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PubMed1997

Ethnicity and variation in breast cancer incidence.

A breast cancer case-control study in Atlanta and 5 counties of central New Jersey involving interviews with 960 white and 281 black cases younger than 54 years of age enabled assessment of reasons for the varying incidence rates among these 2 ethnic groups. Of interest was why rates of breast cancer are higher among older white women, a trend that is reversed among very young women (<40 years). Calculation of the prevalence of exposure to classic and speculative risk factors and associated relative risks enabled derivation of population attributable risks (PARs) for the various combinations of age and ethnic groups. A higher PAR was derived for older (40-54 years) white (62%) than black (54%) women, which appeared to account for the observed difference in incidence between the 2 ethnic groups. Most of the difference in PARs between older whites and blacks was accounted for by whites having fewer births, later ages at first birth and slightly higher risks associated with reproductive and menstrual factors. Consideration of only well-established breast cancer risk factors showed a PAR among older whites of 57%, an estimate comparable to those previously published. Slightly higher overall PARs were derived when analyses considered several speculative but modifiable risk factors, including years of use of oral contraceptives, body size and alcohol consumption. Many of the analyses among younger women (20-39 years) were limited by available numbers, but it appeared that very little disease occurrence in young black women was associated with the factors studied.

Adult↗
PubMed1981

San Francisco General Hospital nurse-midwifery practice: the first thousand births.

Since its inception in 1975, the staff of the Nurse-Midwifery Service at San Francisco General Hospital has attended the deliveries of over 1,000 women. A description of the service and the outcome statistics are presented. The population of women served is a mixed risk group. It includes all women designated as nurse-midwifery patients, including those at risk who were transferred to tertiary care. Outcome statistics are comparable to those of the obstetrics department in general. Use of alternative labor and delivery practices contributes to good perinatal outcome.

Adolescent↗
PubMed1986

An obstetric assessment of the first 100 births from the in vitro fertilization program at Clamart, France.

From April, 1981, to July, 1984, 142 pregnancies have been attained after in vitro fertilization and embryo transfer. They are divided into 22 biochemical pregnancies (human chorionic gonadotropin greater than or equal to 20 mU/ml but remaining below 1000 mU/ml), 27 spontaneous abortions, three ectopic pregnancies, and 90 ongoing pregnancies, of which 11 were twin pregnancies. The 90 women in whom the pregnancies progressed were compared with the 52 women having nonprogressive pregnancies. The two populations did not differ either in age, in the indication for in vitro fertilization and embryo transfer, or in the quality of ovulation or results of semen analysis. The 90 ongoing pregnancies were compared with those pregnancies occurring in the same obstetrics department during this period. We found that the in vitro fertilization group had a higher proportion of arterial hypertension (16.5% versus 8.5%, p less than 0.05), breech presentations (13.9% versus 4.3%, p less than 0.001), and caesarean sections (46.8% versus 15.5%, p less than 0.001) but the sex ratio did not differ.

Abortion, Spontaneous↗
PubMed1998

The influence of reproductive and hormonal factors on the risk of colon and rectal cancer in women.

A case-control study was conducted between 1992 and 1996 in six Italian areas. It included 537 women with colon cancer, 291 women with rectal cancer and 2081 control women in hospital for acute conditions, unrelated to hormonal or gynaecological diseases. A higher age at menopause was associated with increased colon cancer risk (odds ratio (OR) for > or = 53 years compared with < 50 years = 1.39, 95% confidence interval (CI) 1.04-1.87). Among parous women, a significant trend of decreasing colon cancer risk with increasing number of births was seen for colon (OR for > or = 4 births compared with 1 birth = 0.62, 95% CI 0.42-0.90), but not for rectal cancer. Nulliparous women, however, were at lower risk than women with a single birth, and age at first birth was directly associated with risk. While oral contraceptive use showed no significant influence, ever users of hormone replacement therapy had a reduced risk of rectal cancer (OR = 0.56, 95% CI 0.31-1.01). Thus, the association of colorectal cancer with reproductive and menstrual factors is neither strong nor consistent.

Adult↗
PubMed1987

Follow-up of the first national birth cohort: findings from the Medical Research Council National Survey of Health and Development.

The medical work of a 40 year birth cohort study is described in order to show the continuing associations of childhood factors with later life health, behaviour, illness and survival. Comparisons with the health of children born at later times show the importance of a sensitive monitoring of changes in child health. A summary of work on social and psychological topics is also given, together with a complete list of publications from the study.

