Federal aviation regulations prohibit airline pilots from flying beyond the age of 60 years. However, the relation between pilot age and flight safety has not been rigorously assessed using empirical data. From 1987 to 1997, the authors followed a cohort of 3,306 commuter air carrier and air taxi pilots who were aged 45-54 years in 1987. During the follow-up period, the pilots accumulated a total of 12.9 million flight hours and 66 aviation crashes, yielding a rate of 5.1 crashes per million pilot flight hours. Crash risk remained fairly stable as the pilots aged from their late forties to their late fifties. Flight experience, as measured by total flight time at baseline, showed a significant protective effect against the risk of crash involvement. With adjustment for age, pilots who had 5,000-9,999 hours of total flight time at baseline had a 57% lower risk of a crash than their less experienced counterparts (relative risk = 0.43, 95% confidence interval: 0.21, 0.87). The protective effect of flight experience leveled off after total flight time reached 10,000 hours. The lack of an association between pilot age and crash risk may reflect a strong "healthy worker effect" stemming from the rigorous medical standards and periodic physical examinations required for professional pilots.

Gambling is an important public health concern. To better understand gambling behavior, we conducted a classroom-based survey that assessed the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived behavioral control, and attitudes) in past year gambling and gambling frequency among college students. Results from this research support the utility of the TPB to explain gambling behavior in this population. Specifically, in TPB models to predict gambling behavior, friend and family subjective norms and perceived behavioral control predicted past year gambling and friend and family subjective norms, attitudes and perceived behavioral control predicted gambling frequency. Intention to gamble mediated these relationships. These findings suggest that college responsible gambling efforts should consider targeting misperceptions of approval regarding gambling behavior (i.e., subjective norms), personal approval of gambling behavior (i.e., attitudes), and perceived behavioral control to better manage gambling behavior in various situations.

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.

n engl j med 360;5 nejm.org january 29, 2009 538 Zaman K, Roy E, Arifeen SE, et al. Effectiveness of maternal 1. influenza immunization in mothers and infants. N Engl J Med 2008;359:1555-64. Ali HM, Scott R, Toms GL. The effect of foster feeding and 2. bottle feeding expressed breast-milk on the susceptibility of guinea-pig infants to influenza virus. Br J Exp Pathol 1989;70: 183-91. Chantry CJ, Howard CR, Auinger P. Full breastfeeding dura3. tion and associated decrease in respiratory tract infection in US children. Pediatrics 2006;117:425-32.

Clinical data are urgently needed to specify the risk and safety of drug use during pregnancy. For several reasons pregnant women are usually excluded from clinical studies. Therefore, observational data are the main source of knowledge, cohort studies as well as case-control studies. Disadvantages of cohort studies based on observational data have been repeatedly discussed. However, being involved in individual risk characterisation of pregnant women it is the experience of clinical teratologists that even reports on small cohorts should not be disregarded if no other data are available. The recently published "Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement" underlines the value of observational data and provides a checklist regarding the most important inherent methodological problems. Our article describes how Teratology Information Services (TIS) document and evaluate their observations on pregnant women exposed to various drugs and discusses methodological problems and -considering the STROBE statement -how these could be addressed.

Sperm donation seems to be the only solution in cases of negative results with testicular sperm extraction (TESE). However, it implies a genetic dissociation between husband and offspring that results in psychological stress, as well as ethical and existential dilemmas for the couple. Facing these dilemmas, some couples prefer father-to-son donation as an alternative solution. However, father-to-son sperm donation involves many potential medical, ethical and emotional risks. A broad discussion within the scienti®c community on these issues should contribute towards a better approach of these cases.

