Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey.

BACKGROUND: Macrosomia is a risk factor for adverse delivery outcomes. We investigated the prevalence, risk factors, and delivery outcomes of babies with macrosomia in 23 developing countries in Africa, Asia, and Latin America. METHODS: We analysed data from WHO's Global Survey on Maternal and Perinatal Health, which was a facility-based cross-sectional study that obtained data for women giving birth in 373 health facilities in 24 countries in Africa and Latin America in 2004-05, and in Asia in 2007-08. Facilities were selected by stratified multistage cluster sampling and women were recruited at admission for delivery. We extracted data from the medical records with a standardised questionnaire. We used logistic regression with random effects to assess the risk factors for macrosomia and the risks for caesarean section and adverse maternal and perinatal outcomes (assessed by a composite score) in babies with the disorder. FINDINGS: Of 290,610 deliveries, we analysed data for 276,436 singleton livebirths or fresh stillbirths. Higher maternal age (20-34 years), height, parity, body-mass index, and presence of diabetes, post-term pregnancy, and male fetal sex were associated with a significantly increased risk of macrosomia. Macrosomia was associated with an increased risk of caesarean section because of obstructed labour and post-term pregnancy in all regions. Additionally, macrosomia was associated with an increased risk of adverse maternal birth outcomes in all regions, and of adverse perinatal outcomes only in Africa. INTERPRETATION: Increasing prevalence of diabetes and obesity in women of reproductive age in developing countries could be associated with a parallel increase in macrosomic births. The effect and feasibility of control of diabetes and preconception weight on macrosomia should be investigated in these settings. Furthermore, increased institutional delivery in countries where rates are low could be crucial to reduce macrosomia-associated morbidity and mortality. FUNDING: None.

Interventions for improving outcomes for pregnant women who have experienced genital cutting.

BACKGROUND: Female genital cutting (FGC) refers to all procedures that involve the partial or total removal of the external female genitalia, or other injury to the female genital organs for cultural or other non-therapeutic reasons. There are no known medical benefits to FGC, and it can be potentially dangerous for the health and psychological well-being of women and girls who are subjected to the practice resulting in short- and long-term complications. Health problems of significance associated with FGC faced by most women are maternal and neonatal mortality and morbidity, the need for assisted delivery and psychological distress. Under good clinical guidelines for caring for women who have undergone genital cutting, interventions could provide holistic care that is culturally sensitive and non-judgemental to improve outcomes and overall quality of life of women. This review focuses on key interventions carried out to improve outcome and overall quality of life in pregnant women who have undergone FGC. OBJECTIVES: To evaluate the impact of interventions to improve all outcomes in pregnant women or women planning a pregnancy who have undergone genital cutting. The comparison group consisted of those who have undergone FGC but have not received any intervention. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2012) and organisations engaged in projects regarding FGC. SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-randomised trials or quasi-RCTs with reported data comparing intervention outcomes among pregnant women or women planning a pregnancy who have undergone genital cutting compared with those who did not receive any intervention. DATA COLLECTION AND ANALYSIS: We did not identify any RCTs, cluster-randomised trials or quasi-RCTs. MAIN RESULTS: There are no included studies. AUTHORS' CONCLUSIONS: FGC research has focused mainly on observational studies to describe the social and cultural context of the practice, and we found no intervention trials conducted to improve outcomes for pregnant women presenting with complications of FGC. While RCTs will provide the most reliable evidence on the effectiveness of interventions, there remains the issue of what is considered ethically appropriate and the willingness of women to undergo randomisation on an issue that is enmeshed in cultural traditions and beliefs. Consequently, conducting such a study might be difficult.

Alcohol consumption and female urinary incontinence: a community-based study in Japan.

