Insomnia symptoms and increased risk of all-cause mortality by age and sex.

STUDY OBJECTIVES: Prior research suggests that insomnia may increase the risk of death. However, the potential influence of age and sex is unclear. This study aimed to investigate the association of insomnia symptoms with all-cause mortality by age and sex. METHODS: This prospective cohort was drawn from the Health and Retirement Study, a survey of Americans older than 50 years and their spouses of any age from 2002 to 2018. Insomnia symptom scores were based on difficulties initiating sleep, difficulty maintaining sleep, waking up too early, and restorative sleep. Cox proportional hazards regression models were employed to investigate the association between insomnia symptoms and all-cause mortality stratified by age and sex. RESULTS: A total of 33004 participants were included with a mean age of 61.7 years and 56.8% females. Over a mean follow-up of 8.4 years, 8935 (27.1%) deaths were recorded. After adjusting for confounding, males with insomnia symptom scores ranging from 5 to 8 had a 71% increased risk of death (HR=1.71, 95% CI: 1.27, 2.30) compared to their counterparts without insomnia symptoms. Similarly, males aged ≥60, and females aged <60 with insomnia symptoms ranging from 5-8 had an increased risk of death compared to their counterparts without insomnia symptoms (HR=1.15, 95%: 1.02, 1.31, and HR=1.38, 95% CI: 1.00, 1.90, respectively). However, there was no increased risk of death for females aged ≥60 (HR=0.94, 95% CI: 0.84, 1.06). CONCLUSIONS: These findings suggest that insomnia symptoms may serve as predictors of low life expectancy.

The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya.

HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.

Sleep duration and all-cause mortality among stroke survivors.

BACKGROUND: Post stroke sleep duration could increase the risk of death. This study tested the hypothesis that inadequate sleep duration is associated with increased mortality among stroke survivors. METHODS: The REasons for Geographic And Racial Differences in Stroke (REGARDS), a national population-based longitudinal study, was the data source. Sleep duration was ascertained between 2013 and 2016 among stroke survivors who were subsequently followed up until death or censored on December 31, 2022. Sleep duration was estimated as the difference between wake-up time and bedtime to which was subtracted the time spent in bed without sleep. Cox proportional hazards regression models were employed to investigate the association between sleep duration and all-cause mortality adjusting for demographic factors, socioeconomic factors, behavioral factors, and co-morbidities. RESULTS: A total of 468 non-Hispanic Black and White stroke survivors were included in this analysis. The mean age was 76.3 years, 52.6% were females and 56.0% were non-Hispanic White individuals. The distribution of short (≤6 h), adequate (7.0-8.9 h), and long sleep (≥9 h) was 30.3%, 44.7%, and 25%, respectively. Over a mean follow-up of 5.0 years, 190 (40.6%) deaths occurred. Compared to stroke survivors with adequate sleep (7.0-8.9 h), stroke survivors with long sleep (≥9 h) were at increased risk of all-cause mortality (HR=1.46, 95% CI=1.01, 2.12). However, short sleep (≤6 h) was not significantly associated with an increased risk of all-cause mortality (HR=1.31, 95% CI=0.90, 1.91). Subgroup analyses indicated higher risk in the age <75 years, females, non-Hispanic Black individuals, and those living in the Stroke Belt region, but those differences were not statistically significant. CONCLUSION: In this study of stroke survivors, 9 hours or more of sleep per day was associated with an increased risk of all-cause mortality. This finding suggests that excessive sleep duration may be a warning sign of poor life expectancy in stroke survivors.

Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: Insomnia is a common condition affecting more than a third of the US population. However, the link between insomnia symptoms and stroke is understudied and the underlying mechanism remains unclear. This study aimed to investigate the relationship between insomnia symptoms and the incidence of stroke. METHODS: The Health and Retirement Study, a survey of Americans older than 50 years and their spouses, from 2002 to 2020 was used as the data source. Only those who were stroke-free at baseline were included in this study. The exposure variable was insomnia symptoms and was derived from self-reported sleep-related factors including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated-measures latent class analysis was used to identify insomnia trajectories over time. To investigate the relationship between insomnia symptoms and stroke events reported during the follow-up period, Cox proportional hazards regression models were used. Mediation analyses of comorbidities were performed using causal mediation within a counterfactual framework. RESULTS: A total of 31,126 participants were included with a mean follow-up of 9 years. The mean age was 61 years (SD = 11.1) and 57% were females. Insomnia symptom trajectories remained constant over time. Compared with those with no insomnia symptoms, an increased risk of stroke was observed for those with insomnia symptom scores ranging from 1 to 4 and 5 to 8 (hazard ratio (HR) = 1.16, 95% confidence interval (CI) 1.02-1.33) and (HR = 1.51, 95% CI 1.29-1.77), respectively, indicating a dose-response relationship. The association was stronger in participants younger than 50 years (HR = 3.84, 95% CI 1.50-9.85) than in those aged 50 years and older (HR = 1.38, 95% CI 1.18-1.62), comparing those with insomnia symptoms ranging from 5 to 8 with those with no insomnia symptoms. This association was mediated by diabetes, hypertension, heart disease, and depression. DISCUSSION: Insomnia symptoms were associated with an increased risk of stroke, especially in adults younger than 50 years, and the risk was mediated by certain comorbidities. Increased awareness and management of insomnia symptoms may contribute to the prevention of stroke occurrence.

The Mediating Effect of Sleep Duration on the Association between Food Insecurity and Childhood Obesity.

Background: Childhood obesity has increased globally during the past four decades. Food insecurity could heighten the risk of obesity. However, little is known about the underlying mechanism. This study aims to investigate the mediating role of sleep duration in the association between food insecurity and childhood obesity and whether there are differences by age, sex, and race/ethnicity. Method: Data from the National Survey of Children's Health for the years 2016-2020 were used, including children 10-17 years of age. We employed causal mediation analysis within a counterfactual framework to decompose the total effect of food insecurity into natural direct and indirect effects and estimate the proportion mediated. Result: The prevalence of obesity was 15.8% in our study sample. Children with food insecurity had 78% higher odds [odds ratio (OR) = 1.78, 95% confidence interval (CI): 1.70-1.86] of having obesity compared with children who were food secure. Overall, only 6.13% of this association was mediated by sleep duration. The association between food insecurity and obesity was stronger in females (OR = 1.96, 95% CI: 1.84-2.10) than males (OR = 1.66, 95% CI: 1.56-1.75), but the proportion mediated by sleep duration was larger in males (7.13%) than females (5.22%). Evidence of mediation was more pronounced in children 10-11 years of age and non-Hispanic Asian children (proportion mediated = 14.85% and 11.21%, respectively). Conclusion: Food insecurity is associated with an increased prevalence of obesity among children. Although a small proportion of this association is mediated by sleep duration, these results suggest that sleep should be considered when assessing the link between food insecurity and childhood obesity.

Overweight and obesity as risk factors for COVID-19-associated hospitalisations and death: systematic review and meta-analysis.

Objective: To quantify the current weight of evidence of the association between overweight and obesity as risk factors for COVID-19-related hospitalisations (including hospital admission, intensive care unit admission, invasive mechanical ventilation) and death, and to assess the magnitude of the association and the potential dose-response relationships. Design: PubMed, Embase, Cochrane, Web of Sciences, WHO COVID-19 database and Google Scholar were used to identify articles published up to 20 July 2021. Peer-reviewed studies reporting adjusted estimates of the association between overweight or obesity and COVID-19 outcomes were included. Three authors reviewed the articles and agreed. The quality of eligible studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis was used to estimate the combined effects. Results: A total of 208 studies with 3 550 997 participants from over 32 countries were included in this meta-analysis. Being overweight was associated with an increased risk of COVID-19-related hospitalisations (OR 1.19, 95% CI 1.12 to 1.28, n=21 studies), but not death (OR 1.02, 95% CI 0.92 to 1.13, n=21). However, patients with obesity were at increased risk of both COVID-19-related hospitalisations (OR 1.72, 95% CI 1.62 to 1.84, n=58) and death (OR 1.25, 95% CI 1.19 to 1.32, n=77). Similarly, patients with extreme obesity were at increased risk of COVID-19-related hospitalisations (OR 2.53, 95% CI 1.67 to 3.84, n=12) and death (OR 2.06, 95% CI 1.76 to 3.00, n=19). There was a linear dose-response relationship between these obesity categories and COVID-19 outcomes, but the strength of the association has decreased over time. Conclusion: Being overweight increases the risk of COVID-19-related hospitalisations but not death, while obesity and extreme obesity increase the risk of both COVID-19-related hospitalisations and death. These findings suggest that prompt access to COVID-19 care, prioritisation for COVID-19 vaccination and other preventive measures are warranted for this vulnerable group.