Background. The aim of this study was to explore difficulties at work from anaesthetists' own perspective and to examine how anaesthetists handle and cope with situations that are perceived as difficult and potentially stressful. Methods. Two sets of interviews were conducted with 19 specialist anaesthetists in Sweden. The first set of interviews aimed at finding how the anaesthetists experienced difficulties at work. It consisted of in-depth interviews based on one open-ended question. We analysed the interviews with a phenomenological method, looking for themes in anaesthetists' descriptions of difficulties at work. In the second set, the interviews were semi-structured with open-ended questions, based on themes found in the first interview set. These interviews aimed at exploring how the interviewees described their ways of handling difficulties and how they coped with potentially stressful situations. Results. Analysis of the first set of interviews resulted in five themes, describing how the anaesthetists experienced difficulties at work. All interviewees talked about difficulties related to more than one of the themes. The second set of interviews revealed two main categories of ways of handling difficulties. First, problem solving consisted of descriptions of methods for handling difficult situations which aimed at solving problems, and second, coping strategies described ways of appraising potentially stressful situations that minimized stress, despite the problem not being solved. Conclusions. The anaesthetists interviewed in this study maintained that they enjoyed work and could see no external obstacles to doing a good job. They had arrived at a reconciliation of their work with its inherent difficulties and problems. Getting access to their coping strategies might help young anaesthetists to come to terms with their work.

In a population-based case-referent study of urothelial cancer in Stockholm during 1985-87, information was obtained from 80% of 320 identified male cases and 79% of 363 selected male referents. Industrial exposures were assessed for each subject by an industrial hygienist on the basis of questionnaire data. Exposure to benzene (any annual dose) gave a relative risk (with 95% confidence interval) of 2.0 (I .&3.8). The highest risk was seen for a high annual dose. Subjects exposed to both diesel and petrol exhausts (moderatelhigh annual dose) had a relative risk of . However, adjusting for benzene changed the relative risk to 5. I (0.6-43.6). It might be rewarding to consider whether benzene from petrol confounds the associations previously suggested between exhausts and urothelial cancer. Exposure to polychlorinated biphenyls (PCB) gave a relative risk of 3.3 (0.618.4).

aspects of porous polyethylene implant placement. The authors have retrospectively analyzed 136 cases of evisceration, enucleation, and secondary porous polyethylene implant placement and have concluded that there is no significant difference in exposure rates between wrapped and unwrapped implants.

A population-based case-control study was conducted between July 1984 and February 1988 in the Spanish island of Majorca; 286 incident colorectal cancer cases, 295 population controls and 203 hospital controls were interviewed using a food frequency questionnaire. In a multivariate analysis, an increased risk of colon cancer was found for high consumption of fresh meats (RR = 2.87) while a high consumption of cruciferous vegetables afforded protection (RR = 0.48). For rectal cancer an increased risk was associated with dairy products (RR = 3.08) while a protection was afforded by consumption of cruciferae (RR = 0.50). For colorectal cancer, the cereal food group also showed an increase in risk (RR = I .92).

Low body mass index (BMI) is a well-documented risk factor for future fracture. The aim of this study was to quantify this effect and to explore the association of BMI with fracture risk in relation to age, gender and bone mineral density (BMD) from an international perspective using worldwide data. We studied individual participant data from almost 60,000 men and women from 12 prospective population-based cohorts comprising Rotterdam, EVOS/EPOS, CaMos, Rochester, Sheffield, Dubbo, EPIDOS, OFELY, Kuopio, Hiroshima, and two cohorts from Gothenburg, with a total follow-up of over 250,000 person years. The effects of BMI, BMD, age and gender on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson regression model in each cohort separately. The results of the different studies were then merged. Without information on BMD, the age-adjusted risk for any type of fracture increased significantly with lower BMI. Overall, the risk ratio (RR) per unit higher BMI was 0.98 (95% confidence interval [CI], 0.97-0.99) for any fracture, 0.97 (95% CI, 0.96-0.98) for osteoporotic fracture and 0.93 (95% CI, 0.91-0.94) for hip fracture (all p <0.001). The RR per unit change in BMI was very similar in men and women (p >0.30). After adjusting for BMD, these RR became 1 for any fracture or osteoporotic fracture and 0.98 for hip fracture (significant in women). not linearly distributed across values for BMI. Instead, the contribution to fracture risk was much more marked at low values of BMI than at values above the median. This nonlinear relation of risk with BMI was most evident for hip fracture risk. When compared with a BMI of 25 kg/m 2 , a BMI of 20 kg/m 2 was associated with a nearly twofold increase in risk ratio (RR=1.95; 95% CI, 1.71-2.22) for hip fracture. In contrast, a BMI of 30 kg/ m 2 , when compared with a BMI of 25 kg/m 2 , was associated with only a 17% reduction in hip fracture risk (RR=0.83; 95% CI, 0.69-0.99). We conclude that low BMI confers a risk of substantial importance for all fractures that is largely independent of age and sex, but dependent on BMD. The significance of BMI as a risk factor varies according to the level of BMI. Its validation on an international basis permits the use of this risk factor in case-finding strategies.