OBJECTIVES: To investigate the association between alcohol consumption and urinary incontinence among Japanese women. METHODS: A total of 300 women aged 40-75 years were recruited from the community in middle and southern Japan. A validated food frequency questionnaire was given face-to-face to obtain information on dietary intake and habitual alcohol consumption. Urinary incontinence status was ascertained using the International Consultation on Incontinence Questionnaire-Short Form. RESULTS: Among the 298 eligible participants, 82 women (27.5%) experienced urine leakage. The prevalence of alcohol drinking and mean ethanol intake were slightly higher among the incontinent women (39%; 7.1, standard deviation 24.1 g/day) than others without the condition (35.6%; 4.3, standard deviation 10.7 g/day). Relative to non-drinkers, the adjusted odds ratios of urinary incontinence were 1.31 (95% confidence interval 0.74-2.33) for alcohol drinking and 1.69 (95% confidence interval 0.42-6.81) for ethanol intake over 32 g/day, though the increases in risk did not reach statistical significance. CONCLUSIONS: Little association is evident between alcohol consumption and urinary incontinence in middle-aged and older Japanese women. Further studies are required to define the role of alcohol as a contributing factor of this distressing condition.

Green tea drinking is inversely associated with urinary incontinence in middle-aged and older women.

AIMS: To investigate the association between green tea consumption and urinary incontinence among middle-aged and older women. METHODS: Three hundred community-dwelling women aged 40-75 years were recruited in middle and southern Japan. A validated food frequency questionnaire was administered face-to-face to obtain information on dietary intake and habitual tea and coffee consumption. Urinary incontinence status was ascertained using the International Consultation on Incontinence Questionnaire-Short Form. RESULTS: The prevalence of urinary incontinence was 27.5% among 298 eligible participants. The 82 women who leaked urine tended to drink less green tea (daily mean intake 622, SD 554 ml) than others without the condition (daily mean intake 757, SD 571 ml), P = 0.04. Relative to non-drinkers, the adjusted odds ratios of urinary incontinence were 0.37 (95% CI 0.15-0.91) for drinking more than 700 ml and 0.34 (95% CI 0.13-0.88) for drinking 4 or more cups daily. The corresponding dose-response relationships for these quantity (P = 0.04) and frequency (P = 0.01) of intake were significant. However, association with black tea, oolong tea and coffee consumption was not evident. CONCLUSIONS: The findings suggested an inverse association between urinary incontinence and habitual green tea consumption in middle-aged and older women.

Modeling physical activity outcomes: a two-part generalized-estimating-equations approach.

The health benefits of physical activity are well known. Various parameters of physical activity, such as time or energy expenditure, are often assessed in observational and experimental studies. This article highlights several methodologic issues concerning the analysis of physical activity. These include non-normality, presence of many zeros, and violation of the independence assumption. Application of the standard regression model to a (log-transformed) physical activity variable may lead to spurious associations and misleading conclusions. We developed an alternative 2-part generalized-estimating-equations (GEE) approach to analyze the heterogeneous and correlated physical activity data. We first estimated a logistic GEE model for the prevalence of physical activity and factors affecting physical activity participation. We then fit a gamma GEE model to assess the effects of predictors among persons engaging in physical activity. An empirical application to an epidemiologic study of physical activity of community-dwelling older adults illustrates the proposed methodology.

Breathlessness is associated with urinary incontinence in men: A community-based study.

BACKGROUND: Urinary incontinence (UI) is a distressing problem for older people. To investigate the relationship between UI and respiratory symptoms among middle-aged and older men, a community-based study was conducted in Japan. METHODS: A convenience sample of 668 community-dwelling men aged 40 years or above was recruited from middle and southern Japan. The International Consultation on Incontinence Questionnaire-Short Form, the Medical Research Council's dyspnoea scale and the Australian Lung Foundation's Feeling Short of Breath scale, were administered by face-to-face interviews to ascertain their UI status and respiratory symptoms. RESULTS: The overall prevalence of UI was 7.6%, with urge-type leakage (59%) being most common among the 51 incontinent men. The presence of respiratory symptoms was significantly higher among incontinent men than those without the condition, especially for breathlessness (45% versus 30%, p = 0.025). The odds of UI for breathlessness was 2.11 (95% confidence interval 1.10-4.06) after accounting for age, body mass index, smoking and alcohol drinking status of each individual. CONCLUSIONS: The findings suggested a significant association between UI and breathlessness in middle-aged and older men.

