Predictors of past quit attempts and duration of abstinence among cigarette smokers.

OBJECTIVE: Despite the widespread awareness of the harms of smoking, millions continue to smoke around the world partly due to the difficulty it takes to quit smoking. Identifying the factors associated with making quit attempts is an essential pillar to reach successful quitting. The purpose of this study is to assess the factors associated with the past quit attempts and their past length of abstinence in a Lebanese sample of cigarette smokers. METHODS: This study was conducted between March 2014 and March 2015, involving 382 patients randomly chosen from 5 outpatient clinics in 5 hospitals in Lebanon. A standardized questionnaire was completed including socio-demographic characteristics, smoking behavior, chronic respiratory symptoms, Fagerstrom scale, Mondor scale, packaging perception, quitting behavior and readiness to quit ladder. RESULTS: Smokers who have chronic allergies (ORa=2.45, p=0.03), those who have ever stopped smoking for at least one month due to the warnings implemented on the packages (ORa=4.6, p<0.0001) and smokers with an intention to quit in 2months (ORa=2.49, p<0.0001) had significantly more past quit attempts. Furthermore, longer quit attempts duration (more than 1month) were significantly associated with low-nicotine dependent smokers (ORa=0.56, p=0.02), higher-motivated smokers (ORa=1.85, p=0.01), people with chronic allergies (ORa=2.07, p=0.02), smokers who have ever stopped smoking for at least one month due to the warnings (ORa=3.72, p<0.0001) and those with an intention to quit in 2months (ORa=1.98, p=0.05). CONCLUSION: The promoters of smoking cessation services should consider these factors when designing comprehensive tobacco control initiatives and in service planning.

[Influence of the age and the level of transmission on the clinical and biological expression of severe malaria in children]. / Influence de l'âge et du niveau de transmission sur l'expression clinique et biologique du paludisme grave de l'enfant.

INTRODUCTION: This study aimed to determine the influence of the age and the level of malaria transmission on the clinical and biological expression of severe malaria in children. METHODS: A prospective descriptive study was conducted in nine referral hospitals in Kinshasa. A total of 1350 children, less than 15years old and hospitalized for severe malaria, were progressively included in the study between January and November 2011. RESULTS: The majority of these children (74.5%) were less than 5years of age. Major syndromes were severe anemia (11.4%), cerebral malaria (27.1%), and respiratory distress (20.5%). Severe anemia and cerebral malaria were associated with the age of the child and not the area transmission. On the other hand, respiratory distress was associated with high malaria transmission areas (P<0.05). After adjustment, these associations were maintained. High malaria lethality was observed in the group of children aged 12-59months (11.6%) and those from areas of high malaria transmission (8.4%). CONCLUSION: The child's age and level of transmission are associated with certain severe types of childhood malaria. Early and appropriate support would reduce the most fatal consequences associated with severe childhood malaria.

Downward trends in the prevalence of childhood overweight in two pilot towns taking part in the VIASANO community-based programme in Belgium: data from a national school health monitoring system.

BACKGROUND: Multilevel approaches involving environmental strategies are considered to be good practice to help reduce the prevalence of childhood overweight. OBJECTIVES: The objective of this study was to evaluate the effects of VIASANO, a community-based programme using the EPODE methodology, on the prevalence of overweight in two pilot towns in Belgium. METHODS: We analysed data from a national school health monitoring system to compare changes in the prevalence of overweight and obesity over a 3-year period (2007-2010) in children aged 3-4 and 5-6 years in the pilot towns with those of children of the same ages from the whole French-speaking community of Belgium. Heights and weights of all participants were measured by trained school nurses using a standardized method. RESULTS: The prevalence of overweight (-2.1%) and overweight + obesity (-2.4%) decreased in the pilot towns, but remained stable in the comparison population (+0.1% and +0.2%, respectively). After adjustment for lack of homogeneity between the study populations, there was a trend towards a decrease in overweight (P = 0.054) and overweight + obesity (P = 0.058) in the pilot towns compared with the general population. CONCLUSIONS: These results suggest that a community-based programme, such as VIASANO, may be a promising strategy for reducing the prevalence of childhood overweight even over a short period of time.

