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PubMed2002

Birth weight as a predictor of breast cancer: a case-control study in Norway.

The hypothesis that birth weight is positively associated with adult risk of breast cancer implies that factors related to intrauterine growth may be important for the development of this malignancy. Using stored birth records from the two main hospitals in Trondheim and Bergen, Norway, we collected information on birth weight, birth length and placenta weight among 373 women who developed breast cancer. From the same archives, we selected as controls 1150 women of identical age as the cases without a history of breast cancer. Information on age at first birth and parity were collected from the Central Person Registry in Norway. Based on conditional logistic regression analysis, breast cancer risk was positively associated with birth weight and with birth length (P for trend=0.02). Birth weights in the highest quartile (3730 g or more) were associated with 40% higher risk (odds ratio, 1.4, 95% confidence interval, 1.1-1.9) of breast cancer compared to birth weights in the lowest quartile (less than 3090 g). For birth length, the odds ratio for women who were 51.5 cm or more (highest quartile) was 1.3 (95% confidence interval, 1.0-1.8) compared to being less than 50 cm (lowest quartile) at birth. Adjustment for age at first birth and parity did not change these estimates. Placenta weight was not associated with breast cancer risk. This study provides strong evidence that intrauterine factors may influence future risk of breast cancer. A common feature of such factors would be their ability to stimulate foetal growth and, simultaneously, to influence intrauterine development of the mammary gland.

Adult↗
PubMed1993

A computer program for estimating individualized probabilities of breast cancer.

A computer program is presented for estimating the absolute risk of developing breast cancer over a specified age interval for women with combinations of five risk factors, namely age at menarche, age at first live birth, family history of breast cancer, number of previous breast biopsies, and presence of atypical hyperplasia in biopsy specimens. Statistical methods have been developed and applied to data from the Breast Cancer Detection and Demonstration Project to obtain (i) point estimates of absolute risk by combining relative risk estimates from case-control data and estimated composite incidence rates from cohort data, and (ii) confidence intervals by using implicit delta-method arguments. The program is interactive and easy to use and is therefore well suited to assist in medical counseling. For instance, women with high estimated risk might be advised to undergo a program of frequent surveillance with mammography. An executable version for IBM-compatible PCs is available from the author upon submission of a PC diskette formatted with MS-DOS.

Adult↗
PubMed1992

The relation between multiple births and maternal risk of breast cancer.

Data from two case-control studies conducted in New York State during 1982-1986 were used to examine the relation between multiple births and the maternal risk of breast cancer. The cases were 2,561 women between 20 and 79 years of age with a diagnosis of primary breast cancer. Controls (n = 2,616) were selected from driver's license files and matched to cases by year of birth and county of residence. The odds ratio for any multiple birth was 0.94 (95% confidence interval (CI) 0.56-1.56) in women less than 55 years of age and 0.95 (95% CI 0.62-1.46) in women aged 55-79 years. A previous study had shown a multiple last birth to be protective against breast cancer in women less than 55 years of age (odds ratio (OR) = 0.60, 95% CI 0.43-0.85). A decreased risk of breast cancer was also observed for this age group in the present study, but the magnitude of the effect was not as strong and the confidence interval included unity (OR = 0.85, 95% CI 0.43-1.68). A logistic model that controlled for age at first pregnancy, number of live births, age, and county of residence increased the odds ratio to 0.97 for a multiple last birth. The current study does not support an association between multiple births and maternal risk of breast cancer.

Adult↗
PubMed1991

Reference data on gains in weight and length during the first two years of life.

Serial data from studies of infants at the University of Iowa and from the Fels Longitudinal Study were used to develop sex-specific percentiles for increments in weight and recumbent length for selected intervals during the first 24 months of life. Weight increments are presented for 1-month intervals from birth to 6 months, 2-month intervals from birth to 12 months, and 3-month intervals from birth to 24 months. Length increments are presented for 2-month intervals from birth to 6 months, and for 3-month intervals from birth to 24 months of age. Weights and lengths at the target ages were obtained for the Iowa data by simple interpolation, and for the Fels data by fitting families of three-parameter mathematical functions to the serial data from ages 1 to 24 months. The tabular presentations are based on the Iowa data from birth to 3 months of age, on the combined Iowa and Fels data from 3 to 6 months of age, and on the Fels data from 6 to 24 months of age. We believe that these reference data will be useful in screening for deviations from normal growth and may aid in early detection of failure to thrive or excessive weight gain during early life.

