Exposure to electric power generator noise among small scale business operators in selected communities in Ibadan, Nigeria.

Inadequate and erratic power supplies mean small businesses use electric generators for alternative power. The authors' goal in the study described here was to assess noise from electric generators and impacts in the commercial areas of Agbowo and Ajibode in Ibadan, Nigeria. Noise levels (A-weighted decibels [dBA]) were measured over 12 weeks, three times a day, during the 2010 dry season using a sound level meter. A questionnaire was administered (515 respondents; 304 in Agbowo, 211 in Ajibode) and audiometric measurements were conducted on 40% of respondents. Mean noise levels varied by source (104 ± 7.7 dBA [diesel], 94.0 ± 6.3 dBA [petrol]) and were highest midday (90.6 ± 5.3 dBA [Agbowo], 70.9 ± 6.2 dBA [Ajibode]). Mean noise levels in Agbowo (78.5 ± 3.9 dBA) and Ajibode (65.7 ± 4.4 dBA) exceeded World Health Organization guidelines (65 dBA) for outdoor commercial environments. Working and living in Agbowo was significantly associated with current evidence of hearing impairment (odds ratio: 6.8, 95% confidence interval: 3.4-13.7). Reducing exposure to noise from electric power generators serving urban small businesses and homes is warranted.

High tofu intake is associated with worse memory in elderly Indonesian men and women.

BACKGROUND/AIMS: Cell culture studies suggest that phytoestrogens, abundant in soy products such as tempe and tofu, could protect against cognitive decline. Paradoxically, the Honolulu Asia Aging Study reported an increased risk for cognitive impairment and other dementia markers with high tofu (soybean curd) intake. METHODS: A cross-sectional study was carried out in 2 rural sites (Borobudur and Sumedang) and 1 urban site (Jakarta) among mainly Javanese and Sundanese elderly (n = 719, 52-98 years of age). Memory was measured using a word learning test sensitive to dementia and soy consumption was assessed using Food Frequency Questionnaire items. RESULTS: High tofu consumption was associated with worse memory (beta = -0.18, p < 0.01, 95% CI = -0.34 to -0.06), while high tempe consumption (a fermented whole soybean product) was independently related to better memory (beta = 0.12, p < 0.05, 95% CI = 0.00-0.28), particularly in participants over 68 years of age. Fruit consumption also had an independent positive association. The analyses were controlled for age, sex, education, site and intake of other foods. CONCLUSION: The results for tofu consumption as a risk factor for low memory function may tie in with the Honolulu Asia Aging Study data. It is unclear whether these negative associations could be attributed to potential toxins or to its phytoestrogen levels. Estrogen (through which receptors phytoestrogens can exert effects) was found to increase dementia risk in women over 65 years of age. Tempe contains high levels of phytoestrogens, but (due to fermentation) also exhibits high folate levels which may exert protective effects. Future studies should validate these findings and investigate potential mechanisms.

Hormone replacement therapy for cognitive function in postmenopausal women.

BACKGROUND: As estrogens have been found in animal models to be associated with the maintenance and protection of brain structures, it is biologically plausible that maintaining high levels of estrogens in postmenopausal women by medication could be protective against cognitive decline. OBJECTIVES: To investigate the effect of ERT (estrogens only) or HRT (estrogens combined with a progestagen) in comparison with placebo in RCTs on cognitive function in postmenopausal women. SEARCH STRATEGY: The CDCIG Specialized Register was searched 7 March 2006. Additional searches were made of MEDLINE (1966-2006/02); EMBASE (1985-2006/02); PsycINFO (1967-2006/02) and CINAHL (1982-2006/01). SELECTION CRITERIA: All double-blind RCTs trials of the effect of ERT or HRT on cognitive function over a treatment period of at least two weeks in postmenopausal women. DATA COLLECTION AND ANALYSIS: Selection of studies, assessment of quality and extraction of data were undertaken independently by three reviewers with disagreements resolved by discussion. MAIN RESULTS: In total, 24 trials were included, but only 16 (10,114 women) had analysable data. Meta-analyses showed no effects of either ERT or HRT on prevention of cognitive impairment after five and four years of treatment, respectively (odds ratio 1.34, 95% CI 0.95 to 1.9; odds ratio 1.05, 95% CI 0.72 to 1.54 respectively) (trend favouring control in both instances). Analyses assessing the effects of treatment over time found that both ERT and HRT did not maintain or improve cognitive function and may even adversely affect this outcome (WMD = -0.45, 95% CI -0.99 to 0.09; WMD = -0.16, 95% CI -0.58 to 0.26, respectively at maximum follow up). Negative effects were found for ERT after one year and HRT after three and four years of therapy. Results from smaller trials assessing effects on individual cognitive domains mostly reported no evidence of benefit. AUTHORS' CONCLUSIONS: There is good evidence that both ERT and HRT do not prevent cognitive decline in older postmenopausal women when given as short term or longer term (up to five years) therapy. It is not known whether either specific types of ERT or HRT have specific effects in subgroups of women, although there was evidence that combined hormone therapy in similarly aged women was associated with a decrement in a number of verbal memory tests and a small improvement in a test of figural memory. There is insufficient evidence to determine whether subgroups of women using specific types of hormone therapy could benefit from treatment. It remains to be determined whether factors such as younger age (< 60 years of age), type of menopause (surgical or natural) and type of treatment (type of estrogen with or without a progestagen), mode of delivery (transdermal, oral or intramuscular) and dosage have positive effects at a clinically relevant level. In addition, whether the absence or presence of menopausal symptoms can modify treatment effects should be investigated in more detail. Large RCTs currently underway in the USA may be able to provide answers to these uncertainties by the year 2010. In the meantime, based on the available evidence, ERT or HRT cannot be recommended for overall cognitive improvement or maintenance in older postmenopausal women without cognitive impairment.

