Hypothetical blood-pressure-lowering interventions and risk of stroke and dementia.

We aimed to study the effects of hypothetical interventions on systolic blood pressure (SBP) and smoking on risk of stroke and dementia using data from 15 years of follow-up in the Rotterdam Study. We used data from 4930 individuals, aged 55-80 years, with no prior history of stroke, dementia or cognitive impairment, followed for 15 years within the Rotterdam Study, a population-based cohort. We defined the following sustained interventions on SBP: (1) maintaining SBP below 120 mmHg, (2) maintaining SBP below 140 mmHg, (3) reducing SBP by 10% if above 140 mmHg, (4) reducing SBP by 20% if above 140 mmHg, and a combined intervention of quitting smoking with each of these SBP-lowering strategies. We considered incident stroke and incident dementia diagnoses as outcomes. We applied the parametric g-formula to adjust for baseline and time-varying confounding. The observed 15-year risk for stroke was 10.7%. Compared to no specified intervention (i.e., the "natural course"), all interventions that involved reducing SBP were associated with a stroke risk reduction of about 10% (e.g., reducing SBP by 20% if above 140 mmHg risk ratio: 0.89; 95% CI 0.76, 1). Jointly intervening on SBP and smoking status further decreased the risk of stroke (e.g., risk ratio: 0.83; 95% CI 0.71, 0.94). None of the specified interventions were associated with a substantive change in dementia risk. Our study suggests that a joint intervention on SBP and smoking cessation during later life may reduce stroke risk, while the potential for reducing dementia risk were not observed.

Children's acute respiratory symptoms associated with PM2.5 estimates in two sequential representative surveys from the Mexico City Metropolitan Area.

BACKGROUND: Respiratory diseases are a major component of morbidity in children and their symptoms may be spatially and temporally exacerbated by exposure gradients of fine particulate matter (PM2.5) in large polluted urban areas, like the Mexico City Metropolitan Area (MCMA). OBJECTIVES: To analyze the association between satellite-derived and interpolated PM2.5 estimates with children's (≤9 years old) acute respiratory symptoms (ARS) in two probabilistic samples representing the MCMA. METHODS: We obtained ARS data from the 2006 and 2012 National Surveys for Health and Nutrition (ENSaNut). Two week average exposure to PM2.5 was assessed for each household with spatial estimates from a hybrid model with satellite measurements of aerosol optical depth (AOD-PM2.5) and also with interpolated PM2.5 measurements from ground stations, from the Mexico City monitoring network (MNW-PM2.5). We used survey-adjusted logistic regressions to analyze the association between PM2.5 estimates and ARS reported on children. RESULTS: A total of 1,005 and 1,233 children were surveyed in 2006 and 2012 representing 3.1 and 3.5 million children, respectively. For the same years and over the periods of study, the estimated prevalence of ARS decreased from 49.4% (95% CI: 44.9,53.9%) to 37.8% (95% CI: 34,41.7%). AOD-PM2.5 and MNW-PM2.5 estimates were associated with significantly higher reports of ARS in children 0-4 years old [OR2006 = 1.29 (95% (CI): 0.99,1.68) and OR2006 = 1.24 (95% CI: 1.08,1.42), respectively]. We observed positive non-significant associations in 2012 in both age groups and in 2006 for children 5-9 years old. No statistically significant differences in health effect estimates of PM2.5 were found comparing AOD-PM2.5 or MNW-PM2.5 for exposure assessment. CONCLUSIONS: Our findings suggest that PM2.5 is a risk factor for the prevalence of ARS in children and expand the growing evidence of the utility of new satellite AOD-based methods for estimating health effects from acute exposure to PM2.5.

Análisis de aspectos familiares, socioeconómicos y ginecológicos como factores de riesgo para el embarazo en la adolescencia / Famliar, social,, economic, and gyncologic aspects analysis as rissk factors for teenage pregnancy