Sociodemographic Characteristics and Inadequate Usual Sources of Healthcare in a National Sample of US Refugees.

INTRODUCTION: Refugees resettled into the United States (US) face challenges in accessing adequate healthcare. Knowledge of demographic and social characteristics related to healthcare access among refugees is scarce. This study examines potential sociodemographic predictors of inadequate usual sources of care (USCs)-one key component of healthcare access-within the US refugee population. METHODS: The 2016 Annual Survey of Refugees (ASR) involving 4037 refugees resettled into the US served as the data source for this study. Inadequate USC was defined as a USC that was neither a private healthcare provider nor a health clinic. We used multiple binary logistic regression methods to identify sociodemographic predictors of inadequate USCs. In addition, we used multinomial logistic regression to further assess predictors of inadequate USCs with a particular focus on severely deficit USCs (i.e., emergency department dependence and USC absence). RESULTS: Refugees with interrupted healthcare coverage were more likely to have an inadequate USC. Refugees who were young (age 10-19), resettled into the western region of the US, and highly educated were less likely to have an inadequate USC. Refugees with an education level higher than secondary had a significantly lower likelihood of having a severely deficient USC, while refugees with interrupted healthcare were more than twice as likely to have a severely deficient USC. CONCLUSIONS: Considering these results alongside our previous healthcare coverage findings provides a more comprehensive understanding of sociodemographic predictors of poor healthcare access among refugees resettled into the US. This improved understanding has the potential to assist early refugee contacts toward more effective healthcare resource allocation and aid policymakers attempting to improve programs linked to refugee healthcare access.

Predictors of Interrupted Healthcare Coverage in a National Sample of US Refugees.

INTRODUCTION: Many refugees that resettled into the United States (US) arrive with psychological and physical distress. Their health needs are often met with inadequate healthcare. A variety of barriers negatively affect their healthcare access. Knowledge of demographic and social predictors related to key healthcare access components among refugees is limited. This study examines potential predictors of interrupted healthcare coverage-one key component of healthcare access-among refugees living in the US. METHODS: Using the 2016 Annual Survey of Refugees (ASR)nation-wide data collected from 4037 refugees, multiple logistic regression methods were utilized to identify socio-demographic predictors of interrupted healthcare coverage. Interrupted healthcare coverage was defined as one or more months in the past 12 months without coverage by Refugee Medical Assistance (RMA), Medicaid, or private health insurance. RESULTS: The following five socio-demographic factors were associated with a higher likelihood of interrupted healthcare coverage: Male gender, 20-49 years of age, lack of marriage, resettlement into the south or Midwest, and poor or no current English proficiency. Refugees with no job were less likely to have interrupted coverage compared to employed refugees. DISCUSSION: The increased likelihood of interrupted coverage among refugees with poor or no English proficiency supports the belief that limited English proficiency is a barrier to healthcare insurance enrollment. The increased likelihood of interrupted coverage for refugees resettled in the South is consistent with prior literature. In view of clear regional differences, further consideration of the effect of policy differences on refugees living in the US is worthwhile. The findings may help early refugee contacts risk stratify and more effectively allocate limited resources and assist policy makers as they amend and update programs linked to refugee healthcare access (e.g., RMA).

Do African American men have lower survival from prostate cancer compared with White men? A meta-analysis.

Prostate cancer is the second leading cause of cancer-related mortality in men. This meta-analysis was conducted to investigate the relationship between race and survival from prostate cancer. A systematic review of articles published from 1968 to 2007 assessing survival from prostate cancer was conducted. Analysis of unadjusted studies reported that African American men have an increased risk of all-cause mortality (hazard ratio [HR] = 1.47, 95% confidence interval [CI] = 1.31-1.65, p < .001). However, examination of adjusted studies identified no difference (HR = 1.07, 95% CI = 0.94-1.22, p = .308). No statistically significant difference was observed in prostate cancer-specific survival in both analyses using unadjusted (HR = 1.11, 95% CI = 0.94-1.31, p = .209) and adjusted studies (HR = 1.15, 95% CI = 0.95-1.41, p = .157). This meta-analysis concludes that there are no racial differences in the overall and prostate cancer-specific survival between African American and White men.

