Risk factors for stillbirths in two swine farms in the south of Brazil

We evaluated stillbirth risk factors in two commercial swine farms of the Rio Grande do Sul State (south of Brazil). The study was conducted during 1 month in Farm A and during 2 months in Farm B, both during 1999. Data for all farrowings that occurred during the study period were recorded (101 for Farm A and 373 for Farm B), without interference in the farm management. In Farm A, 39% of all litters born during the period of interest had stillborn piglets and the stillborn risk for piglets was 12%. In Farm B, 25% of all litters had stillborn piglets whereas the stillborn risk was 2%. Variables considered as potential risk factors for stillbirths were: parity (1, 2-3, 4+); breed (purebred or crossbred); sow body-condition (normal or fat); use of oxytocin during parturition (yes or no); obstetric intervention through vaginal palpation (yes or no); farrowing duration (<4 or > or =4h); mummified fetuses (yes or no); total litter size (<12 or > or =12 piglets); and litter birth weight (<11 or > or =11kg). All stillborn piglets had their classification validated by necropsy. In multivariable logistic-regressions, the cases were the litters having at least one stillborn piglet. In Farm A, litters having at least 12 pigs and in which oxytocin was used during the parturition had 20.8-times-higher odds of stillborn occurrence. In Farm B, litters from sows having parity > or =4 had 2.2-times-higher odds of stillborn occurrence than litters from parity 2 to 3 females, litters having > or =12 pigs had 2.0-times-higher odds of a stillborn piglet than smaller litters and farrowings in which vaginal palpation was performed had 8.0-times-higher odds. Farrowing room management to minimize stillborn risk should target higher-parity females, large litters and optimization of practices of obstetric interventions.

Transient or persistent asthma-like symptoms and lung growth over 2-year follow-up in pre-adolescent children

BACKGROUND

The main purpose of this study was to assess the effect of transient and continued asthma-like symptoms on lung function growth in preadolescent children.

METHODS

The follow-up respiratory health survey has been conducted on the sample of 1,129 children aged 9 years over 2 years follow-up. The basic health end-points were the occurrence of asthma-like symptoms and slower lung function growth (SLFG), which was defined as the lung function gain over 2 years within the lowest quintile of the distribution of a given spirometric test.

RESULTS

Adjusted odds ratios (OR) for SLFG [forced vital capacity (FVC)] were significantly higher only in the children having continued symptoms [OR = 3.39: 95% confidence interval (CI) = 1.39-8.27]. There was a consistent trend of adjusted ORs for SLFG [forced expiratory volume (FEV,) with the category of symptoms, where OR was 2.00 (95% Cl = 1.17-3.42) in children with transient symptoms: while 4.10 (95% Cl = 1.71-9.86) in children who had persistent symptoms. The corresponding ORs for SLFG [maximal mid-expiratory flow (FEF25_75c)] were 2.27 (95% Cl = 1.37-3.76); and 5.43 (95% Cl = 2.38-12.40).

DISCUSSION

The association between asthma-like symptoms and lung function gain in preadolescent children confirmed the clinical significance of the symptoms in question. The observed slower lung function gain in preadolescence may have implications for the development of chronic lung disease later in adulthood.

Cohort study on low physical activity level and recurrent acute respiratory infections in schoolchildren

The purpose of the study was to explain childhood respiratory infections in terms of life-style factors like being overweight or physically inactive. In the course of the cohort study we gathered data on respiratory health of 1028 preadolescent children in Krakow. Recurrent acute respiratory infections (RARI) in children have been defined as frequent spells (10 or more infections) over the two-year follow-up. In scoring the physical activity level, the data on regularly exercising sport and the number of hours spent daily TV watching or doing homework have been used. Excessive weight was based on the BMI index. In the total sample, the RR estimates of RARI adjusted to BMI and other potential confounders were consistently higher in children with low physical exercise (RR = 2.96; 95% CI: 1.78-4.93) or with moderate exercise (RR = 1.87; 95% CI: 1.33-2.65). Than among the highly active group. In the subgroups of allergic and non-allergic or overweight and not-overweight children the adjusted RR estimates were consistent with those found in the total sample. We concluded that physical exercise in preadolescent children may lessen the risk of acute respiratory infections and that the low physical activity is an independent predictor of increased risk of RARI besides excessive weight and other potential risk factors.

