Notes Washed Up in a Bottle

Don. W. MacCorquodale M.D. M.S.P.H.

Periodic Notes From the Field on Philosophy and Science.

Complications of Pregnancy among Teens;

An international charity, Save the Children, recently reported that complications of pregnancy and childbirth are responsible for 70,000 deaths annually among 15 to 19 year old women in the underdeveloped world (News.   Pregnancy and childbirth are leading causes of death in teenage girls in developing countries.   BMJ 2004: 328:   1152).   The report cited research from Bangladesh that showed the risk of maternal mortality may be five times higher for mothers 10 to 14 than for mothers 20 to 24.

          Nine of the ten high risk countries were in sub-Saharan Africa.   Countries outside of Africa with high risk included Afghanistan, Bangladesh, Guatemala, Haiti, Nepal, Nicaragua, and Yemen.    Risk of maternal mortality was one in seven in Niger (at the bottom of the ranking), but it was just one in 29,800 in the lowest risk country, Sweden.   Birth rates for adolescent girls in the U. S. were higher than in any other industrialized nation.

          COMMENT:   I would find it most interesting to know the source of the data.   Unhappily, I was unable to download the original report from the web.   It seems incredible that one in seven of every pregnancy in 15 to 19 year olds in Niger terminates in a maternal death.

AGE-RELATED MACULAR DEGENERATION

          In the Age-Related Eye Disease Study, investigators evaluated the effects of antioxidants, antioxidants plus zinc, and zinc alone on the development of age-related macular degeneration in older people (A randomized, placebo-controlled clinical trial of high dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss.   Age-Related Eye Disease Study Group.   Archives of Ophthalmology 2001; 119:   1417-1436).   A total of 3640 participants were randomly assigned to receive antioxidants, i. e., vitamins C and E and beta carotene; zinc; antioxidants plus zinc; or, placebo.

          Slightly more than half of the participants were women, 96% were white, and the median age was 69 years.   Eight (8) percent were cigarette smokers.   Fully 90 percent had at least five years of follow-up.   There were two primary outcomes:   1) progression to advanced AMD and 1) at least a 13 letter decline in visual acuity score.

          Those participants who received antioxidants plus zinc had a significant reduction in the risk of developing advanced AMD, OR = 0.72, 99% CI:   0.52-0.98.   Risk was also reduced among the participants who received zinc alone or antioxidants alone, but the reductions in ORs did not quite reach statistical significance.

          Among those participants with minimal changes associated with incipient AMD, just 1.3% progressed to advanced AMD.   When these 1,063 participants were excluded from the analysis, odds reduction estimates were increased:   antioxidants plus zinc, OR = 0.66, 99% CI:   0.47-0.91; zinc, OR = 0.71, 99% CI:   0.52-0.99; antioxidants, OR = 0.76, 99% CI:   0.55-1.05.  

          COMMENT:   The reductions in risk of progression of AMD are certainly not striking.   AMD is such a serious disease, the leading cause of blindness among those age 65 years and older, that one cannot help but hope that the association between dietary supplementation and risk reduction is one of cause and effect.      

CORONARY HEART DISEASE AND JOB STRESS

          Elaine Eaker and her colleagues recently published their analysis of the mortality experience of the Framingham Offspring Study cohort in relation to job stress (Eaker E D et al.   Does job strain increase the risk for coronary heart disease or death in men and women?   Am J Epidemiology 2004; 159:   950-958).   Slightly more than 1,700 men and 1,900 women (95% response rate) completed psychosocial questionnaires, which included variables concerning job strain, occupation, occupational prestige, and income, education, and housework responsibilities.  

          Job strain was classified as high strain, which was based on high job demands and low job decision latitude, low strain based on low job demands and high decision latitude, passive based on low job demands and low decision latitude, and active based on high job demands and high decision latitude.  

          Standard CHD risk factors including blood pressure, BMI, current smoking, history of diabetes, and the ratio of total to high density cholesterol was obtained in a clinic.  

          The cohort was followed for 10 years, and the outcomes of interest included total mortality and incident CHD.   For men job strain was not associated with either incident CHD or total mortality.   A higher educational level and a higher personal income were related to lower risk of development of CHD and total mortality.  

          Job strain was significantly associated with the incidence of CHD in women.   Contrary to the authors’ hypothesis, women with increased job demands and increased decision latitude had significantly higher risk of incident CHD during the 10-year follow-up period.   Job demands were not associated with increased mortality levels.

          COMMENT:   The authors pointed out that of seven studies with prospective data that controlled for CHD risk factors, five studies (four from the same population) found some form of job strain associated with CHD.   Two studies found no association.  

          The authors suggested that the counterintuitive relationship between job strain and incident CHD in women might be related to “historical shifts in social status and role.”   There are new demands in a new social environment where individuals must develop “new attitudes, values, and patterns of behavior.”   In the past women’s social status usually reflected that of their husbands, but women’s roles have changed.  

          I am not wholly persuaded, but I am afraid I cannot come up with a better explanation.