Paludisme à la première consultation prénatale : prévalence et facteurs associés en milieu rural au Sud Kivu à l'Est de la République Démocratique du Congo

Contexte : Les femmes enceintes constituent un groupe vulnérable face au paludisme. Dans l'objectif de déterminer la prévalence et les facteurs associés au paludisme pendant la grossesse, une étude a été menée dans la zone de santé rurale de Miti-Murhesa, à l'Est de la République Démocratique du Congo (RDC), trois ans après une distribution de Moustiquaires Imprégnées d'Insecticide (MII).Méthodes : Les données de 478 femmes enceintes recueillies à leur première consultation prénatale entre novembre 2010 et juillet 2011 ont été analysées. Les femmes étaient recrutées au deuxième trimestre de la grossesse aux centres hospitaliers de Murhesa et de Lwiro. Un cas de paludisme était défini par une goutte épaisse positive pour le plasmodium. L'altitude de la résidence d'origine de chacune des femmes était mesurée par un GPS. Résultats : A l'admission 9,5% (n = 453) de femmes présentaient une infection palustre. En régression logistique, la fréquence du paludisme était plus élevée chez les primigestes, chez les femmes avec niveau socio-économique bas et chez celles vivant à moins de 1683 m d'altitude ; les rapports de cote ajustés (IC 95%) étaient respectivement de [2,55 (1,05-6,19) ; P = 0,039] ; [4,78 (1,36-16,76) ; P = 0,033] et [2,34 (1,10-5,02) ; P = 0,029].Conclusion : Ces résultats montrent que le paludisme est resté présent chez les femmes enceintes trois ans après une distribution de moustiquaires à Miti-Murhesa. La première grossesse, le niveau socioéconomique bas et la résidence en basse altitude étaient des facteurs significativement associés au paludisme. Ces résultats appellent à intensifier les activités de prévention contre le paludisme dans la communauté de manière à protéger plus efficacement les femmes en âge de procréer

[Determinants of breastfeeding in the Brussels Region]. / Facteurs associés à l'allaitement maternel à la maternité en Région bruxelloise.

PURPOSE: The objectives of this paper is to study the prevalence of breastfeeding in Brussels, to assess whether the targets of the Maternal and Child Health program (MCH) were met (prevalence's of breastfeeding of 85 and 75% of exclusive breastfeeding) and finally to identify factors associated with exclusive breastfeeding at the birth. MATERIALS AND METHOD: The cross-sectional survey is representative of children 18 to 24 months living in Brussels. Data on breastfeeding are anamnestic and retrospective. A face to face questionnaire was administered by trained investigators, 16 questions about breastfeeding as well socio-demographic information were collected from 544 mothers. The survey took place in 2012. RESULTS: At the birth, 83.3% (95% CI 80.1-86.4) of mothers exclusively breastfed and 9.7% of the mothers (7.3-12.2) partially. When discharged from maternity unit, 80.9% (77.6-84.2) of mothers breastfed exclusively and 9.7% (7.3-12.2) partially. When fitting a logistic model, predictors associated with exclusive breastfeeding at the birth were gestation, type of birth, father's education level and the main influencing factor was the partner's attitude. DISCUSSION: The targets of the MCH were reached in Brussels. Until now, transversal surveys are the only way of knowing the prevalence and the factors associated with breastfeeding in Brussels. These first representative data on breastfeeding came from the 2012 vaccine coverage survey. Given the primary role of the father in choosing a breastfeeding it is necessary that the father is more often taken into account in regard to the promotion of AM during the prenatal period. A rigorous use of definitions of AM should be systematized.

[Children hospitalized with severe malaria in Kinshasa (Democratic Republic of the Congo): Household characteristics and factors associated with mortality]. / Caractéristiques des ménages des enfants hospitalisés pour paludisme grave et facteurs associés à la létalité palustre à Kinshasa (République démocratique du Congo).

