Factors associated with refusal to treat HIV-infected patients: the results of a national survey of dentists in Canada.
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OBJECTIVES: This study investigated dentists refusal to treat patients who have HIV. METHODS: A survey was mailed to a random sample of all licensed dentists in Canada, with 3 follow-up attempts (n = 6444). Data were weighted to allow for probability of selection and nonresponse and analyzed with Pearson's chi 2 and multiple logistic regression. RESULTS: The response rate was 66%. Of the respondents, 32% had knowingly treated HIV-infected patients in the last year; 16% would refuse to treat HIV-infected patients. Respondents reported willingness to treat HIV-infected patients (81%), injection drug users (86%), hepatitis B virus-infected patients (87%), homosexual and bisexual persons (94%), individuals with sexually transmitted disease(s) (94%), and recipients of blood and blood products (97%). The best predictors of refusal to treat patients with HIV were lack of ethical responsibility (odds ratio = 9.0) and items related to fear of cross-infection or lack of knowledge of HIV. CONCLUSIONS: One in 6 dentists reported refusal to treat HIV-infected patients, which was associated primarily with respondents' lack of belief in an ethical responsibility to treat patients with HIV and fears related to cross-infection. These results have implications for undergraduate, postgraduate, and continuing education. (+info)
An epidemic of congenital syphilis in Jefferson County, Texas, 1994-1995: inadequate prenatal syphilis testing after an outbreak in adults.
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OBJECTIVES: After a syphilis epidemic in Jefferson County, Texas, in 1993 and 1994, congenital syphilis prevalence and risk factors were determined and local prenatal syphilis screening practices were assessed. METHODS: Medical records were reviewed, pregnant women with syphilis were interviewed, and prenatal care providers were surveyed. RESULTS: Of 91 women, 59 (65%) had infants with congenital syphilis. Among African Americans, the prevalence per 1000 live births was 24.1 in 1994 and 17.9 in 1995. Of the 50 women with at least 2 prenatal care visits who had infants with congenital syphilis, 15 (30%) had received inadequate testing. Only 16% of 31 providers obtained an early third-trimester syphilis test on all patients. CONCLUSIONS: Inadequate prenatal testing contributed to this outbreak of congenital syphilis. (+info)
The effects on fetal development of high alpha-fetoprotein and maternal smoking.
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OBJECTIVES: This study determined the risk of impaired fetal growth resulting from the interaction between maternal smoking during pregnancy and unexplained elevated concentrations of maternal serum alpha-fetoprotein (MSAFP). METHODS: This observational study involved 123 pregnant smokers with unexplained second-trimester elevated concentrations of MSAFP, 827 smokers with normal levels, and 471 nonsmokers with raised levels. RESULTS: By logistic regression, coincident smoking and elevated MSAFP levels were found to be associated with increases in the low basic risks of prematurity, small-for-gestational-age births, low birthweight, and need for neonatal care. CONCLUSIONS: Maternal smoking has an adverse effect on fetal development in pregnancies with unexplained elevated MSAFP concentrations. Such pregnancies merit close surveillance. (+info)
Ischemic stroke risk and passive exposure to spouses' cigarette smoking. Melbourne Stroke Risk Factor Study (MERFS) Group.
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OBJECTIVES: This study investigated the association between ischemic stroke risk and passive exposure to cigarette smoking. METHODS: Risk factors among 452 hospitalized cases of first-episode ischemic stroke were compared with 452 age- and sex-matched "neighbor-hood" controls. RESULTS: The risk of stroke was twice as high for subjects whose spouses smoked as for those whose spouses did not smoke (95% confidence interval = 1.3, 3.1), after adjustment for the subject's own smoking, heart disease, hypertension, diabetes, and education level. These results were confirmed when analysis was limited to those who never smoked. CONCLUSIONS: These findings provide evidence that spousal smoking may be a significant risk factor for ischemic stroke. (+info)
Early childhood infection and atopic disorder.