Cohort Studies↗
PubMed1997

Maternal and perinatal risk factors for later delinquency.

BACKGROUND: The early identification of risk factors for juvenile offending is one important step in preventing youth violence and offending. This cohort study examined whether perinatal circumstances predicted offending during adolescence. METHODS: Washington State birth certificates from 1974 to 1975 were linked to juvenile justice data to identify all individuals adjudicated between 10 and 17 years of age. Thirteen thousand five hundred seventy-three offenders were compared with a sample of 38 387 nonoffenders matched on gender and birth order. RESULTS: Both male and female children of mothers who were teenagers at the child's birth or at her first birth, or who were born to unmarried mothers, had significantly increased risk for any juvenile offending, and for being adjudicated for five or more crimes (chronic offending). Males born to unmarried mothers under 18 years old had an 11-fold increased risk of chronic offending compared with males born to married mothers >/=20 years old. Low birth weight and preterm gestational age carried no increased risk for juvenile offending. CONCLUSIONS: Birth to teenage or unmarried mothers are strongly associated with later risk of juvenile delinquency. Although there are multiple, interrelated risk factors for juvenile delinquency, prevention of births to teenage and/or unmarried mothers may help to prevent subsequent juvenile delinquency.

Adolescent↗
PubMed1990

Secular change in birthweight among southeast Asian immigrants to the United States.

We analyzed the Washington State births in 1980-1986 to Southeast Asian parents whose birth place was coded as being outside of the US. The mean birthweight increased from 3188 grams in 1980-81 to 3283 grams in 1986, an annual increment of about 18 grams (95% CI = 11, 25 grams). The prevalence of low birthweight (less than 2500 grams) decreased from 7.2 percent in 1980-81 to 5.4 percent in 1986, an annual reduction of 6.4 percent (95% CI = 1.3, 11.2 percent). In an analysis of information ascertained from the birth certificate, the change of paternal occupational status (from student to employed) was associated with 27 percent of the reduction in the prevalence of low birthweight, independent of maternal age, infant sex, and prior gravidity. A similar temporal change of birthweight during the same period of time was not observed among infants of US-born Asian mothers. Among the women who had two consecutive births from 1984 to 1986, the improvement of birthweight for the second birth compared to the first birth was much greater in infants born to the Southeast Asian mothers than that to White mothers. Our study suggests that living in the United States after immigration from their native countries has had a positive impact on the birthweight of infants born to Southeast Asian immigrants.

Adult↗
PubMedDate not supplied

[The foundation, birth and first steps of the Clinica del Lavoro of Milan. Its historical and social contexts].

After recalling the precursors of social and occupational medicine and the political and social background at the beginning of the century, the author dedicates his attention to Luigi Devoto, lecturer, researcher and organizer. An account is given of his work, his friends (and opponents) and his divulgatory activity, whereby he was able to stimulate the interest of politicians and administrators in the problems of safeguarding the health of the workers and their workplaces. Thanks to the enthusiastic commitment of Luigi Devoto, and with the support of other eminent physicians such as Luigi Mangiagalli, in 1902 the municipal council of Milan voted, by a very large majority, the concession of municipal land to build the first Clinic for the study and treatment of occupational diseases. Building began in 1907 and 3 years later the Clinic was inaugurated. The Directorship was assigned to Luigi Devoto who described the organization, activity and staff of the Clinic in a wealth of detail in the first report drawn up just 3 years later.

Academies and Institutes↗
PubMedDate not supplied

Electronic fetal monitoring in relation to cesarean section delivery, for live births and stillbirths in the U.S., 1980.

In the 1980 National Natality and Fetal Mortality Surveys, information about fetal monitoring and type of delivery was obtained from hospitals for a sample of 9,941 live births and 6,386 fetal deaths of 28 weeks' gestation or more. Data in this analysis are weighted to provide national estimates of live births and late fetal deaths that occurred in U.S. hospitals during 1980. Electronic fetal monitoring (EFM) was used for 47.7 percent of live births; 27.2 percent were monitored by Doppler ultrasound only, 10.2 percent by scalp electrode only, 6.3 percent by Doppler ultrasound and scalp electrode only, and 4.0 percent by other methods and combinations. The distribution by type of EFM used was similar for the 42.7 percent of late fetal deaths (also called stillbirths) that were monitored. Variation in the use of EFM for live births and stillbirths is examined according to maternal age, parity, education, race, marital status, income, previous fetal loss, underlying medical conditions, complications of pregnancy, complications of labor, duration of labor, infant birth weight, and length of gestation. Among live births, 17.1 percent were delivered by cesarean section, as were 16.8 percent of stillbirths. The association between fetal monitoring and the primary cesarean section rate (the probability of cesarean section for women who had never had one) for all birth orders and for first births is examined according to characteristics of the mothers and the infants. Factors involved in the consistent association found between fetal monitoring and the primary cesarean section rate are discussed.

