Proximal deep vein thrombosis among hospitalised medical and obstetric patients in Rwandan university teaching hospitals: prevalence and associated risk factors: a cross-sectional study.

OBJECTIVES: To determine the prevalence of proximal deep vein thrombosis (DVT) by ultrasound scanning, as well as associated clinical features and known risk factors, among medical and obstetrics-gynaecology inpatients in two Rwandan tertiary hospitals. DESIGN: Cross-sectional study. SETTINGS: Rwanda teaching hospitals: Kigali and Butare University Teaching Hospitals. PARTICIPANTS: 901 adult patients admitted to the Departments of Internal Medicine and Obstetrics-Gynecology (O&G) who were at least 21 years of age and willing to provide a consent. OUTCOMES: Prevalence of proximal DVT, clinical features and known risk factors associated with DVT. METHODS: Between August 2015 and August 2016, participants were screened for DVT by compressive ultrasound of femoral and popliteal veins, conducted as a monthly cross-sectional survey of all consenting eligible inpatients. Patients completed a self-report survey on DVT risk factors. Prevalence of proximal DVT by compression ultrasonography was the primary endpoint, with univariate and multivariate regression analyses performed to assess associated clinical features and risk factors. RESULTS: Proximal DVT was found in 5.5% of the study population, with similar rates in medical and O&G inpatients. The mean age was 41±16 SD (range, 21-91), 70% were female and 7% were pregnant. Univariate analysis showed active malignancy, immobilisation, prolonged recent travel and history of DVT to be significant risk factors for proximal DVT (all p values <0.05); while only active malignancy was an independent risk factor on multivariate regression (OR 5.2; 95% CI 2.0 to 13). Leg pain or tenderness, increased calf circumference, unilateral limb swelling or pitting oedema were predictive clinical features of DVT on both univariate analysis and multivariate regression (all p values <0.05). CONCLUSION: Proximal DVT prevalence is high among hospitalised medical and O&G patients in two tertiary hospitals in Rwanda. For reducing morbidity and mortality, research to develop Africa-specific clinical prediction tools for DVT and interventions to increase thromboprophylaxis use in the region are urgently needed.

List and text recall differ in their predictors: replication over samples and time.

This study tested the hypothesis that latent list and text recall invoke somewhat different processes. A bivariate outcome path model of latent list and text recall evaluated the effects of age, latent speed, working memory, and vocabulary as their predictors. Independent of age, working memory reliably predicted both recall variables, whereas speed reliably predicted list recall only. The relationship between vocabulary and recall was mediated by age, working memory, and speed. The generalizability of this model, based on data from the 1994 testing of the Long Beach Longitudinal Study, was evaluated across samples by testing its invariance on baseline data from an additional panel and for eventual attrition at baseline and at a subsequent testing of retested participants and dropouts. Results showed that the model was invariant over all groups, supporting a replicable distinction between list and text recall.

Overweight among low-income Texas preschoolers aged 2 to 4 years.

OBJECTIVE: Determine child/maternal factors associated with overweight among 2- to 4-year-olds enrolled in the Texas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: Matched child and maternal data collected by self-report of the mother during WIC certification. These data were extracted from existing statewide WIC databases and merged. SETTING: Texas WIC children aged 2 to 4 years in April 2006. PARTICIPANTS: Final sample was 22,837 mother-child dyads. MAIN OUTCOME MEASURE: Dependent variable--child overweight; independent variables: Child-related--gender, age, race/ethnicity, Medicaid status, living area, and dental problems; Maternal-related--certification status, age, times certified, overweight, high maternal weight gain, and gestational diabetes. ANALYSIS: Bivariate relationships at P < .05 were included in the logistic regression. RESULTS: Living in a nonborder urban area associated with greater odds of overweight compared to living in a border area. Mother's overweight, high gestational weight gain, and gestational diabetes associated with greater odds of child overweight. CONCLUSIONS AND IMPLICATIONS: Several child- and maternal-related factors were found to be associated with overweight in Texas WIC preschoolers. Health interventions should target 4-year-old Hispanic children living in nonborder urban areas and mothers who are overweight, have high gestational weight gain, or have gestational diabetes.