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BACKGROUND: Atopy is of complex origins but the recent rise in atopic diseases in westernized communities points to the action of important environmental effects. One candidate mechanism is the changing pattern of microbial exposure in childhood. This epidemiological study investigated the relationship between childhood infections and subsequent atopic disease, taking into account a range of social and medical variables. METHODS: A total of 1934 subjects representing a retrospective 1975-84 birth group at a family doctor practice in Oxfordshire were studied. Public health and practice records were reviewed; temporal records were made of all diagnoses of infections and their treatments, all immunisations, and diagnoses of asthma, hay fever and eczema; maternal atopy and a number of other variables were documented. RESULTS: Logistic regression analysis identified three statistically significant predictors of subsequent atopic disease: maternal atopy (1.97, 95% CI 1.46 to 2.66, p < 0.0001), immunisation with whole-cell pertussis vaccine (1.76, 95% CI 1.39 to 2.23, p < 0.0001), and treatment with oral antibiotics in the first two years of life (2.07, 95% CI 1.64 to 2.60, p < 0.0001). There was no significant association found for maternal smoking, bottle feeding, sibship size, or social class. CONCLUSIONS: The prediction of atopic disease by maternal atopy mainly reflects the effect of acknowledged genetic factors. Interpretation of the prediction of atopic disorders by immunisation with wholecell pertussis vaccine and treatment with oral antibiotics needs to be very cautious because of the possibilities of confounding effects and reverse causation. However, plausible immune mechanisms are identifiable for the promotion of atopic disorders by both factors and further investigation of these association is warranted. (+info)
Carotid endarterectomy outcome with vein or Dacron graft patch angioplasty and internal carotid artery shortening.
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OBJECTIVE: This analysis of the outcome of carotid endarterectomy (CEA) was performed during a period of transition from the frequent use of autologous greater saphenous vein grafting to the frequent use of Dacron graft patch reconstruction and from the infrequent use to the moderate use of eversion plication shortening of the endarterectomized internal carotid artery segment. METHODS: From 1990 to 1997, 697 consecutive primary CEAs were performed on 326 men (61 bilateral CEAs) and 272 women (38 bilateral CEAs) with a mean age (+/- SD) of 68 +/- 9 years. The indications were transient ischemic attack in 31% of the patients, stroke or reversible ischemic neurologic deficit in 18%, global ischemia in 12%, and asymptomatic stenosis >/=70% in 39%. Patch reconstruction was performed in the 678 CEAs in which the arteriotomy extended distal to the internal carotid artery bulb (97%; 370 saphenous vein grafts, 308 Dacron grafts). Primary closure was used in the other 19 CEAs. Early in this series, saphenous vein patching frequently was performed, with a gradual transition to the frequent use of knitted Dacron grafts. Concurrent with this, the frequency of the shortening of the internal carotid artery increased from 7% to 40%. Postoperative duplex scans were obtained on 619 CEAs (91%). RESULTS: There were four deaths (0.6%) in 30 days-three from myocardial infarction and one from hyperperfusion stroke. Thirteen strokes (1.9%), nine ipsilateral and four contralateral, occurred in 30 days. Four nonfatal strokes and one death occurred in the saphenous vein group (3.2%), and eight strokes and two deaths occurred in the Dacron graft group (1.4%; P =.16). The combined 30-day stroke or death rate was 2.3% (16/697), and the hospital rate was 1.7% (12/697). Of the three internal carotid artery occlusions, two were identified at 2 months (one Dacron graft, one saphenous vein) and one was identified at 1 year (Dacron graft). Nonocclusive (>/=50%) restenosis was identified in 16 CEAs. Fifteen of these were in the internal carotid artery. The cumulative Kaplan-Meier method of life-table analysis for the >/=50% restenosis rate at 2 months, 6 months, 1 year, and 3 years for Dacron graft patched CEA was 1.7%, 2.3%, 8.8%, and 12.3% and for saphenous vein patched CEA was 0.3%, 0.3%, 0.3%, and 1.1% ( P <.0001). At the same time intervals, the >/=50% restenosis rate for internal carotid artery shortening was 1.0%, 2.5%, 13.7%, and 19.5%, and, when shortening was not done, the rate was 0.8%, 0.8%, 1.1%, and 3.1% (P <.0001). The >/=50% restenosis rate at the same intervals for women was 0.8%, 1.3%, 5.2%, and 8.9%, and, for men, the rate was 0.9%, 