Pelvic pain and associated characteristics among women in northern Mexico.

CONTEXT: Until recently, the reproductive health agenda has focused on a restricted number of morbidity indicators, particularly those associated with life-threatening diseases. However, gynecologic morbidities that are a source of pelvic pain, although not life-threatening, do impose a substantial burden because of their potential to reduce women's overall well-being. METHODS: In 2005, a cross-sectional population-based study was conducted in Hermosillo, Mexico, to assess self- reported pelvic pain conditions in a random sample of 1,307 women aged 25-54. The 12-month prevalence of each condition was calculated, and logistic regression was used to assess the association between pelvic pain and social, demographic, anthropometric and reproductive characteristics, and other medical conditions. RESULTS: The 12-month prevalence of pelvic pain during menstruation among 1,007 menstruating women was 40%. Pelvic pain during or after sexual intercourse was reported by 12% of the 1,183 sexually active respondents. Among 1,201 nonpregnant women, 6% reported chronic pelvic pain. In adjusted analyses, younger age (25-34 years) and having a history of STIs or pelvic inflammatory disease (PID) were associated with an increased risk of pain during menstruation and chronic pelvic pain (odds ratios, 1.6-3.1). An interaction term for younger age and history of STIs or PID was associated with an elevated risk of intercourse-related pelvic pain (6.4). Chronic pelvic pain and pain during menstruation were more frequently reported as interfering with daily activities than was intercourse-related pelvic pain. The proportion of women who had talked with a physician about their condition was highest among those with chronic pelvic pain (40%). CONCLUSION: Pelvic pain associated with menstruation, pelvic pain during or after sexual intercourse, and chronic pelvic pain are common complaints among Mexican women of reproductive age. Health care providers should pay greater attention to these conditions.

Neighborhood resources for physical activity and healthy foods and their association with insulin resistance.

OBJECTIVE: : Little is known about the influence of the built environment, and in particular neighborhood resources, on health. We hypothesized that neighborhood resources for physical activity and healthy foods are associated with insulin resistance. METHODS: : Person-level data (n = 2026) came from 3 sites of The Multi-Ethnic Study of Atherosclerosis, a study of adults aged 45-84 years. Area-level data were derived from a population-based residential survey. The homeostasis model assessment index was used as an insulin resistance measure among persons not treated for diabetes. We used linear regression to estimate associations between area features and insulin resistance. RESULTS: : Greater neighborhood physical activity resources consistently were associated with lower insulin resistance. Adjusted for age, sex, family history of diabetes, race/ethnicity, income and education, insulin resistance was reduced by 17% (95% confidence interval = -31% to -1%) for an increase from the 10th to 90th percentiles of resources. Greater healthy food resources were also inversely related to insulin resistance, although the association was not robust to adjustment for race/ethnicity. Analyses including diet, physical activity, and body mass index suggested that these variables partly mediated observed associations. Results were similar when impaired fasting glucose/diabetes was considered as the outcome variable. CONCLUSION: : Diabetes prevention efforts may need to consider features of residential environment.

Filling the gaps: spatial interpolation of residential survey data in the estimation of neighborhood characteristics.

The measurement of area-level attributes remains a major challenge in studies of neighborhood health effects. Even when neighborhood survey data are collected, they necessarily have incomplete spatial coverage. We investigated whether interpolation of neighborhood survey data was aided by information on spatial dependencies and supplementary data. Neighborhood "availability of healthy foods" was measured in a population-based survey of 5186 persons in Baltimore, New York, and Forsyth County (North Carolina). The following supplementary data were compiled from Census 2000 and InfoUSA, Inc.: distance to supermarkets, density of supermarkets and fruit and vegetable stores, housing density, distance to a high-income area, and percent of households that do not own a vehicle. We compared 4 interpolation models (ordinary least squares, residual kriging, spatial error regression, and thin-plate splines) using error statistics and Pearson correlation coefficients (r) from repeated replications of cross-validations. There was positive spatial autocorrelation in neighborhood availability of healthy foods (by site, Moran coefficient range = 0.10-0.28; all P<0.0001). Prediction performances were generally similar for the evaluated models (r approximately 0.35 for Baltimore and Forsyth; r approximately 0.54 for New York). Supplementary data accounted for much of the spatial autocorrelation and, thus, spatial modeling was only advantageous when spatial correlation was at least moderate. A variety of interpolation techniques will likely need to be utilized in order to increase the data available for examining health effects of residential environments. The most appropriate method will vary depending on the construct of interest, availability of relevant supplementary data, and types of observed spatial patterns.

