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Breast cancer risk among women under 55 years of age by joint effects of usage of oral contraceptives and hormone replacement therapy.
Menopause. 2018 Nov; 25(11):1195-1200.OBJECTIVE: To assess effects on breast cancer risk of exposure to both oral contraceptives and menopausal hormones, an increasingly common exposure. DESIGN: A case-control study of breast cancer among women under the age of 55 years in Atlanta, GA involving 1,031 cases and 919 population controls was conducted. RESULTS: Ever use of oral contraceptives was associated with a relative risk of 1.1 (95% 0.9-1.4), whereas the relative risk for hormone replacement therapy was 0.9 (95% CI 0.7-1.2). Seventeen percent of the cases versus 19% of the population controls reported exposure to both agents, resulting in a relative risk of 1.0 (95% CI 0.7-1.4) relative to those unexposed to either preparation. Although there was little variation in risk associated with joint effects by either age or race, there were statistically nonsignificant elevations in risk for this exposure among women who had experienced a natural menopause (relative risk = 2.0, 95% CI 0.7-5.6), were relatively thin (relative risk = 1.5, 0.8-3.0), or who had a first degree relative with breast cancer (relative risk = 2.0, 0.6-7.0). When joint effects of longer term use of both agents were considered, subjects who reported use of oral contraceptives for 10 or more years and hormone replacement for 3 or more years had a relative risk of 3.2 (95% CI 1.4-7.4) compared with nonusers of either preparation. CONCLUSIONS: Although our results must be cautiously interpreted given small numbers within subgroups, they raise concern and emphasize the need for further evaluation on breast cancer risk of the increasingly common exposure to both oral contraceptives and hormone replacement therapy.
Determinants of maternal deaths amongst mothers who suffered from post-partum haemorrhage: a community-based case control study.
International Journal of Community Medicine and Public Health. 2018 Jul; 5(7):2814-2820.Background: The WHO estimates that, of the 529 000 maternal deaths occurring every year 136 000 take place in India amongst which postpartum haemorrhage (PPH) being the most (29.6%) commonly reported complication. However deaths from PPH can be prevented. The purpose of this study was to identify the risk factors contributing to maternal deaths amongst women who develop PPH. Methods: This was a community based paired case-control study done in rural areas of Lucknow, UP (India) done in a period of one year. Thirty-one maternal deaths due to PPH (cases) were matched and compared with two mothers who survived from PPH (controls). Data was analysed using SPSS version 17.0 and Open Epi version 2.3. The appropriate significance test was applied using MacNemar test for paired data. Risk factors obtained significant in bivariate analysis were subjected to conditional multiple logistic regressions for adjustment and controlling the effect of confounding variables. Results have been given in form of unadjusted Odds ratio (UOR) and adjusted Odds ratio (AOR). Results: It was seen that the mothers who had taken =4 antenatal visits during the index pregnancy had a protective effect against deaths due to PPH. Home delivery raised the odds of death by seven times. Conclusions: Deaths due to PPH can be reduced by ensuring institutional delivery, good antenatal care and better referral facilities, especially for mothers from weaker sections of society.
Risk factors associated with childhood tuberculosis: a case control study in endemic tuberculosis area.
International Journal of Community Medicine and Public Health. 2018 Nov; 5(11):4702-4706.Background: Tuberculosis (TB) in childreen is still considered as important public health problems in various countries, including Indonesia. Risk factors related to childhood tuberculosis is crucial to identify in order to conduct prevention effort effectively. The purpose of this research is to determine the effect of environmental health in house, contact history and nutritional status toward childhood tuberculosis. Methods: This research is an analytical observational study using case-control design, with 35 samples of the case and 35 samples of the control. Several variables such as house environment, contact history and nutritional status were obtained by questionnaire and observation in house of respondents. Data analysis was conducted using Logistic Regression test to determine correlation between independent and dependent variables. Results: This research highlighted that contact history and nutritional status were correlated with childhood tuberculosis. While house environment variables such as lighting level, floor type, house occupancy density were not related to the incidence of tuberculosis in children. Conclusions: Contact history and nutritional status were the factors which determined childhood tuberculosis in Banyumas. It is important for parents to maintain good nutritional status of their children and to avoid them from contact with tuberculosis patients.
Determinants of high fertility among married women in Angacha District, Kambeta Tembero Zone, Southern Ethiopia.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):46-54.BACKGROUND: Fertility is the major component of population dynamics, which is used to show a major role in the size, and structure of a particular population. In Ethiopia, total fertility rate is 4.6 children per woman. This high fertility brings a significant problem on the health of mothers and children. OBJECTIVE: To identify the determinants of high fertility in Angacha District, Southern Ethiopia. METHOD: A community-based case-control study design was conducted from September 20 to October 10, 2017 in Angacha district, Southern Ethiopia. A total of 388 married women in Angacha district were selected using simple random sampling technique. Bi-variable and multi-variable logistic regression analyses were performed. RESULT: A total of 388 eligible women (129 cases and 259 controls) requested to interview, of which 126 cases and 255 controls participated. Educational status of women (AOR[95% CI] = 0.36 [0.160.83]), desire to have more children before marriage (AOR[95% CI] = 0.51[0.28, 0.93]), age at first marriage (AOR[95% CI] = 4.77[2.59, 8.78]), history of under-five mortality (AOR[95% CI] = 4.22[2.43, 7.31]) and not ever use of contraceptive methods (AOR[95% CI] = 4.55[2.21, 9.39]) were identified as determinants of high fertility. CONCLUSION: In this study educational status of women, age at first marriage, desire to have children before marriage, not ever use of contraceptive methods and experiencing under-five mortality were identified as determinants of high fertility. Therefore, all concerned bodies should intervene in improving the education level of women, increase age at first marriage, reduce child mortality and improve the access to contraceptive methods.