BACKGROUND: Malaria is a major health problem in tropical Africa. In DRC, little is known about the characteristics of households of children with severe malaria or the factors associated with its lethality, especially relative to hospital status. METHODS: This study of 9 hospitals of the city-province of Kinshasa studied 1350 children younger than 15 years and hospitalized for severe malaria from January to November 2011. RESULTS: More than three quarters of children admitted to public (state) and church hospitals were from poor households and with uneducated mothers (P < 0.001). The case-fatality rate (5.9% of all children) differed according to hospital status: 5.3% in state hospitals, 8.4% in private hospitals, and 4.0% in the faith-based hospitals (P < 0.001). The risk of death was significantly associated with circulatory collapse (odds ratio, OR = 10.3), number of associated syndromes >2 (OR = 3.5), z-score of weight-for-age ≤-2 (OR = 3.5), delay in seeking medical care (OR = 4.9), body temperature ≥40°C (OR = 2.9), respiratory distress (OR = 1.9) and home rental (versus ownership) a tenant (OR = 2.8), and anorexia was a protective factor (odds ratio = 0.5). CONCLUSION: Severe cases of malaria are rife in poor households and periurban residential areas. Orienting prevention, control, and care- according to the vulnerability of affected households and providing early treatment are imperative if we are to reduce mortality from malaria.

[Association of air-pollution with acute myocardial infarction: A case-crossover study]. / Association entre pollution atmosphérique et infarctus du myocarde sur base de la méthode cas-croisé.

BACKGROUND: A large number of studies have demonstrated an association between ambient air pollutant exposures and acute myocardial infarctions (AMI). Case-crossover methods are frequently used for analyzing the acute health effects of air pollution. Nevertheless, only a few studies controlled for potential confounders like other air pollutants and temperature. METHODS: The defined geographic entity for the collection of acute myocardial infarctions was composed of 15 municipalities in Charleroi. Charleroi is a relatively highly polluted region in Wallonia, the South of Belgium. The analyses presented hereafter concern patients in the 25-74 years age range over time from 1999 to 2009. Ambient concentrations of PM10, O3, NO2, CO and temperature were available from stationary monitors during this time period. A time-stratified case-crossover approach was applied. Season stratified analysis and analysis matching for environmental confounders were also performed. RESULTS: A total of 3303 AMIs were analyzed during the study period. For the entire year, O3 was significantly associated with AMI, OR=1.028 (CI95%: 1.003-1.054). The highest associations (for a 10 µg.m(-3) rise in pollutant levels) between air pollution and myocardial infarction were observed for PM10 and O3 during the warm period, OR=1.086 (CI95%: 1.020-1.151) and 1.064 (CI95%: 1.024-1.105), respectively. Matching cases and controls for temperature produced weaker association between O3 and AMI (OR=1.003, CI95%: 0.974-1.032). In contrast, this matching had no effect on the association between PM10 and AMI. The adjustment for NO2 concentration decreased the association between PM10 and AMI. CONCLUSIONS: The results of this study reinforce the evidence of the short-term effects of air pollution on acute myocardial infarction, especially during the warm season. This also suggests that the case-crossover method is a suitable tool in studying the association between acute events and air pollution. Controlling for potential environmental confounding effects is also feasible with this method.

Breastfeeding duration: a survival analysis-data from a regional immunization survey.

OBJECTIVE: To report the duration of and factors associated with exclusive and any breastfeeding among the French-speaking community of Belgium (Wallonia). MATERIAL AND METHODS: A two-stage cluster sample was drawn from the population of children aged 18-24 months living in the area in 2012. Anamnestic data on breastfeeding and sociodemographic information were collected from 525 mothers. Cox's proportional hazards model was used to identify factors associated with discontinuing breastfeeding. RESULTS AND DISCUSSION: Only 35.1% of the women were satisfied with their duration of any breastfeeding. At 3 months, 54.1% of the infants were breastfed, of which 40.6% exclusively, with these percentages falling to 29.1% and 12.6% at 6 months. Exclusive and any breastfeeding durations were independently positively associated (P < 0.05) with foreign-born mothers, awareness of WHO recommendations, and maternity leave >3 months. Exclusive BF duration was associated with higher parental income and the prenatal decision to breastfeed. The duration of any breastfeeding was associated with the mothers' age of ≥30 years and whether they were exclusively breastfeeding at discharge from the maternity unit. CONCLUSIONS: Programs promoting and supporting BF should concentrate on training prenatal health-care professionals. Prenatal professional advice may promote adherence to WHO BF guidelines. The benefits of exclusive BF should be emphasized. Pregnant women should be discouraged from introducing supplementary feeding in the maternity ward.

[Breastfeeding in the French-speaking community of Belgium (2009)]. / Estimation de la prévalence de l'allaitement maternel au travers d'une enquête en population de couverture vaccinale en Belgique francophone en 2009.