Electricity use is associated with residents' vital data and lifestyles: observational study using an IT health support system in Japan.

Motivated by developments in information technology, recording personal parameters with health devices is effective in health promotion. Today's indoor individual lifestyles often involve using electrical appliances. We developed a health support system combined with wireless electricity monitoring and investigated whether electricity use is associated with residents' vital data and lifestyles. We recruited 116 participants in February 2013. Their vital and electricity use data were collected daily. They completed a self-administered questionnaire. Among participants living alone, electricity from 20 February to 11 March 2013 was negatively associated with high-density lipoprotein (HDL) (P = 0.008) and positively associated with low-density lipoprotein (LDL) (P = 0.007) and neutral fat (P = 0.020) levels. Among all participants, electricity use was negatively associated with vegetable intake (P = 0.044) and step count (P = 0.040). Temperature sensitivity in winter was negatively associated with the LDL/HDL ratio for both men and women. For men, temperature sensitivity in winter was negatively related with alcohol intake; for women, it was positively related to body fat percentage and abdominal circumference and negatively correlated to vegetable intake. Temperature sensitivity in summer was positively associated with vegetable intake for men and women. In conclusion, electricity use was related to vital data and lifestyles and influenced by temperature.

Soy consumption and risk of COPD and respiratory symptoms: a case-control study in Japan.

BACKGROUND: To investigate the relationship between soy consumption, COPD risk and the prevalence of respiratory symptoms, a case-control study was conducted in Japan. METHODS: A total of 278 eligible patients (244 men and 34 women), aged 50-75 years with COPD diagnosed within the past four years, were referred by respiratory physicians, while 340 controls (272 men and 68 women) were recruited from the community. All participants underwent spirometric measurements of respiratory function. Information on demographics, lifestyle characteristics and habitual food consumption was obtained using a structured questionnaire. RESULTS: Total soy consumption was positively correlated with observed lung function measures. The mean soy intake was significantly higher among controls (59.98, SD 50.23 g/day) than cases (44.84, SD 28.5 g/day). A significant reduction in COPD risk was evident for highest versus lowest quartile of daily intake of total soybean products, with adjusted odds ratio (OR) 0.392, 95% CI 0.194-0.793, p for trend 0.001. Similar decreases in COPD risk were associated with frequent and higher intake of soy foods such as tofu and bean sprouts, whereas respiratory symptoms were inversely associated with high consumption of soy foods, especially for breathlessness (OR 0.989, 95% CI 0.982-0.996). CONCLUSION: Increasing soy consumption was associated with a decreased risk of COPD and breathlessness.

Do vegetables and fruits reduce the risk of chronic obstructive pulmonary disease? A case-control study in Japan.

OBJECTIVE: To investigate the relationship between vegetable and fruit consumption and the risk of chronic obstructive pulmonary disease (COPD), a case-control study was conducted in central Japan in 2006. METHODS: A total of 278 referred patients with COPD diagnosed within the past four years and 340 community-based controls undertook spirometric measurements of respiratory function. A structured questionnaire was administered face-to-face to obtain information on demographics, lifestyle and habitual food consumption. RESULTS: The mean vegetable and fruit intakes of cases (155.62 (SD 88.84) and 248.32 (SD 188.17) g/day) were significantly lower (p<0.01) than controls (199.14 (SD 121.41) and 304.09 (SD 253.72) g/day). A substantial reduction in COPD risk was found by increasing daily total vegetable intake, p for trend=0.037. The prevalence of breathlessness also decreased with vegetable consumption, the adjusted odds ratio being 0.49 (95% CI 0.27-0.88) for the highest versus lowest quartile of intake. However, the effects of fruit consumption were not significant. Among the nutrients contained in vegetables and fruits, vitamin A was particularly significant (p=0.008) with an estimated 52% reduction in COPD risk at the highest level of intake. CONCLUSION: The study provided evidence of an inverse association between vegetable consumption and the risk of COPD for Japanese adults.