A Population-Based, Case-Control Evaluation of the Association between Hormonal Contraceptives and Idiopathic Intracranial Hypertension.
American Journal of Ophthalmology. 2018 Sep 21;PURPOSE: To determine if the use of oral contraceptive pills (OCP) and other hormonal contraceptives are associated with a higher incidence of idiopathic intracranial hypertension (IIH). DESIGN: Retrospective, population-based, case-control study METHODS: Setting: Female IIH patients evaluated between January 1, 1990 and December 31, 2016 were identified using the Rochester Epidemiology Project (REP), a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota, residents. STUDY POPULATION: Fifty-three female residents of Olmsted County diagnosed with IIH between 15 and 45 years of age. The use of OCPs and other hormonal contraceptives was compared to controls matched for age, sex and body-mass index. INTERVENTIONS/EXPOSURES: Hormonal contraceptives MAIN OUTCOME MEASURE: Odds of developing IIH RESULTS: Of the 53 women diagnosed with IIH between 15 and 45 years of age, 11 (20.8%) had used hormonal contraceptives within <30 days of the date of IIH diagnosis, in contrast to 30 (31.3%) among the control patients. The odds ratio of hormonal contraceptive use and IIH was 0.55 (95% CI: 0.24-1.23, p=0.146). The odds ratio of OCP use was 0.52 (95% CI: 0.20-1.34, p=0.174). CONCLUSIONS: OCP and other hormonal contraceptives were not significantly associated with a higher incidence of IIH, arguing against the need for women with IIH to discontinue their use. Copyright (c) 2018 Elsevier Inc. All rights reserved.
A comparison of early neonatal deaths among preterm infants with term neonatal deaths at the University Teaching Hospital, Lusaka, Zambia.
Medical Journal of Zambia. 2017; 44(4):250-254.Background: Prematurity is a common complication that contributes significantly to high neonatal mortality. In spite of many efforts by the government and other partners, non-significant decline has been achieved in the recent past. Globally, 15 million babies are born preterm (<37 weeks gestation) each year, and more than 1 million of those do not survive their first month of life. Preterm birth accounts for 75% of all perinatal mortality in some series thus identifying the determinants of preterm deaths is very crucial for policy improvement. This study was aimed at establishing factors associated with preterm deaths at UTH compared to those of term neonatal deaths. Methods: A case-control study was conducted among 208 neonates that were early neonatal deaths i.e. within 7 days in neonatal intensive care unit (NICU) at UTH in 2015. Antenatal and intrapartum details (parity, multiple pregnancy, birth weight, antenatal steroid exposure, antibiotic exposure, and the indication of admission to NICU) were obtained from 104 neonates that were preterm (between 24- 36 completed weeks gestation) and had died and of a further 104 term neonates (>37 weeks gestation) that died around the same time. The data was collected by int e rvi ewe r- admini s t e r ed s t ruc tur ed questionnaire and analyzed by SPSS v21. Bivariate analysis was used to identify variables for multivariate logistic regression model to identify obstetric determinants amongst deaths in neonates that were preterm compared to those born at term. Results: There were few differences between the two groups. The sex of the neonate significantly influenced the odds of dying. We confirmed that male neonates had a 57.1% higher risk than females (42.9%) of dying during the early neonatal period. More term neonates that died were male (P=0.0031) and had a very poor Apgar score (1-3) (P=0.0048). Both the indications for admission to NICU and cause of death were different in the two groups with preterms (P<0.0001) and terms P=0.0309. On multivariate regression analysis, poor Apgar score was associated with six-fold odds of RDS. More preterm neonates had died despite receiving steroids. None of the other factors reached statistical significance (adjOR 6.0, 95% CI 3.03-11.92, p<0.0001). Poor Apgar score was also the only factor associated with sepsis, though it was a neonate with a good Apgar score that had higher odds of dying due to sepsis. Primiparity was associated with a 2.6-fold odds (95% CI 1.03 to 6.68, p=0.04) of hypoxic ischaemic encephalopathy. On logistic regression, a preterm neonate dying only had a higher odds of being a LBW (<2500g) than any other factor [adjusted OR 132.72 (95% CI 39.49 to 387.66) P<00001]. Considering the main causes of death, hypoxic ischemic encephalopathy in preterm neonates was only associated with poor Apgar score (i.e. <7) [adjusted OR 2.03 (95% CI 1.12 to 3.67) P = 0.02]. Sepsis in term neonates OR 0.2 (95% CI 0.15 to 0.54) P<00001]. Respiratory distress syndrome in preterm neonates dying was only associated with poor Apgar score [adjusted OR 6.01 (3.03 to 11.92) P<00001]. Conclusions: Hypoxic ischemic encephalopathy as a cause of early neonatal death is commoner in term neonates but also common in preterm. Sepsis is commoner in preterm neonates as a cause of early neonatal death. Comparing different causes of death, poor Apgar score featured in all cases calling for improved resuscitation.
