Health situation in former communist bloc is dire, says Unicef.(9/257)

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Socioeconomic inequalities in mortality among women and among men: an international study. (10/257)

OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS: National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS: Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.  (+info)

European stillbirth proportions before and after the Chernobyl accident. (11/257)

BACKGROUND: Numerous investigations have been carried out concerning the possible impact of the Chernobyl accident, in April 1986, on the prevalence of anomalies at birth and on perinatal mortality. The accident has contaminated Eastern Europe more heavily than Western Europe. If there was an effect of the radioactive contamination on perinatal mortality or stillbirth proportions one would expect to find it more pronounced in Eastern Europe as compared to Western Europe. We therefore studied long-term time trends in European stillbirth proportions. METHODS: Linear logistic regression was applied to model the time trends in stillbirth proportions. Dummy variables were used to account for effects that can be associated with certain years or locations. A synoptic logistic regression model is suggested for the western, central, and eastern parts of Europe. RESULTS: There is a marked differential effect in the long-term stillbirth time trends between Western Europe (Belgium, France, Great Britain, Iceland, Ireland, Luxembourg, Portugal, Spain), Central Europe (Austria, Denmark, Germany, Italy, Norway, Switzerland), and Eastern Europe represented by four countries (Greece, Hungary, Poland, Sweden). In contrast to the western and central European trends, the eastern European trend exhibits an absolute increase of the stillbirth proportion in 1986 as compared with 1985 and an apparent upward shift of the whole trend line from 1986 on. CONCLUSION: Our results are in contrast to those of many analyses of the health consequences of the Chernobyl accident and contradict the present radiobiological knowledge. As we are dealing with highly aggregated data, other causes or artefacts may explain the observed effects. Hence, the findings should be interpreted with caution and further independent evidence should be sought.  (+info)

Elevated blood lead levels among internationally adopted children--United States, 1998. (12/257)

Lead poisoning has been reported recently among Chinese children adopted by U.S. citizens. However, little is known about the prevalence of elevated blood lead levels (BLLs) among adoptees from China and other countries. Persistent sources of lead exposure outside the United States include leaded gasoline exhaust; industrial emissions; cottage industries (e.g., battery breaking and recycling plants); traditional medicines; and some cosmetics, ceramic ware, and foods. In 1998, approximately 15,000 orphans from countries outside the United States who were adopted abroad or were to be adopted in the United States by U.S. citizens were issued U.S. immigrant visas-a nearly two-fold increase over 1988 (L. Lewis, Immigrant and Visa Control and Reporting Division, VISA Office, Bureau of Consular Affairs, U.S. State Department, personal communication, August 1999). Some orphans have been abandoned for extended periods and have no obtainable medical history. Immigrants aged <15 years are not required to have serologic or blood tests either in their country of origin or on entry into the United States unless exposure to syphilis or human immunodeficiency virus is suspected. To obtain reports on the prevalence of elevated BLLs (> or =10 microg/dL) among international adoptees, CDC contacted 12 international adoption medical specialists identified through the Joint Council on International Children's Services and two collaborating medical specialists. This report summarizes the results of that investigation, which suggest that international adoptees may arrive in the United States with elevated BLLs.  (+info)

Drug resistant tuberculosis can be controlled, says WHO.(13/257)

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Chronic hepatitis B virus in children in Israel: clinical and epidemiological characteristics and response to interferon therapy. (14/257)

