The multiple risk factor intervention trial (MRFIT). III. The model for intervention.
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Behavior Therapy↗
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Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated with the Milwaukee brace.
Ninety-five patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: adolescent idiopathic scoliosis, completion of Milwaukee brace treatment before age 20, a minimum follow-up period of 5 years thereafter, minimum age of 22 years at final follow-up examination. Of these, 85 (90%) were examined personally by an independent investigator, including anteroposterior and lateral full-length spinal roentgenograms. The average length of follow-up was 7.5 years (range, 5-12 yrs). These patients who successfully completed the brace treatment program, in their mid-twenties ended up with curves that were of equal size (33 degrees +/- 3 degrees) as when the treatment started (30 degrees +/- 3 degrees). In the sagittal plane, the spines were normal; none exhibited hypokyphosis (less than 20 degrees). Compared with the straight control group and to a previously reported group of operated patients, the brace group functioned at the same level in regard to marriage, child bearing, sports activities, and job performance. Overall back pain was also reported at a normal rate, with low-back pain significantly less frequent than the control group. Ten patients showed an increase of their curves exceeding 5 degrees; eight of these had been pregnant multiple times before age 25. None of the patients pregnant after that age increased their curve size. This study demonstrates that those patients who complete a Milwaukee brace treatment for adolescent idiopathic scoliosis from a functional and social point of view do very well. Early pregnancy is a significant risk factor for progression after maturity.(ABSTRACT TRUNCATED AT 250 WORDS)
Activities of Daily Living↗
The optimal number of fathers. Evolution, demography, and history in the shaping of female mate preferences.
Around the world polygynous marriage (one man, several women) is vastly more common than polyandrous marriage (one woman, several men), and women tend to be more cautious about entering into sexual relationships than men are. Such patterns are often assumed to reflect essential differences between the sexes. However, the same dichotomy between "ardent" males and "coy" females is not found in other primates. Furthermore, under a range of circumstances females enhance their reproductive success by mating with multiple partners and use polyandrous mating (soliciting copulations from several or more males) to circumvent male-imposed costs on their free choice of mates. The existence of one-male mating systems does not prove that females "naturally" gravitate to them. Typically monandrous (copulating with just one partner) mating systems are maintained by one male excluding rivals or by other circumstances that distort female options. As with many other animals, primate females (including women) can benefit reproductively from polyandrous matings. Understanding this takes us beyond narrow research programs intent on demonstrating "universal" differences between the sexes, and allows us to study females as flexible and opportunistic individuals who confront recurring reproductive dilemmas and tradeoffs within a world of shifting options.
Biological Evolution↗
Marital and sexual satisfaction in Chinese families: exploring the moderating effects.
This study examines the relationship between marital satisfaction and sexual satisfaction in Chinese families. Hierarchical multiple regression using data from the 1993 China Housing Survey indicates that, when controlling for the other variables, sexual satisfaction has considerable impact on marital satisfaction. We also found that the effects of sexual satisfaction on marital satisfaction are moderated by gender and education. The study suggests that marriage counseling, with an emphasis on promoting awareness of sexual quality, would be helpful in addressing marital problems in Chinese families.
Adult↗
Immuno-deficiency in Schwartz-Jampel syndrome.
Two sisters born in a consanguineous marriage and affected by Schwartz-Jampel syndrome had a complex immunodeficiency, involving not only the humoral but also the cellular immune response.
Abnormalities, Multiple↗
[Social determinants of marital fertility in Japan].
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Asia↗
Spread of hepatitis C virus infection within families. Investigators of an Italian Multicenter Group.
In 1995, the intrafamilial spread of hepatitis C virus (HCV) was evaluated among 1379 household contacts of 585 HCV antibody-positive HCV RNA-positive subjects (index cases) in Italy. All index cases were patients with histologically proven chronic liver disease. The presence of antibodies to HCV (anti-HCV) was assessed by third-generation enzyme-linked immunosorbent assay (ELISA); the polymerase chain reaction (PCR) was used to test for HCV RNA. The overall anti-HCV prevalence among household contacts of index cases was 7.3% (101/1379); it was 15.6% in spouses and 3.2% in other relatives (P < 0.05; odds ratio (OR), 6.5; 95% confidence interval (CI), 3.5-8.6). Spouses married to index cases for longer than 20 years had a significantly higher anti-HCV prevalence than those married 20 years or less (19.8% vs 8.0%; P< 0.05; OR, 2.8; 95% CI, 1.5-5.3). Parenteral risk factors were more likely to be reported in anti-HCV positive than in anti-HCV negative household contacts. After adjustment for confounders by multiple logistic regression analysis, age greater than 4 5 years (OR, 3.1; 95% CI, 1.6-5.3) and any parenteral exposure (OR, 3.7; 95% CI, 1.7-8.1), were the only independent predictors of the likelihood of anti-HCV positivity among household contacts. Spouses versus other relatives and length of marriage were both no longer associated. These findings suggest that sexual transmission does not seem to play a role in the intrafamilial spread of HCV infection.