Sexual assault in Virginia: A population-based study.

PURPOSE: Sexual assault is a serious social problem that affects the lives of many women, men, and children. Most sexual assaults are not reported to authorities and most victims do not seek services. As a result, accurate statistics on the prevalence and incidence of this problem are difficult to obtain. As in many states, the magnitude of sexual assault in Virginia is not known. This study was conducted to estimate the prevalence and determine the correlates of sexual assault among women in Virginia. METHODS: A cross-sectional telephone survey was conducted among adult female residents of Virginia between November 2002 and February 2003. A total of 1,769 women aged 18 and older were interviewed using a random digit dialing method. RESULTS: The lifetime prevalence of sexual assault in Virginia was 27.6%. The majority (65%) were rape victims with a prevalence of 17.8%. Approximately 78% of the victims reported that the sexual assault occurred for the first time when they were children or adolescents. Women who reported sexual assault were more likely to be between 35 and 44 years old (OR = 3.57; 95% CI = 2.06-6.15), divorced/separated/widowed (OR = 1.61; 95% CI = 1.13-2.30), consume alcohol four or more times a week (OR = 1.80; 95% CI = 1.01-3.21), ideate suicide (OR = 4.48; 95% CI = 3.23-6.23), and perceive their health status to be poorer (OR = 2.74; 95% CI = 1.30-5.83). CONCLUSION: Sexual assault is a major public health problem in the Commonwealth of Virginia and children are disproportionately affected by the problem. Interventions and prevention programs should focus on children and adolescents.

Obesity as a risk factor for premenstrual syndrome.

PURPOSE: To determine the association between obesity and Premenstrual Syndrome (PMS). METHODS: A cross-sectional study was conducted using a random-digit dialing method. The sampling frame consisted of all possible area codes, exchanges, and 4-digit suffixes in Virginia. A total of 874 women between the ages of 18-44 residing in the state of Virginia between August 1 and September 15, 1994 were interviewed. Cases were defined as women who reported severe or extreme PMS symptom changes using the Shortened Premenstrual Assessment Form. The main exposure variable was obesity as measured by Body Mass Index. RESULTS: The prevalence of PMS in Virginia was 10.3 percent. Obese women (BMI > or = 30) had nearly a three-fold increased risk for PMS than non-obese women OR = 2.8 (95% CI = 1.1, 7.2). PMS was more prevalent among whites, younger women, and smokers. CONCLUSION: This data provided evidence that obesity is strongly associated with PMS. Since obesity is a modifiable risk factor, PMS management strategies should not only consider factors such as, high stress, and smoking but also obesity.

Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis.

PURPOSE: To determine whether hypercholesterolemia is an independent risk factor for CHD morbidity and mortality in persons aged 65 years and above, and to quantify the magnitude of the association, if any, using data from follow-up studies. METHODS: A MEDLINE search of all published studies that evaluated the association between high cholesterol levels and CHD in persons aged 65 years and above, and the relevant articles referenced in these studies, were used as sources of selected articles. RESULTS: In men aged 65 years and above who were followed from middle age, the RR for CHD incidence associated with 1.0 mmol/L increase in total cholesterol was 1.28 (CI: 1.17-1.39). The RR for CHD mortality associated with a similar increase in total cholesterol was 1.22 (CI: 1.18-1.27). In elderly men followed from age 65 and above, the RR was 1.24 (CI: 1.1-1.37) for CHD incidence, and 1.22(CI: 1.15-1.28) for CHD mortality. In elderly women followed after age 65, the association between total cholesterol and CHD mortality was not significant. For men aged 80 years and above at entry, total cholesterol showed an inverse relationship with all-cause mortality. CONCLUSION: Serum total cholesterol shows a positive association with CHD morbidity and mortality in men aged 65 years and above. This may, however, not hold true for persons aged 80 years and above.