Initiating intramuscular depot medroxyprogesterone acetate 24-48 hours after mifepristone administration does not affect success of early medical abortion.
BMJ Sexual and Reproductive Health. 2018; 44(4):242-247.OBJECTIVES: The primary objective of this study was to determine whether intramuscular depot medroxyprogesterone acetate (IM DMPA) given at the time of misoprostol administration, 24-48 hours after mifepristone, affects the rate of continuing pregnancy. In addition, the study explored factors predictive of continuing pregnancy. DESIGN: Case-control study based on database review of women who underwent early medical abortion (EMA) over a 4-year period. SETTING: Single abortion service in Scotland. PARTICIPANTS: 5122 women who underwent an EMA within the timeframe of this study. MAIN OUTCOME MEASURES: Continuing pregnancies among women receiving IM DMPA were compared with those choosing other hormonal methods of contraception, non-hormonal contraception or no contraception at the time of misoprostol administration. Logistic regression was performed to assess the effects of demographic characteristics, gestation at presentation and method of contraception provided, on outcome of pregnancy. RESULTS: A total of 4838 women with complete data were included, of which there were 20 continuing pregnancies (0.4%); 284 women were excluded due to missing data. There was no increased risk of a continuing pregnancy among women who initiated IM DMPA at the time of misoprostol administration (24-48 hours after mifepristone) compared with women who initiated no hormonal contraception at this time (RR 0.48; 95% CI 0.06 to 3.81). Gestation >/=8 weeks and previous terminations were factors associated with increased likelihood of continuing pregnancy. CONCLUSIONS: Women choosing IM DMPA after EMA can be reassured that IM DMPA can be safely initiated at the time of misoprostol administration 24-48 hours after mifepristone without an increase in the risk of a continuing pregnancy. Both increasing gestation and previous termination were factors associated with an increased likelihood of continuing pregnancy following an EMA. (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.
Determinants of stillbirth in Bonga General and Mizan Tepi University Teaching Hospitals southwestern Ethiopia, 2016: a case-control study.
BMC Research Notes. 2017 Dec 7; 10(1):713.OBJECTIVE: This study aimed to identify determinants of still birth in selected hospitals of Southwestern Ethiopia. RESULT: A total 540 charts registered for maternal health services utilization were included in the analysis with proportion of case to control ratio of one to three (135 cases, 405 control). Women who attended antenatal care were 40% less risk for stillbirth compared to those who did not attend antenatal care (AOR = 0.6, 95% CI 0.39, 0.94). Those who had labor length >/= 24 h were 2.4 times at risk to have still birth than = 24 h (AOR = 2.44, 95% CI 1.4, 4.26). Women who developed uterine rupture were about 5 times more likely to have still birth than did not develop the complication (AOR = 4.9, 95% CI 1.67, 14.35). Women who have different antenatal risks were 4.5 times more likely to have still birth (AOR = 4.58, 95% CI 1.45, 14.48). Weight of baby >/= 2.5 kg were 73% less likely to still birth when compared to counterparts (AOR = 0.27, 95% CI 0.14, 0.53).
BJOG. 2016 Apr; 123(5):788-95.OBJECTIVE: To determine the association between intrauterine device (IUD) use, timing of removal prior to pregnancy, and the risk of pre-eclampsia. DESIGN: A case-control study within the Clinical Practice Research Datalink, UK. SETTING: Medical record database in the UK. SAMPLE: Cases of pre-eclampsia (n = 2744) were identified among pregnancies resulting in singleton deliveries from 1993 to 2010. Four controls, or pregnancies unaffected by pre-eclampsia, were matched to each case on maternal age, general practice, and year of delivery. METHODS: Data on IUD use were obtained from patient records. The odds ratios (ORs) for the association between IUD and pre-eclampsia were adjusted for covariates identified a priori, and analyses were stratified by BMI and number of prior deliveries. MAIN OUTCOME MEASURES: Odds ratios (95% confidence intervals, 95% CIs) of pre-eclampsia in pregnancies among women with a history of IUD use, compared with women without a history of IUD use. RESULTS: Prior IUD use was associated with a reduced risk of pre-eclampsia (OR 0.76; 95% CI 0.58-0.98). The timing of removal in relation to the start of pregnancy showed an inverse association, with shorter intervals associated with a larger decrease in risk of pre-eclampsia. IUD removal within a year prior to pregnancy had an OR of 0.68 (95% CI 0.46-1.00). Among women with a prior delivery, the association between IUD use and pre-eclampsia was null. CONCLUSIONS: Intrauterine device use is associated with a small decreased risk of pre-eclampsia, specifically if removed within the year prior to conception. TWEETABLE ABSTRACT: A case-control study of pregnancies in the UK suggests a reduced risk of pre-eclampsia for former IUD users. (c) 2015 Royal College of Obstetricians and Gynaecologists.