Background. Silent infarcts have been reported in 17% of young patients with sickle cell disease and are associated with impaired performance on standardized psychometric tests. Risk factors for the development of these lesions have not been identified.

This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63; 95% CI 1.18-2.25; ≥25 years: AOR 2.56; 95% CI 1.91-3.44], residence in urban areas (AOR 1.76; 95% CI 1.41-2.18), being unmarried (AOR 1.60; 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87; 95% CI 1.29-2.73; ≥35 years: AOR 2.68; 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98; 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36; 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.

Emergency workers are exposed to events involving human pain and suffering on a daily basis. They work to rescue individuals trapped in crashed vehicles, they extricate people from fires, they collect the remains of suicide victims, they care for victims of assault. Although for the most part emergency workers are equipped to deal with these events, on occasion one particular event will have a lasting impact. In recent years, researchers have focused on the potential impact of emergency work and have recognized that exposure

This report reviews the risks and consequences associated with childhood and adolescent obesity. Although no consensus definition of childhood obesity exists, the various measures encountered in the literature are moderately well correlated. The paper is organized in three parts. The first section reviews childhood obesity sequelae that occur during childhood. These short-term risks, for orthopedic, neurological, pulmonary, gasteroenterological, and endocrine conditions, although largely limited to severely overweight children, are becoming more common as the prevalence of severe overweight rises. The social burden of pediatric obesity, especially during middle childhood and adolescence, may have lasting effects on self-esteem, body image and economic mobility. The second section examines the intermediate consequences, such as the development of cardiovascular risk factors and persistence of obesity into adulthood. These mid-range effects of early obesity presage later adult disease...

Background Few studies have examined the psychopathological profiles of child offspring of bipolar parents. Such investigations are useful as a first step to identifying potential prodromal manifestations of bipolar disorder. Methods The presence of psychopathology ...

Traditional cardiovascular risk factors have been shown to cause microvascular dysfunction. Most studies that have evaluated microcirculation rely on invasive measurement tools. We used dobutamine stress echocardiography, a validated method to measure coronary flow velocity (CFV) and coronary flow reserve (CFR), in a previously unstudied population without known significant coronary artery disease to determine the impact of traditional risk factors on CFR. Consecutive patients who had no evidence of regional wall motion abnormalities at rest or during dobutamine stress echocardiography were studied. Left anterior descending artery CFV was measured at baseline and at peak dobutamine stress and CFR was calculated as the ratio of peak stress CFV to baseline CFV. Fifty-nine consecutive patients (28 men) with mean age of 66.8 ؎ 14.5 years were studied. CFR was lower in patients with diabetes mellitus (DM) compared with those without (1.7 ؎ 0.74 vs 2.48 ؎ 0.98, p <0.007), in patients with hypertension compared with those without (2 ؎ 0.8 vs 2.6 ؎ 0.9, p <0.02), and in obese patients compared with nonobese patients (1.6 ؎ 0.5 vs 2 ؎ 0.6, p <0.02). CFR was further impaired in the presence of DM with hypertension, DM with obesity, DM with a wide pulse pressure (>50 mm Hg), and obesity with a wide pulse pressure. In a multivariate model, DM, obesity, and wide pulse pressure were significantly associated with variation in CFR (p <0.0008). In conclusion, CFR was abnormal in patients with DM, hypertension, and obesity. CFR impairment is exaggerated as the number of risk factors increases. Despite a negative dobutamine stress echocardiographic result, aggressive risk factor assessment and control should be implemented in patients with coronary risk factors due to an underlying abnormal CFR.