Prevalence and risk factors for adult paternity among adolescent females ages 14 through 16 years.

To investigate sociodemographic factors associated with adolescent females ages 14-16 years having children fathered by males age 20 years or older and identify differences in correlates across rural, urban, and border areas. The method section was a cross-sectional study using Texas birth record data. From 2000 through 2004, there were 29,186 births to adolescent females aged 14-16 years with valid paternal age. Prevalence of and adjusted odds of paternal age of 20 years or older were identified by paternal and maternal factors. The Results section Having both parents born outside of the U.S. was associated with a 5.29 (95% CI: 4.82, 5.80) times increase in the odds of paternal age of 20 years or older as compared to having both parents born in the U.S. Parental place of birth was associated with greater odds of paternal age of 20 years or older in urban areas compared to rural or border areas. Compared to those with average or high educational attainment relative to age, low educational attainment relative to age was associated with an increase in the odds of paternal age of 20 years or older. This association was present whether maternal or paternal educational attainment was low relative to age. Messages are needed to help adolescent females avoid pregnancy with adult males. In addressing this specific prevention challenge, it is important to consider maternal/paternal place of birth and its association with adolescent births with adult males.

Physical activity participation by parental language use in 4th, 8th, and 11th grade students in Texas, USA.

Research on physical activity (PA) by level of acculturation in Hispanic children is limited and findings have been mixed. We examined PA participation by primary language used with parents in a representative sample of 4th, 8th, and 11th grade Texas public school students. Mixed-effects regression models were conducted using cross-sectional data from the 2004-2005 School Physical Activity and Nutrition Study (n = 22,049). Self-reported PA was compared among three language-ethnic groups: Spanish-Hispanic (SH) (referent); English-Hispanic (EH); and English-Other (EO). EH and/or EO girls were generally between 1.25 and 2.58 [OR] times more likely to participate in PA across grade levels, with the largest differences found for school sports in 8th grade girls. EH and EO 8th grade boys were 1.71 (CI: 1.40, 2.10) and 2.06 (CI: 1.68, 2.51) times, respectively, more likely to participate in school sports. Findings indicate important disparities in Spanish-speaking Hispanic children's PA participation.

Teen pregnancy in Texas: 2005 to 2015.

OBJECTIVES: Texas birth records and population projections were used to simulate pregnancy rates among women ages 15-19 years from 2005 to 2015. METHODS: Monte Carlo simulation based on historical rates of natural increase, contraceptive failure and sexual experience among racial/ethnic groups of teenaged women was used for numerical projections. These projections were used in a systems dynamics model which posits teen pregnancy risk as a stochastic process of contraceptive failure and sexual activity. The PRI was constructed as a logistic function of sexual experience, the weighted average contraceptive failure rates and time-varying probabilities of natural increase among racial/ethnic sub-groups of adolescent women. RESULTS: From 2005 to 2015, the number of adolescent, Hispanic females in Texas is expected to increase by 45%. During this same period, the expected pregnancy risk for 15 to 19 year old females is expected to increase to 13% or 127 per 1,000 women. This increase is due largely to the rise in the pregnancy risk among the growing population of Hispanic adolescents. CONCLUSIONS: Changing population characteristics in Texas and differences in sexual activity and contraceptive failure among racial/ethnic groups indicate that teenage pregnancy will not continue to decline in the coming decade. The adolescents most at risk for pregnancy are expected to increase significantly. Pregnancy prevention programs need to be intensified and adapted to the changing Texas social climate in order to preempt dramatic increases in teenage pregnancy.

Cervical cancer screening among women who gave birth in the US-Mexico border region, 2005: the Brownsville-Matamoros Sister City Project for Women's Health.