PURPOSE: The objectives of this paper were to study the prevalence of breastfeeding in the French-speaking community of Belgium, to assess whether the targets of the Maternal and Child Health program (MCH) were met (prevalence of breastfeeding of 85, 70, 50, and 25% at the maternity hospital and at 3, 6, and 12 months of age, respectively), and to identify factors associated with breastfeeding at the maternity hospital and at 6 months of age. MATERIALS AND METHODS: A sample (two-stage cluster sampling) was drawn from the population of children aged 18-24 months living in the area. A face-to-face questionnaire was administered by trained investigators. Anamnestic data on breastfeeding at the maternity hospital and at 3, 6, and 12 months as well sociodemographic information were collected from 522 mothers. The survey took place in 2009. RESULTS: At the maternity hospital, 75.7% (95%CI [72.7-79.5]) of the mothers were breastfeeding: 72.4% among the Belgians (and French) and 89.0% among foreign mothers. At 3 months of age, the breastfeeding prevalence was 48.3% (CI, 44.0-52.6): 42.5% among the Belgians (and French) and 72.0% among foreign mothers (p<0.001). At 6 months of age, 26.0% of the mothers were breastfeeding (CI, 22.3-29.8): 19.3% among the Belgians (and French) and 53.0% among foreign mothers (p<0.001). At 12 months of age, 10.0% (CI, 7.4-12.5) of the mothers were breastfeeding: 4.8% among the Belgians (and French) and 31.0% among the foreign mothers (p<0.001). When fitting a logistic model, the predictors associated with breastfeeding at the maternity hospital were educational level, nationality of birth, and parity. At 6 months, logistic models were fitted separately in the two strata. Among the Belgians, the level of education and attending a MCH consultation were significantly associated with breastfeeding. In the stratum of foreign mothers, the only factor associated with breastfeeding was working time. No association was observed between breastfeeding and the mother's age at the maternity hospital or at 6 months. DISCUSSION: The targets of the MCH were not reached in Belgian and French mothers, while they were in mothers of other nationalities. Until now, transversal surveys have been the only way of knowing the prevalence and the factors associated with breastfeeding in the French-speaking community of Belgium. These first representative data on breastfeeding came from the 2009 vaccine coverage survey.

[Acute myocardial infarction in Charleroi: evolution of risk factors and therapeutic practices]. / Infarctus aigu du myocarde à Charleroi : évolution des facteurs de risque et des pratiques thérapeutiques.

OBJECTIVES: The aim of the study consists in analyzing the evolution of acute coronary risk factors as well as the 28 days case fatality and the therapeutic practices over 12 years of follow-up in Charleroi. The factors influencing the mortality of these patients are also investigated. METHODS: The Charleroi register of ischaemic cardiopathies is the oldest register of infarctions in the French-speaking community of Belgium. Analyses presented hereafter relate only patients in the 25-69-year age range over time from 1998 to 2009. Some analysis was extended to 25-74-year range. Treatment and risk factors evolutions over time were analysed using Chi(2) tests. Logistic regression was used to identify factors influencing 28 days mortality. RESULTS: The analysis shows a significant decline in 28 days mortality. A marked increase in the prevalence of hypertension and hypercholesterolemia is highlighted as well as an increase of utilization of percutaneous transluminal coronary angioplasty (PTCA) between 1998 and 2009. The use of ß-blockers and antiplatelet drugs remained fairly stable between 1998 and 2009 with approximately 75% and 90% of the patients treated, respectively. The factors associated with fatality were specifically age of patients, antecedents of diabetes and antecedents of myocardial infarction, hypercholesterolaemia as well as oral antiplatelet drugs, ß-blockers therapies and PTCA. CONCLUSIONS: The evolution of the therapeutic data on AMI in this register confirms that PTCA becomes the main coronary reperfusion. Angiotensin-converting enzyme inhibitors were without effect on mortality.

[Prevalence and incidence of HIV and hepatitis B among blood donors and estimated residual risk of transmission of HIV and HBV virus by blood transfusion. A study at the Provincial General Referee Hospital Bukavu, Democratic Republic of the Congo]. / Prévalence et incidence du VIH et de l'hépatite B chez les donneurs de sang et estimation du risque résiduel de transmission du virus VIH et du virus VHB par la transfusion sanguine. Une étude à l'hôpital provincial général de référence de Bukavu, République démocratique du Congo.

