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M Susser

Publications and source records attributed to M Susser.

At least 55 records · Page 3Linked to original sources
PubMed1996

The relation of transient hypothyroxinemia in preterm infants to neurologic development at two years of age.

BACKGROUND: Transient hypothyroxinemia, a common finding in premature infants, is not thought to have long-term sequelae or to require treatment. We investigated whether hypothyroxinemia in premature infants is a cause of subsequent motor and cognitive abnormalities. METHODS: In this historical cohort study, we retrieved blood thyroxine values, obtained on routine screening in the first week of life, from state screening records on children who weighted 2000 g or less at birth, who were born at 33 weeks' gestation or earlier, and who were enrolled in a population-based study of the late sequelae of neonatal brain hemorrhage. We investigated the relation of these values to the odds for disabling cerebral palsy among 463 subjects for whom data were available and to the mental-development score on the Bayley Scales of Infant Development or the Stanford-Binet Intelligence Scales for Children at the age of two years in 400 subjects. The effects of severe hypothyroxinemia, defined as a blood thyroxine value more than 2.6 SD below the mean for New Jersey newborns, were assessed before and after adjustment for gestational age and potentially confounding variables. RESULTS: In analyses adjusted for gestational age, infants with severe hypothyroxinemia had a risk of disabling cerebral palsy that was nearly 11 times that of infants without hypothyroxinemia (odds ratio, 10.8; 95 percent confidence interval, 3.0 to 39.3) and a mean mental-development score at the age of two that was 15.4 points lower (95 percent confidence interval, 8.1 to 22.6 points) than the mean score of children with normal neonatal blood thyroxine concentrations. After adjustment for gestational age and multiple prenatal, perinatal, and early and last neonatal variables, severe hypothyroxinemia was still associated with an increased risk of disabling cerebral palsy (odds ratio, 4.4; 95 percent confidence interval, 1.0 to 18.6) and a reduction of nearly 7 points (95 percent confidence interval, 0.3 to 13.2 points) in the mental-development score. CONCLUSIONS: Severe hypothyroxinemia in preterm infants may be an important cause of problems in neurologic and mental development detected at the age of two years.

Cerebral Palsy↗
PubMed1996

Association of stressful life events with chromosomally normal spontaneous abortion.

Spontaneous abortion is the most common adverse reproductive outcome. Despite evidence that negative life events increase risk for a number of medical disorders, their role in pregnancy disruption has not been investigated. The present study tested an a priori hypothesis that recent negative life events increase the odds of spontaneous abortion of a chromosomally normal conceptus. Between 1984 and 1986, 192 women aged 18-42 years who visited a medical center after spontaneous abortion were interviewed about positive and negative events that had occurred in the 4-5 months preceding the loss. Subsequently, women with chromosomally normal (n = 111) and chromosomally abnormal (n = 81) losses were identified on the basis of tissue culture after interview. The women with chromosomally abnormal loss provided an estimate of the expected frequency of life events against which to compare the event frequencies of women with chromosomally normal loss. Analyses were adjusted for duration of the recall period, payment status, maternal age, education, and ethnicity. Seventy percent of the women with chromosomally normal losses reported having had one or more negative life events in the months preceding loss, compared with 52% of the women with chromosomally abnormal losses (adjusted odds ratio = 2.6, 95% confidence interval (CI) 1.3-5.2). For private patients (n = 69), the adjusted odds ratio was 4.2 (95% CI 1.3-13.4); for public patients (n = 123), it was 1.9 (95% CI 0.8-4.8). The associations held for postconception events alone and were absent for positive events. Results were unaltered by adjustment for smoking, caffeine intake, and alcohol consumption. With recall bias precluded by the study design, the strength, timing, and specificity of these associations suggest that recent negative life events play a role in chromosomally normal spontaneous abortion. Efforts to replicate these results and to elucidate underlying biologic mechanisms are required.

Abortion, Spontaneous↗
PubMed1996

Relations of genetic and environmental factors in the etiology of epilepsy.

We assessed the relations of genetic and environmental factors in the etiology of epilepsy. The study population comprised 9,705 first-degree relatives of 1,951 adults with epilepsy ascertained from voluntary organizations. We calculated standardized morbidity ratios for specific etiologies of epilepsy in the relatives of probands with the same etiologies, using population incidence rates from Rochester, MN, as the reference. Relatives of probands with idiopathic/cryptogenic epilepsy had increased risk for idiopathic/cryptogenic epilepsy and for epilepsy associated with neurological deficit presumed present at birth (cerebral palsy or mental retardation) but not for symptomatic epilepsy associated with postnatal central nervous system insults. Relatives of probands with neurodeficits had increased risks for idiopathic/cryptogenic epilepsy. Risk for epilepsy was not increased among relatives of probands with postnatal symptomatic epilepsy. The degree of increased risk of idiopathic/cryptogenic epilepsy in relatives of probands with idiopathic/cryptogenic epilepsy diminished with increasing age of the relatives; risk was not increased at age 35 or older. These findings support the possibility of shared genetic susceptibility to epilepsy and cerebral palsy, and suggest that the genetic contributions to postnatal symptomatic epilepsy are minimal.

