Medically recommended cessation of employment among pregnant women in Georgia.

OBJECTIVE: To ascertain the proportion of employed pregnant women who receive medical advice to stop working during pregnancy and to describe their characteristics. METHODS: Data were analyzed from the Georgia Pregnancy Risk Assessment Monitoring System, a surveillance system that surveys new mothers about pregnancy risk factors, health behaviors, and birth-related outcomes. Employment during pregnancy was defined as work for pay for 10 hours or more per week. RESULTS: We studied 1635 women who were employed during pregnancy. A physician or nurse had advised 27.7% (95% CI 24.5%, 30.9%) of them to stop working during pregnancy. Independent predictors of receiving this advice were hospitalization (RR 2.3, 95% CI 1.7, 2.8) and history of previous preterm birth (RR 1.6, 95% CI 1.1, 2.2). Low birth weight (under 2500 g) occurred in 5.8% of women not advised to stop work, in 6.9% of women advised to stop work because of swelling, fatigue, stress, or another reason, and in 13.4% of women advised to stop work because of labor, high blood pressure, or vaginal bleeding (P <.001). Among women advised to stop working in the first through seventh months of pregnancy, 91.7% (95% CI 88.8, 94.5) delivered at 36 or more weeks' gestation. CONCLUSION: Work cessation during pregnancy was commonly recommended in this population and was associated with clinical risk factors and adverse birth outcomes. For some women it resulted in a long period of work absence before delivery.

Initial results of 'Language for Health': cardiovascular disease nutrition education for English-as-a-second-language students.

Low literacy skills may negatively affect health through misuse of medication, inability to follow medical directions or due to limitations placed on the consumer's ability to access health information. The association between low literacy among adults and cardiovascular disease has not been thoroughly investigated in some ethnic groups. The purpose of this comprehensive study is to describe the results of a nutritional-related cardiovascular health program for limited English proficient adults enrolled in English-as-a-second-language (ESL) classes. Subjects (n = 408), nearly 87% of whom were Latino, were exposed to either nutrition education (intervention group) or stress management (attention-placebo control group) classes designed specifically for ESL classes. Subjects completed physiological measures assessing blood pressure, total and high-density lipoprotein (HDL) cholesterol, waist and hip circumference, and body mass. Self-report surveys were administered to collect students' nutrition-related knowledge, attitudes and behaviors. Data were collected at baseline, 3 month post-test and 6 month follow-up. Analyses showed that differential group change was seen for fat avoidance, nutrition knowledge, HDL and total cholesterol:HDL ratio, but, for the two latter variables, the effect was not maintained at the 6 month follow-up. Both groups showed positive changes in blood pressure, total cholesterol and nutrition-related attitudes. Results showed moderate success of the intervention, but suggest contamination between experimental groups may have occurred.

Cerebrospinal fluid analyses in migraine patients and controls.

To investigate the role of central neurotransmitters in the pathogenesis of migraine, we measured cerebrospinal fluid (CSF) levels of certain amino acids (glycine, taurine, glutamine) and metabolites of biogenic amines (5-hydroxyindoleacetic acid and homovanillic acid) in 38 migraine patients and compared them with the levels from 10 headache-free controls. The levels of taurine, glycine and glutamine were significantly higher in the migraine patients (p < 0.0001 for taurine and glycine; p < 0.0009 for glutamine); there were no significant differences among the three migraine subgroups (infrequent migraine, frequent migraine and transformed migraine). In seven patients subsequently treated with divalproex sodium, CSF taurine levels decreased significantly from pretreatment baseline values. These data support the concept that migraine is at least in part a disorder of central neurotransmission.

The risk of human T cell leukemia virus and viral hepatitis infection among US Marines stationed in Okinawa, Japan.

The prevalence and incidence of human T cell leukemia virus type I/II (HTLV-I/II) and hepatitis A, B, and C virus infection were determined among US Marines stationed in Okinawa, Japan. Of 2875 personnel, 2 (0.07%) had antibody to HTLV-I/II. After 1-3 years, no HTLV seroconversions were observed, although 23% reported sexual contact with Okinawans. Of 1010 hepatitis-tested marines, 121 (12%) had antibody to hepatitis A virus (anti-HAV), 26 (2.6%) had antibody to hepatitis B core antigen (anti-HBc), and 2 (0.2%) had antibody to hepatitis C virus (anti-HCV). On follow-up, 1 subject seroconverted to anti-HAV, 8 to anti-HBc, and none to anti-HCV. Most marines with recent hepatitis B infection were young, single, and enlisted and had been on short deployments to other countries in Southeast Asia. Marines stationed in Okinawa are not at high risk for HTLV infection but are at increased risk for hepatitis B infection and should be considered for vaccination.

A differential response to treatment with divalproex sodium in patients with intractable headache.