Association of impaired respiratory function with urinary incontinence.

BACKGROUND AND OBJECTIVE: This study investigated the relationship between urinary incontinence and respiratory function in middle-aged and older Japanese men. METHODS: Seven hundred community-dwelling men aged 40 years or above were recruited from community centres and hospital outpatient clinics. The International Consultation on Incontinence Questionnaire-Short Form was administered to ascertain their urinary incontinence status. Standardized spirometric measurements of respiratory function were performed. RESULTS: The prevalence of urinary incontinence was 7.6% among the 668 eligible participants (mean age 62.7 years). The 51 men who leaked urine had significantly lower FEV1 and FVC than those who were continent (P < 0.01). The adjusted risks of urinary incontinence were 0.67 (95% CI: 0.43-1.04) and 0.63 (95% CI: 0.40-0.98) for the two continuous respiratory function variables (L), respectively. CONCLUSION: The findings indicate an inverse association between urinary incontinence and respiratory function and an additional health burden in lung diseases.

Alcohol consumption by older adults in central and southern Japan.

This study ascertained the level of alcohol intake and alcoholic beverages consumed by Japanese older adults. Persons aged 55 to 75 years residing in central and southern Japan were recruited and interviewed face-to-face on their habitual alcohol consumption. Among the 577 (359 men and 218 women) participants from 10 districts/prefectures, 60.5% (75.5% for men and 35.7% for women) regularly drank alcoholic beverages on at least a monthly basis. Beer was the most preferred beverage (45.2%), followed by shochu (19.8%) and sake (16.1%). The mean alcohol consumption was 22.2 g/day (95% confidence interval 19.3-25.2) overall, but drinkers had a much higher mean intake of 36.6 g/day (95% CI 32.4-40.8). Moreover, it is alarming that 25.5% of male drinkers were heavy drinkers consuming more than 60 g of alcohol on average per day. Alcohol control measures should be developed to curtail the excessive drinking by older adults.

Persistent smoking by Japanese patients within four years from diagnosis of chronic obstructive pulmonary disease.

This study ascertained the smoking prevalence and factors affecting continuous smoking by Japanese patients within four years from diagnosis of chronic obstructive pulmonary disease (COPD). Of the 300 patients referred from six hospitals in central Japan, 276 eligible participants (mean age 66.5 years, SD 6.7) were interviewed for their habitual cigarette consumption. Overall, 22.5% of patients were current smokers but the prevalence appeared to decrease from <1 year (24.5%) to 2-4 years (19%) after diagnosis. They had smoked on average for 41 (SD 11) years and 89% of the current smokers smoked daily. Continuous smoking was inversely associated with age (odds ratio (OR)=0.94, 95% CI 0.90-0.98), body mass index (OR=0.88, 95% CI 0.80-0.97) and disease severity (OR=0.29, 95% CI 0.12-0.74 for severe COPD and OR=0.29, 95% CI 0.09-0.92 for very severe COPD). It is alarming to find mild and moderate COPD patients continue to smoke. The implementation of a co-ordinated tobacco control program immediately post diagnosis is needed for the effective pulmonary rehabilitation of COPD patients.

Urinary incontinence in men with chronic obstructive pulmonary disease.