Age Factors↗
PubMed1991

Gross motor development of Nigerian children.

A prospective study of 320 Nigerian children was undertaken to determine their pattern of motor development by recording the age at attainment of 12 gross-motor milestones. The children were all born full term and were neurologically normal at birth. They were recruited in the first week of life and seen at regular intervals in a well-baby clinic, where their parents were questioned about the ages at attainment of milestones. Results show that most gross-motor milestones were attained at earlier ages by these children than by children studied to establish norms for the traditional tests of motor development that have long been in use. Our findings confirm several previous reports which emphasize the more rapid attainment of motor milestones such as 'sit without support', 'crawl', 'stand well alone' and 'walk well alone' by black as compared with white children. But, conversely, a number of transitional milestones such as 'roll over', 'pull self to stand' and 'stand holding on' were achieved later by children in this study than by their non-African counterparts. Girls in this study were slightly advanced, relative to boys, in their attainment of most milestones. The results of this study have been incorporated into a chart which can be used in well-baby clinics to detect children with motor delay.

Black People↗
PubMed2005

The familial risk of subarachnoid haemorrhage.

Relatives of people with aneurysmal subarachnoid haemorrhage (SAH) may be at increased risk of SAH, but precise data on the level of risk and which relatives are most likely to be affected are lacking. We studied two samples: 5478 relatives of patients from the whole of Scotland who had a SAH in one year and 3213 relatives of patients with a SAH admitted to the West of Scotland regional neurosurgical unit 10 years previously. Overall, 2% of all relatives in each sample had a SAH. In the Scotland-wide sample, the absolute lifetime risk of SAH (from birth to 70 years) was higher for first-degree relatives [4.7%; 95% confidence interval (CI): 3.1-6.3%] than for second-degree (1.9%; 95% CI: 1.0-2.9%). In the West of Scotland sample, the lifetime risks were very similar to the Scotland-wide sample. The 10-year prospective risk for first-degree relatives alive at the time of the index patient's SAH was 1.2% (95% CI: 0.4-2%) and for second-degree was 0.5% (95% CI: 0.1-0.8%). There was a trend for risk to be highest in families with two first-degree relatives affected and lowest with only one second-degree affected. Most living relatives of patients who suffer a SAH are at low absolute risk of a future haemorrhage; screening is inappropriate except for the few families in whom two or more first-degree relatives, i.e. index case plus one extra have been affected.

Adolescent↗
PubMed2000

The epidemiology of Theileria parva infections on smallholder dairy farms in Kenya.

The purpose of the study was to characterize the differences in epidemiology (risks of infection, morbidity, mortality) and potential control of East Coast fever (ECF) between the selected strata. Evidence of Theileria parva infection was assessed by increased antibody levels as measured in an indirect ELISA test by the percent positivity (PP) of serum samples relative to a strong positive reference serum. A prospective cohort study was conducted in five purposively sampled agroecological zone (AEZ)-grazing system strata in Murang'a District, Kenya, between March 1995 and June 1996. The study strata were selected to represent the widest range of ECF risks in the district and included, zero-grazing and open-grazing farms in the Upper Midlands (UM) one and four AEZs and zero-grazing farms in the UM2 AEZ. In total, 225 calves from 188 smallholder farms were examined from birth to age six months. Calves were recruited into the study at birth and visited within the first two weeks of life and thereafter at biweekly intervals for up to 14 visits. Important differences were observed between the different AEZ-grazing strata. Seroconversion risks of T. parva were highest in the UM4-open grazing stratum. Antibody prevalence in adult cattle and ECF morbidity and mortality risks were also highest in this stratum. In the open-grazing strata, particularly in the lower elevation AEZ, UM4, there was stronger challenge and a greater impact of ECF. There is likely to be an expansion of smallholder dairy farming into this area so that it is likely to be the most important target production system for ECF control in the central highlands of Kenya.

Animals↗
PubMed2006

Acculturation and breast density in foreign-born, U.S. Chinese women.