Objective: To assess the prevalence of risk factors and risk for cardiovascular disease and Type 2 diabetes in employees with sedentary occupations enrolled in a workplace health-promotion program. Methods: Participants (n = 762) were recruited from ten Melbourne workplaces, participating in a physical activity program. Demographic, behavioral, biomedical, and physical measurements were collected. Results: The majority of employees were not meeting recommended guidelines for physical activity (62%), fruit intake (70%), vegetable intake (86%), body mass index (58%), or waist circumference (53%). Most had intermediate (53%) or high (7%) risk of developing Type 2 diabetes. Conclusions: The majority of Australian adults in sedentary occupations were not meeting guidelines for a number of chronic disease risk factors and a substantial proportion were unaware of their increased risk. This study supports the potential of chronic disease risk factor detection and intervention programs in the workplace.

Objective: Although olfactory dysfunction is commonly associated with Parkinson's disease (PD), it is not known whether such dysfunction can predate the onset of clinical PD in a community-based population. This study examines the association of olfactory dysfunction with future development of PD in Honolulu-Asia Aging Study cohort members. Methods: Olfaction was assessed from 1991 to 1996 in 2,267 men in the Honolulu-Asia Aging Study aged 71 to 95 years who were free of clinical PD and dementia at the time of olfaction testing. Participants were followed for up to 8 years for incident PD. Results: In the course of follow-up, 35 men were diagnosed with PD (24.6/10,000 person-years). The average age at the time of diagnosis was 82.9 Ϯ 3.8 (range, 76 -93) years, and the average time to a diagnosis was 4.0 Ϯ 1.9 (range, 1-8) years. During the first 4 years of follow-up, age-adjusted incidence of PD declined from 54.5/10,000 person-years in the lowest quartile of odor identification to 26.6, 8.2, and 8.4/10,000 person-years in the second, third, and fourth quartiles, respectively ( p Ͻ 0.001 for trend). After adjustment for age and other potential confounders, the odds ratios for PD in the lowest quartile was 5.2 (95% confidence interval, 1.5-25.6) compared with the top two quartiles. This relation was not evident beyond 4 years of follow-up. Interpretation: Impaired olfaction can predate clinical PD in men by at least 4 years and may be a useful screening tool to detect those at high risk for development of PD in later life.

Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS.Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters.Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI = 1.5–103.41, p = 0.0025)). The CAARMS had good to excellent reliability.Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring subthreshold psychotic symptoms for worsening into full-threshold psychotic disorder.

Background and Purpose-Little is known about activities that trigger rupture of an intracranial aneurysm. Knowledge on what triggers aneurysmal rupture increases insight into the pathophysiology and facilitates development of prevention strategies. We therefore aimed to identify and quantify trigger factors for aneurysmal rupture and to gain insight into the pathophysiology. Methods-During a 3-year period, 250 patients with aneurysmal subarachnoid hemorrhage completed a structured questionnaire regarding exposure to 30 potential trigger factors in the period soon before subarachnoid hemorrhage (hazard period) and for usual frequency and intensity of exposure. We assessed relative risks (RR) of rupture after exposure to triggers with the case-crossover design comparing exposure in the hazard period with the usual frequency of exposure. Additionally, we calculated population-attributable risks.

Background: Although human immunodeficiency virus (HIV)-related morbidity and mortality rates in patients with advanced HIV infection who are treated with combination antiretroviral drugs have declined, significant metabolic adverse effects associated with these regimens have been increasingly recognized. However, since data from patients studied before and after initiation of protease inhibitor (PI) therapy are scant, the true effect of PIs on these metabolic changes remains unknown.

Objective: To investigate factors associated with pelvic inflammatory disease (PID). Methods: A case-control study was used to investigate demographic and behavioural factors, and causative agents associated with PID. Results: A total of 381 participants were recruited: 140 patients, and 105 and 136 controls in tubal ligation and general practice groups, respectively. When compared with a PID-free tubal ligation control group, increased risk of PID was associated with: age ,25 years; age at first sexual intercourse ,20 years; non-white ethnicity; not having had children; a self-reported history of a sexually transmitted disease; and exposure to Chlamydia trachomatis. When compared with a general practice control group, increased risk was associated with: age ,25 years; age at first sexual intercourse ,15 years; lower socioeconomic status; being single; adverse pregnancy outcome; a self-reported history of a sexually transmitted disease; and exposure to C trachomatis. Of the cases, 64% were not associated with any of the infectious agents measured in this study (idiopathic). Conclusions: A high proportion of cases were idiopathic. PID control strategies, which currently focus on chlamydial screening, have to be reviewed so that they can prevent all cases of PID. Behavioural change is a key factor in the primary prevention of PID, and potential modifiable risk factors were associated with PID.