BACKGROUND: To estimate the residual risk of transmission of HIV and HBV virus by blood transfusion in Bukavu. METHODS: Retrospective cohort study designed for exploratory purposes, which took place in Bukavu (DR Congo) between January 2001 and December 2005, among 3292 blood donors. The incidences were estimated by survival curves and Cox models. The adjusted relative risks with their confidence interval at 95% were derived from Cox models. The residual risk of viral transmission associated with the serological window is equal to the incidence rate multiplied by the duration of the serological window divided by 365. RESULTS: The prevalence among blood donors in Bukavu was 1% for HIV and 3.7% for HbsAg. The number of incident cases observed was seven for HIV and 40 for hepatitis B between 2001 and 2005. The incidence rates obtained were 3.57 for 1000 person-years (0.93/1000-6.23/1000) and 25.4 per 1000 person-years (17.6/1000-33.36/1000), respectively for HIV and hepatitis B. The residual risk was 1/4608 donations for HIV or 0.22 (0.02-0.65) and 1/257 donations for HBV or 3.90 (1.20-9.96). Also there were more seroconversions among family blood donors than in volunteer donors. The risk of seroconversion in family donors compared to volunteer donors adjusted for age, sex and residence was 7.09 (3.75-13.39) for HIV and 4.03 (2.63-6.20) for HBsAg. The same result was observed with the survival curves. CONCLUSION: The prevalences of HIV and HBsAg in Bukavu are lower than in most major cities in sub-Saharan Africa. Residual risks are especially important for hepatitis B.

[HIV testing among women in delivery rooms in Lubumbashi, Democratic Republic of the Congo: a catch-up strategy for prevention of mother-to-child transmission]. / Dépistage du VIH en salle de travail à Lubumbashi, République Démocratique du Congo. Une stratégie de rattrapage dans le cadre de la prévention de la transmission de la mère à l'enfant.

BACKGROUND: Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS: Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS: Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION: Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.

[Impact of method of recruitment of blood donors on the prevalence of HIV and HBV in Bukavu, DR Congo]. / Impact du mode de recrutement des donneurs de sang sur la prévalence du VIH et du VHB à Bukavu, République démocratique du Congo.

OBJECTIVES: To determine the impact of the mode of recruitment of blood donors on the prevalence of blood-borne infections (HIV and HBV). METHODOLOGY: Retrospective cohort study, conducted in Bukavu (eastern DR Congo) 2001-2005. HBsAg and HIV tests were analyzed according to age, sex, type, and category of donors. Proportions were compared with Pearson Chi2 or Fisher's exact tests and Chi2 trend tests, and the strength of associations measured by odds ratios (and their 95% CI). RESULTS: Men accounted for 70.2% of the donors, and 88.3% were volunteers (n = 3292). Regular donors (n = 7442) provided 75% of the donations . The proportion of family donors decreased over time, from 14.3% in 2001 to 5.1% in 2005. HIV prevalence was 1% and that of HBsAg 3.7%. Prevalence rates were higher among new donors than among regular donors (HIV 1.9% versus 0.2% and HBsAg 7.3% versus 0.5%), among family donors than among volunteers (4.2% versus 1.6% for HIV and 9.9% versus 7% for HBs Ag, and among women than among men (2.8% versus 1.6%, OR = 1.79 [1.08-2.96]). Thus new women family donors were 3.75 times more likely to be HIV-positive as new volunteers who were women (OR = 3.75 [1.65-8.55]). The prevalence of HBsAg among new women donors was 5.8%, lower than among their male counterparts, 7.9% (OR = 0.71 [0.51-0.98]). CONCLUSION: Risk of contamination by seropositive donors was lowest for regular and volunteer blood donors.

Clinical aspects and outcome of suspected severe pediatric malaria.