Association between progestin-only contraceptive use and cardiometabolic outcomes: A systematic review and meta-analysis.
European Journal of Preventive Cardiology. 2018 Jul; 25(10):1042-1052.Aims The association between progestin-only contraceptive (POC) use and the risk of various cardiometabolic outcomes has rarely been studied. We performed a systematic review and meta-analysis to determine the impact of POC use on cardiometabolic outcomes including venous thromboembolism, myocardial infarction, stroke, hypertension and diabetes. Methods and results Nineteen observational studies (seven cohort and 12 case-control) were included in this systematic review. Of those, nine studies reported the risk of venous thromboembolism, six reported the risk of myocardial infarction, six reported the risk of stroke, three reported the risk of hypertension and two studies reported the risk of developing diabetes with POC use. The pooled adjusted relative risks (RRs) for venous thromboembolism, myocardial infarction and stroke for oral POC users versus non-users based on the random effects model were 1.06 (95% confidence interval (CI) 0.70-1.62), 0.98 (95% CI 0.66-1.47) and 1.02 (95% CI 0.72-1.44), respectively. Stratified analysis by route of administration showed that injectable POC with a RR of 2.62 (95% CI 1.74-3.94), but not oral POCs (RR 1.06, 95% CI 0.7-1.62), was associated with an increased risk of venous thromboembolism. A decreased risk of venous thromboembolism in a subgroup of women using an intrauterine levonorgestrel device was observed with a RR of 0.53 (95% CI 0.32-0.89). No effect of POC use on blood pressure was found, but there was an indication for an increased risk of diabetes with injectable POCs, albeit non-significant. Conclusions This systematic review and meta-analysis suggests that oral POC use is not associated with an increased risk of developing various cardiometabolic outcomes, whereas injectable POC use might increase the risk of venous thromboembolism.
Osteoporosis International. 2017 Jan; 28(1):291-297.There has been concerning about women receiving depot medroxyprogesterone acetate (DMPA) contraception because of the prolonged hypoestrogenemic state regarding the potential negative effects on bone health. This study showed that DMPA exposure is associated with increased fracture risk and that fracture risk increases with longer DMPA exposure. INTRODUCTION: DMPA has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. We performed this large population-based study to assess the association between use of DMPA or combined oral contraceptives and the incident risk of fracture. METHODS: We identified 4189 women between 20 and 44 years of age with a first-time fracture diagnosis, matched them with 4189 random controls using the Disease Analyzer database and investigated the relation with DMPA exposure. RESULTS: Overall, 11 % of the fracture cases and 7.7 % of the controls had DMPA use recorded. The adjusted OR for developing a fracture in patients with current use of DMPA compared to non-users was 0.97 (95 % CI 0.51-1.86), 2.41 (95 % CI 1.42-4.08), and 1.46 (95 % CI 0.96-2.23) for 1-2, 3-9, and >/=10 prescriptions, respectively. The adjusted OR for developing a fracture in patients with past use of DMPA compared to non-users was 0.96 (95 % CI 0.73-1.26), 1.14 (95 % CI 0.86-1.51), and 1.55 (95 % CI 1.07-2.27) for 1-2, 3-9, and >/=10 prescriptions, respectively. The highest fracture risk was identified in young patients less than 30 years with longer DMPA exposure (>/=10 prescriptions; OR 3.04, 95 % CI 1.36-6.81), as well as in patients in the late reproductive years with past use of DMPA (OR 1.72, 95 % CI 1.13-2.63). CONCLUSIONS: Our results indicate that DMPA exposure is associated with increased fracture risk and may have negative effects on bone metabolism, resulting in impaired bone mineral acquisition during adolescence and accelerated bone loss in adult life.
Association between Hormonal Contraception and Injuries Induced by Human Papillomavirus in the Uterine Cervix. Associacao entre a contracepcao hormonal e lesoes induzidas pelo virus do papiloma humano no colo uterino.
