RESUMEN
OBJECTIVE: To identify risk factors for incident sexually transmitted infections (STI) in a remote Aboriginal community in Australia. DESIGN: A population based cohort study. SETTING: An Aboriginal community in central Australia. PARTICIPANTS: 1034 Aboriginal people aged 12-40 years, resident in the study region, seen during the period 1 January 1996 to 30 June 1998 for STI diagnosis. MAIN OUTCOME MEASURES: Incident rate of gonorrhoea, chlamydia, and syphilis per 100 person years. RESULTS: There were 313 episodes of incident gonorrhoea, 240 of incident chlamydial infection, and 17 of incident syphilis. For gonorrhoea, risk factors were age, substance abuse, and previous prevalent chlamydial infection with a rate ratio (RR) of 3.2 in people aged 15-19 years, 1.6 in people who abused alcohol, and 3.2 in women who had sniffed petrol on a regular basis. For chlamydia, risk factors were sex, age, and a previous history of STI with a RR of 2.7 in people aged 15-19 years. Similar factors were associated with an increased risk of syphilis but the associations were not statistically significant. CONCLUSION: This study identified objective predictors of incident STI which can be used to target interventions and maximise their impact. The results of this study may well have relevance to indigenous communities in other countries that are faced with high levels of STI and substance abuse.
Asunto(s)
Nativos de Hawái y Otras Islas del Pacífico , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/efectos adversos , Australia/epidemiología , Niño , Infecciones por Chlamydia/epidemiología , Estudios de Cohortes , Femenino , Gonorrea/epidemiología , Humanos , Incidencia , Masculino , Petróleo , Recurrencia , Factores de Riesgo , Enfermedades de Transmisión Sexual/complicaciones , Trastornos Relacionados con Sustancias/complicaciones , Sífilis/epidemiologíaRESUMEN
OBJECTIVE: To describe the reporting of occupational exposures to blood and body fluids in Australian teaching hospitals. DESIGN: Survey by questionnaire of the major teaching hospitals in Australia, December 1992. RESULTS: Completed questionnaires were received from 88% of the 69 teaching hospitals in Australia. All responding hospital reported an established procedure for reporting and managing occupational exposures to blood and body fluids and 82% indicated willingness to contribute data to a national monitoring project. Information concerning the actual incident was recorded by all hospitals and two-thirds of hospitals had forms which specifically detailed exposures history. Patient and healthcare worker risk factors for HIV were recorded less frequently. but in 87% of hospitals blood tests were performed on both the staff member and source patient. Among 87 026 equivalent full time staff employed by the responding hospitals, 5803 injuries were reported in 1991. The median number of reported injuries as a percentage of equivalent full time staff was 7%. Estimates of non-reporting ranged from 5% to 70% (median 25%). Prophylactic zidovudine was prescribed for 50 staff from 21 hospitals in 1991. CONCLUSIONS: All Australian teaching hospitals have an established procedure for documenting occupational exposure to blood and body fluids. Although there is limited standardisation at a national level, the information already collected and the willingness to participate indicated by a large number of teaching hospitals are sufficient for a national surveillance mechanism to be established.
Asunto(s)
Patógenos Transmitidos por la Sangre , Hospitales de Enseñanza , Exposición Profesional/estadística & datos numéricos , Gestión de Riesgos/estadística & datos numéricos , Accidentes de Trabajo/prevención & control , Accidentes de Trabajo/estadística & datos numéricos , Australia , Líquidos Corporales/virología , Estudios de Factibilidad , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Programas Nacionales de Salud , Encuestas y Cuestionarios , Zidovudina/uso terapéuticoRESUMEN
A study was carried out in Swaziland to assess the relationship between aflatoxin exposure, hepatitis B infection, and the incidence of liver-cell carcinoma, which is the most commonly occurring malignancy among males in Swaziland. Levels of aflatoxin intake were evaluated in dietary samples from households across the country, and crop samples taken from representative farms. Prevalence of hepatitis B markers was estimated from the serum of blood donors, and liver cancer incidence was recorded for the years 1979-83 through a national system of cancer registration. Across 4 broad geographic regions, there was a more than 5-fold variation in the estimated daily intake of aflatoxin, ranging from 3.1 to 17.5 micrograms. The proportion of HBV-exposed individuals was very high (86% in men), but varied relatively little by geographic region; the prevalence of carriers of the surface antigen was 23% in men, and varied from 21 to 28%. Liver cancer incidence varied over a 5-fold range, and was strongly associated with estimated levels of aflatoxin. In an analysis involving 10 smaller subregions, aflatoxin exposure emerged as a more important determinant of the variation in liver cancer incidence than the prevalence of hepatitis infection. Aflatoxin estimates from crop samples appeared to be a reasonable surrogate for dietary measurements. A comparison with dietary aflatoxin levels measured in an earlier survey in Swaziland suggested that programmes aimed at reducing contamination levels had had some success.
Asunto(s)
Aflatoxinas/análisis , Portador Sano/epidemiología , Hepatitis B/epidemiología , Neoplasias Hepáticas/epidemiología , Aflatoxinas/efectos adversos , Donantes de Sangre , Portador Sano/inmunología , Exposición a Riesgos Ambientales , Esuatini , Fabaceae/análisis , Femenino , Hepatitis B/inmunología , Anticuerpos contra la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/análisis , Humanos , Neoplasias Hepáticas/etiología , Masculino , Plantas Medicinales , Sistema de Registros , Análisis de Regresión , Zea mays/análisisRESUMEN
An ecologic study design was used to investigate the relationship between exposure to air emissions produced by the petroleum and chemical industries, and average annual cancer incidence and major cause mortality rates among whites in Contra Costa County, California. Estimates for the exposure to major industrial sources of sulfur dioxide, hydrocarbons and oxides of nitrogen were used to subdivide the county by level of exposure to petroleum refinery and chemical plant emissions. Cancer incidence and major cause mortality rates were then calculated for whites in each of the exposure areas. In both males and females, residential exposure to petroleum and chemical air emissions was associated with an increased incidence of cancer of the buccal cavity and pharynx. In males, age-adjusted incidence rates for cancers of the stomach, lung, prostate and kidney and urinary organs were also associated with petroleum and chemical plant air emission exposures. In both sexes, we found a strong positive association between degree of residential exposure and death rates from cardiovascular disease and cancer, and a less strong positive association between exposure and death rates from cerebrovascular disease. There was also a positive association in men for deaths from cirrhosis of the liver. Although these observed associations occurred across areas of similar socioeconomic and broad occupational class, confounding variables and the "ecologic fallacy" must be considered as possible explanations. In particular, the stronger findings in men suggest an occupational explanation of the cancer incidence trends, and the effect observed in cirrhosis mortality suggests that lifestyle variables such as alcohol consumption were not adequately controlled for. While the public health implications of our findings remain unclear, the evidence presented is sufficient to warrant follow-up studies based on individual data in which possible biases can be more readily controlled.