[Keep the discussion on research ethics alive!].
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Ethics, Medical↗
Biomedical subjects
G Jacobsen
Publications and source records attributed to G Jacobsen.
Prenatal growth in symmetric and asymmetric small-for-gestational-age infants.
We tested the hypothesis that growth retardation in symmetric small-for-gestational-age (SGA) infants may start in the first trimester of pregnancy, whereas in asymmetric SGA infants, it may start in the third trimester. We also examined if there may be a brain sparing effect in asymmetric SGA infants. Infants were classified as symmetric or asymmetric SGA infants, and 474 non-SGA infants. Intrauterine growth was assessed by prenatal ultrasonic measurements of fetal abdominal diameter, femur length and biparietal diameter at week 17, 25, 33 and 37 of gestation. Cross-sectional data as well as longitudinal growth curves suggested that growth retardation in both SGA groups started in the second trimester, and followed similar patterns until birth. Thus, our results did not support the hypothesis that symmetric and asymmetric growth retardation is associated with clear temporal differences in growth, and we found no sign of brain sparing in asymmetric compared to symmetric SGA infants.
Abdomen↗
[Epidemiological studies--why is it so difficult y to make accurate conclusions?].
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Epidemiologic Methods↗
On the prognostic value of systemic methotrexate clearance in childhood acute lymphocytic leukemia.
The prognostic value of systemic methotrexate clearance (ClMTX) during high-dose therapy was evaluated in a cohort of 42 children with acute lymphocytic leukemia (ALL). As part of an extensive chemotherapy protocol, they had received a total of 293 methotrexate (MTX) infusions in the 6-8 g/m2 dose range. At the termination of the study, when they had all been followed up for 3.5 years or more, 26 of these patients were still in continuous complete remission, whereas 16 had suffered relapse. The intrapatient variability in ClMTX during the eight courses was up to six-fold. In 67% of the patients, the maximum level of ClMTX reached at least twice the minimum value. The coefficients of variation for the intra- and interindividual variability in ClMTX were 9-57% and 26-41%, respectively. The cumulative probability of relapse, estimated by the Kaplan-Meier procedure, was increased for patients with a high ClMTX during the initial treatment course, but the difference was not significant on a 5% level. There was no significant relationship between high individual median ClMTX and subsequent relapse of ALL. However, ClMTX during the initial infusion, the time-dependent mean for ClMTX, and the individual patient's median ClMTX, were significant predictors for event-free survival in a Cox proportional hazards regression analysis. The present study demonstrates gross pharmacokinetic variability and unpredictable values of ClMTX in subsequent courses after standardized administration of MTX to paediatric patients with ALL. In spite of the association between ClMTX and prognosis shown by some of the analyses, estimates of ClMTX rates may not necessarily be related to disease outcome in a way that can be exploited to the benefit of the individual patient.
Adolescent↗
Dubowitz assessment of gestational age and agreement with prenatal methods.
We compared assessment of gestational age by Dubowitz score with ultrasonic measurement of the biparietal diameter (BPD), and then evaluated how infants were classified by these methods as small-for-gestational age (SGA), and as pre- or post-term births. BPD gestational age was assessed at week 17 to 20 of pregnancy while the Dubowitz scoring was done at birth. "Limits of agreement" between methods and kappa values were calculated and used to evaluate agreement. Among 839 included infants, there was moderate agreement between Dubowitz score and BPD (limits of agreement; -2.3; +2.1 weeks; weighted kappa: 0.46) in the assessment of gestational age. Agreement between Dubowitz score and BPD in the classification of SGA (kappa: 0.75, 95% confidence interval [CI]: 0.69-0.81) and preterm infants (kappa: 0.68, 95% CI: 0.56-0.80) was good, whereas agreement on infants born post-term was no better than chance (kappa: 0.14, 95% CI: -0.02(-)+0.30). We conclude that despite moderate agreement between Dubowitz score and BPD in the assessment of gestational age, agreement in the classification of low-birth-weight infants as SGA and as premature births was good.
Cephalometry↗
Physical abuse and low birthweight: a case-control study.