Revista Brasileira De Ginecologia E Obstetricia. 2018 Apr; 40(4):196-202.OBJECTIVE: To evaluate the association between hormonal contraception and the appearance of human papillomavirus HPV-induced lesions in the uterine cervix of patients assisted at a school outpatient clinic - ObGyn outpatient service of the Universidade do Sul de Santa Catarina. METHODS: A case-control study, with women in fertile age, performed between 2012 and 2015. A total of 101 patients with cervical lesions secondary to HPV were included in the case group, and 101 patients with normal oncotic colpocytology, in the control group. The data were analyzed through the Statistical Package for the Social Sciences (SPSS, IBM Corp. Armonk, NY, US) software, version 24.0, using the 95% confidence interval. To test the homogeneity of the proportions, the chi-square (chi(2)) test was used for the qualitative variables, and the Student t-test, for the quantitative variables. RESULTS: When comparing the occurrence of HPV lesions in users and non-users of combined oral contraceptives (COCs), the association with doses of 0.03 mg or higher of ethinylestradiol (EE) was observed. Thus, a higher probability of developing cervical lesions induced by HPV was identified (odds ratio [OR]: 1.9 p = 0.039); and when these cases were separated by the degree of the lesion, the probability of these patients presenting with low-grade squamous intraepithelial lesion was 2.1 times higher (p = 0.036), but with no impact on high-grade squamous intraepithelial lesions and the occurrence of invasive cancer. No significant differences were found in the other variables analyzed. CONCLUSION: Although the results found in the present study suggest a higher probability of the users of combined hormonal contraceptives with a concentration higher than 0.03 mg of EE to develop low-grade intraepithelial lesions, more studies are needed to conclude causality. Thieme Revinter Publicacoes Ltda Rio de Janeiro, Brazil.
Contraception. 2018 Apr 17;OBJECTIVE: Understanding the effect of contraceptives on the development of precancerous lesions of the cervix and cervical cancer may provide information that is valuable to women in contraceptive decision-making. The purpose of this study was to evaluate the association between recent intrauterine device (IUD) use (by type) and cervical intraepithelial neoplasia 2, 3, adenocarcinoma in situ or cancer (CIN2+ or CIN3+). STUDY DESIGN: Case-control study of 17,559 women age 18-49 with incident CIN2+ cases and 5:1 age-matched, incidence-density selected controls (N=87,378) who were members of Kaiser Permanente Northern California Healthcare System from 1996 to 2014. Recent IUD use, within 18 months prior to index, was the exposure of interest. RESULTS: We identified 1,657 IUD users among the cases and 7,925 IUD users among controls. After adjusting for sexually transmitted infection testing, smoking, HPV vaccination, hormonal contraceptive use, parity, race and number of outpatient healthcare system visits, IUD use was associated with an increased rate of CIN2+ [rate ratio (RR) 1.12, 95% confidence interval (1.05-1.18), p<0.001] but not CIN3+ [RR 1.02 (0.93-1.11), p=0.71]. Levonorgestrel-IUD use was associated with an increased rate of CIN2+ [RR 1.18 (1.08-1.30), p<0.001] but not CIN3+ [RR 1.05 (0.91-1.21), p=0.48]. Copper-IUD use was not associated with CIN2+ [RR 0.88 (0.75-1.04), p=0.13] or CIN3+ [RR 0.81 (0.64-1.02), p=0.07]. CONCLUSION: Recent IUD use had variable weak associations with CIN2+ but was not associated with increased risk of CIN3+. IMPLICATIONS: Recent levonorgestrel-IUD use may be associated with CIN2, a lesion with a high rate of regression, but not CIN3, which is considered a true pre-cancerous lesion. The observed association between levonorgestrel-IUDs and CIN2+ was modest but warrants further investigation. It may have clinical importance for contraceptive counseling if this finding is shown to be consistent across other studies and other populations. Copyright (c) 2018 Elsevier Inc. All rights reserved.
MBio. 2017 Jul 25; 8(4)Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4(+) T cells or dendritic cells. The foreskin is a major site of viral entry in heterosexual transmission of HIV. Although the probability of acquiring HIV from a sexual encounter is low, the risk varies even after adjusting for known HIV risk factors. The genital microbiome may account for some of the variability in risk by interacting with the host immune system to trigger inflammatory responses that mediate the infection of mucosal immune cells. We conducted a case-control study of uncircumcised participants nested within a randomized-controlled trial of male circumcision in Rakai, Uganda. Using penile (coronal sulcus) swabs collected by study personnel at trial enrollment, we characterized the penile microbiome by sequencing and real-time PCR and cytokine levels by electrochemiluminescence assays. The absolute abundances of penile anaerobes at enrollment were associated with later risk of HIV seroconversion, with a 10-fold increase in Prevotella, Dialister, Finegoldia, and Peptoniphilus increasing the odds of HIV acquisition by 54 to 63%, after controlling for other known HIV risk factors. Increased abundances of anaerobic bacteria were also correlated with increased cytokines, including interleukin-8, which can trigger an inflammatory response that recruits susceptible immune cells, suggesting a mechanism underlying the increased risk. These same anaerobic genera can be shared between heterosexual partners and are associated with increased HIV acquisition in women, pointing to anaerobic dysbiosis in the genital microbiome and an accompanying inflammatory response as a novel, independent, and transmissible risk factor for HIV infection.IMPORTANCE We found that uncircumcised men who became infected by HIV during a 2-year clinical trial had higher levels of penile anaerobes than uncircumcised men who remained HIV negative. We also found that having higher levels of penile anaerobes was also associated with higher production of immune factors that recruit HIV target cells to the foreskin, suggesting that anaerobes may modify HIV risk by triggering inflammation. These anaerobes are known to be shared by heterosexual partners and are associated with HIV risk in women. Therefore, penile anaerobes may be a sexually transmissible risk factor for HIV, and modifying the penile microbiome could potentially reduce HIV acquisition in both men and women. Copyright (c) 2017 Liu et al.