We consecutively recruited 75 patients with intractable headache syndromes, divided them into three groups (frequent migraine = FM, transformed migraine = TM, and tension type headache = TT) based on their headache symptoms and treated all 75 with divalproex sodium. Thirty-six patients (48%) reported a > or = 50% reduction in headache frequency. We noted significantly different treatment response rates in the three patient groups, with FM patients reporting the highest rate of improvement (11/18 = 61%), TM patients an intermediate rate (22/43 = 51%), and TT patients the lowest response rate (3/14 = 21%). These data suggest that prophylactic therapy with divalproex may be effective in selected patients with intractable headache syndromes and that identification of clinically distinct headache subtypes may assist in predicting response to treatment.

The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions.

OBJECTIVES: The purpose of this study was to implement and evaluate the effectiveness of a long-term tobacco use prevention program for junior high school students that used college undergraduate change agents and telephone boosters. METHODS: A psychosocial intervention combining refusal skills training, contingency management, and other tobacco use prevention methodologies such as telephone and mail boosters was implemented in 11 junior high schools in San Diego County, California. Eleven other junior high schools served as controls. Of the 2668 participants, 57% were White/non-Hispanic, 24% were Hispanic, and 19% were of other racial/ethnic groups. College undergraduates served as change agents for both the classroom and booster interventions, the latter of which was delivered in the third (ninth-grade) year of the program. RESULTS: At the end of the third year, the prevalence of tobacco use within the past month was 14.2% among the intervention students and 22.5% among the controls, yielding an odds ratio of 0.71 for analysis at the school level. CONCLUSIONS: Both college undergraduate change agents and direct one-to-one telephone interventions appear to provide cost-effective tobacco-related behavior modification.

HTLV-I among U.S. Marines stationed in a hyperendemic area: evidence for female-to-male sexual transmission.

Among 5,255 active duty United States Marines on permanent tour in Okinawa, Japan, screened for human T-cell leukemia/lymphoma virus type I (HTLV-I) seropositivity, 3 (0.06%) were confirmed by Western blot analysis to have core and envelope reactivity. All three seropositive individuals have a history of prolonged sexual contact with Okinawan women, and two of the three individuals are married to seropositive Okinawan wives. Two gave a prior history of gonorrhea, while all three were negative for syphilis (MHA-TP) and hepatitis B. No other risk factors associated with HTLV-I seropositivity in the United States were identified. A banked sample from one individual, obtained 8 months after initial sexual relations with his HTLV-I-seropositive Okinawan spouse and 20 months before being retested in the survey, showed a pattern suggesting seroconversion. Although based on small numbers, these data suggest that female-to-male transmission of HTLV-I occurs in the absence of other cofactors, e.g., ulcerative genital lesions.

Depression late after combat: a follow-up of Finnish World War Two veterans from the seven countries east-west cohort.

An analysis from the Finnish East and West Cohort of the Seven Countries Study tested the hypothesis that front line service during modern warfare is associated with depression later in life. World War Two-era Finnish combat veterans were compared to Finnish veterans who were non-combatants. Both groups were followed from 1959 to 1984. Dependent variables were the Zung depression scale and other measures of psychosocial adaptation and mental health. Analysis of variance of Zung scores by combat exposure was close to statistical significance (p = 0.0501). Even if statistical significance had been reached, it is felt that the absolute magnitude of the differences between the populations appear quite trivial. A significant association was found for those who had participated in over nine battles and when grouping depression, sleeplessness, paranoia, hallucinations, schizophrenia, and other mental illness into the general category of any mental illness (O.R. = 4.414; 95% C.I. = 1.113, 17.503). This seems to support the residual stress hypothesis pertaining to modern combat exposure.

Stages of adolescent tobacco-use acquisition.

The present study extended the results of previous research in applying the "stages of acquisition" model to the onset of smokeless tobacco as well as cigarette use. Three expert judges classified an initial pool of items as to whether they represented "precontemplation," "contemplation," "action," or "maintenance" stages of smokeless tobacco acquisition. Fifty items with adequate inter-rater reliability were combined with 21 previously developed items pertaining to cigarette smoking acquisition in an overall tobacco acquisition questionnaire, which in turn was administered to 358 junior and senior high public school students. Three distinct components labeled precontemplation, action, and maintenance were delineated through principal component analyses. Coefficient alphas and discriminant analyses according to self-reported use demonstrated adequate reliability and validity for the new smokeless tobacco- and previously developed smoking-acquisition scale.

Methodological issues concerning the sensitive query in AIDS/alcohol research: sample size estimates for randomized response procedures.

Quantification of sample size requirements for two common models of the RRT as compared to conventional survey techniques demonstrates that Campbell is fundamentally correct. However, the absolute increase in sample size necessitated by either model of the RRT is not of such a magnitude as to make use of the method always impractical. Where the appropriate sample size exists, it may well be the method of choice for selected issues pertaining to AIDS and alcohol research.

Epidemiology of head trauma and neurocognitive impairment in a multi-ethnic population.