OBJECTIVE: To examine whether physical abuse of a woman by her partner was associated with low birthweight. DESIGN: A case-control study. SETTING: Department of Gynaecology and Obstetrics, University Hospital of Trondheim, Norway. PARTICIPANTS/SAMPLE: Eighty-six women who were delivered of a low birthweight (< 2500 g) infant (cases) and 92 women who were delivered of an infant with birthweight > or = 2500 g (controls). METHODS: An in-depth interview, either postpartum at the maternity ward or one year after delivery. Information about abuse was obtained by direct questioning and a modified version of the Conflict Tactics Scales. RESULTS: A total of 17% of the women had experienced abuse by a partner. While 7% had been abused by their current partner before the index pregnancy only one woman reported abuse during pregnancy. Relatively more mothers of low birthweight infants were abused (20%) compared with controls (15%), but the association was not statistically significant (OR 1.37, 95% CI 0.63-2.99). Abused women reported a higher consumption of alcohol and cigarettes in pregnancy compared with nonabused women. CONCLUSION: Abuse was not found to be a risk factor for low birthweight in this study.
Adult↗
Decompression sickness from saturation diving: a case control study of some diving exposure characteristics.
A comprehensive computerized database of diving activity for a Norwegian offshore diving contractor [Stolt-Nielsen Seaway (SNS)] covering the years 1983-1990 has been established. The database contains detailed dive information about 12,087 surface-oriented and 2,622 saturation dives. During this period a majority of the divers were permanently employed. Preliminary analysis had suggested that decompression sickness (DCS) might be the result of exposure to factors causing pathophysiologic effects which accumulate over the course of a single dive or a series of dives. This concept evolved into the HADES (Highest Accumulated Decompression Score) theory which assumes that DCS is predictable once the underlying exposure factors are understood. The incidence of DCS among the SNS divers from saturation diving in the North Sea was studied by use of a "nested" case-control design. Twenty-one case dives (i.e., dives where DCS occurred) were compared with 41 randomly selected control dives. For these dives, several saturation dive characteristics were established. The relative pressure change between maximum and minimum storage depths was significantly greater among the cases. For each 1% increase in the relative pressure change there was a 5% increase in the probability of a saturation dive resulting in DCS. Significantly more cases than controls performed a saturation dive with more than one storage depth, and the data suggested that there were more and greater ascending and descending changes in storage depth conditions among the affected divers.
Case-Control Studies↗
Intrauterine growth pattern by the tendency to repeat small-for-gestational-age births in successive pregnancies.
BACKGROUND: Fetuses of women who repeat small-for-gestational-age births in successive pregnancies may have a different intrauterine growth pattern than SGA birth of non-repeater mothers. Also repeated SGA births may grow differently depending on whether the tendency to repeat is due to some external factors such as cigarette smoking ("false repeaters") or due to genetic or intrinsic factors ("true repeaters"). MATERIAL AND METHODS: Fetal growth were compared in a "nested case-control" study within a longitudinal (cohort) study, comparing three types of SGA births, 23 of "true repeater" mothers, 46 of "false repeater" mothers and 65 of non-repeater mothers, and these were compared with 1017 non-SGA births. Fetal growth was compared using a regression analysis based on repeated measurements (four for each woman). RESULTS: For mean abdominal diameter the "true repeater" SGA births grew more slowly towards the end of pregnancy. However, the growth curves show only minor differences between the three types of SGA births, but the patterns are grossly different from the growth of non-SGA births (controls). CONCLUSION: The intrauterine growth retardation starts early in pregnancy, and is not strikingly different between births of repeater and non-repeater mothers.
Case-Control Studies↗
Psychosocial factors and small-for-gestational-age infants among parous Scandinavian women.
BACKGROUND: We wanted to analyze the association between small-for-gestational-age (SGA) births, defined as a newborn with a birthweight below the 15th percentile-for-gestational age, and socioeconomic and psychosocial risk factors. METHODS: Information on social background, psychological status, and life events was collected prospectively by use of questionnaires in the second and third trimester of pregnancy. The respondents were 1552 women who expected their second or third child and took part in a Scandinavian multicenter study of fetal growth and perinatal outcome. RESULTS: No significant differences were found in relational stress, state and trait anxiety, depression, and physical strain between SGA and non-SGA births, whereas smoking around time of conception and low prepregnant body mass were significant SGA birth predictors. Maternal and paternal education of nine years or less increased the SGA birth risk (RR 1.46 (95% CL 1.12; 1.92) and RR 1.34 (95% CL 1.01; 1.79), respectively. The increased risk from a low maternal education was still significant when body mass and low paternal education were controlled, but not after adjustment for maternal smoking. A protective effect of paternal, but not maternal, education of 12 years or more was also observed and retained its effect when maternal smoking and body mass were controlled. CONCLUSION: In this seemingly homogeneous Scandinavian population, parental education and maternal body proportion and life style influenced the prevalence of small-for-gestational-age births. Relational stress, anxiety, depression, and physical strain did not influence birth outcome.