Methods. All patients aged 80 years or older (n ‫؍‬ 282) undergoing isolated AVR between November 1995 and June 2006 at our institution were reviewed according to logistic EuroSCORE (ES log ) risk stratification. Surgical risk was defined as low risk (ES log < 10% [n ‫؍‬ 107]), moderate risk (10% < ES log < 20% [n ‫؍‬ 103]), and high risk (ES log > 20% [n ‫؍‬ 72]). Patient age was 82 ؎ 2 years (low risk), 82.7 ؎ 2.7 years (moderate risk), and 83.6 ؎ 3.1 years (high risk), respectively (p < 0.05). Mean ES log predicted risk of mortality was 7.3% ؎ 1.4% (low risk), 13.7% ؎ 2.5% (moderate risk), and 33.0% ؎ 11.5% (high risk; p < 0.05). Follow-up was 99.7% complete.

Diabetes is associated with increased fracture rates but the effect size, time course and modifying factors are poorly understood. This study was undertaken to assess the effect of diabetes on fracture rates and possible interactions with age, duration of diabetes and comorbidity. A retrospective, population-based matched cohort study was performed using the Population Health Information System (POPULIS) for the Province of Manitoba, Canada. The study cohort consisted of 82,094 diabetic adults and 236,682 non-diabetic matched controls. Diabetes was subclassified as long term, short term, and newly diagnosed. Number of ambulatory diagnostic groups (ADGs) was an index of comorbidity. Poisson regression was used to study counts of combined hip, wrist and spine (osteoporotic) fractures (5691 with diabetes and 16,457 without diabetes) and hip fractures (1901 with diabetes and 5224 without diabetes). Independent effects of longer duration of diabetes (p-for-trend < 0.0001) and number of ADGs (p-for-trend < 0.0001) were observed on fracture rates. Newly diagnosed diabetes showed a reduction in osteoporotic fractures (rate ratio [RR] 0.91 [95% CI, 0.86-0.95]) and hip fractures ). Long-term diabetes showed an increase in osteoporotic fractures (RR 1.15 [CI,) and hip fractures ). We conclude that long-term diabetes is associated with increased fracture risk, whereas newly diagnosed diabetes shows a reduction in fractures. It is hypothesized that the opposing effects of overweight/obesity and diabetes-related complications contribute to the observed biphasic fracture risk, though causality cannot be proven from this observational study.

La lombalgie commune constitue un problème de santé publique par sa fréquence et ses conséquences en milieu de travail. Les objectifs de notre étude sont la détermination de la prévalence de la lombalgie commune chez le personnel hospitalier, l'analyse des conséquences médicoprofessionnelles et la recherche de facteurs associés à la lombalgie commune. Méthodes.-Nous avons réalisé une enquête portant sur 350 employés de l'hôpital universitaire Fattouma-Bourguiba de Monastir. Ces employés ont répondu à un questionnaire pré-établi comportant 51 items. Résultats.-La prévalence cumulée de la lombalgie était de 57,1 % des cas, la prévalence annuelle était de 50,1 % des cas, la prévalence de la lombalgie chronique était de 12,8 % des cas. Les soins médicaux étaient nécessaires dans 61,9 % des cas. Les explorations radiologiques étaient effectuées dans 45 % des cas. L'arrêt de travail était observé dans 26,1 % des cas et un changement de poste de travail était nécessaire pour deux agents. Les facteurs associés à la lombalgie étaient l'âge (p < 0,01), le sexe féminin (p = 0,024), le BMI élevé (p = 0,01), le fait d'être marié ou divorcé (p < 0,01), le tabagisme (p = 0,016), les antécédents de lombalgie (p < 0,0001), l'activité extra-professionnelle (p < 0,01), la migraine (p < 0,001), l'ancienneté dans l'établissement (p = 0,007) ainsi que le port de charges lourdes (p = 0,008). Le sport constitue plutôt un facteur protecteur de la lombalgie (p = 0,019). Conclusion.-La prévalence de la lombalgie chez les personnels hospitaliers ainsi que ses répercussions socioprofessionnelles sont importantes. Plusieurs facteurs sont associés à cette lombalgie incitant à entreprendre des mesures préventives de cette affection.