Adult↗
PubMed1997

Sibling models of socioeconomic effects on the timing of first premarital birth.

Data on 1,000 pairs of sisters from the National Longitudinal Survey of Youth are used to estimate the effects of observed individual-level factors, common family-level variables, and shared unobserved family-level traits on the timing of premarital births. Results show a moderate correlated risk of premarital childbearing among siblings after controlling for the effects of measured covariates. The effect of older sisters' out-of-wedlock childbearing on the timing of younger sisters' premarital birth is overestimated when shared unmeasured family-level traits are ignored. Public policy measures designed to reduce premarital births have a smaller multiplier effect via reduced younger sisters' premarital births because unmeasured family-level factors are less amenable to policy measures. However, because the older-sibling effect is large when other sources of variability in premarital birth timing are controlled, interventions may be effective in reducing premarital births among young women in high-risk families.

Adolescent↗
PubMed1996

Risk factors for breast cancer according to family history of breast cancer. For the Nurses' Health Study Research Group.

BACKGROUND: Family history of breast cancer is an established risk factor for this disease and is used to identify women at higher risk, although the impact of risk factors for breast cancer among women with a family history is not well defined. PURPOSE: Using a modified extended log-incidence Pike model, we prospectively examined the impact of risk factors for breast cancer among women with and without a family history of the disease. METHODS: Data analyzed were obtained prospectively from the Nurses' Health Study. Two thousand two hundred forty-nine incident cases of invasive breast cancer were identified in a cohort of 89,132 women aged 30-55 years in 1976 followed biennially through 1990 (1.1 million person years of follow-up). With the use of proportional hazards models, we evaluated the association between risk factors for breast cancer and risk among women with and those without a family history of the disease. We then fit a modified extended log-incidence Pike model to these data. RESULTS: Among women with a family history of breast cancer, reproductive risk factors has associations that were different from those observed among women without a family history of the disease. In particular, we observed little protection from later age at menarche, no protection from multiple births when compared with nulliparity, nor from early, as compared with later, age at first birth. Fitting these data to a model of breast cancer incidence on the basis of reproductive risk factors, we observed an adverse effect of first pregnancy on risk of breast cancer among women with a family history of breast cancer that was approximately 50% greater in magnitude than among women without a family history. Additional births after the first birth conveyed little protection for women with a family history. History of benign breast disease, past use of oral contraceptives, and use of postmenopausal hormones showed relative risks that did not differ between women with a family history and those without a family history of the disease. CONCLUSIONS: We observed a consistent increase in risk of breast cancer among women with a mother or sister history of the disease that was exacerbated by first pregnancy. Among women with a family history of breast cancer, the adverse effect of pregnancy persisted so that to age 70 years, parous women were at higher risk of breast cancer than nulliparous women. Among women without a family history of the disease, first pregnancy was associated with a smaller increase in risk, and early pregnancy and higher number of births were each associated with reduced breast cancer incidence.

Adult↗
PubMed2001

Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study.

OBJECTIVE: To determine whether first and second births among teenagers are associated with increased risk of adverse perinatal outcomes after confounding variables have been taken into account. DESIGN: Population based retrospective cohort study using routine discharge data for 1992-8. SETTING: Scotland. MAIN OUTCOME MEASURES: Stillbirth, preterm delivery, emergency caesarean section, and small for gestational age baby among non-smoking mothers aged 15-19 and 20-29. RESULTS: The 110 233 eligible deliveries were stratified into first and second births. Among first births, the only significant difference in adverse outcomes by age group was for emergency caesarean section, which was less likely among younger mothers (odds ratio 0.5, 95% confidence interval 0.5 to 0.6). Second births in women aged 15-19 were associated with an increased risk of moderate (1.6, 1.2 to 2.1) and extreme prematurity (2.5, 1.5 to 4.3) and stillbirth (2.6, 1.3 to 5.3) but a reduced risk of emergency caesarean section (0.7, 0.5 to 1.0). CONCLUSIONS: First teenage births are not independently associated with an increased risk of adverse pregnancy outcome and are at decreased risk of delivery by emergency caesarean section. However, second teenage births are associated with an almost threefold risk of preterm delivery and stillbirth.

Adolescent↗