(1/286) Age distribution of Helicobacter pylori seroprevalence among young children in a United States/Mexico border community: evidence for transitory infection.
Helicobacter pylori infection has been linked to a spectrum of gastroduodenal diseases of broad public health impact, yet the natural history of this frequently asymptomatic infection remains poorly understood. Evidence suggests that initial acquisition occurs primarily during childhood and may persist throughout life. The seroprevalence of H. pylori antibodies was examined in 365 primary schoolchildren aged 4-7 years in a low-income United States/Mexico border community from January to May 1996. Overall, 21% of the 365 children tested positive, with a significant monotonic decrease in seroprevalence by 1-year age intervals (36% in children aged 4 years, 24% in those aged 5 years, 20% in those aged 6 years, and 14% in those aged 7 years). The odds ratio for each 1-year age increase was 0.76 (95% confidence interval: 0.6, 1.0) after adjustment for relevant covariates. Given that H. pylori antibodies diminish after infection clears, this trend suggests that transient infection may be common in young children. In contrast, hepatitis A virus seroprevalence increased with age. There was a moderate association (odds ratio = 1.47, 95% confidence interval: 0.8, 2.9) of H. pylori with hepatitis A virus seroprevalence that weakened after adjustment for age and socioeconomic status (odds ratio = 1.26, 95% confidence interval: 0.6, 2.5). Follow-up studies are needed to clarify the natural history of Helicobacter pylori infection and identify predictors of initial acquisition, persistence, and recurrence. (+info)
(2/286) Growth in utero and during childhood among women who develop coronary heart disease: longitudinal study.
OBJECTIVE: To examine whether women who develop coronary heart disease have different patterns of fetal and childhood growth from men in the same cohort who develop the disease. DESIGN: Follow up study of women whose body size at birth was recorded and who had an average of 10 measurements of height and weight during childhood. SETTING: Helsinki, Finland. SUBJECTS: 3447 women who were born in Helsinki University Central Hospital during 1924-33 and who went to school in Helsinki. MAIN OUTCOME MEASURES: Hazard ratios for hospital admission for or death from coronary heart disease. Results Coronary heart disease among women was associated with low birth weight (P=0.08 after adjustment for gestation, P=0.007 after adjustment for placental weight) and was more strongly associated with short body length at birth (P=0.001 and P<0.0001, respectively). The hazard ratio for women developing coronary heart disease increased by 10.2% (95% confidence interval 4.3 to 15.7) for each cm decrease in length at birth. The effect of short length at birth was greatest in women whose height "caught up" after birth so that as girls they were tall. Such girls tended to have tall mothers. In contrast, men in the same cohort who developed the disease were thin at birth rather than short, showed "catch up" growth in weight rather than height, and their mothers tended to be overweight rather than tall. CONCLUSION: Coronary heart disease among both women and men reflects poor prenatal nutrition and consequent small body size at birth combined with improved postnatal nutrition and "catch up" growth in childhood. The disease is associated with reductions in those aspects of body proportions at birth that distinguish the two sexes-short body length in women and thinness in men. (+info)
(3/286) Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group.
OBJECTIVE: To investigate the risks of the sudden infant death syndrome and factors that may contribute to unsafe sleeping environments. DESIGN: Three year, population based case-control study. Parental interviews were conducted for each sudden infant death and for four controls matched for age, locality, and time of sleep. SETTING: Five regions in England with a total population of over 17 million people. SUBJECTS: 325 babies who died and 1300 control infants. RESULTS: In the multivariate analysis infants who shared their parents' bed and were then put back in their own cot had no increased risk (odds ratio 0.67; 95% confidence interval 0.22 to 2.00). There was an increased risk for infants who shared the bed for the whole sleep or were taken to and found in the parental bed (9.78; 4.02 to 23.83), infants who slept in a separate room from their parents (10.49; 4.26 to 25.81), and infants who shared a sofa (48.99; 5.04 to 475.60). The risk associated with being found in the parental bed was not significant for older infants (>14 weeks) or for infants of parents who did not smoke and became non-significant after adjustment for recent maternal alcohol consumption (>2 units), use of duvets (>4 togs), parental tiredness (infant slept =4 hours for longest sleep in previous 24 hours), and overcrowded housing conditions (>2 people per room of the house). CONCLUSIONS: There are certain circumstances when bed sharing should be avoided, particularly for infants under four months old. Parents sleeping on a sofa with infants should always be avoided. There is no evidence that bed sharing is hazardous for infants of parents who do not smoke. (+info)
(4/286) Survey of directors of emergency departments in California on overcrowding.
OBJECTIVE: To survey the directors of emergency departments in California on their opinions of the extent and factors associated with overcrowding in emergency departments. METHODS: Surveys were mailed to a random sample of emergency department directors. Questions included estimated magnitude, frequency, causes, and effects of overcrowding. RESULTS: Of 160 directors surveyed, 113 (71%) responded, and 109 (96%) reported overcrowding as a problem. All (n = 21) university or county hospital directors and most (n = 88 [96%]) private or community hospital directors reported overcrowding. The 4 private or community hospital directors reporting no overcrowding serve smaller communities with populations less than 250,000. Thirty-two directors (28%) reported daily overcrowding. The most cited causes were increasing patient acuity and volume, hospital bed shortage, laboratory delays, and nursing shortage. These putative causes were similar between university or county and private or community hospital directors, except for consultant delays, which were more prevalent in university or county hospital emergency departments. CONCLUSIONS: Overcrowding is perceived to be a serious problem by emergency department directors. Many factors may contribute to overcrowding, and most are beyond the control of emergency departments. (+info)
(5/286) Parental smoking, socioeconomic factors, and risk of invasive meningococcal disease in children: a population based case-control study.
