Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries.

OBJECTIVE: To assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries. DESIGN: Cross-country comparative study of linked population-based databases. SETTING: Provincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden. POPULATION: All immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995-2010). METHODS: Data was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI). MAIN OUTCOME MEASURES: Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries). RESULTS: There were 9,028,802 deliveries (3,031,399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest. CONCLUSION: Immigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.

Changing mortality patterns for major cancers in Spain, 1951-1985.

Mortality trends for main cancer sites in Spain from 1951-1985 are presented. Age-standardized mortality rates per 100,000 were computed using the direct method. The Spanish population of 1970 was used as the standard. Age-standardized mortality rates for total cancer showed a marked increase among men throughout the period of study. This can be attributed mainly to the increase in lung cancer mortality (from 8.63 person-years to 44.74 between 1951 and 1985), which was only partially balanced by a reduction in the stomach cancer mortality (from 36.18 to 18.31). Among women the increase in total cancer is lower overall. It occurred mainly during the 1950s and thereafter the trend has remained stable and even declined in recent years. Lung cancer mortality rates among women have remained fairly stable and stomach cancer followed the same pattern as for men. Breast cancer mortality increased constantly during the period (from 7.21 to 19.38) but it was not until 1978 that it became the leading cause of cancer mortality among women.

Determinants of HIV-1 infection in intravenous drug users in Valencia, Spain, 1987-1991.

From 1987 through 1991, 2687 intravenous drug users recruited at three AIDS information centres in the Region of Valencia (Spain) were interviewed about drug use and sexual behaviour and subsequently tested for HIV-1 antibody. The overall seroprevalence was high, 50% (95% confidence interval [CI]: 41.8-51.9%). There were no differences by gender, but HIV-1 infection was related to older age and city of residence. After adjustment by means of logistic regression age (odds ratio [OR] = 1.80), sharing of injection equipment (OR = 2.16), duration of addiction (OR = 6.59) and prostitution (OR = 1.77) were significantly associated with HIV-1 prevalence. High educational level was inversely related to HIV-1 status (OR = 0.43) and a decreasing trend of prevalence with time was observed.

Prevalence of antibiotics to hepatitis C in a population of intravenous drug users in Valencia, Spain, 1990-1992.

BACKGROUND: Hepatitis C has been related to other viral diseases such as the human immunodeficiency virus infection (HIV) or hepatitis B (HBV). The objective of this study was to estimate the prevalence and determinants of antibodies to hepatitis C virus (HCV) in intravenous drug users (IVDU) in Valencia (Spain) and to compare the seroprevalence between the HCV, HIV and HBV in this high risk group. METHODS: A cross-sectional study was conducted in a sample of 1056 current IVDU from the Valencia area who attended the city's AIDS Information Centre between January 1990 and December 1992. Information on sociodemographic, sexual behaviour, and drug use variables was collected by means of a structured questionnaire. Antibodies to HCV, HIV and HBV were assayed by ELISA test. RESULTS: The seroprevalence of HCV for the whole period was 85.5% (95% confidence interval [CI]: 83.2-87.5%), ranging from 76.5% in 1990 (95% CI: 71.9-81.1%) to 87.8% in 1992 (95% CI: 82.5-93.1%). Year of testing and prevalence of HBV markers showed an independent association with HCV seroprevalence. When only IVDU aged < 25 years were analysed, sharing of needles also appeared as an independent dominant. Of those IVDU with less than one year of addiction, 69% were HCV seropositive compared with 41% for HBV and 14% for HIV. CONCLUSIONS: Intravenous drug users in Valencia showed one of the highest reported hepatitis C seroprevalences (85.5%). A more efficient parenteral transmission of hepatitis C virus than HBV or HIV is suggested.

Sharing of injection equipment among 3755 intravenous drug users in Valencia, Spain, 1987-1992.

BACKGROUND: In order to identify, in a sample of heroin intravenous drug users (IVDU), those factors associated with the predominant risk behaviour related to the transmission of HIV-1 infection--sharing of injection equipment--a cross-sectional survey was carried out in Valencia, Spain from 1987 to 1992. METHODS: Informed consent and pertinent data were obtained from 3755 heroin IVDU recruited at two public AIDS Information Centres in two cities in the region of Valencia. Data were gathered on sociodemographic variables, and sexual and drug use behaviour by interview. The subjects were subsequently tested for HIV-1 antibody. A univariate analysis was carried out to identify variables that were significantly associated with sharing injection equipment. A logistic regression model was used to control for possible confounders. RESULTS: The IVDU who were teenagers, prostitutes (OR = 1.95), who had antibodies to HIV-1 (OR = 1.30) or who had an IVDU steady partner were at significantly higher risk for sharing of injection equipment. Higher levels of education, condom use (OR = 0.65) and living in the smaller city (OR = 0.75) were inversely related to sharing injection equipment. CONCLUSIONS: Our results suggest that different subgroups of IVDU have different characteristics that place them at different risk for HIV-1 infection. These characteristics should guide the design and intensity of specific preventive interventions. Teenagers and IVDU with low educational levels should be targetted for special attention by health authorities.