The role of acculturation in the breast cancer risk increase among U.S. Chinese women is unclear. We examined the association between acculturation and breast density in a sample of foreign-born, U.S. Chinese women and examined factors that may explain such an association. Between January 2002 and May 2003, 212 Chinese women were recruited from Philadelphia region screening programs. Cranial-caudal mammographic images were classified into one of four categories ranging from "entirely fatty" to "extremely dense." Questionnaires assessed information on sociodemographic, cultural, reproductive, and lifestyle factors. An index of acculturation was created based on self-reported English proficiency and within- and cross-ethnicity social interactions. To estimate odds ratios (OR) for falling into a higher versus lower category for breast density, we conducted logistic regression analysis using proportional odds models for polychotomous outcomes. We found that women in the highest acculturation category had denser breasts [age-adjusted OR, 3.1; 95% confidence interval (95% CI), 1.6-6.0]. They also had fewer live births, higher age at first live birth, and higher dairy food intake, all factors associated with breast density. In 196 women with complete covariate data, only adjustment for number of live births and dairy food intake attenuated the estimate for acculturation by >10%. With adjustment for both simultaneously, the most acculturated women were still more likely to have denser breasts (age- and menopause-adjusted OR, 2.0; 95% CI, 1.0-4.2). These analyses are the first to show breast density differences by level of acculturation among foreign-born, U.S. Chinese women. Despite reproductive and lifestyle differences by level of acculturation, differences in these factors did not explain the acculturation-breast density association. Future longitudinal research will examine whether the association is due to early-life factors, postmigration lifestyle changes, or perimenopausal exposures.

Acculturation↗
PubMed1989

Is induction of labor indicated in prolonged pregnancy? Results of a prospective randomised trial.

In 345 women with a favorable cervical score at due date, labor was either induced by means of intravaginal application of tablets containing 3 mg of prostaglandin E2 or spontaneous onset of labor was awaited until the 42nd week of pregnancy. Eighty percent of the nulliparae and 96.3% of the multiparae of the induction group gave birth within 24 h of the administration of the first tablet. All pertinent delivery intervals were significantly shorter in this group compared to those women where spontaneous onset of labor was awaited. The rate of operative deliveries was lower in the induction group. With the exception of 1 fetal death 3 days after due date, fetal outcome was excellent in both groups. Elective induction was at least equivalent to awaiting the onset of spontaneous labor and was not associated with higher complication rates due to the method of induction.

Clinical Trials as Topic↗
PubMed1989

Estimating birth stopping and spacing behavior.

A decomposition of age-specific marital fertility rates into indices related to spacing and stopping is developed by using Coale and Trussell's indices and the first few parity progression ratios. This approach leads to estimates of the mean birth interval among low-parity births that can be used to address the issue of fertility control early in marriage. In this way the model addresses several of the most serious limitations of Coale and Trussell's approach. The usefulness of the proposed indices is demonstrated by applications to historical data from the United States and Europe.

Birth Intervals↗
PubMed1995

Is the risk of cancer of the corpus uteri reduced by a recent pregnancy? A prospective study of 765,756 Norwegian women.

We have examined the relations between the incidence of cancer of the corpus uteri and pregnancies in a cohort of 765,756 Norwegian women, contributing a total of 9,307,118 person-years in the age interval 30-56 years. Incidence rate ratios (IRR) were calculated by Poisson regression analyses of person-years at risk. Separate analyses were carried out for the 2 main histological subtypes, endometrial carcinomas (554 cases) and sarcomas (112 cases). We observed a decrease in risk of endometrial carcinoma with an increasing number of full-term pregnancies (p < 0.001). The reduction in risk associated with the first pregnancy was more pronounced than that observed for any subsequent pregnancy. The risk of endometrial carcinoma increased with increasing time since last birth (IRR = 1.20, 95% CI = 1.08-1.34 per 5-year time interval). The reduction in risk among parous women compared to nulliparous women diminished with increasing time since last birth. For endometrial carcinoma, the decrease in risk with increasing age at first and last birth disappeared after adjustment for time since last birth. For sarcomas, however, the relation with age at births remained in analyses adjusted for time since birth, and time since birth seemed to be of minor importance as an independent risk factor. Our results support the hypothesis that the reduction in risk of endometrial carcinoma associated with a pregnancy is related to a mechanical shed of malignant or pre-malignant cells at each delivery.

Adult↗
PubMed1999

Sire marbling score expected progeny difference and weaning weight maternal expected progeny difference associations with age at first calving and calving interval in Angus beef cattle.