0.9%, 1.8%, and 2.5% (P =.11). Univariate analysis of the rate of >/=50% restenosis in 3 years for the 346 vein patched (2; 0.6%) and 186 Dacron graft patched (7; 3.8%) CEAs that did not have internal carotid artery shortening gave a P value of .015. Similarly, Kaplan-Meier method analysis of this subset of nonshortened CEAs gave a higher restenosis rate with Dacron graft patching (P =.012). With multiple logistic regression, the >/=50% restenosis rate was significantly associated with Dacron graft patching (P =.023; odds ratio, 4.5) and internal carotid artery shortening (P =.025; odds ratio, 3.1) and was weakly associated with female gender (P =.15; odds ratio, 2.0). Cox proportional hazards model analysis for >/=50% restenosis gave relative risk ratios of 3.0 (1.6 to 6.8; 95% confidence interval [CI]) for Dacron graft versus vein patching, 2.0 (1.2 to 3.3; 95% CI) for shortening versus not shortening, and 1.5 (0.9 to 2.4; 95% CI) for female versus male gender. CONCLUSION: CEA patching with Dacron grafts and saphenous vein grafts have similar low perioperative thrombosis, stroke, and death rates, although the stroke and death rates were slightly higher but not statistically different when Dacron grafts were used. Dacron graft patched CEAs are more likely to develop >/=50% restenosis than are those that are patched (+info)
Poverty area residence and changes in depression and perceived health status: evidence from the Alameda County Study.
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BACKGROUND: Previous evidence from the Alameda County Study indicated that residential area has an independent effect on risk for mortality, adjusting for a variety of important individual characteristics. The current research examined the effect of poverty area residence on risk for developing depressive symptoms and decline in perceived health status in a sample of 1737. METHODS: Data were from a longitudinal population-based cohort. Multiple logistic regression analyses were used. RESULTS: Age- and sex-adjusted risk for incident high levels of depressive symptoms in 1974 was higher for poverty area residents (odds ratio [OR] 2.14; confidence interval [CI]: 1.49-3.06). Those reporting excellent/good health in 1965 were at higher risk for having fair/poor health in 1974 if they lived in a poverty area (age- and sex-adjusted OR 3.30; CI: 2.32-4.71). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with change in outcome variables. CONCLUSION: These results further support the hypothesis that characteristics of place affect health conditions and health status. (+info)
Investigation of under-ascertainment in epidemiological studies based in general practice.
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BACKGROUND: One of the aims of the Study of Infectious Intestinal Disease (IID) in England is to estimate the incidence of IID presenting to general practice. This sub-study aims to estimate and correct the degree of under-ascertainment in the national study. METHODS: Cases of presumed IID which presented to general practice in the national study had been ascertained by their GP. In 26 general practices, cases with computerized diagnoses suggestive of IID were identified retrospectively. Cases which fulfilled the case definition of IID and should have been ascertained to the coordinating centre but were not, represented the under-ascertainment. Logistic regression modelling was used to identify independent factors which influenced under-ascertainment. RESULTS: The records of 2021 patients were examined, 1514 were eligible and should have been ascertained but only 974 (64%) were. There was variation in ascertainment between the practices (30% to 93%). Patient-related factors independently associated with ascertainment were: i) vomiting only as opposed to diarrhoea with and without vomiting (OR 0.37) and ii) consultation in the surgery as opposed to at home (OR 2.18). Practice-related factors independently associated with ascertainment were: i) participation in the enumeration study component (OR 1.78), ii) a larger number of partners (OR 0.3 for 7-8 partners); iii) rural location (OR 2.27) and iv) previous research experience (OR 1.92). Predicted ascertainment percentages were calculated according to practice characteristics. CONCLUSION: Under-ascertainment of IID was substantial (36%) and non-random and had to be corrected. Practice characteristics influencing variation in ascertainment were identified and a multivariate model developed to identify adjustment factors which could be applied to individual practices. Researchers need to be aware of factors which influence ascertainment in acute epidemiological studies based in general practice. (+info)