Adolescent↗
PubMed1996

Clinical indicators of genetic susceptibility to epilepsy.

We evaluated clinical indicators of genetic susceptibility to epilepsy in the families of 1,957 adults with epilepsy (probands) ascertained from voluntary organizations. Very few of the probands in this series had idiopathic epilepsy syndromes. Among relatives of probands with postnatal CNS insults, risks of epilepsy were no higher than in the general population. Risk was increased in relatives of probands without identified CNS insults (i.e., those with idiopathic/cryptogenic epilepsy) or with neurological deficit presumed present at birth, compared with relatives of probands with postnatal CNS insults. Among relatives of probands with idiopathic/cryptogenic epilepsy, risks were higher in parents and siblings, but not in offspring, of probands with generalized onset as compared with partial onset seizures. Risks in offspring were higher if the probands had onset of idiopathic/cryptogenic epilepsy before age 10 as compared with age > or = 10 years, but risks in parents and siblings were not associated with the probands's age at onset. These results suggest that genetic susceptibility increases risk of some forms of cryptogenic epilepsy and of epilepsy associated with neurological deficit presumed present at birth, but not of postnatal symptomatic epilepsy. The influences on risk in offspring may differ from those in parents and siblings.

Adolescent↗
PubMed1996

Choosing a future for epidemiology: I. Eras and paradigms.

To inform choices about the future of epidemiology, the present condition of epidemiology is examined, in terms of its evolution through three eras, each demarcated by its own paradigm: (1) the era of sanitary statistics with its paradigm, miasma; (2) the era of infectious disease epidemiology with its paradigm, the germ theory; and (3) the era of chronic disease epidemiology with its paradigm, the black box. The historical context in which these eras arose is briefly described. In each era, the public health was at the center of the concerns of the founders and early protagonists of the prevailing paradigm. Around this intellectual development we weave a further theme. We argue that in the present era, the public health has become less central a concern. At the same time, in epidemiology today the dominant black box paradigm is of declining utility and is likely soon to be superseded.

Communicable Diseases↗
PubMed1996

Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology.

Part I of this paper traced the evolution of modern epidemiology in terms of three eras, each with its dominant paradigm, culminating in the present era of chronic disease epidemiology with its paradigm, the black box. This paper sees the close of the present era and foresees a new era of eco-epidemiology in which the deployment of a different paradigm will be crucial. Here a paradigm is advocated for the emergent era. Encompassing many levels of organization--molecular and societal as well as individual--this paradigm, termed Chinese boxes, aims to integrate more than a single level in design, analysis, and interpretation. Such a paradigm could sustain and refine a public health-oriented epidemiology. But preventing a decline of creative epidemiology in this new era will require more than a cogent scientific paradigm. Attention will have to be paid to the social processes that foster a cohesive and humane discipline.

Epidemiologic Methods↗
PubMed1995

Cigarette smoking and spontaneous abortion of known karyotype. Precise data but uncertain inferences.

Data from the first phase (1974-1979) of this New York City case-control study showed that 1) cigarette smoking during pregnancy was associated positively with chromosomally normal spontaneous abortion and 2) both past and current smoking were associated inversely with trisomic loss in women under age 30 years and positively in older women. The authors used data from two subsequent study phases (1979-1982 and 1982-1986) to test the stability of these associations over time and the homogeneity between payment groups (private vs. public). Spontaneous abortions (cases) were classified as chromosomally normal (n = 1,388), trisomic (n = 557), or other chromosomally aberrant (n = 409). Controls (n = 4,165) were women who had registered for prenatal care before 22 weeks' gestation and delivered at 28 weeks or later. For chromosomally normal loss, later data gave modest support to prior observations. In the total sample, current smoking (defined as smoking during the month of the last menstrual period) of 14 or more cigarettes per day was increased among chromosomally normal cases in comparison with controls (adjusted odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.1-1.7) and in comparison with other aberrant cases (adjusted OR = 1.2, 95% CI 0.8-1.8). Stronger associations in public patients than in private patients (adjusted odds ratios of 1.4-1.5 versus 0.8-0.9, respectively) might indicate either a mediating effect of social disadvantage or a chance fluctuation. For trisomic loss, later data did not support prior observations. Associations between trisomy and past or current smoking did not vary significantly with age in either payment group; assuming no effect modification of age, adjusted odds ratios for smoking in relation to trisomy were 0.9-1.0.

Abortion, Spontaneous↗
PubMed1995

Early ultrasound dating of pregnancy: selection and measurement biases.

