnancies with excessive weight gain, according to the 2009 Institute of Medicine (IOM) recommendations. A retrospective cohort of 170 patients from a single practice with twin pregnancies at 37 weeks or more of gestation from 2005 to 2010 were analyzed. We compared outcomes between three cohorts based on the 2009 IOM recommendations for weight gain during pregnancy: poor weight gain, normal weight gain, and excessive weight gain. One-way analysis of variance and χ for trend were used when appropriate. Comparing poor, normal, and excessive weight gain, the proportion of women delivering both newborns weighing more than 2,500 g increased from 40% to 60.5% to 79.5% across the three groups (P<.001). Additionally, the mean birth weight of the larger (P<.001) and smaller (P=.002) twin increased significantly across the three groups. The proportion of women with gestational diabetes, gestational hypertension, or pre-eclampsia did not increase significantly across the three subgroups. Our results were similar when we only included women with a normal prepregnancy body mass index. Excessive weight gain in term twin gestations, as defined by the IOM, does not appear to be associated with worse maternal outcomes and is associated with larger birth weights. Our results call into question the 2009 IOM definition of excessive weight gain for a twin pregnancy.

Maternal age, ethnicity and gestational diabetes mellitus

Backgroundin Australia, and globally, rates for gestational diabetes mellitus (GDM) have risen dramatically in recent decades. This is of concern as GDM is associated with adverse pregnancy outcomes and additional health-care costs. Factors linked to increasing incidence include older maternal age and non-Caucasian ethnicity. However, as yet, there is no clear consensus on the magnitude of effect associated with these factors in combination. This study therefore investigated the effect of maternal age and country/region of birth on GDM incidence. Methodsall women who gave birth in Victoria, Australia in 2005 and 2006 (n=133,359) were included in this population-based cross-sectional study. Stratified cross-tabulations were conducted to examine the incidence of GDM by maternal age group and country/region of birth. Primiparous women were further analysed separately from parous women. The proportion of women with GDM was reported, along with the χ2 for linear trend. Findingswhilst women born outside Australia constituted just 24.6% of women giving birth during the study period, they accounted for 41.4% of GDM cases. The highest GDM incidence was seen among Asian women at 11.5%, compared with Australian born women at 3.7%. There was strong evidence that women born in all regions except North America were increasingly likely to develop GDM in pregnancies at older ages (p<0.001).On examining age related GDM trends by maternal region of birth, higher rates were seen across all regions studied but were most marked among women born in Asia and the Middle East. Conclusionsolder maternal age and non-Australian birth increased a woman's risk of developing GDM and this increase was most evident among Asian women. As GDM is associated with adverse maternal and infant outcomes, it is important to explore ways of preventing GDM, and to put in place strategies to effectively manage GDM during pregnancy and to reduce the later risk of developing type 2 diabetes. Pregnancy presents midwives with a unique opportunity to provide education and to encourage dietary and behavioural modifications as women have repeated contact with the health system during this time.

Factors associated with functional ability in Brazilian elderly

The purpose of this observational study, designed as a cross-sectional sample of 621 elderly residents in Viçosa, Minas Gerais state, Brazil was to evaluate the prevalence of inadequate functional ability and associated factors in Brazilian elderly. Interviews were conducted at study subjects’ houses using a questionnaire focused on socio demographic information and health conditions. Elderly who reported some difficulty in performing six or more activities, or total inability to carry out at least three activities identified on the scale developed by Katz et al. (1963) and Lawton and Brody (1969) were considered to have inadequate functional ability. Data analysis included frequency distribution, bivariate and multivariate Poisson regression. The prevalence of inadequate functional ability was of 16.2% (95% CI: 13–19%) in the sample analyzed. With aging, there was a significant trend of inadequate functional ability increasing in men (χ2 for trend=8.481; p=0.003) and women (χ2 trend=13.667; p<0.001). Factors positively associated with inadequate functional ability were age over 80 years, low monthly income, poor self-health perception, history of hospitalization in the last year, use of 5 or more medicines in the last 15 days; history of depression, history of osteoporosis, and negatively associated to physical activity. Factors associated with inadequate functional ability highlighted in this study demonstrate the importance of health programs in Brazil focused on adults and the elderly in preventing or delaying functional decline and promote healthy aging.