Cesarienne de MISGAV LADACH VERSUS cesarienne de Pfannenstiel : erude comparative a propos de cesariennes au CHU de Cocody

Notre etude prospective comparative randomisee sur 5 mois du 1er Janvier 2005 au 31 mars 2005 au service de gynecologie obstetrique du CHU de COCODY a Abidjan nous a permis d'enregistrer 210 cesariennes (105 cesariennes de Misgav Ladach et 105 cesariennes de Pfannenstiel) La frequence des cesariennes pendant la periode d'etude etait de 32pour cent. L'age moyen des cesarisees etait de 27;32 ans. Les principales indications sont representees par les dystocies et les souffrances foetales (81pour cent). Les cesariennes en urgence etaient predominantes (72pour cent). L'anesthesie locoregionale etait la plus utilisee (60;48pour cent). La cesarienne de Misgav Ladach est plus avantageuse que celle de Pfannenstiel en ce qui concerne le delai d'extraction foeta1e; la duree operatoire; la douleur post operatoire; le cout de l'intervention; la qualite de la cicatrisation et la satisfaction des patientes. Par contre les differences ne sont pas significatives pour les pertes sanguines; le pronostic foeto-matemel; la reprise du transit; l'analgesie post operatoire et la duree d'hospitalisation. A terme la technique de Misgav Ladach devrait devenir la methode de reference pour les cesariennes

Les hysterectomies : indications; techniques et resultats. A propos de 108 cas colliges dans le Servcie de Gynecologie Obstetrique du CHU de Cocody du 1er Janvier 2001 au 31 Decembre 2002

Notre etude retrospective effectuee sur une periode de 2 ans du ler janvier 2001 au 31 decembre 2002 au service de gynecologie obstetrique du CHU de Cocody nous a permis d'enregistrer 108 hysterectomies toutes indications confondues pour 3370 interventions chirurgicales et 8634 accouchements dont 2449 par cesarienne.Les hysterectomies representaient 3;2pour cent des interventions chirurgicales gyneco-obstetricales majeures.L'age moyen des patientes etait de 41;03 ans avec des extremes de 16 et 71 ans.La parite moyenne etait de 3;97pour cent avec 9;26pour cent de nullipares.Pres de la moitie (47;22pour cent) des patientes etait evacuee et dans un peu plus de la moitie des cas (52;78pour cent) l'hysterectomie a ete realisee en urgence.Les principales indications d'hysterectomies etaient:- les ruptures uterines au cours du travail (37;96pour cent)-le fibrome uterin (28;70pour cent)-les complications des TVG (13;95pour cent)-les cancers gynecologiques (12;04pour cent)-les prolapsus uterins (8;33pour cent)La voie abdominale a ete utilisee dans la majorite des cas (84;26pour cent).Dans 54;63pour cent il s'agissait d'hysterectomies totales contre 39;81pour cent de subtotales et 5;56pour cent d'hysterectomies elargies. Il a ete note 0;93pour cent de complications peroperatoires. Un tiers des patientes a presente des complications postoperatoires dominees par l'anemie (44;74pour cent) et les infections surtout parietales (28;95pour cent). Ces complications sont surtout liees au 'mode de recrutement; a la pathologie initiale; aux modalites operatoires et aux conditions d'hygiene.La duree moyenne d'hospitalisation a ete de 7;08 jours.Il a ete constate 6 deces soit une letalite de 5;56pour cent