Reversibility of asthma-like symptoms and lung function growth over two-year follow-up in preadolescent children

BACKGROUND

The interesting feature of childhood asthma is the great reversibility of symptoms. The main purpose of this study was to assess the effect of persistent and reversed asthma-like symptoms on lung function growth in preadolescent children.

MATERIAL AND METHODS

The follow-up respiratory health survey has been conducted in the sample of 1129 children aged 9 yrs over two years follow-up. The basic health end-points was the occurrence of asthma-like symptoms and the slower lung function growth (SLFG).

RESULTS

Adjusted OR for SLFG(FVC) was significantly higher only in the children having the continued symptoms(OR = 3.40; 95% CI: 1.32-8.77). There was a consistent trend of adjusted ORs for SLFG(FEV1) with the category of symptoms, where OR was 1.46 (95% CI: 1.02-2.10) in children with recent new symptoms; 2.06; (95% CI: 0.93-4.58) in those with symptoms remitted, while 3.46; (95% CI: 1.43-8.40) in children who had persistent symptoms. The corresponding ORs for SLFG(FEF25-75%) were 2.03; (95% CI: 0.97-4.28), 2.63; (95% CI: 1.38-4.99), and 5.84; (95% CI: 2.53-13.50).

CONCLUSIONS

The consistent association between reversibility of asthma-like symptoms and lung function gain in preadolescent children confirmed the clinical significance of the symptoms in question. The observed slower lung function gain in preadolescence may have implications for the development of chronic lung disease later in adulthood.

Capsular type distribution and susceptibility to antibiotics of Streptococcus pneumoniae clinical strains isolated from Uruguayan children with systemic infections. Pneumococcus Study Group

Children under 24 months of age are at high risk for serious infection with Streptococcus pneumoniae but they do not elicit effective immune responses to the currently available capsular polysaccharide vaccines. A polysaccharide protein conjugated vaccine involving the most frequent types has become an urgent need. To produce such a vaccine for Latin America, information on type distribution is required. Recently, Uruguay was 1 of the 6 countries in Latin America where surveillance for invasive pneumococcal infections in children under the age of 5 years was carried out. Seventy percent of the 182 invasive S. pneumoniae isolates were recovered from patients under 24 months of age, and 19% were recovered from infants under 6 months. The 7 most frequent types were 14, 5, 1, 6B, 3, 7F, and 19A; representing 80% of invasive isolates. Twenty-one types were identified, 16 in pneumonia and 14 in meningitis. Resistance to penicillin increased during the study period, from 29% in 1994, to 40% in 1995-1996, mainly because of the spread of type 14 strains resistant to penicillin and trimethoprim/sulphamethoxazol (89% of resistant isolates). The high proportion of systemic pneumococcal infections recorded in patients under 24 months of age and the increasing resistance of these agents to first-choice antibiotics point to an urgent need for a capsular polysaccharide protein conjugated vaccine.

Clinical efficacy and tolerability of a steady dosage schedule of local nasal immunotherapy. Results of preseasonal treatment in grass pollen rhinitis

BACKGROUND

Local nasal immunotherapy (LNIT) is an effective and safe alternative to conventional subcutaneous immunotherapy. A specific nasal provocation test (SNPT) could be used to indicate the optimal subclinical dose to carry out LNIT.

OBJECTIVE

We hypothesize that LNIT could be carried out with only one predefined dose for all patients, so we have evaluated the efficacy and the tolerability of LNIT administered at steady dosages in patients with seasonal allergic rhinitis.

METHODS

Twenty grass pollen-sensitized patients suffering from seasonal allergic rhinitis were studied in a randomized, double-blind, placebo-controlled trial. The treatment was carried out according to a schedule based on the administration of a steady subclinical dosage of the allergenic extract, selected on the basis of the sensitivity threshold of the SNPT. The patients were divided into two groups of 10 people each, which were treated either with grass pollen extract in a hydroglyceric solution or with placebo.

RESULTS

During the peak pollen period, with regard to the placebo (P) group, in the grass treated (GT) group a significant decrease of both nasal symptoms (P = .021) and consumption of antihistamines (P = 0.047) was found. Furthermore, only in the GT group was the provocative dose assessed by the SNPT significantly lower (P = .049) at the end of the treatment. In this group of patients an inverse correlation between such provocative dose and the nasal symptom score reported during the peak pollen period was also evidenced (r = 0.708; P = .038). Adverse reactions to LNIT were mild, rare, and did not interfere with the completion of the therapeutic schedule.

