Obesity: does it occur in African children in a rural community in South Africa?
(25/1913)
BACKGROUND: Total body fatness and a centripetal fat patterning are recognized as risk indicators of cardiovascular disease in adulthood. In this study, the development of these risk factors in rural South African children during the preschool years and first years of formal schooling is explored. METHOD: The initial cross-sectional data from the Ellisras Longitudinal Investigations in Rural Community Children Project, ongoing since 1996, were used, involving 684 boys and 652 girls, aged 3-10 years, in the Ellisras rural community. Overweight was measured using the body mass index (BMI) (kg/m2). Overfatness was based on the sum of the triceps and subscapular skinfold thicknesses. A centripetal fat patterning was measured by the sum of trunk skinfolds relative to limb skinfolds and the ratio of the subscapular to triceps skinfold. Further, the ratio of the subscapular to supraspinale skinfold was used as an indicator of lower body fat patterning. The 85th percentiles of the NHANES III were used as cutoff values for overweight, overfatness and a centripetal fat patterning. RESULTS: At ages 7 and 8 years, mean BMI was statistically significantly higher in males compared to females (P < 0.05). The log transformed supraspinale skinfold thickness was larger in females compared to males at ages 4-7 years; the log transformed subscapular skinfold was larger in girls compared to boys aged 7-10 years. Less clear patterns were found for the extremity skinfolds and the skinfold ratios. Very few children (0-2.5% in males and 0-4.3% in females) had BMI values above the NHANES III 85th percentiles, indicating a very low prevalence of overweight children in the area. About 15% of the males showed overfatness at ages 3-4 years, while low prevalence was found at older ages. CONCLUSION: Few Ellisras rural children had above normal values for BMI, indicating a low prevalence of obesity in this population. In the 3- and 4-year-old group more subjects were found to have excessive fat, as indicated by the sum of the triceps and subscapular skinfold thicknesses. (+info)
Occupational exposure to environmental tobacco smoke: results of two personal exposure studies.
(26/1913)
Personal monitoring is a more accurate measure of individual exposure to airborne constituents because it incorporates human activity patterns and collects actual breathing zone samples to which subjects are exposed. Two recent studies conducted by our laboratory offer perspective on occupational exposure to environmental tobacco smoke (ETS) from a personal exposure standpoint. In a study of nearly 1600 workers, levels of ETS were lower than or comparable to those in earlier studies. Limits on smoking in designated areas also acted to reduce overall exposure of workers. In facilities where smoking is permitted, ETS exposures are 10 to 20 times greater than in facilities in which smoking is banned. Service workers were exposed to higher levels of ETS than workers in white-collar occupations. For the narrower occupational category of waiters, waitresses, and bartenders, a second study in one urban location indicated that ETS levels to which wait staff are exposed are not considerably different from those exposure levels of subjects in the larger study who work in environments in which smoking is unrestricted. Bartenders were exposed to higher ETS levels, but there is a distinction between bartenders working in smaller facilities and those working in multiroom restaurant bars, with the former exposed to higher levels of ETS than the latter. In addition, ETS levels encountered by these more highly exposed workers are lower that those estimated by the Occupational Safety and Health Administration. Concomitant area monitoring in the smaller study suggests that area samples can only be used to estimate individual personal exposure to within an order of magnitude or greater. (+info)
Development of a multiple sclerosis functional composite as a clinical trial outcome measure.
(27/1913)
The primary clinical outcome measure for evaluating multiple sclerosis in clinical trials has been Kurtzke's expanded disability status scale (EDSS). New therapies appear to favourably impact the course of multiple sclerosis and render continued use of placebo control groups more difficult. Consequently, future trials are likely to compare active treatment groups which will most probably require increased sample sizes in order to detect therapeutic efficacy. Because more responsive outcome measures will be needed for active arm comparison studies, the National Multiple Sclerosis Society's Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis appointed a Task Force that was charged with developing improved clinical outcome measures. This Task Force acquired contemporary clinical trial and historical multiple sclerosis data for meta-analyses of primary and secondary outcome assessments to provide a basis for recommending a new outcome measure. A composite measure encompassing the major clinical dimensions of arm, leg and cognitive function was identified and termed the multiple sclerosis functional composite (MSFC). The MSFC consists of three objective quantitative tests of neurological function which are easy to administer. Change in this MSFC over the first year of observation predicted subsequent change in the EDSS, suggesting that the MSFC is more sensitive to change than the EDSS. This paper provides details concerning the development and testing of the MSFC. (+info)
Dental fear among university students: implications for pharmacological research.