OBJECTIVE: The authors had for aim to evaluate diagnosis and treatment practices applied to children with clinically suspected severe malaria, in two referral hospitals of Kisangani. PATIENTS AND METHODS: A prospective study was carried out between January 1, 2010 and February 28, 2011 including all children admitted for clinically suspected severe malaria, with at least one of the WHO severity criteria. RESULTS: One thousand one hundred and fifty-four children were admitted in the two hospitals, 427 (37.0%, n=1.154) for clinically suspected severe malaria: 155 (36.3%, n=427) had a positive thick drop examination (TDE), 198 (46.4%, n=427) a negative one, and 74 (17.3%, n=427) without thick blood smear examination. Prostration (48.0%) and anemia (40.3%) were the most common severity criteria, while 14.5% and 9.8% presented with convulsions and impaired consciousness respectively. The etiological treatment was quinine infusion. The case specific fatality rate was 19.4% (n=427), 7.7% (n=155) in confirmed cases, 9.6% (n=198) in patients with negative thick blood smear, and 70.3% (n=74) in patients without any TDE (P <0.001). CONCLUSION: Poor technical support and inadequate organization of the patient circuit can result in underestimating the metabolic complications of severe malaria and of other severe infections of early childhood. This is detrimental to the patients, even when effective drugs are available.

Waterpipe smoking and dependence are associated with chronic bronchitis: a case-control study in Lebanon.

Waterpipe smoking and its association with chronic bronchitis has not been assessed in Lebanon. This case-control study in Beirut in 2009/2010 evaluated this relationship: 274 cases of chronic bronchitis and 559 controls without the condition aged > or = 40 years were enrolled. Data were collected by questionnaire on: sociodemographic characteristics, respiratory symptoms, smoking (waterpipe and cigarette) and nicotine dependence. ANOVA, Student, Kruskal-Wallis, chi-squared and Fisher exact tests were used when applicable and logistic regression analysis was carried out. Previous waterpipe smoking (OR = 6.4), previous mixed smoking (OR = 38.03) and current mixed smoking (OR = 7.68) were significantly associated with chronic bronchitis (P < 0.001 for all) but current exclusive waterpipe smokingwas not (OR = 1.87, 95% CI: 0.74-4.72). Current waterpipe dependence was significantly associated with chronic bronchitis (OR = 3.74, P < 0.001). After adjustment for covariates/confounders, ever waterpipe smoking > 20 WP-years (P < 0.001) was significantly associated with chronic bronchitis.

Waterpipe smoking and dependence are associated with chronic bronchitis: a case-control study in Lebanon

Waterpipe smoking and its association with chronic bronchitis has not been assessed in Lebanon. This case-control study in Beirut in 2009/2010 evaluated this relationship: 274 cases of chronic bronchitis and 559 controls without the condition aged >/=40 years were enrolled. Data were collected by questionnaire on: sociodemographic characteristics, respiratory symptoms, smoking [waterpipe and cigarette] and nicotine dependence. ANOVA, Student, Kruskal-Wallis, chi-squared and Fisher exact tests were used when applicable and logistic regression analysis was carried out. Previous waterpipe smoking [OR = 6.4], previous mixed smoking [OR = 38.03] and current mixed smoking [OR = 7.68] were significantly associated with chronic bronchitis [P < 0.001 for all] but current exclusive waterpipe smoking was not [OR = 1.87, 95% CI: 0.74-4.72]. Current waterpipe dependence was significantly associated with chronic bronchitis [OR = 3.74, P < 0.001]. After adjustment for covariates/confounders, ever waterpipe smoking > 20 WP-years [P < 0.001] was significantly associated with chronic bronchitis

[Influence of malnutrition on childhood mortality in a rural hospital in Rwanda]. / Influence de la malnutrition sur la mortalité des enfants dans un hôpital rural au Rwanda.

BACKGROUND: Recent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda. METHODS: A prospective cohort study included children aged 6-59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression. RESULTS: At the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5-8.4) and 4.0 (IC95% 2.0-8.2) respectively. CONCLUSION: The study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition.

Differences in nasopharyngeal bacterial carriage in preschool children from different socio-economic origins.