Trends in mortality from lung cancer in Spain, 1951-80.

Lung cancer mortality rates in Spain were calculated for the years 1951 to 1980. Increasing age-standardised rates for men and levelled off ones for women were observed. Available cigarette consumption data suggest that these current trends could change at the beginning of the next century when there may be a levelling off of male rates and an "epidemic" of female lung cancer.

Oesophageal cancer mortality: relationship with alcohol intake and cigarette smoking in Spain.

STUDY OBJECTIVE: The aim of the study was to explore temporal changes in mortality from oesophageal cancer that could be related to tobacco and alcohol consumption. DESIGN: The study used mortality trends from oesophageal cancer over the period 1951-1985. In addition, available trends on per capita consumption of alcohol and cigarettes are also presented. SETTING: Data for this study were derived from Spain's National Institute for Statistics. MAIN RESULTS: Age standardised mortality rates from oesophageal cancer have increased significantly among men in Spain from 1951 to 1985 (p less than 0.01). Mortality rates in women have not changed significantly during the same period, although there is evidence of a certain decrease in recent years. Trends of per capita cigarette consumption from 1957 to 1982 related positively with oesophageal cancer mortality among men, whereas no significant relationship was observed in women. Trends of beer, spirits, and total alcohol consumption were also positively correlated with oesophageal cancer mortality in men. Among women, a weaker relationship was found. Wine consumption showed no relationship with oesophageal cancer mortality either in men or women. CONCLUSIONS: These results are similar to those found in other studies, supporting a role of alcohol (spirits and beer) and cigarette consumption in causation of oesophageal cancer. No relationship was observed with wine consumption.

Smoking and drinking habits before and during pregnancy in Spanish women.

STUDY OBJECTIVE: To investigate possible changes in smoking and drinking habits during pregnancy and to elucidate the sociodemographic factors associated with these changes in Spanish women. DESIGN: A cross-sectional survey. PARTICIPANTS AND SETTING: A total of 1004 pregnant women of between 12 and 18 weeks of gestation who were attending the antenatal clinic of the main regional hospital of Valencia (Spain) during 1989 were studied. All participants completed the study and only one eligible woman refused to participate when approached. MEASUREMENTS AND MAIN RESULTS: Information was obtained by structured questionnaire (Euromac questionnaire), which included items on age, educational level, marital status, occupation, parity, previous and present smoking habits, and previous and present alcohol consumption. Women were asked about the consumption of cigarettes and alcohol for a typical week before they knew they were pregnant, and details of current consumption were obtained for the week before the interview. The number of drinks taken per week was later converted to the amount of absolute alcohol (in g). Sixty per cent of the women smoked and 72% drank alcohol before pregnancy. Forty eight per cent of smokers stopped smoking and 37% of drinkers stopped drinking alcohol during pregnancy. No sociodemographic factor showed an independent association with either smoking or drinking cessation. Only the number of cigarettes and the amount of alcohol consumed before pregnancy were identified as significant independent predictors for stopping. CONCLUSIONS: Pregnant Spanish women seemed to stop smoking at about three times the rate found in Spanish women in the reproductive years. The sociodemographic variables usually associated with stopping smoking could not account for the high rate of quitting in these Spanish women, a rate higher than that in women from other developed countries. The high prevalence of smoking before pregnancy might explain not only the high rate of stopping smoking but also the absence of a well defined profile of "quitters". In our study, high levels of alcohol consumption were limited to a small group of pregnant women, and preventive efforts should be focused on this group.

Acute lymphoblastic leukaemia among Spanish children and mothers' occupation: a case-control study.