To compare risk factors for cardiovascular disease in pet owners and non-owners. Accepted risk factors for cardiovascular disease were measured in 5741 participants attending a free, screening clinic at the Baker Medical Research Institute in Melbourne. Blood pressure, plasma cholesterol and triglyceride values were compared in pet owners (n = 784) and non-owners (n = 4957). Pet owners had significantly lower systolic blood pressure and plasma triglycerides than non-owners. In men, pet owners had significantly lower systolic but not diastolic blood pressure than non-owners, and significantly lower plasma triglyceride levels, and plasma cholesterol levels. In women over 40 years old, systolic but not diastolic pressure was significantly lower in pet owners and plasma triglycerides also tended to be lower. There were no differences in body mass index and self-reported smoking habits were similar, but pet owners reported that they took significantly more exercise than non-owners, and a...

This study explored women's use of aggression, focusing on how they define initiation of aggression and what motives they have for behaving aggressively. Twenty-five women who had used aggression during conflicts with their romantic partners were interviewed. Results indicated that, while the women reported initiating aggression in the majority of conflicts described (54%), they varied in how they defined initiation, with some believing that initiating aggression meant being angry, bringing up the conflict issue, or persistently asking the partner to engage verbally. Twelve categories of motives for the use of aggression were also identified. Theoretical and practical implications are discussed, highlighting the ongoing need for an ecological perspective when studying women's use of aggression.

Temporal trends in the incidence of opportunistic diseases (ODs) related to acquired immunodeficiency syndrome (AIDS) were studied during 1989-1997 in 1115 outpatients infected with human immunodeficiency virus (331 of whom had AIDS) in a hospital in Madrid, Spain. We analyzed the effect of adherence to antiretroviral therapy and Pneumocystis carinii pneumonia (PCP) prophylaxis on the incidence of OD. Diseases that showed a significant decreasing trend were esophageal candidiasis, pulmonary and extrapulmonary tuberculosis, and cerebral toxoplasmosis. Patients who adhered to antiretroviral therapy had a smaller risk of OD. Patients who adhered to PCP prophylaxis had a reduced risk of cerebral toxoplasmosis and PCP. A reduction in the incidence of AIDS-related ODs was observed, mainly in patients who underwent prophylaxis. Adherence to antiretroviral treatment and PCP prophylaxis was associated with a reduction in the risk of disease.

OBJECTIVES: To examine hospital use for patients with evidence of cognitive decline indicative of early cognitive impairment. DESIGN: Medicare Part A hospital utilization data were linked to data from the MacArthur Research Network on Successful Aging Community Study to examine the association between baseline cognition and decline in cognitive function over a 3-year period and any hospitalization over that same period. SETTING: New Haven, Connecticut, and East Boston, Massachusetts. PARTICIPANTS: Subjects (N 5 598) were from two sites of the MacArthur Research Network on Successful Aging Community Study, a 7-year cohort study of communitydwelling older persons with high physical and cognitive functioning. MEASUREMENTS: Multivariate logistic regression was used to determine the association between any hospitalization over 3 years (1988-91) as the outcome variable and baseline cognitive function and decline in cognition over 3 years as primary predictor variables. Decline was based upon repeated (1988 and 1991) measures of delayed verbal recall and the Short Portable Mental Status Questionnaire (SPMSQ). RESULTS: Of 598 subjects, 48 died between 1988 and 1991. No baseline (1988) delayed recall scores or change in recall scores were associated with hospitalization. Although 48.2% declined on verbal memory scores, decline was not associated with risk of hospitalization. Of 494 subjects with complete 3-year data, 31.2% declined at least one point on the SPMSQ, and 4.7% declined more than two points. Among individuals aged 75 and older at baseline, the adjusted odds ratio for hospitalization for those who declined more than 2 points compared with those who declined less was 7.8 (95% confidence interval 5 2.0-30.8). CONCLUSION: Although specific memory tests were not associated with hospitalization, high-functioning older persons who experienced decline in overall cognitive function were more likely to be hospitalized. Variation in baseline cognitive function in this high-functioning cohort did not affect hospitalization, but additional research is needed to evaluate associations with other healthcare costs.