A prospective cohort study of preschool healthy children (3-6 years old) from two distinct socio-economic settings in the Brussels area, Belgium, was conducted during the years 2006-2008. The objectives were to evaluate nasopharyngeal colonization by Streptococcus pneumoniae, Staphylococcus aureus, Moraxella catarrhalis and Haemophilus influenzae at the time of PCV7 vaccine introduction and to assess the socio-economic level impact on flora composition and antibiotic resistance. Three hundred and thirty-three children were included and a total of 830 nasopharyngeal samples were collected together with epidemiological data. Pneumococcal serotypes and antibiotic resistance profiles were determined. Risk factors for carriage and bacterial associations were analysed by multivariate logistic regression. Carriage rates were high for all pathogens. Fifty per cent of the children were colonized at least once with S. aureus, 69% with S. pneumoniae, 67% with M. catarrhalis and 83% with H. influenzae. PCV7 uptake was higher among children from a higher socio-economic setting and S. pneumoniae serotypes varied accordingly. Children from lower socio-economic schools were more likely to carry M. catarrhalis, S. aureus and antibiotic-resistant S. pneumoniae, including a high proportion of non-typeable pneumococcal strains. Positive associations between S. pneumoniae and H. Influenza, between H. influenzae and M. catarrhalis and between H. influenzae and S. aureus were detected. Our study indicates that nasopharynx flora composition is influenced not only by age but also by socio-economic settings. A child's nasopharynx might represent a unique dynamic environment modulated by intricate interactions between bacterial species, host immune system and PCV7 immunization.

The impact of concomitant rhinitis on asthma-related quality of life and asthma control.

BACKGROUND: Characterizing the interactions between the upper and lower airways is important for the management of asthma. This study aimed at assessing the specific impact of concomitant rhinitis on asthma-related quality of life (QOL) and asthma control. METHODS: A cross-sectional, observational survey was conducted among 1173 patients with asthma (aged 12-45) recruited by general practitioners and chest physicians. AR was defined by self-reported rhinitis symptoms and previously documented sensitization to inhalant allergens. The primary outcomes were (1) asthma control assessed by the Asthma Control Questionnaire (ACQ) and (2) asthma-specific QOL evaluated through the Mini Asthma Quality of Life Questionnaire (mAQLQ). RESULTS: AR was present in 73.9% of the population with asthma and nonallergic rhinitis (NAR) in 13.6%. AR and NAR were associated with an increased risk of uncontrolled asthma (i.e. ACQ score > 1.5) with adjusted odds ratios (OR) of 2.00 (95% confidence interval [CI]: 1.35-2.97) and 1.77 (95%CI: 1.09-2.89), respectively. Multivariate linear regression analysis showed that AR and NAR had a modest, although significant, negative impact on the global mAQLQ score (beta coefficient: -0.293, standard error [SE]: 0.063 and beta coefficient: -0.221, SE: 0.080, P < 0.001, respectively), even after adjustment for the level of asthma control and demographic characteristics. CONCLUSION: This survey provides direct evidence that AR and NAR are associated with an incremental adverse impact on the disease-specific QOL of patients with asthma and the level of asthma control. Further investigations are required to determine whether appropriate treatment of rhinitis would efficiently reduce asthma morbidity.

Working conditions predict incidence of long-term spells of sick leave due to depression: results from the Belstress I prospective study.

BACKGROUND: During the last few years, a high incidence of sick leave due to depression has been reported, resulting in important economic and social impacts. Only a limited number of studies investigating the influence of psychosocial working conditions on sick leave have been prospective and have utilised a valid methodology, while none have studied sick leave due to depression. In this study, the impact of adverse psychosocial working conditions is analysed on the risk for long-term sick leave due to depression. METHODS: This study resulted from the large-scale Belstress I study on the relationship between perceived job stress and health problems. Subjects were Belgian employees selected from 11 large companies (n = 9396). Using a longitudinal design, the association between the three Karasek stress dimensions (job control, psychological demand, and social support) was explored, separately and combined according to the demand-control and demand-control-support models and the incidence of long-term sick leave for depression as diagnosed by the family physician. RESULTS: After adjusting for age, occupational categories, living situation, and baseline depression score, 'passive jobs' (OR 2.67; 95% CI 1.15 to 6.19) and 'high strain' jobs (OR 3.23; 95% CI 1.40 to 7.43) predicted sick leave due to depression at follow-up in men. Job control predicted sick leave due to depression in both men (OR 2.43; 95% CI 1.27 to 4.66) and women (OR 2.21; 95% CI 1.05 to 4.68). CONCLUSIONS: This study provides evidence that the psychosocial working environment influences long-term sick leave due to depression. Efforts to improve skill discretion and decision authority at work could help prevent depression.