In utero exposure to polychlorinated biphenyls and sensorineural hearing loss in 8-year-old children.

Early-life exposure to polychlorinated biphenyls (PCBs), a ubiquitous environmental contaminant, increases the hearing threshold at selected frequencies in rats. Among humans from the Faroe Islands with unusually high early-life PCB exposure, exposure was directly associated with increased hearing thresholds at two frequencies, although the deficits were present in the left ear but not the right. We examined PCB levels in maternal pregnancy serum in relation with audiometrically determined hearing thresholds among offspring when they were of school age. Complete data were available for 195 children with sensorineural hearing loss (SNHL) and 615 children selected at random, all of whom were born in 1959-1966 in the Collaborative Perinatal Project (CPP) U.S. cohort. The median exposure among those selected at random, as reflected by the mother's third trimester serum total PCB concentration, was 2.8 microg/l, about twofold higher than recent background levels in the United States. Based on the average hearing threshold across the frequencies essential for speech recognition in the "worst ear," the maternal serum PCB level was unrelated to the adjusted odds of SNHL or to adjusted mean hearing threshold. Overall, an adverse effect of early-life, background-level PCB exposure on SNHL was not supported by these data.

Osteoporosis in pulmonary clinic patients: does point-of-care screening predict central dual-energy X-ray absorptiometry?

STUDY OBJECTIVES: Patients in a pulmonary clinic have disorders that predispose them to osteoporosis and may use glucocorticoid therapy, which has been associated with low bone mineral density (BMD) and increased fracture risk. Ideally, all patients at risk for osteoporosis would be screened using the best test available, which is central BMD by dual-energy x-ray absorptiometry (DXA). We proposed to stratify the risk for osteoporosis by the use of a simple questionnaire and point-of-care heel ultrasound BMD measurements. DESIGN: Cross-sectional screening study. SETTING: Pulmonary clinic in a single Veterans Affairs Medical Center. PATIENTS: Approximately 200 male and female patients who had not had previous BMD testing were eligible for the study, and 107 gave consent. INTERVENTIONS: One hundred seven men (white, 71 men; black, 35 men; and Asian, 1 man) underwent heel BMD testing and filled out a questionnaire. Ninety-eight men underwent a central DXA. RESULTS: Of 98 subjects, 24.5% had a spine, total hip, or femoral neck (FN) T-score of or= 7 days, and race, which accounted for 52 to 57% of the variance. When a heel ultrasound T-score of -1.0 was tested to predict a central DXA T-score of -2.0, the sensitivity was 61% and the specificity 64%. Adding the questionnaire score and body mass index (BMI) to the heel T-score improved sensitivity but not specificity. Moreover, BMI and age predicted central BMD with similar sensitivity and specificity. Importantly, of 24 patients with a central DXA T-score of

Spouse/partner violence education as a predictor of screening practices among physicians.

INTRODUCTION: Spouse/partner violence is a major public health problem that affects 3 to 6 million women per year. Many studies show that the majority of health care practitioners do not detect or respond to cases of spouse/partner violence in their practice. Research suggests that there are potential barriers to reporting or detecting this problem. A barrier often cited is lack of proper education or training regarding spouse/partner violence. The objective of this study was to determine if physicians who received spouse/partner violence education at various stages of their careers were more likely to screen patients for spouse/partner violence. METHODS: A survey was developed and administered to family physicians and obstetricians/gynecologists in Virginia. The data were analyzed to determine screening practice and spouse/partner violence education among respondents. Four different educational opportunities were analyzed to determine potential determinants of screening. RESULTS: All respondents who had spouse/partner violence education were more likely to screen every patient than those who were lacking this education. Receiving lectures during residency training was found to be a significant predictor of screening every patient for spouse/partner violence among respondents. DISCUSSION: Screening every patient for exposure to spouse/partner violence is the ideal situation. This study indicates that education about spouse/partner violence has a significant impact on screening tendencies if provided during a physician's residency program.

Beliefs and traditional treatment of malaria in Kishe settlement area, southwest Ethiopia.