CELL PHONE USE AND RELATED SYMPTOMS AMONG ADOLESCENTS: A SURVEY OF 2150 STUDENTS IN IZMIR, TURKEY

Background and Aims: There is no large community-based study on cell phone (CP) use and symptom frequency in Turkey. Adolescents are an important risk group (Heinrich et al 2011). The aim of this study was to find out the CP use patterns and related symptom frequencies of high school students in Bornova. Methods: All high school students in Bornova (20,493 students in 26 schools) comprised the target group of the survey. A sample size of 2530 students was calculated with p=50%, d= 3%, design-effect=2 and 20% non-response. Systematic random sampling was applied to choose 87 classes out of 704, to obtain a cluster sample stratified according to schools. A 77-item questionnaire was applied. SAR values were obtained according to the model and brand of CP. 2150 students were included in the analyses. EMF magnitudes were measured at each school. Results: The mean age of the participants was 15.6±1.3 and 52.2% were female. Among participants, 92.8%(n=1991) were using CP and 91.5%(n=1954) had his/her own CP. The ratio of CP users and owners significantly increased with increasing school grade (Χ2 trend p&lt;0.001 both). 14.0% had CPs with SAR&gt;1.00W/kg, 53.9% had 1-4 calls/day, 4.6% had over 10 calls/day, the total duration of calls/day were &lt;5min. for 29.0% and &gt;30min for 11.7%, 27.3% sent/received ≥200 sms/day, 10.8% connected to the internet, 71.8% were registered to promotional campaigns. They were unaware of their CPs’ SAR values and 64.1% never used earphones. Among the 23 symptoms surveyed, 21 increased with increasing call durations, 14 with number of calls, 13 with number of instant messages, 6 with increasing SAR values (Χ2 trend p&lt;0.05). Registration to campaigns significantly increased the presence of 12 symptoms (Χ2 p&lt;0.05). Conclusions: CP ownership rate was high. Students mostly used their CPs for sms, a less risky attitude in terms of EMF exposure. Some students frequently spoke on their CPs. The use of earphones and other protective attitudes must be improved.

Plasmodium falciparum gametocyte carriage, sex ratios and asexual parasite rates in Nigerian children before and after a treatment protocol policy change instituting the use of artemisinin-based combination therapies

The effects of artemisinin-based combination therapies (ACTs) on transmission of Plasmodium falciparum were evaluated after a policy change instituting the use of ACTs in an endemic area. P. falciparum gametocyte carriage, sex ratios and inbreeding rates were examined in 2,585 children at presentation with acute falciparum malaria during a 10-year period from 2001-2010. Asexual parasite rates were also evaluated from 2003-2010 in 10,615 children before and after the policy change. Gametocyte carriage declined significantly from 12.4% in 2001 to 3.6% in 2010 (χ2 for trend = 44.3, p < 0.0001), but sex ratios and inbreeding rates remained unchanged. Additionally, overall parasite rates remained unchanged before and after the policy change (47.2% vs. 45.4%), but these rates declined significantly from 2003-2010 (χ2 for trend 35.4, p < 0.0001). Chloroquine (CQ) and artemether-lumefantrine (AL) were used as prototype drugs before and after the policy change, respectively. AL significantly shortened the duration of male gametocyte carriage in individual patients after treatment began compared with CQ (log rank statistic = 7.92, p = 0.005). ACTs reduced the rate of gametocyte carriage in children with acute falciparum infections at presentation and shortened the duration of male gametocyte carriage after treatment. However, parasite population sex ratios, inbreeding rates and overall parasite rate were unaffected.

Tumor–ratio–metastasis staging system as an alternative to the 7th edition UICC TNM system in gastric cancer after D2 resection—results of a single-institution study of 1343 Chinese patients

BackgroundIn this study, we assessed the prognostic value of the lymph node ratio (LNR), established a hypothetical tumor–ratio–metastasis (TRM) staging system and compared it with the 7th edition International Union Against Cancer pathological N (pN) and tumor–node–metastasis (TNM) system. Patients and methodsA total of 1343 gastric cancer patients undergoing D2 resection were staged using the TRM staging system and the 7th edition TNM system. Optimal cut points of LNR were calculated using X-tile software and validated by bootstrapping. Homogeneity, discriminatory ability, and monotonicity of gradients of the TRM and TNM systems were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations. ResultsOptimal cut points classified patients into LNR0 (0%), LNR1 (1%–30%), LNR2 (31%–60%), and LNR3 (61%–100%) groups. In univariate, multivariate and stratified analyses, the LNR staging showed superiority to the 7th edition pN staging. The TRM staging system had higher linear trend and likelihood ratio χ2 scores and smaller AIC values compared with those for the TNM system, which represented the optimum prognostic stratification. ConclusionsThe novel TRM staging system predicts survival of gastric cancer more accurately than the 7th edition TNM system. It may be considered as an alternative to TNM system.

Statins Are Associated With a Reduced Risk of Gastric Cancer: A Population-Based Case–Control Study

Experimental studies have shown that statins have potential protective effects against cancer. The aim of this study was to investigate whether the use of statins was associated with gastric cancer risk. We conducted a population-based case-control study in Taiwan. Data were retrospectively collected from the Taiwan National health Insurance Research Database. Cases consisted of all patients who were aged ≥50 years and had a first-time diagnosis of gastric cancer for the period between 2005 and 2008. The controls were matched to cases by age, sex, and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using multiple logistic regression. We examined 337 gastric cancer cases and 1,348 controls. We found that ever-use of any statin was associated with a significant decrease in gastric cancer risk (OR=0.68, 95% CI=0.49-0.95). Compared with no use of statins, the adjusted ORs were 0.90 (95% CI=0.60-1.36) for the group having been prescribed statins with cumulative defined daily doses (DDDs) <134.25 and 0.49 (95% CI=0.30-0.79) for the group with cumulative statin use of ≥134.25 DDDs. Also, there was a significant trend toward decreasing gastric cancer risk with increasing cumulative dose (χ(2) for linear trend=7.42, P=0.006). The results of this study are the first to suggest that statins may reduce the risk of gastric cancer.