INTRODUCCIÓN: El embarazo en la adolescencia es un tema de gran importancia por su impacto en salud, economía y dentro de la sociedad. OBJETIVO: Analizar los aspectos familiares, socioeconómicos y ginecológicos como factores de riesgo implicados en el embarazo en adolescentes. MATERIALES Y MÉTODOS: Diseño metodológico: Casos y controles Estudio comparativo de adolescentes embarazadas de la comunidad Santa Ana la Nueva con adolescentes nuligestas del mismo núcleo, entre abril a junio del 2012. Se confeccionó una encuesta basada en la aglutinación de instrumentos previamente seleccionados. Cálculo de tamaño de muestra: 22 casos y 22 controles. RESULTADOS: La edad promedio fue 16.13 años (DS: ± 1.641) para controles y para los casos fue 17.7 años (DS: ± 1.445). De los casos, 10 (45.45%) eran solteras, 10 (45.45%) concubinas y 2 (9.09%) casadas; para los controles 20 (90.1%) fueron solteras. En los casos 16 (72.73%) se dedicaban a los labores de casa, 5 (22.73%) eran estudiantes y 1 (4.55%) dedicada al comercio. Para los casos, el 40.91% tuvieron un nivel de educación igual a primaria o menor comparado con el total de los controles que cursaban secundaria. 19 mujeres de los casos (86.36%) tuvo madre cuyo primer hijo nació antes de los 20 años, comparado con 12 (54.55%) de los controles (p=0.045) (OR: 5.27, IC 95% 1.02 - 34.58). La funcionalidad familiar y el tipo familiar no representaron diferencia cuando se compararon ambos grupos. En relación al nivel socioeconómico, 100% de los casos provenían de un nivel bajo comparado con el 95.45% de los controles. En este grupo poblacional el consumo de tabaco, alcohol y drogas no tuvo relación con el embarazo en la adolescencia. El inicio de vida sexual activa ≤ 15 años en el grupo de casos no representó un factor para el embarazo en adolescentes comparado con el grupo control, donde 16 (72.73%) no iniciaron vida sexual (p=0.08). Todas las mujeres del grupo control tenían conocimiento de métodos anticonceptivos, comparado con sólo 12 (45.45%) de los casos (p<0.001).18 de los casos (81.82%) no utiliza anticonceptivos actualmente (OR:15.3, IC 95% 2.93 - 87.71) y 9 (41.01%) tuvieron más de una pareja sexual (OR: 6.92, IC 95% 1.11 - 72.63). CONCLUSION: Haber tenido una madre cuyo hijo haya nacido en la adolescencia, el conocimiento de métodos anticonceptivos, la falta de uso de los mismos y tener más de una pareja sexual en esta etapa son factores relacionados con un incremento de la probabilidad de embarazo en la adolescencia.

INTRODUCTION: Pregnancy in adolescence is topic of great importance for the impact in public health, economy and society. OBJETIVE: To analyze familiar, social, economic and gynecologic aspects as risks factors involved in teen pregnancy. MATERIAL AND MÉTHODS: Design: Case-control study. Comparative study of adolescents with previous or current pregnancy from the community Santa Ana la Nueva - Tarija, with nulliparous adolescents from the same area, between april and june, 2012. A questionnaire was made based on different chosen instruments. Sample size: 22 cases and 22 controls RESULTS: Mean age was 16.13 years (SD: ± 1.641) for controls and for the cases was 17.7 years old (SD: ± 1.445). Of cases, 10 (45.45%) were single, 10 (45.45%) lived with couple and 2 (9.09%) were married. 20 controls were single (90.1%). Among the cases 16 (72.73%) were households and 5 (22.73%) were students, 1 (4.55%) worked in business. From this cases, 40.91% had a primary education, uncompleted or complete, compared to the total of controls who were enrolled in secondary education (p<0.001), 19 (86.36%) of the cases had a mother who had her first born before 20 years, compared to 12 (54.55%) of the controls (p=0.045) (OR: 5.27 95% IC 1.02 - 34.58). Type of family and familiar dysfunctionality did not represent differences when comparing both groups. About the socioeconomical status, 100% of cases came from a low status, compared to 95.45% of controls. In this studied group nor tabacco, alcohol or drug consumption had relation with pregnancy. Starting sexual intercourse at the age of ≤ 15 years did not represent a risk factor for pregnancy, compared to the control group where 16 (72.73%) did not initiated intercourse (p=0.08) . All women from the control group had knowledge about contraception, compared to only 12 (45.45%) of cases (p<0.001). 18 (81.82%) cases do not use contraception actually (OR:15.3, 95% IC 2.93 - 87.71) and 9 (41.01%) had more than 1 sexual couple (OR: 6.92, 95% IC 1.11 - 72.63). CONCLUSION: Having a mother whose first child was born in her adolescence, lack of knowledge in contraception, and its use, and having more than one sexual couple in this period are risk factors related with a major probability for pregnancy in adolescence.