Indicators of moisture and ventilation system contamination in U.S. office buildings as risk factors for respiratory and mucous membrane symptoms: analyses of the EPA BASE data.

We assessed associations between indicators for moisture in office buildings and weekly, building-related lower respiratory and mucous membrane symptoms in office workers, using the U.S. EPA BASE data, collected in a representative sample of 100 U.S. office buildings. We estimated the strength of associations between the symptom outcomes and moisture indicators in multivariate logistic regression models as odds ratios (ORs) and 95% confidence intervals (CI), controlling for potential confounding factors and adjusting for correlation among workers in buildings. This analysis identified associations between building-related symptoms and several indicators of moisture or contamination in office buildings. One set of models showed almost a tripling of weekly building-related lower respiratory symptoms in association with lack of cleaning of the drip pans under air-conditioning cooling coils (OR [CI] = 2.8 (1.2-6.5)). Other models found that lack of cleaning of either drip pans or cooling coils was associated with increased mucous membrane symptoms (OR [CI] = 1.4 (1.1-1.9)). Slightly increased symptoms were also associated with other moisture indicators, especially mucous membrane symptoms and past water damage to building mechanical rooms (OR [CI] = 1.3 (1.0-1.7)). Overall, these findings suggest that the presence of moisture or contamination in ventilation systems or occupied spaces in office buildings may have adverse respiratory or irritant effects on workers. The analysis, however, failed to confirm several risks identified in a previous study, such as condition of drain pans or outdoor air intakes, and other hypothesized moisture risks. Studies with more rigorous measurement of environmental risks and health outcomes will be necessary to define moisture-related risks in buildings.

Radiation and breast cancer: a review of current evidence.

This paper summarizes current knowledge on ionizing radiation-associated breast cancer in the context of established breast cancer risk factors, the radiation dose-response relationship, and modifiers of dose response, taking into account epidemiological studies and animal experiments. Available epidemiological data support a linear dose-response relationship down to doses as low as about 100 mSv. However, the magnitude of risk per unit dose depends strongly on when radiation exposure occurs: exposure before the age of 20 years carries the greatest risk. Other characteristics that may influence the magnitude of dose-specific risk include attained age (that is, age at observation for risk), age at first full-term birth, parity, and possibly a history of benign breast disease, exposure to radiation while pregnant, and genetic factors.

Mucous membrane and lower respiratory building related symptoms in relation to indoor carbon dioxide concentrations in the 100-building BASE dataset.

UNLABELLED: Indoor air pollutants are a potential cause of building related symptoms and can be reduced by increasing ventilation rates. Indoor carbon dioxide (CO(2)) concentration is an approximate surrogate for concentrations of occupant-generated pollutants and for ventilation rate per occupant. Using the US EPA 100 office-building BASE Study dataset, we conducted multivariate logistic regression analyses to quantify the relationship between indoor CO(2) concentrations (dCO(2)) and mucous membrane (MM) and lower respiratory system (LResp) building related symptoms, adjusting for age, sex, smoking status, presence of carpet in workspace, thermal exposure, relative humidity, and a marker for entrained automobile exhaust. In addition, we tested the hypothesis that certain environmentally mediated health conditions (e.g., allergies and asthma) confer increased susceptibility to building related symptoms. Adjusted odds ratios (ORs) for statistically significant, dose-dependent associations (P < 0.05) for combined mucous membrane, dry eyes, sore throat, nose/sinus congestion, sneeze, and wheeze symptoms with 100 p.p.m. increases in dCO(2) ranged from 1.1 to 1.2. Building occupants with certain environmentally mediated health conditions were more likely to report that they experience building related symptoms than those without these conditions (statistically significant ORs ranged from 1.5 to 11.1, P < 0.05). PRACTICAL IMPLICATIONS: These results suggest that provision of sufficient per-person outdoor ventilation air, could significantly decrease prevalence of selected building related symptoms. The observed relationship between indoor minus outdoor CO(2) concentrations and mucous membrane and lower respiratory symptoms suggests that air contaminants are implicated in the etiology of building related symptoms. Levels of indoor air pollutants that are suspected to cause building related symptoms could be reduced by increasing ventilation rates, improving ventilation effectiveness, or reducing sources of indoor air pollutants, if known.