Hyperuricemia is associated with hypertension, vascular disease, renal disease, and cardiovascular events. In this report, we review the epidemiologic evidence and potential mechanisms for this association. We also summarize experimental studies that demonstrate that uric acid is not inert but may have both beneficial functions (acting as an antioxidant) as well as detrimental actions (to stimulate vascular smooth muscle cell proliferation and induce endothelial dysfunction). A recently developed experimental model of mild hyperuricemia also provides the first provocative evidence that uric acid may have a pathogenic role in the development of hypertension, vascular disease, and renal disease. Thus, it is time to reevaluate the role of uric acid as a risk factor for cardiovascular disease and hypertension and to design human studies to address this controversy.

We review the risk and protective factors for child physical abuse (CPA). An etiological model based on moderate to strongly supported risk factors would begin with distal perpetrator variables of being abused as a child/teen and receiving less family social support as a child. Next might come current family variables such as parents' youth, father's drinking, and family's living in a community that is impoverished and/or has a lower percentage of two parent families. More proximal variables that increase the probability of parents, especially mothers, employing severe or abusive physical tactics could include mothers' dysphoria (e.g., unhappiness, emotional distress, anxiety, loneliness and isolation, depression, somatic complaints, interpersonal problems, feelings of incompetence as a parent, a tendency toward becoming upset and angry), and stress (more stressful life events, including parenting and other family stresses) and coping (most likely a protective factor, including problem solving and social support). Finally, risk factors that are proximal to abuse could include mothers' high reactivity (impulsivity, high negative affect and autonomic nervous system arousal), high-risk parenting (harsh discipline strategies, verbal aggression, yelling), and negative attributions, and children's behavior problems (e.g., socialized aggression, attention deficits, and internalizing and externalizing problems).

One of the many factors that must be considered when conducting juvenile risk assessments is treatment amenability. Traditionally, research on risk assessments has focused on treatment needs, likelihood of violence, and likelihood of recidivism. However, there has been little empirical guidance for assessing treatment amenability. This article proposes the possibility of using locus of control as a psychological construct to aid in assessing treatment amenability of juveniles. Through a review of the locus of control literature, the authors found that internal orientation has been found to relate to increased treatment participation, help-seeking behaviors, and positive treatment outcomes. Further, external orientation has been found to be related to poorer treatment participation and outcomes. While there is some debate whether locus of control is a static or a fluid phenomenon, its ability as a predictor of treatment amenability as well as an indicator of treatment response is discussed.

Background-Low tidal volume ventilation for Acute Respiratory Distress Syndrome (ARDS) is a well accepted concept. However, controversy persists regarding the optimal ventilator settings for ventilated patients without ARDS. This study tested the hypothesis that ventilator settings influence the development of new ARDS. Methods-Retrospective analysis of patients from the MIMIC-II database who were mechanically ventilated for ≥48 hours between 2001 and 2005. Results-2583 patients required greater than 48 hrs of ventilation. Of 789 patients who did not have ARDS at admission, 152 (19%) went on to develop ARDS. Univariate analysis revealed high peak inspiratory pressure (PIP) (OR 1.53 per standard deviation, 95% confidence interval 1.28-1.84), increasing PEEP (OR 1.35 per SD, 95%CI 1.15-1.58) and tidal volume (OR 1.36 per SD, 95%CI 1.12-1.64) to be significant risk factors. Major non-ventilator risk factors for ARDS included sepsis, low pH, elevated lactate, low albumin, transfusion of packed red blood cells, transfusion of plasma, high net fluid balance, and low respiratory compliance. Multivariable logistic regression showed that peak pressure (OR 1.31 per SD, 95%CI 1.08-1.59), high net fluid balance (OR 1.3 per SD, 95%CI 1.09-1.56), transfusion of plasma (OR 1.26 per SD, 95%CI 1.07-1.49), sepsis (OR 1.57, 95%CI 1.00-2.45) and tidal volume (OR 1.29 per SD, 95%CI 1.02-1.52) were significantly associated with the development of ARDS. Conclusions-The associations between the development of ARDS and clinical interventions, including high airway pressures, high tidal volume, positive fluid balance and transfusion of blood products, suggests that ARDS may be a preventable complication in some cases.