STUDY OBJECTIVE: The aim was to investigate the association between mothers' occupational exposure during pregnancy and the incidence of acute lymphoblastic leukaemia in children. DESIGN: The study was a case-control investigation. A face to face interview was used to assess exposures at work and relevant confounding variables. SETTING: The study was community based and was carried out in five provinces of Spain. SUBJECTS: 128 cases less than 15 years of age were interviewed (91% of those eligible). Controls (one for each case) were chosen from the census lists and were matched on year of birth, sex and municipality. MEASUREMENTS AND MAIN RESULTS: Children of mothers working at home had a relative risk (RR) of 7.0 (95% CI = 1.59-30.79) of developing acute lymphoblastic leukaemia. Exposure to organic dust was associated with a RR of 5.5 (95% CI = 1.21-24.8). There was a statistically significant interaction between exposure to organic dust and working at home. The majority of women working at home were hired by local industries to sew different types of tissues (cotton, wool, synthetic fibres) on a machine. CONCLUSION: A similar association has not been reported before: if confirmed, this finding may suggest a new health concern.

[Income, percent of women living in rural areas, parity, and breast cancer mortality in Spain, 1975-1991]. / Renta per cápita, población rural femenina, promedio de hijos y distribución provincial de la mortalidad por cáncer de mama en España, 1975-1991.

BACKGROUND: The aim of the present study was to analyze breast cancer mortality by provinces in Spain during the period 1975-91, and to assess the relationship with the geographical distribution of income level, percent of women living in rural areas and average parity of women in each province. SUBJECTS AND METHODS: Data were obtained from national statistical sources. Standardized mortality ratios (SMR) for breast cancer were estimated by provinces for the periods 1975-1980, 1981-1986 and 1987-1991, and for the whole period 1975-1991. Poisson regression analysis was used to explore the association between breast cancer mortality and the above mentioned variables. Provinces were categorized according to the quintile distribution of independent variables, and ecological relative risks were estimated for each category. RESULTS: Higher SMR were observed in island provinces (Canary and Balearic island), Catalonia, Basque Country, Navarre and the provinces of Saragosa, Seville and Valencia. Lowest SMR were observed in the inner provinces of Spain and the east part of Andalusian region. This pattern has remained very similar along the study period: income level showed a positive association with mortality from breast cancer. On the contrary, percent of women living in rural areas and parity were negatively associated to breast cancer mortality. The relative risk estimated for each child of parity adjusted by the other factors was 0.92 (95% confidence interval: 0.89-0.94). CONCLUSIONS: The highest mortality from breast cancer in Spain has been observed in those provinces with the highest income level, the lowest percent of women living in rural areas and the lowest parity. These findings at the ecological (provinces) level are in concordance with results from other studies at the individual level, and further supports the hypothesis that for the etiology of breast cancer, environmental factors could play a dominant role.

[The effect of moderate intake of alcohol during pregnancy on the weight of the newborn]. / Efecto del consumo moderado de alcohol durante el embarazo sobre el peso del recién nacido.

BACKGROUND: There is currently no doubt concerning the detrimental effects of the intake of high doses of alcohol during pregnancy. Nonetheless, there has been some controversy regarding the effects of intake of low or moderate quantities of alcohol. The aim of the present study, carried out within the framework of a more extensive European study (EUROMAC), was to specifically analyze the relation between moderate intake of alcohol in pregnant women and the weight of the newborns. METHODS: A prospective cohort study including 1,005 women who attended prenatal consultation in the Hospital La Fe of Valencia between 12 and 18 weeks of pregnancy during 1989 was performed. All the subjects were asked on alcohol intake during the week prior to the interview with data on other sociodemographic and biologic variables being collected. Variance analysis was carried out to evaluate the association of the weight of the newborn with alcohol intake as well as with each of the control variables. Multiple lineal regression analysis was performed by the minimum squares method to evaluate possible effects of confusion and interaction. RESULTS: Following adjustment for parity, weight of the mother prior to pregnancy, sex of the newborn, age at pregnancy and tobacco consumption, only a slight reduction in the weight of the newborns was observed in the category of intake greater than 90 g/week, however this difference was not statistically significant. CONCLUSIONS: The low or moderate intake of alcohol during the first months of pregnancy has no detectable effect on fetal growth.

[Rheumatology research. An analysis of the situation in Spain]. / Investigación en Reumatología. Un análisis de la situación española.

To analyze the present status of rheumatological research in Spain, three indicators have been evaluated: use of the different study designs, use of statistical techniques and relevance of the studies. This last point was determined by the comparison of the research areas that had been reported during one year and the lines of rheumatological research established as priorities by 10 investigators from the 10 units of clinical care with a higher scientific output during the period 1985-1987. A revision has been made of the 67 articles from Spain out of the 1106 reported in seven of the journals with a better national and international impact index: Scandinavian Journal of Rheumatology, Arthritis and Rheumatism, Journal of Rheumatology, Annals of the Rheumatic Diseases, British Journal of Rheumatology, Clinical Experimental Rheumatology and Revue du Rhumatisme, in addition to Revista Española de Reumatología. It was found that few studies with analytical design are being published and that complex statistical analysis techniques are not being used; therefore, most articles do not have a possible statistical inference and lack value as predictors. The reports of cases and clinical series in the Letters to the Editor section are most common, particularly in the Spanish journal. Most studies are related with clinical research, although the consulted investigators consider that basic and epidemiological research have a higher priority. It is concluded that the Spanish contribution to the international rheumatological literature is still small and has a mainly descriptive character; thus, it is necessary to emphasize the use of analytical designs to improve the competitiveness. The type of studies to be carried out in the future, according to the priorities established by the investigators themselves, should change if their wishes are to be fulfilled.