This study investigated urinary incontinence in men with chronic obstructive pulmonary disease (COPD). A total of 244 community-dwelling men (mean age 66.5 years) diagnosed with COPD within the past 4 years were recruited from six hospital outpatient departments in central Japan. The prevalence of urinary incontinence was 10% according to the International Consultation on Incontinence criterion. Urine leakage among the 24 incontinent men was typically a small amount (75%) and occurred once a week or less often (58%). Fifteen (63%) of them reported urge incontinence while only two men experienced stress incontinence. On average they had urine leakage for 2.5 (SD 2.3) years and the majority (n = 19, 79%) developed the condition after diagnosis of COPD. The finding of higher prevalence of urge incontinence challenges the conventional view that COPD is associated with stress incontinence due to high pressure coughs.

Alcohol consumption in patients with chronic obstructive pulmonary disease in Japan.

This study investigated the consumption level, beverage preference and factors affecting alcohol intake by Japanese COPD patients. Three hundred patients diagnosed with COPD within the past four years were recruited from six hospitals in central Japan and interviewed. Of the 278 eligible participants (244 men and 34 women), 61.5% of male and 23.5% of female patients drank alcohol regularly on at least a monthly basis. The most preferred alcoholic beverage was beer (30.9%). The overall mean alcohol consumption was 29.7 (SD 42.5) g/day but drinkers had much higher mean intake of 52.2 (SD 44.8) g/day. Alcohol consumption level was significantly associated with the habit of adding soy sauce to food, gender and dyspnea but not the smoking status. The high alcohol consumption by COPD patients is alarming, with drinkers drinking well exceeded the government's recommended limit of 20 g daily. Alcohol control programs targeting male patients should be promoted to minimise the harm due to excessive drinking.

Smoking by older adults in central and southern Japan.

The study ascertained the smoking status among Japanese older adults. Persons aged 55-75 years residing in middle and southern Japan were recruited and interviewed face-to-face on their habitual tobacco consumption. Among the 576 (358 male and 218 female) participants from 10 prefectures, 18.4% were current smokers the great majority of whom (89%) smoked daily. Although the average cigarette consumption was similar between ex-smokers and current smokers, men had significantly higher consumption level than women in both categories (p < 0.05). The prevalence of current smoking was also significantly higher (p < 0.01) for older men (26.3%) than older women (5.5%). About 75% of male smokers and 25% of female smokers smoked on average at least one pack of cigarettes daily. It is alarming to find the higher prevalence of smoking among Japanese elderly men than other countries. The implementation of a coordinated tobacco control program targeting older adults is needed.

Child death and maternal psychosis-like experiences in 44 low- and middle-income countries: The role of depression.

BACKGROUND: Studies on the effect of child death on the mental wellbeing of women in low- and middle-income countries (LMICs) are scarce despite the high child mortality rates. Thus, the aim of the current study was to assess the association between child death and psychosis-like experiences (PLEs), as well as the role of depression in this association. METHODS: Data from 44 LMICs which participated in the World Health Survey (WHS) were analyzed. A total of 59,444 women who ever gave birth, aged 18-49years, without a self-reported lifetime psychosis diagnosis, were included in the analysis. The World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI) was used to establish the diagnosis of past 12-month DSM-IV depression, and assess four positive psychotic symptoms. Depression was defined as self-reported lifetime depression diagnosis and/or past 12-month depression. Multivariable logistic regression analyses were performed. RESULTS: After adjustment for potential confounders, women who experienced child death had higher odds for all types of PLEs (when unadjusted for depression) (OR 1.20-1.71; p<0.05) and depression (OR=1.64; 95%CI=1.39-1.93). When adjusted for depression, only delusion of control was strongly associated with child death (OR=1.54; 95%CI=1.20-1.97). CONCLUSIONS: Child death may be an important determinant of mental wellbeing among women in LMICs. Given the known adverse health outcomes associated with PLEs and depression, as well as the co-occurrence of these symptoms, mental health care may be particularly important for mothers who have experienced child loss in LMICs.

Association between childhood asthma and chronic obstructive pulmonary disease in later life.