OBJECTIVE: To describe the clinical and epidemiological features of hepatitis B virus infection in Israeli children, and to evaluate their response and compliance to therapy. METHODS: We retrospectively studied 51 patients (34 males, 17 females), aged 2-18 years, from several medical centers in Israel. RESULTS: Of the 51 patients, 38 with elevated transaminase, positive hepatitis B e antigen and/or HBV DNA, and histologic evidence of liver inflammation were treated. Interferon was administered by subcutaneous injections three times a week for 3-12 months (dosage range 3-6 MU/m2). Only 16% were native Israelis, while 78% of the children were of USSR origin. A family history of HBV infection was recorded in 25 of the 51 patients (9 mothers, 16 fathers or siblings). Five children had a history of blood transfusion. The histological findings were normal in 3 patients, 24 had chronic persistent hepatitis, 14 had chronic active hepatitis and 2 had chronic lobular hepatitis. Five children also had anti-hepatitis D virus antibodies. Twelve of the 38 treated patients (31.5%) responded to IFN completely, with normalization of the transaminase levels and disappearance of HBeAg and HBV DNA. In no patient was there a loss of hepatitis B surface antigen. The main side effects of IFN were fever in 20 children, weakness in 10, headaches in 9, and anorexia in 6; nausea, abdominal pain, and leukopenia were present in 3 cases each. The response rate was not affected by age, country of origin, alanine/aspartate aminotransferase levels, or histological findings. However, a history of blood transfusion was a predictor of good response, 60% vs 27% (P < 0.05). CONCLUSIONS: We found IFN to be a safe and adequate mode of treatment in children with chronic HBV infection, regardless of their liver histology and transaminase levels. Therefore, in view of the transient side effects associated with this drug, we recommend considering its use in all children with chronic hepatitis B.  (+info)

The relation between alcohol and cardiovascular disease in Eastern Europe: explaining the paradox. (15/257)

BACKGROUND: Recent evidence from Eastern Europe of a positive association between alcohol and cardiovascular disease has challenged the prevailing view that drinking is cardioprotective. Consuming amounts of alcohol comparable to those consumed in France has been linked to detrimental cardiovascular effects. One possibility is that this could be related to the particular consequences of binge drinking, which is common in Russia. METHODS: A systematic review of literature on the relation between cardiovascular disease and heavy drinking and irregular (binge) drinking. RESULTS: Most existing reviews of the relation between alcohol and cardiovascular disease have examined the amount drunk per week or month and have not looked at the pattern of drinking. These have consistently shown that alcohol has a cardioprotective effect, even at high levels of consumption. In contrast, studies that have looked at pattern of drinking, either directly, or indirectly, using indicators such as frequency of hangovers or reports of the consequences of drunkenness, have consistently found an increased risk of cardiovascular death, particularly sudden death. A separate review of the physiological basis for a difference between regular heavy drinking and heavy binge drinking demonstrates that the two types of drinking have quite different effects. CONCLUSION: An association between binge drinking and cardiovascular death meets the standard criteria for causality. It is important that future studies of alcohol related harm examine the pattern of drinking as well as the amount drunk.  (+info)

Defaulting from tuberculosis treatment in The Netherlands: rates, risk factors and trend in the period 1993-1997. (16/257)

The aim of this study was to assess the rate of defaulting from treatment among tuberculosis patients diagnosed in the Netherlands in the period 1993-1997, whether risk groups for defaulting can be identified at the start of treatment and the trend of defaulting over time. The Netherlands Tuberculosis Register provided data on all patients diagnosed in the Netherlands during the period 1993-1997. Defaulting probabilities were determined using Kaplan-Meier survival analysis and risk factors were identified with Cox's proportional hazard analysis. Of 7,529 patients with reported treatment outcome, 718 (10%) defaulted or left the country within 1 yr after starting treatment. Defaulting probabilities were 9% (95% confidence interval (CI) 8-10%) among 5,256 patients in low-risk groups, 17% (95% CI 14-19%) among 1,437 asylum seekers and 29% (95% CI 24-34%) among 836 patients in other high-risk groups (other recent immigrants, illegal immigrants, the homeless, prisoners and nationals from Eastern Europe). Defaulting probabilities decreased over time from 12% in 1993 to 7% in 1997. Risk groups for defaulting can be recognized at the start of treatment. The decreasing defaulting probabilities were probably due in part to shortening treatment from 9 to 6 months and improved follow-up of asylum seekers. However, additional measures are needed to reduce defaulting among the homeless, recent immigrants, illegal immigrants and prisoners.  (+info)