Risk factors for severe acute malnutrition among children aged 6-59 months admitted at Lubango Pediatric Hospital, Angola.
African Journal of Health Sciences. 2018 Jan-Mar; 31(1):1-12.Background: The 4th Millennium Development Goal (MDG) is to reduce the mortality rates among under-fives by two thirds between 1990 and 2015. Efforts to prevent child deaths need to be stepped up in order to meet that target but the challenge is how to reduce morbidity and mortality among children with SAM. In SSA, the nutritional and health situation is worsening. The hospital case fatality rates (CFR) for SAM remain high due to faulty case management in resource-poor settings. Despite the improved understanding of the clinical management of SAM, the CFR among admitted children in SSA has remained between 20- 30%. This study sought to determine the social demographic and clinical risk factors associated with severe acute malnutrition among children admitted at Lubango Pediatric Hospital. Methods: This was a case-control design where cases were compared with age and sex -matched controls with weight for height. Data was collected using an interviewer administered structured questionnaire, with caregivers as respondents: Clinical history and examination was conducted by a trained clinician eliciting duration of illness and categorizing symptoms such as fever and cough among others. The Nutritional status of the child was determined using anthropometric measurement. A pre- HIV test counselling was done to the care takers and the ones who gave consent, an HIV antibody test was conducted to the child using Determine and unigold HIV rapid test followed by a post-test counselling for both the HIV positive and negative children. For children who had been admitted the same year, the files were found for confirmation of the diagnosis of the previous admission(s). Results: The significant predictors of severe malnutrition were family order, HIV test results, previous history of admission with diarrhea and malnutrition, duration of breast feeding and number of previous admissions Conclusion: The burden of severe malnutrition is still high among children admitted in hospital. There is need to strengthen breast feeding campaigns and family planning strategies. Further clinicians need to be proactive in assessing the risk of malnutrition in HIV positive children and children with recurrent admissions especially with malnutrition and diarrhea.
Predictors of HIV Antiretroviral Treatment Failure among Patients Attending a Semi – Urban HIV Clinic– Kenya, 2012: Can Social Support Help?
African Journal of Health Sciences. 2018 Jan-Mar; 31(1):60-72.Background: HIV antiretroviral treatment [ART] failure increases morbidity and mortality. In Kenya, use of treatment supporter, HIV serostatus disclosure, and support groups are believed to reduce the risk of treatment failure by improving adherence. Methods: We conducted a case-control study to identify factors associated with clinical or immunologic indicators of treatment failures. Cases and controls were adult patients attending a semi-urban HIV clinic who initiated ART at least six months prior to the study. Cases were patients who had a] a decline in CD4 count [below baseline or 30% from highest value since ART initiation] or b] unimproved CD4 counts or c] a World Health Organization [WHO] stage III or IV opportunistic infection. Controls did not meet either immunologic or clinical criteria for treatment failure. Information was obtained through face-to-face interviews medical chart reviews. Results: We enrolled 52 cases and 104 controls. Twenty-eight [53%] cases and 71 [70%] controls were women, and median age was 44 years [range: 38-50 years] among cases and 43 years [range: 38-49 years] among controls. Discontinued ART for 2 weeks or more [adjusted odds ratio [AOR] 8.9, 95% confidence interval [CI] 1.4-57.4] and alcohol use [AOR 7.2, 95% CI 1.1-45.5] were found to significantly increase the risk of ART failure. Compared to men who discontinued ART for less than 2 weeks, women who discontinued ART for less than 2 weeks had reduced risk [AOR 0.4, 95% CI 0.2-0.9] while those who discontinued for two weeks or more had a greater risk [AOR 12.97, 95% CI 1.5-111.8] of developing ART failure. Social support factors were not associated with treatment failure. Conclusions: Discontinuing ART and alcohol use were identified to be modifiable factors associated with clinical or immunologic criteria of ART failure. Interventions with proven efficacy at reducing alcohol use and increasing continuous ART should be implemented.
Virology Journal. 2017 Jul 26; 14(1):142.BACKGROUND: Preeclampsia is a major health problem. Although, the pathophysiology of preeclampsia is not fully understood, there are recent studies on association between infections and preeclampsia. OBJECTIVE: The aim of the present study was to investigate the association between maternal seropositivity of rubella, Herpes simplex virus type 2 (HSV-2) and preeclampsia. METHOD: A case -controls study (90 women in each arm) was conducted at Saad Abualila Maternity Hospital, Khartoum, Sudan. The cases were women with preeclampsia and the controls were healthy pregnant women. Rubella and HSV-2 IgG antibodies were analysed in the maternal sera of all of the participants using ELISA. RESULTS: There was no significant difference in the age, parity and gestational age between the two groups. Maternal serum IgG seropositivity for rubella (92.2% vs. 34.4%, P < 0.001) and HSV-2 (87.8% vs. 57.8%, P < 0.001) were significantly higher in preeclampsia than in the controls. There was no significant difference in the maternal serum IgM seropositivity for rubella (3.3% vs. 2.2%, P = 0.650) and HSV-2 (2.2% vs. 1.1%, P = 0.560). All the IgM seropositive cases were IgG seropositive too. In binary logistic regression women with rubella (OR = 4.93; 95% CI = 2.082-11.692, P < 0.001) and HSV-2 (OR = 5.54; 95% CI = 2.48-12.38, P < 0.001) IgG seropositivity were at higher risk for preeclampsia. CONCLUSION: In the current study rubella and HSV-2 IgG seropositivity is associated with preeclampsia. Preventive measure should be implemented.