The current study examined whether a social desirability response bias is a source of measurement error in prevention research. Six hundred and seventy-seven female students in Grade 7 (n = 345) and Grade 8 (n = 332) were divided into either an intervention condition, in which participants watched a videotape promoting body acceptance and discouraging dieting and then discussed issues related to the video, or a control condition. Questionnaires were completed at baseline, postintervention, and at 1-month follow-up. Social desirability scores were correlated at a low but significant level with baseline body dissatisfaction, drive for thinness, bulimic tendencies, intention to diet, and size discrepancy for intervention participants. Social desirability did not correlate significantly with change over time in the outcome measures. The findings suggested that changes in girls&#39; self-reports related to a prevention program were relatively free of social desirability response bias.

Central venous catheters are being increasingly used in both intensive care units and general wards. Their use is associated with both mechanical and infectious complications. This review will focus on short-and medium-term mechanical complications of catheter placement; infectious complications will be discussed in a separate article. The most important risk factors are patient characteristics (morbidity, underlying disease and local anatomy), the expertise of the doctor performing the procedure, and nursing care. Placement aids, such as ultrasoundguided catheter insertion, are also discussed.

Objective Numerous genes have been associated with the risk for type 2 diabetes mellitus (DM2). In an attempt to understand how specific variants of different genes interact and intervene in the molecular and physiological mechanisms of disorders such as diabetes or insulin resistance, the search for gene-gene interactions is constantly growing. We searched for a possible interaction between two polymorphisms (Trp64Arg of ADRB3 gene and-75G/A of APOA1 gene) and the risk for DM2 in a population from southern Spain. Design and methods A cross-sectional study in southern Spain of 1020 people, aged 18-65 years. All persons underwent a clinical, anthropometrical and biochemical evaluation, including an oral glucose tolerance test (OGTT). Insulin resistance was measured by homeostasis model of assessment (HOMA). The polymorphisms-75G/A of APOA1 and Trp64Arg of ADRB3 were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and real-time PCR, respectively. Results The genotype frequencies of the-75G/A polymorphism of the APOA1 gene were 62•7% GG, 25•7% GA and 11•6% AA, whereas for the Trp64Arg polymorphism of the ADRB3 gene, they were 87•5% Trp/Trp, 11•7% Trp/Arg and 0•8% Arg/Arg. Subjects with both gene variants had a greater odds ratio (OR) of having DM2 [OR = 5•5; 95% confidence interval (CI) = 1•2-23•5] than persons with one or none of the variants, after adjusting for age, sex, body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR). Conclusions Joint association of allele-75A (APOA1) and allele Arg64 (ADRB3) increase the risk of DM2 in a population from southern Spain.

We hypothesized that a suicide risk assessment (SRA) training module incorporating standardized patients (SPs) would enhance pediatric resident SRA performance. We conducted an educational survey of pediatric residents regarding SRA (N = 80). In addition, we tested the performance of a SRA training module among pediatric interns who received SRA practice with SPs simulating suicidality scenarios, with (n = 6) or without (n = 6) SRA lecture, or SRA lecture only (n = 12) and control interns (n = 10). We examined postintervention confidence in SRA and self-reported and objectively measured knowledge of suicidal risk factors. Resident confidence and knowledge regarding SRA were low, compared with assessment of medical illness. Interns in the SP plus lecture group had significantly greater confidence in screening adolescents for suicide risk factors and assessing suicidal adolescents (screening, 4.2 +/- 0.4; assessing, 4.2 +/- 0.4), compared with subjects in either the lecture-only (scre...