Adult↗
Correlates of age at natural menopause: a community-based study in Alexandria.
Differences in the age at natural menopause were examined using a retrospective population sample of 289 naturally menopausal women. The mean age at natural menopause was 46.70 +/- 5.44 years. Earlier menopause occurred in women living in semiurban areas, divorced/separated and less educated women, and women who were younger at: first marriage, widowhood, divorce/separation and first or last full-term pregnancy. Later menopause occurred in women who had: irregular menstrual periods before 25 years, dysmenorrhoea and mid-cycle spotting. Duration of oral contraceptives use, weight and body mass index were significantly positively correlated with age at natural menopause. Multiple regression analyses indicated that age at last full-term pregnancy, residence, pattern of menstrual cessation and duration of oral contraceptive use were the significant predictors of the end of menstrual activity.
Adult↗
Impact of military life stress on the quality of life of military wives.
Ten domains of life satisfaction were developed for military wives based on a factor analysis of 44 items derived from various studies of quality of life. Factor scores were computed for each domain, and multiple regressions were performed with the domains of satisfaction as the independent variables. Two dependent variables were used--namely--a measure of general well-being and overall satisfaction with life. The most important component of both general well-being and life satisfaction was a factor dealing with marriage, health, and family life. Factors related to domains of satisfaction with military life also explained significant amounts of variance in both dependent variables.
Factor Analysis, Statistical↗
A case-control study of dietary and nondietary factors in ovarian cancer.
A case-control study is presented that estimates ovarian cancer risk for various factors, including diet. Data collected by interview between 1957 and 1965 for 274 white women aged 30-79 years with epithelial carcinoma of the ovary are compared to data similarly collected for 1,034 hospital controls. Relative risk estimates are presented for the total group as well as for premonopausal (ages 30-49) and postmenopausal (ages 50-79) are groups. In the total group, cancer risk increased with increasing age at first marriage (P less than .01) and previous history of benign breast disease (P less than 0.1), and risk decreased with increasing number of previous pregnancies (P less than .01). In the 50- to 79-year age group, a marginally significant trend for decreasing risk with increasing obesity was observed (P less than .10). There was no significant risk (i.e., P less than .10) associated with the consumption of alcohol, cigarettes, coffee, tea, total dietary protein, vitamin C, or fat at any age. In the 30- to 49-year age group only, increased risk (P less than .01) was seen in women reporting diets low in fiber and vitamin A from fruit and vegetable sources. Multiple regression analysis demonstrated that the apparent protective effect of vitamin A in the 30- to 49-year age group (but not dietary fiber) was independent of the nondietary factors analyzed in this study (P less than .05).
Adult↗
A phenomenological study of the experience of being a mother of a child with cerebral palsy.
PURPOSE: The purpose of this study is to describe the lived experience of being the mother of a child with cerebral palsy. METHOD: A convenience sample of 15 mothers whose children with spastic cerebral palsy receiving care at the high-risk and neurology clinics of a medical center in a southern state participated in two audiotaped interviews. The mothers described how being the mother of a child from 1 to 5 years of age with cerebral palsy affects her life. Labov's (1982) transcription and Colaizzi's (1978) phenomenological methods were used to analyze transcripts of the interviews. An exhaustive description of the experience was written, and subsequently, in a second interview, was validated by the mothers. FINDINGS: Four clustered themes emerged from the interviews: caregiver burden, family/social support, women's/mothers' roles, and socioeconomics. CONCLUSION: Mothers reported the following: (a) strong family relationships are counted on during difficult times; (b) caregiving stressors and day-to-day caregiving is difficult; (c) a positive caregiver role and interest in learning about cerebral palsy improve children's quality of life; (d) therapy and social services assist them with their children; (e) multiple roles and alterations in activities affect daily living; and (f) families financial status is affected.