INTRODUCTION: The objective of this study was to examine correlates of ever having had a Papanicolaou (Pap) test among women who recently delivered a live infant and who resided near the US-Mexico border. METHODS: This cross-sectional study included women who delivered a live infant in Matamoros, Mexico (n = 488) and Cameron County, Texas (n = 453). Women were interviewed in the hospital before discharge between August 21 and November 9, 2005. Multivariable logistic regression was used to estimate the odds of ever having had a Pap test. RESULTS: Significantly fewer Matamoros women (62.1%) than Cameron County women (95.7%) reported ever having had a Pap test. Only 12% of Matamoros women said they received their most recent Pap test during prenatal care, compared with nearly 75% of Cameron County women. After adjusting for potential confounders, the odds of ever having had a Pap test were 7.41 times greater in Cameron County than in Matamoros (95% confidence interval, 4.07-13.48). CONCLUSION: The Healthy Border 2010 goals are to cut cervical cancer mortality by 20% to 30% in the border region. The significant difference in Pap test prevalence among our survey respondents may reflect that routine prenatal Pap testing is more common in the United States than in Mexico. Because women who are receiving prenatal care have increased interaction with health care providers, Matamoros providers may need to be educated about the need to screen for cervical cancer during this time.

Attempted breastfeeding before hospital discharge on both sides of the US-Mexico border, 2005: the Brownsville-Matamoros Sister City Project for Women's Health.

INTRODUCTION: The US-Mexico border region has a growing population and limited health care infrastructure. Preventive health behaviors such as breastfeeding ease the burden on this region's health care system by reducing morbidity and health care costs. We examined correlates of attempted breastfeeding before hospital discharge on each side of the US-Mexico border and within the border region. METHODS: The cross-sectional study included women who delivered a live infant in Matamoros, Tamaulipas, Mexico (n = 489), and Cameron County, Texas (n = 457), which includes Brownsville, Texas. We interviewed women before hospital discharge from August 21 through November 9, 2005. We used multivariate logistic regression to estimate the odds of attempted breastfeeding before hospital discharge in Cameron County, Texas, the municipality of Matamoros, Mexico, and the 2 communities combined. RESULTS: Prevalence of attempted breastfeeding before hospital discharge was 81.9% in Matamoros compared with 63.7% in Cameron County. After adjusting for potential confounders, the odds of attempted breastfeeding before hospital discharge were 90% higher in Matamoros than in Cameron County (adjusted odds ratio [AOR], 1.93; 95% confidence interval [CI], 1.31-2.84 for the combined model). In the 2 communities combined, odds of attempted breastfeeding before hospital discharge were higher among women who had a vaginal delivery than among women who had a cesarean delivery (AOR, 1.98; 95% CI, 1.43-2.75) and were lower among women who delivered infants with a low birth weight than among women who delivered infants with a normal birth weight (AOR, 0.26; 95% CI, 0.15-0.44). CONCLUSION: The rate of attempted breastfeeding in Matamoros was significantly higher than in Cameron County. Additional breastfeeding support and messages on the US side of the US-Mexico border are needed.

Characteristics of young women who gave birth in the US-Mexico border region, 2005: the Brownsville-Matamoros Sister City Project for Women's Health.

INTRODUCTION: Childbearing during adolescence and young adulthood is associated with adverse effects on health and quality of life. Lowering birth rates among young women is a binational priority in the US-Mexico border region, yet baseline information about birth rates and pregnancy risk is lacking. Increased understanding of the characteristics of young women who give birth in the region will help target high-risk groups for sexual and reproductive health services. METHODS: We examined data on reproductive health characteristics collected in hospitals from 456 women aged 24 years or younger who gave birth from August 21 through November 9, 2005, in Matamoros, Tamaulipas, Mexico, and Cameron County, Texas. We calculated weighted percentages and 95% confidence intervals (CIs) for each characteristic and adjusted odds ratios (AORs) for Matamoros and Cameron County women by using multiple logistic regression techniques. RESULTS: Numbers of births per 1,000 women aged 15 to 19 years and 20 to 24 years were similar in the 2 communities (110.6 and 190.2 in Matamoros and 97.5 and 213.1 in Cameron County, respectively). Overall, 38.5% of women experienced cesarean birth. Matamoros women reported fewer prior pregnancies than did Cameron County women and were less likely to receive early prenatal care but more likely to initiate breastfeeding. Few women smoked before pregnancy, but the prevalence of alcohol use in Cameron County was more than double that of Matamoros. In both communities combined, 34.0% of women used contraception at first sexual intercourse. CONCLUSION: Despite geographic proximity, similar ethnic origin, and comparable birth outcomes, young Mexican and US women showed different health behavior patterns. Findings suggest possible pregnancy prevention and health promotion interventions.