Educational Status↗
Pre-pregnancy risk factors of small-for-gestational-age births and perinatal mortality.
The Scandinavian part of the NICHD study of successive small-for-gestational-age (SGA) births included 5722 parous women from Trondheim and Bergen (in Norway) and Uppsala (in Sweden). Study enrollment took place from January 1986 through March 1988. The aim of the main study was to investigate factors associated with inhibited intrauterine growth. This paper reports on the fetal, perinatal, and neonatal deaths among the births in the study in relation to different risk factors. The cause of deaths were analyzed to see if there were any associations with the risk factors. There was a total of 84 deaths, 65 of these were fetal, perinatal or neonatal deaths and included in this analysis. The remaining 19 are for different reasons excluded. Thirty-two (60%) of the autopsies regarded the high risk group who comprised only 42.4% of the total study population. The high risk group was selected using the following risk criteria: a previous low weight birth or perinatal death, maternal low weight (pre-pregnancy weight < 50 kg), the presence of a chronic maternal disease, and smoking at the time of conception. A significant association was found between perinatal mortality and the presence of one or more of the defined risk criteria (relative risk 2.0; 95% CI 1.2, 3.4). Asphyxia and related disorders was the most important single cause of death and was found to be associated with the maternal risk factors (RR 3.9; 95% CI 1.5, 9.8). A significant association was found between maternal risk factors and SGA autopsies (RR 3.9; 95% CI 1.7, 8.9). No association was found between asphyxia and SGA. It is concluded that women with risk factors based on complications in a previous pregnancy are more prone to stillbirths, perinatal, and neonatal deaths, and with asphyxia as the most prominent cause of death.
Asphyxia Neonatorum↗
Prediction of fetal growth based on maternal serum concentrations of human chorionic gonadotropin, human placental lactogen and estriol.
BACKGROUND: The purpose was to determine the usefulness of maternal serum concentrations of human chorionic gonadotropin (hCG), human placental lactogen (hPL) and estriol as predictors of fetal growth. METHOD: From a large cohort serum obtained serially at 17, 25, 33 and 37 weeks of gestation were analyzed for randomly selected pregnancies resulting in small for gestational age (SGA, n = 102) and non-SGA (n = 112) infants. RESULTS: There were no significant correlations between birthweight ratio (ratio of birthweight to mean weight for gestational age) and hCG, but between birthweight ratio on one hand and estriol for all stages of pregnancy (r = 0.19-0.38, p < 0.01 - p < 0.001) and hCL except at 33 weeks (r = 0.11-0.40, p ns-p < 0.001) on the other. There were statistically significant, but small median differences and substantial overlaps between the SGA and non-SGA infants for hCG at 17 and 37 weeks, for hPL at 17, 33 and 37 weeks, and for estriol at all the stages of pregnancy. The sensitivity and positive predictive value of low hormone concentrations (below the 10th percentile) in predicting the birth of an SGA infant were in the range of 6-26% and 17-39%, respectively. The corresponding specificity and prediction of a non-SGA infant from normal levels were 91-93% and 85-88%. CONCLUSIONS: HPL and estriol, but not hCG concentrations, are positively related to the size of the fetus, but the relationships are too weak to be of predictive value in an unselected population.
Adult↗
Cell division in placentas of appropriate and small-for-gestational-age infants. A flow cytometry study.