Can using early ultrasound examinations to date pregnancy introduce information bias in perinatal research? Our purpose was to identify determinants of early ultrasound examinations and to compare early ultrasound to menstrual history dating. Between January 1987 and June 1989, 1159 white, largely middle class, prenatal patients were contacted for a prospective observational study. 876 (76%) agreed to participate. Of these 764 (87%) met the eligibility criteria for this analysis, namely singleton pregnancy, delivered after 20 weeks (spontaneous or induced, vaginal or c-section), with prenatal chart abstracted. Selection factors for early ultrasound identified in multivariate analysis were: bleeding in early pregnancy, OR = 1.9 (1.0, 3.5), attendance at health maintenance organization OR = 7.2 (3.4, 15), no insurance or Medicaid only OR = 0.3 (0.1, 0.6), and increasing time from last menstrual period to first prenatal visit in weeks OR = 0.89 (0.85, 0.93). In conformity with previous results, ultrasound dating of pregnancy led to a higher estimate of preterm delivery (10 vs 7.6%), a higher estimate of term delivery (87.2 vs 82.7%) and a lower estimate of postterm delivery (2.8 vs 9.7%) than dating by menstrual history, p < 0.001. Selection factors and measurement issues, such as those described here, could introduce bias and should be carefully considered in the design, analysis and interpretation of perinatal research.

Female↗
PubMed1995

Maternal smoking, alcohol drinking, caffeine consumption, and fetal growth: results from a prospective study.

In a prospective study of 712 pregnancies, we examined associations between maternal smoking, alcohol, and caffeine consumption and fetal growth. We interviewed patients at entry into care [12.9 +/- 4.3 (standard deviation) weeks], and at 28 and 36 weeks of gestation. We found the expected reductions in adjusted birthweight among women who smoked throughout pregnancy: 168 gm [95% confidence limits (CL) = -326, -10] for low/moderate amounts (< or = 15 cigarettes per day); 288 gm (95% CL = -491, -84) for heavy smoking (> 15 cigarettes per day). We also found a decrease in birthweight (-179 gm; 95% CL = -364, 7) among smokers who reported quiting early in pregnancy. First trimester alcohol consumption (average: four drinks per week) was associated with a 155-gm reduction in fetal growth (95% CL = -324, 15), even after adjustment for number of cigarettes smoked. The association, observed with all types of alcohol consumption, was stronger among smokers (-270 gm) but was also present in nonsmokers (-115 gm). Caffeine consumption showed no relation to fetal growth, even among heavy consumers, although they were relatively few. This study implicates heavy maternal smoking at any point in pregnancy, including solely in the early months, and possibly moderate alcohol drinking as causes of low birthweight.

Adult↗
PubMed1994

Previous use of oral contraceptives and spontaneous abortion.

This analysis tests the hypothesis that women who conceive within 3 months after stopping oral contraceptives ("the pill") have an intrinsically lower risk of chromosomally normal loss. About 30% of women show evidence of endocrine dysfunction, including anovulation, for 1-3 months after stopping the pill. In women who recover rapidly, and therefore are at risk of pregnancy, a common endocrinologic factor may account for both the quick return to normal functioning and improved intrauterine survival of the chromosomally normal conceptus. The hypothesis was tested in women with chromosomally normal (N = 334) and chromosomally aberrant (N = 239) spontaneous abortions. Women were classified according to the number of months between last pill use and last menstrual period. The adjusted odds ratios relating conception in months 0 and 1 after stopping the pill to chromosomally normal (vs chromosomally aberrant) loss were each 0.4, with upper 95% confidence limits of 1.0 and 0.9, respectively. The odds ratios for conception at longer intervals after stopping were 1.1 [95% confidence interval (CI) = 0.4-3.1], 0.7 (95% CI = 0.3-1.2), and 0.9 (95% CI = 0.5-1.5) for 2, 3-11, and > or = 12 months, respectively. Rates of spontaneous abortion in previous pregnancies were lowest in women who conceived quickly after stopping the pill. Further support for an endocrinologic explanation requires direct measures of endocrine functioning in the post-pill period among women with varying reproductive histories.

Abortion, Spontaneous↗
PubMed1994

Timing in prenatal nutrition: a reprise of the Dutch Famine Study.

The array of results discussed in this paper is assembled by stage of gestation in the following table (Table 1). We must allow some uncertainty for some outcomes as to the precise stages of gestation in which they originate. For instance, with obesity, the effects of famine exposure may extend beyond the first trimester into the second. Yet, the table is perhaps sufficient in itself to support the point with which the paper opened, namely, that stage of development is crucial to the appreciation of the effects of prenatal nutrition.

Animals↗
PubMed1994

The logic in ecological: I. The logic of analysis.

This paper addresses ecological studies in public health research in terms of the logic of their analysis. It makes several distinctions between studies based on ecological and individual units. First, it identifies the variables common to both types of study and those particular to ecological studies. Second, it shows how ecological and individual units combine in two classes: unmixed (purely ecological, purely individual) and mixed. Third, it details how the relationships among and between individual and grouped units (expressed in terms of regression coefficients between independent and dependent variables) yield four coefficients: for all individual members; for all groups; for all individuals within each group; and for all individuals within groups (a weighted average). Equipped with an understanding of the dimensions involved at ecological and individual levels and of the relationships between them, researchers are in a position to exploit the public health potential of the ecological approach.

Ecology↗