Prenatal HIV testing in the US-Mexico border region, 2005: the Brownsville-Matamoros Sister City Project for Women's Health.

INTRODUCTION: Routine prenatal human immunodeficiency virus (HIV) screening provides a critical opportunity to diagnose HIV infection, begin chronic care, and prevent mother-to-child transmission. However, little is known about the prevalence of prenatal HIV testing in the US-Mexico border region. We explored the correlation between prenatal HIV testing and sociodemographic, health behavior, and health exposure characteristics. METHODS: The study sample consisted of women who delivered live infants in 2005 in hospitals with more than 100 deliveries per year and resided in Matamoros, Tamaulipas, Mexico (n = 489), or Cameron County, Texas (n = 458). We examined univariate and bivariate distributions of HIV testing in Matamoros and Cameron County and quantified the difference in odds of HIV testing by using logistic regression. RESULTS: The prevalence of prenatal HIV testing varied by place of residence--57.6% in Matamoros and 94.8% in Cameron County. Women in Cameron County were significantly more likely than those in Matamoros to be tested. Marital status, education, knowledge of methods to prevent HIV transmission (adult-to-adult), discussion of HIV screening with a health care professional during prenatal care, and previous HIV testing were significantly associated with prenatal HIV testing in Matamoros, although only the latter 2 variables were significant in Cameron County. CONCLUSION: Although national policies in both the United States and Mexico recommend prenatal testing for HIV, a greater proportion of women in Cameron County were tested, compared with women in Matamoros. Efforts between Matamoros and Cameron County to improve HIV testing during pregnancy in the border region should consider correlates for testing in each community.

Prior contraceptive use among women who gave birth in the US-Mexico border region, 2005: the Brownsville-Matamoros Sister City Project for Women's Health.

INTRODUCTION: Dramatic population growth in the US-Mexico border region suggests more effective family planning services are needed, yet binational data are scarce. The Brownsville-Matamoros Sister City Project for Women's Health collected binational, standardized data from 947 postpartum women in Cameron County (Texas) and Matamoros (Tamaulipas, Mexico) hospitals from August through November 2005. METHODS: We analyzed these data to estimate the proportion of women with unintended pregnancy and the proportion of these women who reported contraceptive use, and to identify associated factors. RESULTS: The current pregnancy was unintended for 48% of women overall. Almost half of these women reportedly used birth control at conception, but many used low-efficacy methods. Among women with unintended pregnancy who did not use contraception, 34.1% of Mexico residents believed they could not become pregnant and 28.4% of US residents reported no reason for nonuse. Overall, contraceptive use to prevent pregnancy was less common among younger than older women and among women who had not graduated high school compared with those who had. Among Mexico residents, those who had a source of routine health care were more likely than those who did not to have used contraception. CONCLUSION: More effective contraceptive practices are needed in this population, especially among younger and less-educated women. A cooperative binational approach that integrates reproductive and family planning services may be most effective.

BART to HIVEd: adapting an HIV education prevention program.

One of the fastest growing segments of the population infected with HIV is the nation's youths. Thus, prevention in this high-risk population is vital. The authors detail the process of adapting an evidence-based HIV/AIDS educational program (HIVEd) to the unique needs of high-risk youths in adjudicated and detained facilities and alternative high schools. The HIVEd program derives from St. Lawrence's Becoming A Responsible Teen (BART) curriculum. This article describes the modification of BART into HIVEd, identifies the challenges encountered and lessons learned, and suggests future directions for HIVEd as a useful tool for prevention of HIV/AIDS and sexually transmitted infection in high-risk youths.

Adult age differences in multiple cognitive functions: differentiation, dedifferentiation, or process-specific change?

Adult age differences in covariance structures of latent variables of vocabulary, list recall, speed, working memory, and text recall, were analyzed to test hypotheses of structural changes with age. There were baseline data from 613 men and women aged 30-97, data from a second wave of testing from 322 people, and complete longitudinal data from 289 people. There were age differences in the size but not configuration of factor loadings cross-sectionally but not longitudinally. There were no changes in factor standard deviations or covariances. Findings did not support models of dedifferentiation with age.