BACKGROUND: The purpose of this study was to examine if placentas of small- for-gestational-age (SGA) and non-SGA infants differ with respect to proliferative cell activity. METHOD: Cell cycle distribution was studied in placentas from 181 SGA (birthweight < 10th percentile) and 528 non-SGA births by flow cytometry measurements of relative DNA content. RESULTS: The fraction of cells in various cell cycle phases (G1-, S- and G2-phases) did not differ with gestational age from 30 to 43 weeks in either of the groups. The placentas of the SGA infants had a significantly lower mean (+/-1 SEM) growth fraction than placentas of non-SGA infants (S-phase 5.2 +/- 0.2 vs 5.5 +/- 0.1, p = 0.05, and G2-fraction 5.4 +/- 0.2 vs 6.3 +/- 0.1, p < 0.001), but the overlaps of the distributions were large. Thus sensitivity, specificity and predictive values of low fractions did not differ substantially-from a purely random prediction of SGA. CONCLUSIONS: Cell division in the placenta is maintained until and beyond term. Placentas of SGA infants have on average, lower proliferative activity than placentas of non-SGA infants, but the difference is too small to be of predictive value in identifying intrauterine growth retardation.
Adult↗
Body proportions and early neonatal morbidity in small-for-gestational-age infants of successive births.
BACKGROUND: We wanted to examine if infants who were small for gestational age (SGA) at term had increased perinatal mortality or morbidity compared to non-SGA infants, and if this could be related to the infant's body proportions, or to whether the mother previously had delivered a low-birthweight infant ("repeater") or not ("non-repeater"). METHODS: From a cohort of 5722 para 1 and para 2 women, we compared perinatal mortality in 541 SGA (birthweight < 10th percentile) and 4737 non-SGA infants. From the same cohort, early neonatal morbidity was studied in 368 SGA and 462 control infants without congenital malformations. RESULTS: SGA infants had a 6.4 (95% CI: 2.6-15.7) higher risk of perinatal death than controls, but when infants who died with congenital malformations were excluded, this risk was not significantly increased. SGA infants were more often transferred to an intensive care unit than controls (1.7, 95% CI: 1.0-2.9). Among SGA births, infants with asymmetric body proportions (i.e. low ponderal index) more often had symptoms in the neonatal period (RR: 2.5; 95% CI: 1.4-4.3) and were more often transferred to an intensive care unit (3.4; 95% CI: 1.6-7.4) than symmetric SGA infants, whereas there were no differences between SGA infants of repeaters and non-repeaters. CONCLUSIONS: We found that SGA infants had higher perinatal mortality than controls, but this was due to a higher prevalence of congenital malformations. Among SGA infants without malformations, our results indicated increased neonatal morbidity in infants with asymmetric body proportions.
Abnormalities, Multiple↗
Small-for-gestational-age (SGA) infants born at term: growth and development during the first year of life.
BACKGROUND: The purpose was to compare growth patterns and psychomotor development of healthy small-for-gestational-age (SGA) and non-SGA infants, and identify factors predictive of outcome at 13 months of age. METHOD: A total of 265 SGA infants and 329 non-SGA controls were identified from a multicenter cohort of 5722 para 1 and 2 women who had been followed during pregnancy. The infants were examined at 2 days and at 13 months of age. Psychomotor development at 13 months was assessed with The Bayley Scale of Infant Development. RESULTS: The SGA infants showed partial catch-up growth, but had still lower (mean +/- SEM, p < 0.0001) weight (9750 +/- 65 vs 10505 +/- 67 g), crown-heel length (75.9 +/- 0.2 vs 77.5 +/- 0.2 cm) and head circumference (46.9 +/- 0.1 vs 47.7 +/- 0.1 cm) than the non-SGA infants at 13 months. The SGA children scored equally well on the motor (PDI 106.8 +/- 1.0 vs 107.2 +/- 0.8) but lower on the mental scale (MDI 112.1 +/- 0.8 vs 116.5 +/- 0.7, p < 0.0001) of the Bayley Scale, and the asymmetric SGA scored lower than the symmetric SGA infants (MDI 110.2 +/- 1.3 vs 113.3 +/- 0.9, p = 0.05). In a multivariate regression analysis the parents' growth parameters had the greatest effect on growth measures at 13 months while education and maternal smoking had no significant effect. SGA vs non-SGA status had the greatest effect on growth velocities during infancy. For mental development only SGA vs non-SGA status and the mothers' education made significant contributions, but only accounted for 6% of the variance. CONCLUSION: The negative impact of intrauterine factors on growth are partly abolished by catch-up growth during infancy, and growth parameters at one year of age are mostly determined by genetic factors even in SGA infants. Decreased intrauterine growth may possibly have a negative effect on brain growth and mental developmental potential.