CONCLUSIONS

Our study indicates that LNIT, when administered at steady dosages, may be proposed as a treatment for grass pollen seasonal allergic rhinitis as it appears to be effective and well tolerated.

Predisposition to acute respiratory infections among overweight preadolescent children: an epidemiologic study in Poland

This cross-sectional field health survey has as its subjects 1129 preadolescent children resident in Krakow. Trained health visitors interviewed the mothers at the children's schools or at the parents' homes in order to gather standardized information regarding the families' social background and the families' and children's respiratory health and episodes of respiratory infections. Predisposition to respiratory infections in children has been defined as frequent spells (3 or more) of acute respiratory infections experienced by a given child over the 12 months preceding the interview. Clinical examination of children consisted of anthropometric measurements and spirometric testing. Anthropometric measurements (weight and height) were used for calculation of the body mass index (kg/m2). A child whose BMI was 20 or higher was defined as overweight (90th percentile). Susceptibility to acute respiratory infections was related significantly to body mass index. The children with BMI > or = 20 experienced twice as high a risk for acute respiratory infections than children with low BMI (OR = 2.02, 95% CI: 1.13-3.59). Out of other potential factors possibly involved in the occurrence of respiratory infections only the presence of chronic respiratory symptoms (OR = 2.43, 95% CI: 1.64-3.59), allergy (OR = 1.89, 95% CI: 1.34-2.66), and Environmental Tobacco Smoke (OR = 1.54; 95% CI: 1.05-2.25) increased the susceptibility of children to acute respiratory infections. Central heating in the household was shown to have a protective effect (OR = 0.65, 95% CI: 0.43-1.00) when compared with children from households where coal or gas was used for home heating.

A double-blind, placebo-controlled study of preventive immunotherapy with E.P.D., in the treatment of seasonal allergic disease

Control of seasonal symptoms by means of a preventive and easy to use (only one intradermal injection eight weeks before the pollen peak) immunotherapy, is recommended nowadays. We verified the clinical efficacy of E.P.D. (Enzyme Potentiated Desensibilization) in a double-blind, placebo-controlled study. This particular immunotherapy consists of an intradermal injection mix, made up of allergenic extracts at extremely low doses and an enzyme called beta-glucuronidase. The vaccine is administered once a year, eight weeks before pollen peaks. We studied a group of 40 patients allergic to grass pollen. The results, analysed statistically on the basis of a symptoms score, showed good clinical efficacy and a significant reduction of drug consumption during the high pollen period. Due to the clinical effectiveness, easy administration (only on injection) and excellent tolerance of the immunotherapy, E.P.D. is particularly suited for the prevention of seasonal symptoms in patients allergic to grass pollen.

Environmental pollution in central and eastern European countries: a basis for cancer epidemiology

The main objective of this paper is to discuss the environmental issues in the countries of central and eastern Europe (CCEE) and to show their significance for cancer epidemiology. Of known cancer risk factors that may be related to environmental exposure in the CCEE, tobacco smoking is probably the most important. The worsening trends in cancer mortality noted in middle-aged men in the CCEE can be attributed to smoking. Other lifestyle factors that interact with environmental hazards include high alcohol consumption and unhealthy nutrition. Among other factors, the most common environmental exposure in the CCEE that has potential adverse effects on health in terms of cancer incidence is related to high levels of ambient and indoor pollutants exceeding the air quality guidelines of the World Health Organization. Millions of people, usually in urban areas, are estimated to be exposed to such levels of pollution. Outdoor air pollution is a substantial environmental problem in many areas of the CCEE, where heavy industries are concentrated without adequate technology for emission control. Chemically contaminated drinking water provides a major route of exposure for many potential environmental health hazards. The pollution of water resources, including groundwaters, by industrial and agricultural wastes is a widespread problem in both the CCEE and the former USSR. An estimated 13% of treatment plants in the Russian Federation lack the necessary equipment to treat drinking water, particularly for disinfection, to meet the required standards. Many countries in the region have problems in rural areas, where the networks are small or consumers depend on private wells, and treatment of drinking water is either poor or nonexistent. Consequently, because the standards are difficult to meet, drinking-water accumulates high levels of arsenic and nitrates. The main concern is nitrate, arsenic, fluoride, and pesticides. In countries like Bulgaria, Hungary, Romania, and Slovakia, locations are known where nitrate concentration in drinking water are high enough to cause methemoglobinemia. Lack of appropriate data hamper valid estimates of the extent of unhealthy working conditions or of poor housing conditions. Unsafe industrial installations are potential environmental health hazards, the possible scale of which is difficult to estimate reasonably.