Determinants to antiretroviral treatment non-adherence among adult HIV/AIDS patients in northern Ethiopia.
AIDS Research and Therapy. 2017; 14:16.BACKGROUND: Adhering 95% and above of antiretroviral therapy reduces the rate of disease progression and death among people's living human immunodeficiency virus. Though manifold factors have reported as determinant factors of antiretroviral therapy adherence status, perhaps determinants of non-adherence differ up on the activities of patients in the study setting. METHODS: An institution based unmatched case-control study was conducted in Aksum town. Individuals who had a 6-month follow-up with complete individual information were included in the study. Document review and interviewer based techniques were used to collect the data. Binary logistic regression analysis was used to identify the determinant factors of non-adherence. RESULTS: A total of 411 (137 cases and 274 control) study participants were included in the study. The majority of them were male in sex. Having 2 years and above duration on ART [AOR = 7, 95% CI (2.2, 22.6)], history of adverse effect [AOR = 6.9, 95% CI (1.4, 32.9)], substance use [AOR = 5.3, 95% CI (1.4, 20.0)], living with parents [AOR = 3.4, 95% CI (1.2, 10.3)], having depression symptom [AOR = 3.3, 95% CI (1.4, 7.5)], <350 cells/mm(3) cluster of differentiation 4 count [AOR = 3.2, 95% CI (1.8, 5.8)] and low dietary diversity [AOR = 2, 95% CI (1.1, 3.7)] were found significant determinants of non-adherence to antiretroviral drug. CONCLUSION: Program, social and individual related factors showed a statistically significant associated with non-adherence to antiretroviral therapy. Managing lifestyle by developing self-efficacy of individuals and treating related threat to improve adherence status of antiretroviral therapy is recommended in this study.
International Journal of offender therapy and Comparative Criminology. 2018 Oct; 62(13):4174-4186.Female homicides are widely prevalent in Turkey with rising trend. The aim of this study is to identify gender role attitudes, childhood trauma histories, and individual characteristics of men who have been involved in the femicide, and to compare them with men who do not exercise violence against women. Participants completed a Sociodemographic and Clinical Information form, Semistructured Interview form, and the Childhood Trauma Questionnaire. Case group was not significantly different than the control group in terms of any measured individual characteristics including childhood traumas, psychopathology, and gender attitudes. Our data indicate that only migration history may be linked to femicide. A unique psychopathology that could be related to being a femicide perpetrator was not identified. Migration and perception of gender roles stand out as factors that separate men who exercise violence from men who do not.
Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: The role of the progestogen type and estrogen dose.
Thrombosis Research. 2018 Mar 15; 165:68-78.INTRODUCTION: Currently available combined oral contraceptives (COC) reportedly increase the risk of venous thromboembolism (VTE). We aimed to quantify this risk considering both progestogen type and estrogen dose. MATERIALS AND METHODS: PubMed, Embase and LIVIVO were searched for relevant publications until April 2017. Case-control and cohort studies including healthy women taking COC and assessing incident VTE as outcome were selected. Adjusted relative risks (RR) with 95% confidence intervals (CI) derived from random effects model using a generic inverse-variance approach are reported. RESULTS: Overall, 1,359 references were identified and 17 studies were included in the meta-analysis. The pooled RR of VTE was associated with various COC, with the association depending on their respective estrogen dose and progestogen type. Compared to the reference, levonorgestrel with 30-40mug ethinylestradiol, the overall risk of VTE was higher for all other COC. Preparations with desogestrel with 30-40mug estrogen showed the highest relative risk (RR: 1.46; 95% CI: 1.33-1.59), while RRs for drospirenone (30-40mug ethinylestradiol) and desogestrel (30-40/20mug ethinylestradiol) were lower. COC containing gestodene and cyproterone with 30-40mug estrogen showed the lowest risk (RR: 1.27; 95% CI: 1.15-1.41 and RR: 1.29; 95% CI: 1.12-1.49, respectively). CONCLUSIONS: Compared to levonorgestrel with 30-40mug ethinylestradiol, all COC showed a significantly increased VTE risk. The association varied depending on the progestogen type and the dose of estrogen. Our results suggest that the prescription of COC with the lowest possible dose of ethinylestradiol may help to avoid VTE cases among young, healthy women. Copyright (c) 2018 Elsevier Ltd. All rights reserved.
Correlates of Knowledge of HIV Transmission Among Incident Cases of HIV in a Cohort of Injection Drug Users Receiving Harm Reduction Services at Karachi, Pakistan.
