Breast-feeding in Geneva: Prevalence, duration and determinants

Summary: A telephone survey was carried out with the objective of measuring the prevalence, duration and determinants of breast-feeding in the canton of Geneva, between August and December 1993. The participants were 278 out of 320 families with a telephone number in Geneva, from a random sample of families in which a child had been born in Geneva in the preceding 15 months. Prevalence of breast-feeding at 1 day of life was 93.3%, at 3 months 62.5%, at 4 months 51.1%, at 6 months 28.1%; median duration was 4.2 months. For complete (exclusive or predominant) breast-feeding, results were: 1 day 87.3%, 3 months 37.5%, 4 months 19.4%, 6 months 3.8%; median duration 2.4 months. Initial prevalence of breast-feeding was significantly higher in girls (97.2%) than in boys (89.4%, p<0.01). Duration of breast-feeding was shorter in children of women who smoked (p<0.001). Relative risks for no breast-feeding at 4 months were 1.53 (95% confidence limits 1.20-1.96) for less than 15 cigarettes per day during pregnancy, and 3.65 (2.19-6.09) for 15 cigarettes or more. Duration of breast-feeding was shorter if the mother worked as an employee. Prevalence and duration were higher if the mother was originally from Africa, Asia, Middle-East or Latin American countries. Although the initial prevalence of breast-feeding was relatively high, only half of children were breast-fed at 4 months. Promotive efforts are needed to increase the duration of breast-feeding, in particular by legislation on maternal protection. Further studies are required to clarify gender differences in breast-feedin

Self-selection of enrollers at the creation of a managed care organization

Factors affecting choice between a managed care organization (MCO) and a fee-for-service insurance plan were examined when the University of Geneva health insurance plan was transformed into an MCO, in October 1992. A case-control study using a mailed questionnaire (response rate 84%) was conducted to compare former members who joined the MCO (joiners, n=421) to former members who opted out in order to keep fee-for-service coverage (non-joiners, n=222). Non-joiners were more likely to be women (odds ratio (OR) from multivariate model was 1.15, p=0.50), to be born in Switzerland (OR=2.04, p75,000 Swiss francs (OR=2.00, p<0.01), to have a personal physician (OR=1.96, p<0.01) and to have consulted a specialist (OR=1.69, p=0.02) or used unconventional medicine (OR=4.59, p<0.01) in the past year. During the previous year, non-joiners had more health care visits than joiners (14.6 versus 9.1, p=0.01). Non-joiners reported better mental health and fewer complained of persistent fatigue (OR=2.18, p=0.03). The choice of health plan was strongly influenced by socio-demographic characteristics, past patterns of health services utilization and health status. The self-selection process was paradoxical: MCO joiners had used fewer health care visits than non-joiners, but their self-reported health status was worse. The differences we have observed between self-selected populations have important implications for the financial performance of competing health care delivery system

Seasonality and Malaria in a West African Village: Does High Parasite Density Predict Fever Incidence?

In this cohort study, the authors studied the effect of blood malaria parasite density on fever incidence in children in an endemic area with 9 days' follow-up of 1- to 12-year-old children during two time periods: the end of the dry season (May 1993: n = 783) and the end of the rainy season (October 1993: n = 841) in Bougoula, West Africa (region of Sikasso, Mali). The cumulative incidence of fever (temperature >38.0°C) was 2.0% in the dry season and 8.2% in the rainy season (p 15, 000/μl (RR = 2.7, 95% Cl 1.4-5.4); in children with an enlarged spleen (RR = 2.0, 95% Cl 1.2-3.3); or in those with anemia (hematocrit <30%: RR = 1.8, 95% Cl 1.1-2.9). In the dry season, anemia was the only predictor of fever incidence. In the rainy season, the best predictors of fever were, in order, age (<4 years), enlarged spleen, and high parasite density. Even in the higher risk groups, the cumulative incidence was <20%. The authors conclude that most children with high parasite density do not develop fever subsequently. The association between parasite density and fever varies according to age and season. Since even high levels of parasite density do not reliably predict fever incidence, parasite density should be considered as just one of a group of indicators that increase the probability of a fever of malarial origin. Am J Epidemiol 1997; 145: 850-