Relationship between obsessive-compulsive personality disorder and obsessive-compulsive disorder

This study investigated the presence of obsessive-compulsive personality disorder (OCPD) in a group of 277 patients (88 with obsessive-compulsive disorder [OCD], 58 with major depressive disorder [MDD], and 131 with panic disorder [Panic]) to test the specificity of the relationship between OCPD and OCD. OCPD is statistically significantly more frequent in patients with OCD than in those with Panic and MDD. The distribution of single criteria of OCPD in the three groups does not differ significantly. Discriminant analysis selects a list of items that provide a correct classification rate of 66% based on OCPD criteria selected by canonical function. OCD patients with and without OCPD do not differ in sex, age of onset, duration of illness, positive family history for Tics disorder/Tourette syndrome (TS), or morbidity risk for OCD.

Individual susceptibility to inhaled pollutants--identification, mechanisms and public health policy implications

In every community, there are individuals whose chances of illness or accident are greater than those of others. In susceptible persons, adverse health effects occur at a lower exposure than in the majority of population. The reason for this, though often weak, can usually be ascertained. The paper focuses primarily on host factors that may increase an individual's susceptibility to air pollutants present in the general environment. These factors include genetic background, age, gender, nutritional status, physiological status, presence of coexisting lung disease, and lifestyle. They relate to various mechanisms of individual susceptibility to air pollutants from the environment into the body, to alterations in detoxification and immunological reactions, and to variations in the responsiveness of lung tissues. Several epidemiological techniques to detect biological events relevant to host susceptibility and disease progression are mentioned. They are mainly based on genetic traits, host characteristics, pulmonary function tests, biochemical and immune changes. Measuring the variations in risk among susceptible individuals is necessary to assess correctly respiratory health risk due to inhaled pollutants at the population level, and subsequently to develop rational public health policy to reduce the incidence of those diseases in a given population. Before being able to formulate this policy, however, one must know how to detect those individuals who are susceptible to air pollutants.

Effects of Deomestic Gas Cooking and Passive Smoking on Chronic Respiratory Symptoms and Asthma in Elderly Women

The purpose of the study was to assess the effect of indoor air pollution resulting from the use of gas stoves for cooking on women more than 65 years old, who may be more susceptible than younger women to the harmful effects of pollutants. A total of 1,544 women living in Cracow took part in a survey. The data were collected to standardized interviews dealing with respiratory symptoms (coughing, phlegm production, dyspnea on exertion), chronic chest diseases diagnosed by a doctor, active and passive smoking, educational level, type of cooking fuel used, and average time spent daily in cooking. Lung function was tested with a spirometer. Comparison of the prevalence of respiratory symptoms by daily duration of cooking of smokers with that of never-smokers showed more symptoms in smokers even in the low-exposure category. In multivariate analysis, the effects of duration of cooking with gas on asthma for the highest exposure category in terms of odds ratios (ORs) were 2.8 for the never-smokers and 2.4 for the smokers; however, passive smoking had no significant effect. As regards dyspnea on exertion, both gas cooking and passive smoking had significant effects in never-smokers (OR for gas cooking 7.2, for passive smoking 2.2). The OR for dyspnea due to cooking with gas in smokers was 3.1. Mean FVC and FEV&inf1; levels were not decreased among passive smokers or those who were subject to high levels of gas-cooking exposure.

Better perspectives on use of biological markers in monitoring of lung cancer risk in occupational settings

Although conventional approaches in cancer epidemiology and prevention have provided a wealth of information, they are seriously limited in their ability to detect and evaluate carcinogenic hazards. However, traditional methods combined with newly developed laboratory procedures provide biological markers of molecular or biochemical events linked to carcinogen exposure and open a new approach to the study of human cancer risk assessment. The goal of the new approach is to identify as precisely as possible specific carcinogenic hazards in the environment, to assess their biologically effective dose and biological effect, and to provide a means of appraising host factors that modify susceptibility. A particular promising new tool of cancer risk assessment is the highly sensitive immunoassay for carcinogen-DNA adducts. These assays may provide a tissue dosimeter of carcinogen exposure. In this paper research studies were mentioned that aimed at assessing the levels of benzo[a]pyrene-DNA adducts and protein adducts, utilizing white blood cells, or tissue specimens obtained from tissue biopsy or autopsy. Another promising method in discovering BAP exposure are levels of carcinogen-metabolizing enzymes. The potential significance in surveillance and monitoring of aryl-hydrocarbon hydroxylase (AHH) has been discussed.