Adolescent↗
Alternate scenarios for population control in Pakistan: the issue of contraceptive method mix.
The authors review Pakistan's population program, with a focus on the ideal mix of contraceptive methods needed to slow population growth. "Our objective in this exercise is to estimate the extent of services required to achieve a certain level of the Contraceptive Prevalence Rate (CPR) necessary to bring fertility down to a level desired by women." Comparison is made between single- and multiple-method approaches.
Asia↗
Ethics and the law: the law and assisted human conception.
This article aims to provide no more than a brief summary and overview of some of the principal legal questions which arise in connection with assisted human conception. There is no requirement of legal suitability for natural parenthood, though a child may be removed from parental care at birth if its welfare is considered to be at risk. Where medical or other assistance is required, however, the law and social judgments may impinge on the freedom of individuals to procreate. Commercial surrogacy has recently been criminalized, but private surrogacy arrangements without reward are not illegal--although any contract would probably be unenforceable through the courts. If medical intervention is required to achieve assisted conception, the availability of resources for NHS treatment, the physical and mental health of the prospective mother and father, and the welfare (or lack of it) of any prospective child, may be factors in deciding whether an infertility unit will offer treatment. Such practices must not operate unfairly and must not discriminate on racial grounds. If treatment is provided, and a woman becomes pregnant, the ordinary abortion laws will apply and, it is thought, will extend to the selective reduction of a multiple pregnancy--there is no claim in English law for 'wrongful birth'. AID does not constitute adultery, and the law has recently been reformed to recognize children born following AID as legitimate to their social parents. A child may be regarded as the legitimate child of a surrogate mother's marriage, but where the baby is genetically distinct from the surrogate mother, the law, and is uncertain and as yet could be conflicting claims of parenthood without legislation. The storage and disposal of human gametes and embryos may raise problems of 'ownership'.
Ethics, Medical↗
New multiple congenital anomalies syndrome in a stillborn infant of consanguinous parents and a prediabetic pregnancy.
We report on a term stillborn female infant with multiple congenital anomalies (MCA) which have not previously been reported as occurring together. The malformations include a first and second branchial arch sequence, ectopia cordis with congenital heart defect, caudal "regression" sequence with absent sacrum and hypoplastic right femur, ectrodactyly, left radial abnormality, islet cell hyperplasia, and skin lesions. The pregnancy was complicated by abdominal cramping with exercise, heavy vaginal bleeding, maternal obesity, and a normal screening glucose tolerance test at 6 months gestation. The infant was born to 20-year-old G3P1SAB2 Mexican-American parents who are first cousins. There was strong maternal family history of adult-onset diabetes. The malformations have some findings in common with those seen in infants of diabetic mothers. Structural defects similar to, but not inclusive of, those in our infant have been reported in 2 sibs born to a prediabetic mother with a first cousin marriage as well as in focal dermal hypoplasia. Parental consanguinity is suggestive of an autosomal recessive disorder. Alternatively, it may represent a combined multifactorial effect making the conceptus more sensitive to metabolic teratogens and thus placing it at increased risk for disruption of normal development.
Abnormalities, Multiple↗
Marriage still protects pregnancy.
OBJECTIVE: To assess the risk factors and outcome of pregnancy outside marriage in the 1990s, in conditions of a high percentage of extramarital pregnancies and high standard maternity care, used by the entire pregnant population. DESIGN: Hospital-based cohort study. SETTING: A university-teaching hospital in Finland. POPULATION: The 25,373 singleton pregnancies of known marital and cohabiting status. METHODS: Odds ratios (ORs) with 95% confidence intervals were calculated to estimate the effect of extramarital childbearing on pregnancy outcome. Multiple logistic regression analyses were conducted to control for confounding maternal risk factors. MAIN OUTCOME MEASURES: Small-for-gestational age (SGA) infants, preterm birth (less than 37 completed weeks), low birthweight (LBW; under 2500 g). RESULTS: Of the study population, 67.5% were married and 32.5% were unmarried; 24.2% of all mothers were cohabiting. Unmarried status was strongly associated with social disadvantage and particular risk factors, specifically unemployment, smoking and previous pregnancy terminations, which in turn had an impact on obstetric outcome. There were significantly more SGA infants among unmarried mothers (P < 0.001), with an absolute difference of 45%; more preterm deliveries (P= 0.001), with an absolute difference of 17.5%; and more LBW infants (P < 0.001), with an absolute difference of 26%. The differences in adverse pregnancy outcomes between study groups (i) all unmarried women, (ii) cohabiting women and (iii) single women, remained significant after multivariate analysis at adjusted ORs of 1.11, 1.11 and 1.07 for SGA, 1.17, 1.15 and 1.21 for LBW and 1.15, 1.15 and 1.29 for the preterm births, respectively. CONCLUSION: Even in the 1990s when cohabitation was already common, pregnancy outside marriage was associated with an overall 20% increase of adverse outcomes, and free maternity care did not overcome the difference.