Case-Control Studies↗
Pre- and post-natal growth in children of women who smoked in pregnancy.
Pre- and post-natal growth was studied from week 17 of pregnancy until 5 years of age in children of women who reported daily smoking at the time of conception, and compared to the growth in children of non-smokers. Fetal abdominal diameter, femur length and biparietal diameter were measured in weeks 17 and 37 of pregnancy, and weight, height and head circumference were measured at birth, and at 6, 13 and 60 months of age in 185 children of smokers and 345 children of non-smokers. Cross sectional data at birth showed that infants of smokers had lower weight and length, but similar ponderal index as infants of non-smokers and this may suggest a symmetrical growth retardation. Longitudinal growth curves indicated that the growth retardation took place in the second half of pregnancy. During the first 5 years of life, children of smokers had complete catch-up growth in weight, a partial catch-up in height, and no catch-up growth in head circumference. At 5 years, children of smokers had a higher ponderal index and skinfold thickness, suggesting that these children, on average, were more obese than children of non-smokers.
Body Height↗
[Physicians pilloried? On physicians' blunders and blundering physicians in Norwegian tabloids].
Doctors frequently claim that the tabloid press focuses too much on malpractice cases and that the identity of the individual physicians is also revealed. A systematic review of two Norwegian tabloids over six months in 1994 showed that articles on malpractice occurred less often than expected. We found 1.6 articles each week, on average. In addition, the doctors were identified in only three of 42 articles. The situation leading to the complaint was commented by the doctor involved in one article, while criticism from a colleague who was not directly involved was included in two of 42 articles. The results indicate that doctors need to be trained to handle the press.
Confidentiality↗
Maternal body mass, proportional weight gain, and fetal growth in parous women.
This study is designed to examine the impact of maternal body mass index (BMI), proportional weight gain, and other variables on fetal growth. From a 10% random sample of 5722 Norwegian and Swedish para one and two women (n = 561), three hundred and sixty-nine women for whom prepregnant weight and height were recorded and for whom four fetal ultrasound measurements were taken at 17, 25, 33, and 37 weeks of gestation, were divided into low, average, and high body mass index groups (weight/height2). Fetal growth rate (mm/day) was determined by taking the mean of three measurements of the sagital and transverse diameters of the fetal abdomen (MAD) in each of three study time periods: weeks 17 to 25, first period; weeks 25 to 33, second period; weeks 33 to 37, third period. Proportional weight gain (kilograms gained within a specific time period/prepregnant weight) was measured in those same intervals. Fetal growth rate was significantly slower in the first and second periods, and significantly faster in the third time period for women with a low BMI, compared with those of average BMI. Fetal growth also significantly increased with increases in proportional weight gain in the second and third periods, but not in the first. Fetal growth appears to be independently associated with maternal BMI and proportional maternal weight gain.
Adult↗
Clinical evaluation of the Allergan Humphrey 500 autorefractor and the Nidek AR-1000 autorefractor.
AIMS/BACKGROUND: The intentions of this study were to estimate agreement between two different autorefractors and standard subjective refraction techniques and to evaluate the clinical implications of relying on the autorefractor measurements. METHODS: Subjective refraction was carried out on 448 cycloplegic eyes and compared with cycloplegic readings with the Allergan Humphrey 500 autorefractor (448 eyes) and the Nidek AR-1000 autorefractor (160 eyes). Each refraction was followed by clinical visual acuity measurement. The study population comprised 224 healthy students, 107 men and 117 women, with a mean age of 20.6 (SD 1.1) years. RESULTS: Both the Nidek and Humphrey autorefractors measured more negative or less positive refractive values compared with subjective refraction and these biases were statistically significant (Humphrey right eye -0.23 D, p = 0.0001, left eye -0.20 D, p = 0.0001), (Nidek right eye -0.13 D, p = 0.0001, left eye -0.11 D, p = 0.0002). Comparing the results of autorefraction with subjective refraction, the Nidek was better than the Humphrey autorefractor in several ways: a smaller mean difference, better agreement between spherical equivalent values, narrower limits of agreements, and better visual acuity obtained with the autorefraction. On the other hand, the Humphrey autorefractor agreed better with subjective refraction concerning cylinder axis. CONCLUSION: The results show that both autorefractors represent a valuable complement to subjective refraction, but cannot be used as a replacement.
Adolescent↗