Persistent chronic inflammation and impaired lung growth due to asthma in childhood may have long-term impact on pulmonary function and increase susceptibility to chronic obstructive pulmonary disease (COPD) in later life. To investigate whether childhood asthma is associated with adult lung function and the risk of developing COPD among Japanese older adults, a case-control study was conducted in central Japan. A total of 300 patients with COPD aged 50 to 75 years were referred by respiratory physicians, while 400 controls were recruited from the community. All participants underwent spirometric measurements of lung function. Information on childhood asthma, demographic characteristics, and lifestyle characteristics was obtained by face-to-face interview using a structured questionnaire. The prevalence of childhood asthma was higher (P = .015) among the cases (6.3%) than among the control group (2.4%). Childhood asthma was significantly associated with the risk of COPD (adjusted odds ratio 3.32, 95% confidence interval 1.05-10.45). Participants with childhood asthma had lower (P = .010) forced expiratory volume in 1 second (mean 1.63 L, standard deviation [SD] 0.64 L) than those without (mean 2.04 L, SD 0.75 L). However, the adjusted lung function difference did not attain statistical significance after controlling for confounding variables such as age and cumulative smoking exposure. The epidemiological evidence suggested a positive association between childhood asthma and COPD in later life. Further study of the effect of adequate childhood asthma treatment on future risk of COPD should be undertaken.

Dietary Nutrients and Urinary Incontinence in Japanese Adults.

OBJECTIVES: To investigate the association between dietary nutrients and urinary incontinence (UI) among Japanese adults. METHODS: A total of 1017 adults (710 men and 307 women) were recruited from the community in central and southern Japan. A structured questionnaire, incorporating the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and a validated food frequency questionnaire, was administered to participants by face-to-face interview. Information on dietary nutrients intake from each food item was obtained using the Japanese food composition tables. Logistic regression analyses were performed to determine the association between nutrients intake and the prevalence of UI. RESULTS: The observed prevalence of UI was 8.7% (n = 62) for men (mean age 62.5 years) and 29% (n = 89) for women (mean age 62.0 years) based on the ICIQ-SF criterion. Of the 50 dietary nutrients and micronutrients considered, soluble fiber (P = 0.03) and omega-6 polyunsaturated fatty acids (P = 0.01) were found to be inversely associated with the UI prevalence for men, whereas increasing the intake of lutein/zeaxanthin appeared to be marginally associated (P = 0.04) with a reduced risk of UI for women. CONCLUSION: Three dietary nutrients have been identified to be associated with UI in middle-aged and older Japanese adults. Further research and clinical trials are needed to ascertain the effects of dietary nutrients on UI.

Physical activity and urinary incontinence in older adults: a community-based study.

BACKGROUND: Urinary incontinence (UI) is a distressing condition that affects the lifestyle of older people. To investigate the relationship between UI and physical activity among older adults, a community-based study was conducted in Japan. METHODS: A total of 700 men and 300 women (mean age 66.2, SD 7.7 years) were recruited from the community in middle and southern Japan. The International Consultation on Incontinence Questionnaire-Short Form was administered by face-to-face interviews to ascertain UI status. Habitual physical activity levels (walking, moderate and vigorous activities) were assessed using the International Physical Activity Questionnaire and measured in terms of energy expenditure as metabolic equivalent tasks (MET). RESULTS: The prevalence of UI was 7.2% (n = 49) among the 683 eligible male participants and 27.5% (n = 82) among the 298 female participants, who had experienced urine leakage for 2.6 (SD 1.9) years and 4.2 (SD 5.1) years, respectively. Habitual walking levels were lower among incontinent subjects than others without the condition. The adjusted risk of UI was 0.36 (95% confidence interval (CI) 0.14, 0.92) for men and 0.43 (95% CI 0.20, 0.96) for women, when comparing frequent walkers with over 1000 MET minutes of walking per week to completely sedentary participants. The prevalence of UI also decreased with total and moderate activity levels, but the corresponding reductions in risk were not statistically significant. CONCLUSION: The finding of an inverse association between UI and walking has important implications for the prevention and treatment of this distressing condition.