AIMS: To investigate the effects of parental smoking, socioeconomic characteristics, and indoor environment on the risk of invasive meningococcal disease in children. METHODS: Population based case-control study. A total of 68 incident cases of invasive meningococcal disease in children less than 15 years old were compared with 135 controls selected from the same school and matched for year of birth, sex, and place of residence. Information on exposures was obtained in interviews with parents. RESULTS: Invasive meningococcal disease was strongly associated with parental smoking; rate ratios adjusted for socioeconomic factors were 3.5 (95% confidence interval 1.4-8.7) for smoking of mother, 3.2 (1.5-6.9) for smoking of father, and 2.7 (1.3-5.4) for every 20 cigarettes smoked at home on an average day. The risk of the disease was strongly inversely related to maternal education and, less strongly, to ownership of a car and of a weekend house, father's education, crowding, and the number of siblings, but these associations were reduced or eliminated in multivariate models. The type of heating and cooking (used as proxies for indoor air pollution) were not associated with the disease. CONCLUSION: The risk of invasive meningococcal disease in children is strongly influenced by parental smoking and unfavourable socioeconomic circumstances. (+info)
(6/286) Childhood housing conditions and later mortality in the Boyd Orr cohort.
STUDY OBJECTIVES: To examine associations between five measures of housing conditions during childhood and subsequent mortality from all causes, coronary heart disease, stroke, and cancer. DESIGN: Historical cohort study. SETTING: Data on housing conditions were collected from survey centres in 16 areas of England and Scotland. PARTICIPANTS: Children of families participating in the Carnegie Survey of Family Diet and Health in pre-war Britain (1937-1939). Analyses are based on a subset of 4168 people who were traced and alive on 1 January 1948. MAIN RESULTS: Poorer housing conditions were generally associated with increased adult mortality. After adjustment for childhood and adult socioeconomic factors, statistically significant associations were only found between lack of private indoor tapped water supply and increased mortality from coronary heart disease (hazard ratio 1.73, (95% CI 1.13, 2.64); and between poor ventilation and overall mortality (hazard ratio for people from households with poorest ventilation relative to best ventilation 1.30, 95% CI 0.97, 1.74). CONCLUSIONS: This study provides evidence that associations between housing conditions in childhood and mortality from common diseases in adulthood are not strong, but are in some respects distinguishable from those of social deprivation. (+info)
(7/286) Zip code-level risk factors for tuberculosis: neighborhood environment and residential segregation in New Jersey, 1985-1992.
OBJECTIVES: This study examined zip code-level risk factors associated with very high tuberculosis (TB) rates among non-Hispanic Whites, African Americans, Hispanics, and Asians in New Jersey (1985-1992). METHODS: Exposure indices (poverty, crowded housing, and dilapidated housing) and segregation indices (contact with immigrants, isolation, and density) were used to characterize zip codes. A Boolean-logic methodology was used to determine which configurations of risk factors significantly distinguish zip codes where TB rates are very high from other zip codes. RESULTS: For Whites and Asians, risk factors were rare in zip codes with very high TB rates. In agreement with the distribution of TB cases by age and foreign-born status, this suggests that cases among Whites may be caused by reactivation, whereas cases among Asians may be imported. In contrast, Hispanics and African Americans were exposed to risk factors that may facilitate TB transmission. Among Hispanics, high contact with immigrants was an important factor. African Americans were the group most frequently exposed to multiple risk factors. CONCLUSIONS: For Hispanics and African Americans, zip code-level risk factors were associated with very high TB rates. (+info)
(8/286) Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, 1984-1998: implications for future prevention and research.
AIM: To look for changes in risk factors for sudden infant death syndrome (SIDS) after decrease and stabilisation of the SIDS rate. METHODS: Questionnaires were distributed to parents of 174 SIDS infants, dying between 1984 and 1998, and 375 age and sex matched controls in southeast Norway. RESULTS: The proportion of infants sleeping prone has decreased, along with the decrease in SIDS rate for the region during the periods studied, but over half of the SIDS victims are still found in the prone position. As the number of SIDS cases has decreased, additional risk factors have become more significant. Thus, after 1993, a significantly increased risk of SIDS is seen when the mother smokes during pregnancy. After 1993, young maternal age carries an increased risk. Maternal smoking and young maternal age are associated with each other. For SIDS victims, an increase in the number of infants found dead while co-sleeping is seen, and the age peak between 2 and 4 months and the winter peak have become less pronounced. CONCLUSION: Changes in risk factor profile following the decrease in SIDS rate in the early 1990s, as well as consistency of other factors, provides further clues to SIDS prevention and to the direction of further studies of death mechanisms. (+info)