Journal of the International Association of Providers of AIDS Care. 2017 May/Jun; 16(3):286-289.BACKGROUND: Knowledge of risk factors for HIV transmission in high-risk population plays a critical role in averting the risk of HIV transmission. In Pakistan, injection drug users (IDUs) constitute the core risk group of HIV prevalence, where the epidemic has transitioned to a "concentrated level." Still nothing is known about the role of knowledge in HIV transmission and HIV sero-conversion among IDUs in Pakistan. METHODS: From 2009 to 2011, a nested case-control study was conducted in a cohort of 636 IDUs receiving harm reduction services in the mega city of Karachi. RESULTS: In multivariable regression analysis, 3 factors, namely HIV does not spread through unprotected sex (adjusted odds ratio [AOR]: 3.1, 95% confidence interval [CI] 1.39-6.90, P value .01), HIV does not transmit by sharing syringes (AOR: 3.5, 95% CI 1.97-6.40, P value <.00), and the risk of HIV cannot be minimized by using new syringe every time (AOR: 2.0, 95% CI 1.16-3.60, P value .01), were significantly associated with the incident cases of HIV. CONCLUSION: The study findings suggest the association between knowledge of HIV transmission and HIV sero-incident cases.
[Prenatal care and risk factors associated with premature birth and low birth weight in the a capital in the Brazilian Northeast] Atencao pre-natal e fatores de risco associados a prematuridade e baixo peso ao nascer em capital do nordeste brasileiro.
Ciencia and Saude Coletiva. 2016 Jun; 21(6):1965-74.The main determinants of the risk of mortality in the neonatal period are low birth weight and premature birth. The study sought to analyze the adequacy of prenatal care and risk factors associated with premature birth and low birth weight in a northeastern Brazilian capital. This is a case-control study. A model for adequacy of prenatal conditions composed of four indicators was created. Descriptive statistics for univariate analysis were used; as well as Wald linear trend tests, Student's t and chi-square test for bivariate analysis and multiple logistic regression for multivariate analysis with p <0.05. Multivariate analysis showed that poor education, not performing gainful activity, caesarean section, oligohydramnios, placental abruption and pre-eclampsia are independent factors associated with premature birth and/or low birth weight. For adequacy of prenatal care, variable indicator III remained significant, showing that mothers who had inadequate prenatal care had an increased chance for the occurrence of the outcome, highlighting the need for adequate public health policies of care for pregnant women in the municipality under scrutiny.
Cluster of HIV Infections Associated With Unsafe Injection Practices in a Rural Village in Cambodia.
Journal of Acquired Immune Deficiency Syndromes. 2017 Jul 1; 75(3):e82-e86.Add to my documents.
Factors associated to maternal death in case of uterine rupture at the the Gyneco-Obstetrics and Pediatric Hospital of Yaounde. Facteurs Associés à la Mortalité Maternelle au cours des Ruptures Utérines à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé.
Health Sciences and Diseases. 2018 Feb; 19(1 Suppl):3-6.Background. Uterine rupture is an obstetrical tragedy. It is a common cause of maternal death in the world. Out study aimed to identify factors associated to maternal mortality in case of uterine rupture. Methodology. This was a case control study with a cross-sectional shutter and retrolective data collection from March, 1st 2006 to December, 31st 2015, conducted at the Yaoundé Gyneco-Obstetric and Pediatric Hospital. The women who died of uterine rupture were the cases and those who survived were witnesses. The variables of interest were sociodemographic, obstetric and neonatal characteristics. The Epi Info 3.5.4 software and Microsoft Office Excel 2010 were used for the analysis of collected data. The calculation of the Odds Ratios and their 95% Confidence intervals was used to assess the strength of association between factors studied and maternal death the uterine ruptures. The Chi square and Ficher’s exact test were used to compare categorical variables. The P value was considered significant when p< 0.05. Results. Of the 73 women with uterine rupture, seven died, giving a lethality rate of uterine rupture of 9.58%. The only factor significantly associated with maternal death in case of uterine rupture after multivariate analysis was coagulopathy ORa=34.71[(95% CI: 1.19-1013.95), p=0.040]. Conclusion. The occurrence of coagulopathy in the presence of uterine rupture increases significantly the risk of maternal death. Blood products must be available to reduce the risk.
Rawal Medical Journal. 2017 Oct-Dec; 42(4):507-510.Objective: To determine the association of ante partum, intra partum and post partum risk factors with perinatal mortality in a public hospital. Methodology: This case-control study was conducted at children hospital, PIMS. All still births and live births that expired within seven days of life were categorized as cases. 100 cases were taken, similar number of gestational age and birth weight matched babies who survived till the 7th day of life were taken as controls. Data regarding maternal profile, ante partum, intra partum and postpartum risk factors was analyzed by SPSS v 10. Results: Maternal residence, booking status, maternal nutritional status, anemia, pregnancy induced hypertension, maternal diabetes, placental abruption and respiratory distress syndrome were identified as significantly contributing factors to perinatal mortality. Conclusions: Majority of the risk factors associated with perinatal mortality were ante partum risk factors related to antenatal care. Proper antenatal care would help to reduce the risk of perinatal death by linking the woman to health care system.