Spatial variations and determinants of infant and under-five mortality in Bangladesh.

Reducing child mortality is a Sustainable Development Goal yet to be achieved by many low-income countries. We applied a subnational and spatial approach based on publicly available datasets and identified permanent insolvency, urbanicity, and malaria endemicity as factors associated with child mortality. We further detected spatial clusters in the east of Bangladesh and noted Sylhet and Jamalpur as those districts that need immediate attention to reduce child mortality. Our approach is transferable to other regions in comparable settings worldwide and may guide future studies to identify subnational regions in need for public health attention. Our study adds to our understanding where we may intervene to more effectively improve health, particularly among disadvantaged populations.

Site-specific cancer risk due to diabetes mellitus history: evidence from the Japan Collaborative Cohort (JACC) Study.

The study examined the association of diabetes mellitus (DM) history with total and common site-specific cancers using a large cohort of 23,378 men and 33,503 women, extracted from 127,477 healthy participants of the JACC Study who were aged 40-79 years and living in 24 municipalities in Japan. At enrollment during 1988-90, each subject completed a self-administered questionnaire including items for age, sex, body mass index (BMI), smoking, drinking, past history of DM and cancer. Adjusting for age, BMI, smoking, and drinking in the Cox's proportional hazard model, incidence rate ratios (IRR) with 95% confidence intervals (95%CIs) were estimated for both sexes. During the follow-up period, total cancers and site-specific cancers were identified. A history of DM was reported by 7.5% of men and 4.6% of women. DM significantly increased the risk of liver cancer for both men (IRR=2.30; 95%CI=1.47-3.59) and women (IRR=2.70; 95%CI=1.20-6.05). Significant increased and reduced risk due to DM for men were also found for non-Hodgkin lymphoma (IRR=2.77; 95%CI=1.04-7.38) and stomach cancer (IRR=0.67; 95%CI=0.46-0.99) respectively. For females, a reduced risk of stomach cancer due to DM (IRR=0.49; 95%CI=0.23-1.04) was also revealed. Since a history of DM here demonstrated significant associations with some site-specific cancers, their relationships should be studied further in Japan for validation.

Risk of endometrial cancer mortality by ever-use of sex hormones and other factors in Japan.

OBJECTIVES: To examine associations of ever-use of sex hormones (EUSH) and other factors with endometrial cancer (EC) mortality through a nation-wide Japan Collaborative Cohort Study. METHODS: A total of 63,541 women aged 40-79 years, enrolled in 1988-90 from 45 municipalities of Japan, were followed until 2003 to record their vital status. Using baseline data, the Cox proportional hazard model (age adjusted and multivariate) was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for EC mortality by selected factors, including EUSH. Bivariate analysis was also conducted to establish associations between EUSH and other factors. RESULTS: The mortality rate from EC was 2.6 per 100,000 person-years during the mean follow-up period of 13.3 years. Prevalence rate of EUSH was 5.2%. Significantly increased risk of EC mortality was found for EUSH with both age adjusted (HR=6.43, 95%CI=2.10-19.67) and multivariate (HR=5.33; 95%CI=1.51-18.82) analyses. Bivariate analysis indicated that history of diabetes mellitus, smoking, drinking, and age at first delivery were positively associated with EUSH, whereas age, number of delivery, number of pregnancy, and age at menarche demonstrated inverse links. CONCLUSIONS: Our results imply that EUSH may increase the risk of EC mortality among Japanese women. However, further studies with more deaths are needed to validate the results.

Diabetes mellitus and kidney cancer risk: the results of Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study).

BACKGROUND: Diabetes mellitus (DM) is reported as being a risk factor associated with kidney cancer in Western countries. The incidence of both kidney cancer and DM is lower in Japan than the other developed countries, albeit on the rise. METHODS: We evaluated the risk factors for kidney cancer mortality using the database of the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) study. The analytic cohort included 46 462 males and 64 326 females aged 40-79 years old. The Cox proportional hazards model was used to determine age- and sex-adjusted relative risk and its 95% confidence intervals. RESULTS: DM showed an increased, age- and sex-adjusted hazard ratio for kidney cancer mortality, but it failed to achieve statistical significance after controlling for other factors. CONCLUSION: The present study showed that DM increased the risk of kidney cancer death among the Japanese population. However, further studies may be needed to confirm the findings in the present study because DM failed to remain as a significant risk factor after controlling for other factors because of the small number of kidney cancer deaths in the present study.

Unintended pregnancy in bangladesh.

Unintended pregnancy is a serious concern in reproductive health which needs to be addressed. Analyzing 717 pregnant women extracted from the Bangladesh Demographic and Health Survey 1999-2000, this study identified that unwanted pregnancy is significantly associated with higher numbers of living sons (P<0.001), longer marital duration (P<0.05), exceeding desired family size (P<0.001), use of contraception (P<0.01), and breastfeeding practice (P<0.05). For mistimed pregnancy, higher age (P<0.05), breastfeeding practice (P<0.01), exceeding desired family size (P<0.01), pregnancy termination (P<0.05), and having last birth during last three years (P<0.001) were significant. Since unintended pregnancy is strongly associated with exceeding desired family size, a multidimensional approach may be needed through the family planning, health and educational sectors in Bangladesh to maintain desirable family sizes.