This study tested two hypotheses. These were: (1) that mild cognitive impairment of the type that may characterize early-onset dementia of the Alzheimer type varies by ethnic group among the noninstitutionalized elderly, and (2) that head trauma is a risk factor associated with the development of this disease. The study sample consisted of a cohort of 2,105 Black, Mexican-American and White subjects aged 45 years and over at baseline in 1985-1987 in San Diego, Calif. Intellectual functioning was measured by Pfeiffer's Short Portable Mental Status Questionnaire. Percent prevalence of test failure after Pfeiffer's adjustment for education and ethnicity was highest for Whites (5.7%, CI = 4.26, 7.57) and lowest for Blacks (1.3%, CI = 0.61, 2.63), with Mexican-Americans intermediate (3.5%, CI = 2.28, 5.29). The difference between Blacks and Whites was statistically significant at the 0.05 level. Females failed more often (4.2%, CI = 3.15, 5.56) than males (3.1%, CI = 2.13, 4.47) across all ethnic groups, but the difference was not statistically significant after Pfeiffer's adjustment for education and ethnicity. Self-reported head traumas and other possible risk factors for dementia of the Alzheimer type were examined by logistic regression in a case-control analysis. A statistically significant association (OR = 8.577, CI = 3.056, 24.064) was noted for those with mild intellectual impairment who reported head traumas in a multivariate environment.

An alternative stochastic framework for estimating pure measures of fertility.

A stochastic fertility model is developed that incorporates a state of "viable pregnancy" within parity i. This model is used as a framework to derive formulas expressing relationships between various central rates and probabilities within parity i. Specifically, formulas are derived to relate the total fertility rate with the parity progression probability, a pregnancy rate with a pregnancy progression probability, and a direct fertility rate with a direct parity progression probability.

Maternal alcoholism and anorexia nervosa: a possible association?

The use of modern epidemiological and biostatistical methods has been lacking in the research literature on anorexia nervosa. The present study utilized a retrospective case control design in which 40 cases of anorexia nervosa were matched to two separate control series, one being population based and one being clinic based. Odds ratio of 4.00 (p less than 0.006) and 7.67 (p less than 0.001) were obtained for family history of alcoholism and family history of psychological disorders, respectively, among the families of anorexia nervosa cases. The implications of this result for treatment planning and implementation are discussed.

Neuroepidemiology of human T-lymphotrophic virus type-I-associated tropical spastic paraparesis.

Tropical spastic paraparesis (TSP) is a chronic neurological syndrome of gradual onset involving the pyramidal tracts and upper motor neurons, resulting in weakness and stiffness of the lower extremities, hyperactive tendon reflexes, spasticity, low back pain, and urinary disturbances. Clusters of endemic TSP have been noted in Africa, the Seychelles Islands, Colombia, and the Caribbean. Recently, studies have linked human T-lymphotrophic virus type-I (HTLV-I) with the endemic form of the disease. In Japan a very similar clinical syndrome has been identified as HTLV-I-associated myelopathy and may be a non-tropical version of the same disease. The purpose of the present review is to examine the role HTLV-I may play in the pathogenesis of these myelopathies from a neuroepidemiological point of view.

Prevention of tobacco use among adolescents in public schools in San Diego County, U.S.A.

Project S.H.O.U.T. (which stands for "Students Helping Others Understand Tobacco") is a tobacco-use prevention project funded by the United States National Cancer Institute for preventing the use of cigarettes and smokeless tobacco (snuff and chewing tobacco) in public schools in San Diego County, California. Based on principles of behavior modification, Project S.H.O.U.T. teaches students how to anticipate and overcome negative peer pressure to use tobacco and reinforces them for having done so. Preliminary results indicate that the prevalence of tobacco use among students receiving peer pressure resistance skills training was somewhat but not statistically significantly lower than the control group after one year of intervention. In addition, students in a third lottery condition, who were reinforced for simply not using tobacco, showed lower prevalence rates compared to controls. Additional support for the efficacy of the intervention program was provided by the refusal skills assessment test, which indicated that students exposed to the intervention were able to refuse tobacco offers more effectively than the control students. Our results indicate that tobacco use prevention experts should do more than provide decision-making and behavioral skills for resisting tobacco use, but should also reinforce the non-use of tobacco.

Amyotrophic lateral sclerosis and history of skeletal fracture: a case-control study.

A retrospective case-control study was conducted, using 66 amyotrophic lateral sclerosis (ALS) patients and 66 closely matched controls. Cases were ascertained primarily through a neurology clinic. A self-administered questionnaire probed for history of skeletal fractures. Using McNemar's test, no association was found between history of skeletal fracture and pathogenesis of ALS. No predilection for the head, neck, or spine was demonstrated. The extremities accounted for most fracture sites in cases and controls. Among cases, 68% of the fractures occurred before diagnosis, 58% occurring more than 10 years before diagnosis of ALS.

Probabilistic approaches to current life table estimation.

"Two simple current life table estimators of conditional probabilities of death result from making either a uniform or exponential distributional assumption of time at death in the age interval. Each is compared with Chiang's estimator based on the concept of fraction of the last age interval of life. Graphical and numerical results are presented to assess the magnitude and direction of differences between estimators when the true value of Chiang's fraction takes on specific values."