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J Epidemiol Community Health. 2007 July; 61(7): 656.
PMCID: PMC2465747

Hygieia

Hypospadias in Australia

Hypospadias, a common birth defect, has shown widespread variation in reported rates and temporal trends across countries over the past 30 years. A study carried out in Western Australia between 1980 and 2000 to determine the prevalence and trends of hypospadias found that the condition affects one in 231 births and seems to have increased significantly over the past 20 years. There were 1788 cases of hypospadias registered in Western Australia in 1980–2000 with an overall prevalence of 34.8 per 10 000 births. The prevalence increased significantly by 2.0% per year from 27.9 in 1980 to 43.2 per 10 000 births in 2000. Hypospadias was diagnosed as mild in 84% of cases, 11% were moderate to severe, and 5% unspecified; moderate to severe hypospadias cases almost doubled over this time. There were 1465 cases of isolated hypospadias and 18% with co‐existing anomalies. Infants with co‐existing genital or non‐genital anomalies were more likely to have moderate to severe hypospadias compared with isolated cases. Future investigation of the aetiology of hypospadias is important to identify potentially modifiable risk factors and ensure optimal male reproductive health in the future. (Arch Dis Child published online 3 April 2007; doi: 10.1136/adc.2006.112862)

Cryptorchidism and hypospadias in England

There is controversy as to whether there is an increasing birth prevalence of cryptorchidism and hypospadias that, together with testicular cancer, are components of “testicular dysgenesis syndrome.” Evidence suggests there is geographical and temporal variation in the birth prevalence of these anomalies; the speed of reported increase in birth prevalence over time suggests environmental causes. Exposure to synthetic chemicals acting as endocrine disruptors in utero has been put forward as a possible explanation. Cryptorchidism and hypospadias have also been linked with low birth weight, suggesting that fetal androgen dysfunction plays a part in aetiology. Analyses of prevalence and temporal trends of cryptorchidism and hypospadias in northern England in patients diagnosed between 1993 and 2000 were carried out using the Northern Region Hospital Episodes Statistics (HES). Prevalence was shown to be 7.6 per 1000 male live births for cryptorchidism and 3.1 per 1000 male live births for hypospadias. The orchidopexy rate for 0–4 year olds and 5–14 year olds was 1.8 and 0.8 per 1000 male population respectively. The rate for hypospadia repair was 0.6 and 0.1 cases per 1000 male population aged 0–4 and 5–14 years, respectively. There was no significant change in the prevalence of surgically corrected hypospadias; however there was an apparent decline in the prevalence of surgically corrected cryptorchidism that may reflect a decrease in the prevalence of the condition or may be the result of a decrease in the rate of surgical intervention. (Arch Dis Child published online 7 December 2006; doi: 10.1136/adc.2006.102913)

Asthma, rhinoconjunctivitis and obesity in Spanish schoolchildren

A study from Spain linking diet with prevalence of asthma and rhinoconjunctivitis found that a Mediterranean diet had a protective effect. The survey, taking in over 20 000 schoolchildren aged 6–7 years old from eight Spanish cities, set out to evaluate the association of various foods and a Mediterranean diet with the prevalence of asthma and rhinoconjunctivitis adjusting for obesity and exercise. The Mediterranean diet refers to dietary patterns found in olive growing areas of the Mediterranean region: the common components are high monounsaturated/saturated fat ratio; high consumption of vegetables, fruits, pulses and grains; and moderate consumption of milk and dairy products. Using the International Study of Asthma and Allergies in Childhood (ISAAC) phase III questionnaire parents reported chest and nose symptoms, food intake, weight and height, and exercise. A Mediterranean diet score was developed and the score between obese and non‐obese children was compared using the Mann–Whitney U test. A distinction was made between current occasional asthma (COA) and current severe asthma (CSA). Results showed that the Mediterranean diet is a potential protective factor for CSA in girls. Exercise was a protective factor for COA and rhinoconjunctivitis for both girls and boys. Obesity was a risk factor for CSA, only for girls. The more frequently the children ate seafood and, to a lesser extent, cereals the more a protective effect for CSA was seen, while fast food was a risk factor for CSA. Seafood and fruit were shown to protect against rhinoconjunctivitis. (Thorax published online 24 Jan 2007; doi: 10.1136/thx.2006.060020)

Development of database indexes of asthma in Canada

Although the use of administrative databases to perform epidemiological studies of asthma has expanded, the unavailability of clinical factors to measure the severity and control of asthma has limited database studies. This study's aim was to develop and validate two database indexes to address these shortcomings. The database index of asthma severity (three categories) and the database index of asthma control (two categories) were derived from the definitions found in the Canadian Asthma Consensus Guidelines and were based upon dispensed prescriptions as well as medical services for asthma, which were recorded on two large administrative databases in Quebec province. Seventy‐one asthma patients were randomly selected and their spirometric lung function measures obtained from their medical records. Data on their prescriptions and use of medical services were also obtained. The database indexes of asthma severity and control were validated against the pulmonary function test results using t‐tests. Using the database indexes, 49.3%, 29.6% and 21.1% of the recruited patients were found to have mild, moderate and severe asthma, respectively, while 53.5% had controlled asthma. The mean predicted value of the forced expiratory volume in one second (FEV1) ranged from 89.8% for mild asthma to 61.5% for severe asthma, whereas the range from controlled to uncontrolled asthma was 89.5% to 67.3%. The ratio of the FEV1 to the forced vital capacity (FEV1/FVC ratio) was measured for 56 patients and ranged from 75.8% for mild asthma to 61.8% for severe asthma, whereas the range from controlled to uncontrolled asthma was 75.3% to 65.7%. The database indexes were valid to the extent that currently treated asthma patients were adequately classified into categories of severity and control. (Thorax published online 7 Feb 2007; doi: 10.1136/thx.2006.061572)

Glenys Hughes ghughes@bmjgroup.com


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