[Work absenteeism of the nursing personnel of Valencia hospitals]. / Absentismo laboral del personal de enfermería de los hospitales valencianos.

A survey was carried out on a sample of 973 nurses from hospitals in the Valencian Region. The objective was to study work absenteeism due to health reasons depending on socio-demographic factors, work organization and self perception of health status. Information was collected by means of a self-administered questionnaire. Duration and frequency of absenteeism was analysed over the previous twelve months. A 34.4% of female nurses and 35.4% of male nurses reported at least one episode, with an average length of 21 and 26 days respectively. There is a relation between absenteeism and self-perception of health status. We did not find man/woman differences with regards to absenteeism.

[Multiple codification of the causes of death: from dying "of" to dying "from"]. / Codificación múltiple de las causas de muerte: de morir "por" a morir "con".

Multiple-cause mortality data is examined in the Valencian Region. In addition to coding the underlying cause of death (UCD), all causes of death which appeared mentioned on death certificates (MCD) were coded according to preliminary rules established by the Mortality Statistics Office. Specific diseases were selected to explore mortality patterns. The average number of conditions coded per death certificate was 2.7. Two or more conditions on the lowest used line appeared in 33.8% of all medical certificates. Septicaemia, high blood pressure and arteriosclerosis stand out among the conditions more often coded as MCD than coded as UCD. Exploring for mortality patterns a statistical association between coronary heart disease and diabetes emerged (p less than 0.0001). Multiple-cause mortality coding allow to discriminate mortality patterns and show a new magnitude to some specific causes of death.

[Smoking reduces the biological capacity of conception. Results from a European multicenter study. The European Study Group on Infertility and Subfecundity]. / Rygning nedsaetter den biologiske evne til at få børn. Resultater fra et europoeisk multicenterstudie. The European Study Group on Infertility and Subfecundity.

The aim of the study was to examine the impact on subfecundity of male and female smoking at the start of a couple's waiting time to a planned pregnancy. Two types of designs were applied: a population based sample of women aged 25-44 years of age and a consecutive sample of pregnant women. Both studies were conducted within well-defined geographical regions in a number of European countries and data were collected by personal interviews in the population-based sample and by interview or self-administered questionnaires in the pregnancy study. A total of 10,665 couples participated in the study. Data on possible risk factors for infertility and subfecundity were collected at the start of the pregnancy planning, and fecundity was estimated by using time from the beginning of unprotected intercourse to a pregnancy, which survived at least 20 gestational weeks. Only couples who planned a pregnancy were included in the analyses. The results showed remarkably coherent associations between female smoking and subfecundity in each individual country and in all countries put together. In the population sample the odds ratio for subfecundity in the first pregnancy was 1.7 (95% c.l. 1.3-2.1 at the upper level of tobacco consumption) and during the most recent waiting time to pregnancy the odds ratio was 1.6 (95% c.l. 1.3-2.1). Results based on the pregnancy sample were similar with an odds ratio of 1.7 (95% c.l. 1.3-2.3). No significant association was found between male smoking and the couple's fecundity.

Breastfeeding initiation in immigrant and non-immigrant women in Spain.

Research about inequities between native and immigrant women regarding the quality of health care is still scarce. Initiation of breastfeeding in hospital is considered a quality care indicator. In this study, we explore the association between the geographical origin of the women and the establishment of breastfeeding in Spanish hospitals. Prevalence of breastfeeding initiation is higher for women from Latin America, Eastern Europe, Maghreb or sub-Saharan Africa than for Spanish women, and lower for Chinese women. Compared with Spanish women the odds of not breastfeeding in hospital were lower in all these immigrant groups but more than five times higher for Chinese immigrants. Culturally adapted health services are necessary to maintain breastfeeding rates in most immigrant groups. Moreover, it seems urgent to identify the factors influencing patterns of breastfeeding in Chinese immigrants and to develop innovative strategies to encourage breastfeeding initiation in hospital.