Analysis of the spatial distribution of cryptosporidiosis in AIDS patients in San Francisco using density equalizing map projections (DEMP).

Environmental transmission of cryptosporidiosis has occurred repeatedly in defined spatial areas during outbreaks of disease attributed, for example, to drinking water contamination. Little work has been done to investigate the possibility of cryptosporidiosis infection in defined spatial areas in non-outbreak (i.e., endemic) settings. This study applies a novel approach to the investigation of the spatial distribution of cryptosporidiosis in AIDS patients in San Francisco. Density equalizing map projection (DEMP) maps were created for nine race/ethnicity-age groups of AIDS patients based on census tract of residence. Additionally, census tracts with a "high density" of cryptosporidiosis cases were identified by applying smoothing techniques to the DEMP maps, and included as a covariate in multivariate Poisson regression analyses of other known risk factors for cryptosporidios. These analyses suggest: (1) cases of cryptosporidiosis among Black and Hispanic AIDS patients, but not among Whites, show a statistically significant non-random spatial distribution (p < 0.05) even after adjustment for the underlying spatial distribution of AIDS patients for these demographic groups, and (2) the risk of residence in these high density census tracts, adjusted for other known risk factors, was not statistically significant (relative risk = 1.27, 95% confidence interval 0.15, 10.53). These results do not support an independent effect of spatial distribution on the transmission of cryptosporidiosis among AIDS patients.

Risk factors for breast cancer in a population with high incidence rates.

BACKGROUND: This report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates. METHODS: Eligible women who were residents of Marin County diagnosed with breast cancer in 1997-99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews. RESULTS: In multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990-94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over. CONCLUSIONS: Despite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis.

Breast cancer incidence and mortality trends in an affluent population: Marin County, California, USA, 1990-1999.

BACKGROUND: Elevated rates of breast cancer in affluent Marin County, California, were first reported in the early 1990s. These rates have since been related to higher regional prevalence of known breast cancer risk factors, including low parity, education, and income. Close surveillance of Marin County breast cancer trends has nevertheless continued, in part because distinctive breast cancer patterns in well-defined populations may inform understanding of breast cancer etiology. METHODS: Using the most recent incidence and mortality data available from the California Cancer Registry, we examined rates and trends for 1990-1999 for invasive breast cancer among non-Hispanic, white women in Marin County, in other San Francisco Bay Area counties, and in other urban California counties. Rates were age adjusted to the 2000 US standard, and temporal changes were evaluated with weighted linear regression. RESULTS: Marin County breast cancer incidence rates between 1990 and 1999 increased 3.6% per year (95% confidence interval, 1.8-5.5), six times more rapidly than in comparison areas. The increase was limited to women aged 45-64 years, in whom rates increased at 6.7% per year (95% confidence interval, 3.8-9.6). Mortality rates did not change significantly in Marin County despite 3-5% yearly declines elsewhere. CONCLUSION: Patterns of breast cancer incidence and mortality in Marin County are unlike those in other California counties, and they are probably explained by Marin County's unique sociodemographic characteristics. Similar trends may have occurred in other affluent populations for which available data do not permit annual monitoring of cancer occurrence.