Patient demographics and disease variables correlate with distinct cytokine patterns in mitogen-stimulated peripheral blood mononuclear cells from rheumatoid arthritis patients.

There is paucity of literature on the association of peripheral blood cytokine patterns with patient demographics and disease variables in rheumatoid arthritis (RA). We test the hypothesis that there may be differences in peripheral blood levels of inflammatory cytokines in RA subjects according to various disease variables. In this case, we could identify peripheral blood cytokine markers that correlate with different disease variables. Forty-two seropositive RA patients were characterized according to the age at onset, gender, disease duration, severity, activity and ACR functional class. The production levels in mitogen-stimulated PBMCs of five pro-inflammatory cytokines (IFNgamma, TNFalpha, TNFbeta, IL-8, IL-18) and three anti-inflammatory cytokines (IL-4, IL-10, IL-13) were evaluated in these patients and in healthy controls. Several new findings emerge: (1) higher levels of IL-4 correlate with female gender, milder disease, non-erosive disease, and earlier age at onset; (2) higher levels of IL-10 correlate with the requirement of < or =2 DMARDs; (3) higher levels of IL-18 correlate with non-erosive disease and younger age at onset; (4) higher TNFbeta levels correlate with older present age of patients; and (5) higher IL-8 levels correlate with established/late disease. There are several interesting differences in cytokine patterns with respect to age at onset, current age, disease severity, and the number of DMARDs the patients require.

Determinants of antenatal morbidity: a multivariate analysis.

OBJECTIVES: The aim of this paper was to investigate the potential risk factors for developing complications and their magnitude during the antenatal period. METHODOLOGY: The data used in this paper came from a prospective survey in rural areas of Bangladesh conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT) between November 1992 and December 1993. The differential patterns were analyzed for respondents' selected characteristics, and multivariate analysis was performed employing logistic regression and proportional hazards models for life-threatening and high-risk complications during pregnancy. RESULTS: For life-threatening complications during pregnancy, several factors emerged as potential risk factors, such as number of the pregnancy, age at marriage, duration of pregnancy, economic status and history of anemia prior to the index pregnancy. The last two covariates were associated only in the proportional hazards. Potential risk factors for high-risk complications during pregnancy were level of education, age at marriage, wanted pregnancy, duration of pregnancy and economic status. CONCLUSIONS: Health planners and policy makers in developing countries are trying to facilitate health services at the doorsteps of rural people. Our findings will help them understand the magnitude and underlying determinants of maternal morbidities and help their health planning process to reduce both life-threatening and high-risk complications during the antenatal period. Early age at marriage needs to be prevented through encouragement of girls' education as well as through increased social awareness programs. An effective quick referral mechanism should be developed to provide emergency services to high risk-groups. Finally, the importance of additional food supplements needs to be promoted during antenatal care visits as well as through mass media in order to reach people living in remote areas of rural Bangladesh.

A computer program to estimate the parameters of covariate dependent higher order Markov model.

This paper presents a computer program developed in S-plus to estimate the parameters of covariate dependent higher order Markov Chain and related tests. The program can be applied for two states Markov Chain with any order and any number of covariates depending on the PC capabilities. The program provides the maximum likelihood estimates of the parameters, together with their estimated standard error, t-value and significance level. It also produces the test results for likelihood ratio and model chi-square. To illustrate the program we have used a longitudinal data set on maternal morbidity of rural women in Bangladesh. The occurrences of haemorrhage, convulsion, or fits at different follow-ups were used as outcome variable. Economic status, wanted pregnancy, ages at marriage, and education of women were used as covariates.

Unmet need for contraception in Kuwait: issues for health care providers.

Based on a nationally representive household survey of Kuwaiti women held in 1999 (n = 1502) unmet need for contraception was analyzed in Kuwait, an oil-rich Muslim country. It was found that 9.7% currently married women had an unmet need for contraception. Of those, 6.1% wanted to stop child bearing, while 3.6% wanted to space their children. A bivariate comparison of the women with unmet need and current contraceptors showed that the unmet need group comprised of relatively older women with a significantly higher level of parity and ones where husband or wife disapproved of contraception. Also, larger percentages of the unmet need group belonged to relatively lower socio-economic status and were Bedouins. Among the reasons for current non-use, two-third believed that they had a low risk of pregnancy due to infrequent sexual activity or sub-fecundity, and 22% were not using a method because of health concerns. A significantly larger percentage of the unmet need group disapproved of contraception, and believed that Islam forbids family planning, compared to current users (30% and 15%, respectively). The logistic regression analysis showed that the wife's perception of the husband's disapproval of contraceptive use had the strongest negative association with unmet need. We conclude that the contraceptive needs of about 90% of all non-pregnant currently married women who wanted to delay or limit children were being met adequately despite the absence of a formal family planning program, while about 10% women had an unmet need. Issues for health care providers are discussed and family planning counseling is recommended for higher risk older women with unmet need.