Erythrocytes parameters due to aging, smoking, alcohol consumption and occupational activity in a working population of petrochemical industry. The Pavia Study

The main purpose of the study was to assess the red blood cell disorders in works employed in the petrochemical industry in the Lombardia region (ENI). In the analysis of the data the confounding factors such as age, smoking habit, alcohol consumption, nutritional status based on body mass index have also been taken into consideration. In total, material consisted of 1175 male workers in whom red blood cell examination of the peripheral fasting blood was carried out. The results of the study showed that clinical anemia has been found in 1.7% of subjects examined. The distribution of anemia cases was not related to job category or physical occupational activity, neither to age, smoking or alcohol consumption. However, the results of the study suggest that aging processes are associated with weakening of hemopoietic system which affect in a great extent hemoglobin production. The effect of smoking on hemopoietic system appeared to have different features from that attributed to aging. Smoking increased hemoglobin level and hematocrit significantly in comparison to nonsmokers, but had no effect on the number of erythrocytes. It was concluded that adaptation to carbon monoxide inhaled with cigarette smoke is reflected by an increased red cell mass and hemoglobin. Occupational factors measured by the type of job (manual vs nonmanual) appeared to have no harmful effect on the hemopoietic system, however, respondents who reported working physically in an intensive way, showed significantly lower mean corpuscular concentration hemoglobin level than those having a sedentary job or engaged in very small physical activity at work.

A computerized program of skin test evaluation and its predictive value in immunotherapy

The present study describes a computerized methodology for the assessment of specific skin testing which is both sensitive and reproducible. We evaluated the predictive value of this technique in identifying patients at great risk for developing undesirable reactions during hyposensitization. In 11 of 93 patients we were able to detect an unusual dermal response in the patients who developed either generalized or local generalized adverse reactions.

Discriminant analysis in the differential diagnosis of hypercalcaemia

Linear discriminant analysis, a multivariate statistical procedure, applied to serum calcium, phosphate, alkaline phosphatase, bicarbonate, chloride, creatinine and tubular reabsorption of phosphate, proved to be effective in distinguishing patients with Primary Hyperparathyroidism from other hypercalcaemic patients in eithy-four retrospective cases. The application of the model to thirty-four prospective cases enabled us to separate correctly, hyperparathyroid patients from non-parathyroid hypercalcaemic patients.

Failure of somatostatin to diagnose organic hyperinsulinism

In four patients with organic hyperinsulinism (two with surgically proven beta-cell adenomas of the body of the pancreas) a standard tolbutamide test during continuous somatostatin infusion (5 microgram/min) was carried out. Tolbutamide induced insulin release was completely inhibited by somatostatin as in normal subjects. These results suggest that the inhibition test with somatostatin does not seem to be a better or safer way of diagnosing insulin producing tumours.

[Serum calcium evaluation and incidence of primary hyperparathyroidism in hospitalized patients (author's transl)]

Automated laboratory procedures have made possible to "screen" a large population for specific biochemical abnormalities. Primitive hyperparathyroidism is for several respects an excellent disease model for testing "mass screening". Il is often asymptomatic, not uncommon, and is manifested by abnormalities in the levels of serum calcium and inorganic phosphorus, that can be detected cheaply with automated equipment. A computer program has been developed to screen patients with hypercalcaemia. During a period of 18 months 22720 hospitalized patients were investigated by the evaluation of serum calcium, and 80 hypercalcaemic patients were found. The diagnosis of primary hyperparathyroidism was established in 24 patients (in 19 histologically confirmed) so that the incidence of primary hyperparathyroidism (1,05%) compares favorably with that reported from some foreign Authors.

Primary hyperparathyroidism: diagnostic value of a model of multivariate statistical analysis

In examining a group of 90 hypercalcaemic patients (37 with primary hyperparathyroidism), a comparison was made of the diagnostic reliability of: 1) tests commonly used for diagnosis of primary hyperparathyroidism; 2) radioimmunoassay of plasma parathormone; 3) a recently introduced model of multivariate statistical analysis. The results indicate that, at present, the model of multivariate statistical analysis used is of higher diagnostic reliability in the diagnosis of primary hyperparathyroidism than renal phosphate excretion tests and the radioimmunoassay of PTH itself.