"Test and treat" or presumptive treatment for malaria in high transmission situations? A reflection on the latest WHO guidelines

Recent WHO guidelines recommend a universal "test and treat" strategy for malaria, mainly by use of rapid diagnostic test (RDT) in all areas. The evidence for this approach is questioned here as there is a risk of over-reliance on parasitological diagnosis in high transmission situations, which still exist. In such areas, when a patient has fever or other malaria symptoms, the presence of Plasmodium spp neither reliably confirms malaria as the cause of the fever, nor excludes the possibility of other diseases. This is because the patient may be an asymptomatic carrier of malaria parasites and suffer from another disease

Evolution in intergenerational exchanges between elderly people and their grandchildren in Taiwan; data from a multiple round cross-sectional study from 1993 to 2007

<p>Abstract</p> <p>Background</p> <p>This study aimed to evaluate social evolution in Taiwan in recent decades using the changing pattern of care provided by grandparents for their grandchildren as an indicator.</p> <p>Methods</p> <p>Data from the second, fourth and sixth wave surveys of the <it>Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan </it>were used for the analysis. This survey collected individual characteristics, including age, gender, education, ethnicity, dwelling place, living with partners, co-resident with children, employment status, self-reported health status and their provision of care for their grandchildren. Information about the attitudes toward National Health Insurance (NHI) was further collected in a questionnaire of 1999 following the implementation of NHI in 1995. By elders, we mean persons 60 or more years old. By grandchildren, we mean persons under 16 years of age. First, changes in individual characteristics were compared during these study periods (chi-square test). Then the logistic regression was performed to determine how significantly elders' grandchild-care behavior was associated with their individual characteristics.</p> <p>Results</p> <p>The percentage of elders providing grandchild care increased from 7.7% in 1993 to 13.6% in 1999, and then to 19.4% in 2007. By analysis, significant association was found between behavior in taking care of grandchildren and individuals of lower age, grandmothers, those living with partners or co-residing with children, those unemployed and those with better self-reported health status. And the effect of year was confirmed in the multivariable analysis.</p> <p>Conclusions</p> <p>This study pointed out the changing pattern of elders' behavior in taking care of their grandchildren as the main indicator and their related individual characteristics. We argue the need for improving social security policies in an ageing society. We suggest that the interaction between population policies and those of social welfare, including policies for health care and childcare, should be carefully evaluated.</p

Antiretroviral-naive and -treated HIV-1 patients can harbour more resistant viruses in CSF than in plasma

Objectives The neurological disorders in HIV-1-infected patients remain prevalent. The HIV-1 resistance in plasma and CSF was compared in patients with neurological disorders in a multicentre study. Methods Blood and CSF samples were collected at time of neurological disorders for 244 patients. The viral loads were >50 copies/mL in both compartments and bulk genotypic tests were realized. Results On 244 patients, 89 and 155 were antiretroviral (ARV) naive and ARV treated, respectively. In ARV-naive patients, detection of mutations in CSF and not in plasma were reported for the reverse transcriptase (RT) gene in 2/89 patients (2.2%) and for the protease gene in 1/89 patients (1.1%). In ARV-treated patients, 19/152 (12.5%) patients had HIV-1 mutations only in the CSF for the RT gene and 30/151 (19.8%) for the protease gene. Two mutations appeared statistically more prevalent in the CSF than in plasma: M41L (P = 0.0455) and T215Y (P = 0.0455). Conclusions In most cases, resistance mutations were present and similar in both studied compartments. However, in 3.4% of ARV-naive and 8.8% of ARV-treated patients, the virus was more resistant in CSF than in plasma. These results support the need for genotypic resistance testing when lumbar puncture is performe