(28/1913)
University students are often subjects in randomized clinical trials involving anxiolytic and analgesic medications used during clinical dental and medical procedures. The purpose of this study was to describe a typical university student population available for research by using data from a mail survey. Subjects were 350 students chosen randomly from all enrolled, full-time, traditional students on the main campus at the University of Washington in Seattle, WA. The aim was to determine the extent and nature of dental anxiety in this population. In addition, the relationships between subject willingness to receive dental injections and general and mental health and medical avoidance and medical fears were examined. The Dental Anxiety Scale (DAS) was used to measure dental anxiety. Dental anxiety was prevalent in this population; 19% of students reported high rates of dental fear. Thirteen percent of students had never had a dental injection. Students with no experience with dental injections were more reluctant than those with experience to receive an injection if one were needed. DAS scores were correlated with injection reluctance. Students who were reluctant to go ahead with a dental injection also reported poorer general and mental health than those who were less reluctant. These students also reported higher medical avoidance and medical anxiety scores. University students provide a rich source of potential subjects for clinical research. The student population, like the community at large, contains people with high levels of dental and medical fear. (+info)
Characteristics of nurse-midwife patients and visits, 1991.
(29/1913)
OBJECTIVES: This study describes the patient populations served by and visits made to certified nurse-midwives (CNMs) in the United States. METHODS: Prospective data on 16,729 visits were collected from 369 CNMs randomly selected from a 1991 population survey. Population estimates were derived from a multistage survey design with probability sampling. RESULTS: We estimated that approximately 5.4 million visits were made to nearly 3000 CNMs nationwide in 1991. Most visits involved maternity care, although fully 20% were for care outside the maternity cycle. Patients considered vulnerable to poor access or outcomes made 7 of every 10 visits. CONCLUSIONS: Nurse-midwives substantially contribute to the health care of women nationwide, especially for vulnerable populations. (+info)
Lower body osteoarticular pain and dose of analgesic medications in older disabled women: the Women's Health and Aging Study.
(30/1913)
OBJECTIVES: This study assessed use and dosage of analgesic medications in relation to severity of osteoarticular pain. METHODS: The type and dose of analgesic medication and the severity of pain in the lower back, hips, knees, or feet of 1002 older disabled women were assessed. RESULTS: Severe pain and the use of analgesic medications were reported by 48.5% and 78.8% of women, respectively. Among those who had severe pain, 41.2% were using less than 20% of the maximum analgesic dose. Overall, 6.6% of women were using more than 100% of the maximum dose. CONCLUSIONS: Severe pain is common. Additional, more effective, and safe analgesic treatments are needed for controlling pain in older persons. (+info)
Biometrical threshold of biparietal diameter for certain fetal sex assignment by ultrasound.
(31/1913)
OBJECTIVES: The aim of this study was to establish the biometric threshold of biparietal diameter (BPD), assumed to be an independent variable of gestational age, at which 100% accuracy in the assessment of fetal sex by ultrasonography is achievable. METHODS: Transvaginal and/or transabdominal sonography was used for detecting the 'sagittal sign' as a marker of fetal sex in 385 fetuses with BPD between 18 and 29 mm. The results of ultrasound examination were compared with sex at birth or with karyotype obtained from amniotic fluid cells or chorionic villus sampling. RESULTS: Fetal sex assignment was feasible in 337 of 385 cases (87.5%). Of the 312 fetuses with known fetal sex outcome, 164 were males and 148 were females. An accuracy rate of 100% was achieved when a BPD of > or = 23 mm was obtained. CONCLUSION: This study provides important information about the earliest stage of fetal development, expressed in terms of BPD, at which a diagnosis of fetal sex can be made with 100% accuracy. (+info)
Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old.
(32/1913)
OBJECTIVE: To investigate the occurrence rate of adnexal lesions in premenopausal women. METHODS: A random sample of women 25-40 years old was invited to undergo a transvaginal ultrasound examination, and 335 women were examined. The criteria used to define an adnexal lesion were either a cystic lesion with its largest diameter of at least 25 mm within the pelvic region, or the appearance of solid parts in any lesion regardless of size. RESULTS: Adnexal lesions were found in 26/335 cases, (7.8%) (95% confidence interval (CI), +/- 2.9%). The occurrence rate of ovarian cysts was 22/335 (6.6%) (95% CI, +/- 2.7%). There were no differences between the women with or without ovarian cysts related to age, smoking habits, parity or body mass index. At follow-up 3 months later, 18 of the 22 (82%) cysts had disappeared (95% CI, +/- 16%). Women using progesterone contraception (either oral contraception or an intrauterine device with levonorgestrel) had a significantly higher relative risk of 2.7 (95% CI, 1.1-6.9) of functional cysts as compared to women with natural cycles. Polycystic ovaries were found in 10.2% (95% CI, +/- 4.2%) of the women not using any hormonal contraception. The mean volumes of the polycystic ovaries were significantly larger compared to those in natural cycles. CONCLUSION: Adnexal lesions are common in asymptomatic women in the age group 25-40 years, but four out of five ovarian cysts disappeared spontaneously after 3 months. The ultrasound appearance of the cyst, the woman's family history and her own feelings must be considered if a persisting cyst is to be surgically removed or followed by repeated transvaginal ultrasound. (+info)