Kishe settlement area southwest Ethiopia, is endemic for malaria, and malaria-related morbidity and mortality are important public health problems. Malaria beliefs and practices are often related to culture, and can influence the effectiveness of control strategies. This study assessed attitude and practices relative to causation, treatment, prevention and control of malaria, and documented traditional malaria treatment practices and remedies, in order to provide baseline data for control program planning and further investigation. A cross-sectional study was conducted in December 1997 by interviewing 254 randomly selected study subjects 85 indigenous and 169 settlers. Eighty three percent of 254 respondents attributed the cause of malaria infection to dirt and rubbish. Ranking of vector control measures was poor, with 77% prioritizing cleaning dirt and rubbish, while only 36% mentioned drainage of swampy areas. Ninety eight percent accepted Dichlorodiphenyltrichlroethane (DDT) house spraying. The prevalence of clinical malaria attacks was 77% and communities had good knowledge about malaria morbidity and mortality. Forty three percent had used traditional medicine for malaria, for reasons including greater accessibility (82%), low cost (48%), lack of awareness about modern medicine (25%) and belief that traditional medicine is better (7%). Most are well informed about malaria morbidity and mortality, understood about the use of DDT spraying and have good treatment seeking behavior but practice of prevention and concept about causation prevention, and control of malaria is poor. It is wise to put emphasis on health education particularly on preventive aspects. Malaria control technicians and environmental health technicians, who closely interact with the community could be used for this purpose. The common traditional treatments for malaria could be further investigated for their effects on malaria parasites and/or symptomatic relief of clinical illness.

Effect of HMG-CoA reductase inhibitors (statins) on bone mineral density.

Recent studies have suggested that 3-hydroxy-3-methylglutaryl - coenzyme A (HMG-CoA) reductase inhibitors (statins) can increase the bone mineral density (BMD). Our objective was to determine if patients on statin drugs were more likely to have a greater bone mineral density and lower risk of osteoporosis than patients not taking these drugs. A computerized pharmacy system provided complete medication dispensing records for the 983 patients (697 men and 286 women) referred for bone mineral density testing at a single Veterans Affairs Medical Center. In an analysis of covariance model that adjusted for age, body mass index, race, and vitamin use, men using statin drugs were more likely to have a greater BMD of the spine (p < 0.005). The mean difference (effect size) was 0.05 g/cm2 (95% confidence interval of [CL] 0.02-0.09), about 5.3% greater BMD. In women, the association was not significant. The risk of osteoporosis (defined as a T-score < or = -2.5) was determined using logistic regression analysis after adjustment for potential confounding variables. Although not statistically significant, men who received statin drugs for more than 2 yr were approximately half as likely to develop osteoporosis (odds ratio [OR] =.55, 95% CI = 0.28-1.08). A similar effect was observed in women taking statins for any length of time (OR = 0.36, 95% CI = 0.12-1.07). This study suggests that statin drugs may decrease osteoporosis risk, warranting a randomized controlled trial.

Risk factors for malaria among expatriates living in Kampala, Uganda: the need for adherence to chemoprophylactic regimens

This investigation was conducted in response to a report of an increased number of malaria cases among United States Embassy personnel in Kampala; Uganda in the spring of 1992. The objectives of the investigation were to determine if an outbreak had occurred; to identify potential risk factors for malaria in this population; and to assess the effectiveness of various chemoprophylactic regimens. The risk of developing malaria during the first half of 1992 was more than six times greater than during the same time period in 1991 (relative risk [RR] = 6.6; 95CONFIDENCE INTERVAL [ci] = 1.6-27.8) and almost seven times greater than all the previous six years combined (RR=6.8; 95CI = 2.9-15.9). In this outbreak; children and young adults less than 20 years of age had more than a three-fold increase in risk (RR=3.7; 95CI=0.7-19.8) than those in the 20-39 year-old- age group. African-Americans had a six-fold increased risk compared with Caucasians (RR=6.0; 95CI = 1.6-22.7). Those who did not tale any drug prophylaxis were 10 times more likely to develop malaria (RR=10.0; 95CI=2.7-37.0) than those who took mefloquine; dexycycline; or chloroquine plus proguanil. In this setting; weekly mefloquine was 82 more effective and chloroquine plus proguanil was 92more effective than weekly chloroquine alone. This outbreak underscores the need for compliance with appropriate chempprophylactic regimens in preventing malaria infection. Source: Am.J.Trop.Med. Hyg. 1995 March; 52(3):207-12