Cohort Studies↗
Relationships among marital investment, marital satisfaction, and marital commitment in domestically victimized and nonvictimized wives.
The present investigation examined the association between marital investment, marital satisfaction, and commitment to marriage among physically abused women. We applied an investment model and a social learning model to understanding victimized wives' satisfaction and commitment to stay married. Thirty wives who reported physical abuse and 58 nonabused wives completed measures of marital stability, investment in marital problem solving, and dyadic adjustment. Investment in marital problem solving was assessed by having subjects indicate how much energy that they have put into solving 34 common marital problems and whether their efforts were successful or not successful. Consistent with a social learning model but counter to an investment perspective, correlational and multiple regression analyses for each group revealed that failed investment was significantly related to lower, not greater, commitment. Group differences also emerged. Whereas nonabused wives' commitment was related to their dyadic adjustment abused wives' commitment was related to their level of failed investment. Results are consistent with the notion that women may remain in abusive relationships because of psychological entrapment.
Adult↗
The risk factors of nursing home entry among residents of six continuing care retirement communities.
We identified client characteristics related to nursing home entry for 3,316 residents of six continuing care retirement communities with a longitudinal dataset that follows an initially healthy entry cohort for up to 15 years. The Cox Proportional Hazards Model was used for the analysis of survival data that includes censored data. We calculated hazard indices for residents with different characteristics to show the independent effect of these variables on the probability of nursing home entry. Seven variables emerged as statistically significant covariates: sex, marital status, roommate status, entry year into the community, entry age into the community, number of hospitalizations, and community of residence. The community of residence, which in large part reflects system effects on nursing home entry, was found to be the single most important variable explaining variance in the data. Tobit analysis was used to examine the factors associated with multiple nursing home entries and total days per year spent in a nursing home. With a few exceptions, most of the variables listed above were also significant correlates of multiple entries and total days per year spent in a nursing home.
Age Factors↗
Infant mortality in Israel during 1950-2000: rates, causes, demographic characteristics and trends.
We evaluated the trends and risk factors in infant mortality in Israel over five decades (1950-2000), based on data obtained from the official notifications of live births, and death certificates. Until the 1960s the main cause of infant mortality was infectious disease; this was replaced by congenital anomalies in Moslems and Druzes, and preterm birth in Jews and Christians. In 2000, there were 746 infant deaths, and the national infant mortality rate (IMR) was 5.4 per 1000 live births (Jews 3.9; [95% CI 3.5, 4.3]; Moslems 9.2 [8.3, 10.3]; Christians 3.6 [1.4, 5.8]; Druzes 6.3 [3.6, 9.0]). Between 1955 and 2000 the overall IMR declined sevenfold (absolute declines of 56.8, 56.3, 45.0 and 28.3 per 1000 live births, in Moslems, Druzes, Christians and Jews, respectively). The reduction in IMRs between 1990 and 2000 in all religious groups (>45%) exceeded the goal set by the World Summit for Children in 1990 of 33%. In 2000, the main risk factors were birthweight < 1500 g [relative risk (RR) = 69], major congenital malformations (RR = 22.0 [18.8, 25.7], and multiple births (RR of 9.3 and 4.2 in triplets and twins respectively). We conclude that the marked decline in IMRs in Israel over five decades reflects a major improvement in population health. Today, infant mortality in Israel represents a unique combination of high rate of congenital malformations among Moslems, where consanguineous marriages are common, and medical termination of pregnancy of malformed fetuses are infrequent; and relatively high IMRs from preterm birth in Jews, associated with high rates of assisted reproduction.
Adult↗