A multistage model for maternal morbidity during antenatal, delivery and postpartum periods.

There is acute dearth of information regarding factors affecting complications during different stages of childbearing in Bangladesh. This study employs a multistage model that involves transitions at different stages to complications. The proposed model appears to display more meaningful explanation concerning the impact of different factors on the incidence of complications taking into account types of transitions. Two alternative models are also presented in this paper in order to demonstrate possible simplifications of the proposed model. This study uses data from a prospective survey on Maternal Morbidity in Bangladesh. The survey was conducted during the period 11 1992-12 1993. A total of 1020 pregnant women were followed during pregnancy, delivery and 90 days after delivery. This study reveals some very important findings regarding the potential impact of antenatal visits, economic status, whether the index pregnancy was desired or not and number of pregnancies prior to the index pregnancy. It is observed that slightly more than 50 per cent of the women suffer from at least one of the major complications (haemorrhage, excessive vomiting, oedema and fits/convulsion) during pregnancy. It is noteworthy that if a woman suffers from one or more of the major complications during pregnancy, then it is more likely that she will suffer from complications during delivery. This study reveals that the women who suffer from one or more of the major complications during pregnancy are expected to have a substantially higher risk of suffering from complications during postpartum period, irrespective of no complications or complications during delivery. Generally speaking, higher economic status can reduce the complications at the postpartum stage, although women belonging to higher economic status may suffer from complications during pregnancy and delivery at a higher rate. It is surprising that antenatal visit is positively associated with incidence of complications during pregnancy and delivery, but antenatal visit reduces complications at the postpartum stage.

Determinants of the use of maternal health services in rural Bangladesh.

Utilization of health services is a complex behavioral phenomenon. Empirical studies of preventive and curative services have often found that use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. In this paper an attempt is made to examine the factors associated with the use of maternal health care services in Bangladesh on the basis of data from a survey of maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). The results from both the bivariate and multivariate analyses confirmed the importance of mother's education in explaining the utilization of health care services. Female education retains a net effect on maternal health service use, independent of other women's background characteristics, household's socioeconomic status and access to healthcare services. The strong influence of mother's education on the utilization of health care services is consistent with findings from other studies. Women whose husbands are involved in business/services also positively influenced the utilization of modern health care services. However, the study results are inconclusive with respect to the influence of other predisposing and enabling factors, such as women's age, number of previous pregnancies and access to health facilities. Multivariate logistic regression estimates do not show any significant impact of these factors on the use of maternal health care. The influence of severity of disease condition in explaining the utilization of maternal health care appears to be significant. Multivariate analysis indicate that women having had a life-threatening condition are little over two times more likely to seek care from a doctor or nurse to treat their maternal morbidities.

Analysis of ante-partum maternal morbidity in rural Bangladesh.

This paper presents the results of a prospective study of maternal morbidity during the ante-partum period in rural areas of Bangladesh. The data came from a survey of Maternal Morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT) during the period from November 1992 to December 1993. Since then no such national level survey has been conducted in Bangladesh. This paper employs multiple-decrement life table technique, a convenient way of analysing the risks of different types of disease conditions that women experience during the antenatal period for different age categories. The high-risk complications such as ante-partum haemorrhage, excessive vomiting, fits/convulsion and oedema were considered in this study. In this study a cause specific model was applied to explore the differences in the risks exerted at different ages of reproductive life attributable to some selected complications of pregnancy. The results of this study indicate that women of age 25-29 years are less susceptible to most of the selected life-threatening and high-risk complications during pregnancy such as haemorrhage, fits/convulsion and oedema. However, younger women (age < 25 years) are more likely to have excessive vomiting during pregnancy, and older women (age > or = 30 years) are at greater risk of haemorrhage, fits/convulsion and oedema.

Utilisation of postnatal care in Bangladesh: evidence from a longitudinal study.

Utilisation of health services is a complex behavioural phenomenon. Empirical studies of preventive and curative services in Bangladesh have often showed that the use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. The present paper attempts to examine factors associated with the utilisation of healthcare services during the postnatal period in Bangladesh by using prospective data from a survey on maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERT). Both bivariate and multivariate analyses of the data confirmed that the mother's age at marriage had a significant and positive impact on the utilisation of quality healthcare services. The husband's occupation also showed a strong impact on healthcare utilisation, indicating higher use of quality care for postpartum morbidity by wives of business and service workers. The bivariate analysis showed that the number of pregnancies prior to the index pregnancy and desired pregnancies are significantly associated with the utilisation of postpartum healthcare. However, the results of this study were inconclusive on the influence of other predisposing and enabling factors, such as maternal education, the number of previous pregnancies, the occupation of the husband, antenatal care visits during pregnancy and access to health facilities. Multivariate logistic regression estimates did not show any significant impact of these factors on the use of maternal healthcare.