Field records from the American Angus Association were used to study the associations of sire marbling score EPD and sire weaning weight maternal (milk) EPD with age at first calving (AFC) and calving interval (CI). Cows were selected based on the accuracy of their sire's milk (> or =.7) or marbling (> or =.6) EPD. The data were screened using biological constraints, and regression models were used to identify records that were greater than 5 SD from the mean. The AFC was modeled for both milk and marbling data sets to account for effects of year, sire EPD, and their interaction. The CI was subdivided into first, second, and mature calving interval traits and modeled to account for state, year, calf sex, calf birth weight (BW), calf weaning weight (WW), sire EPD, and interactions of EPD with year and state. Derivative-free REML was used to estimate heritability and genetic correlations for AFC and CI. Sire milk EPD and marbling EPD were predictors of AFC (P < .001); however, pooled estimates were unreliable because of state x EPD interactions (P < .001). Increases in sire milk EPD resulted in reductions in AFC; however, there was no consistent pattern to effects of marbling EPD increases. Models accounted for < 8% of variation in AFC. Sire milk EPD was not a predictor of first, second, or mature CI (P > .1). Sire marbling score EPD was not a predictor of second, or mature CI (P > .1); however, it was associated (P = .059) with first CI, although regression estimates varied across states and prevented pooling. The BW, sex, and WW were predictors of CI (P < .001). Increases in BW resulted in longer mature CI, and mature CI decreased as WW increased. The AFC was heritable (.22), and CI traits had heritabilities ranging from .01 to .03. The AFC was genetically correlated with first CI (-.6) and mature CI (-.93). Genetic correlations between CI traits were uninterpretable because of low additive genetic variances. In conclusion, sire marbling score and milk EPD do not seem to be reliable predictors of AFC or CI. The BW and WW have significant but small effects on AFC and CI. Selection for AFC is possible, but earlier calving heifers may have longer calving intervals.

Adipose Tissue↗
PubMed2006

Fertility among female hairdressers.

OBJECTIVES: The study investigated whether working as a hairdresser has a negative impact on fertility, measured as time to pregnancy and miscarriage risk. METHODS: Self-administered questionnaires were sent to 5289 Swedish hairdressers (response rate 50%) and to 5299 age-matched women from the general Swedish population (response rate 54%). Information was collected on time to pregnancy or trying time for women who had tried, but failed, to conceive at the time of the study. The outcome of the pregnancy was determined and categorized as either miscarriage or stillbirth or live birth. The hairdressers were compared with the referents with respect to these two outcomes. Within the hairdresser cohort, the effects of hair treatments, as well as physical workload and stress were investigated. RESULTS: The hairdressers were less successful than the reference cohort in conceiving (fecundability ratio 0.91, 95% confidence interval 0.83-0.99). The effect was reduced after first-month conceptions were excluded, the indication being that the effect may be the result of birth control bias. Within the hairdresser cohort, a self-perceived stressful work situation seemed to prolong the time to pregnancy. No effects were found for the different chemical hair treatments. There was no cohort difference with respect to miscarriage risk (odds ratio 1.12, 95% confidence interval 0.88-1.42), but miscarriage risks were increased for most of the hair treatments and for self-perceived stressful work situations. However, none of these effects were statistically significant. CONCLUSIONS: The present study indicates a negative impact on time to pregnancy and miscarriage risk for working as a hairdresser".

Abortion, Spontaneous↗
PubMed2006

Lessons learned from maternal deaths at an East African health center.

AIMS: To analyze maternal deaths occurring at the Mikumi Health Center in Tanzania, East Africa, to discuss causes for the high maternal mortality rate at the Health Center, and to define possible strategies for the reduction of maternal deaths. METHODS: Between 2002 and 2003, a total of nine maternal deaths were identified and analyzed from hospital records of the East-African Mikumi Health Center. RESULTS: During the two-year period, the total number of deliveries was 977 including two maternal deaths during pregnancy and seven deaths during labor or postpartum (0.7% of total deliveries). The maternal mortality ratio (MMR) was 921 per 100,000 live births. The maternal average age was 27 years (range 18-37). The average interval between the first contact with the Health Center and maternal death was 3.5 days. CONCLUSION: The main cause for maternal complications and subsequent deaths might have been the patient's delayed presentation at the Health Center. Aggravating circumstances such as long distance from the health services and hospital fees hinder patients from a timely and eventually life-saving presentation. The womens' low educational level affects their health as well as their nutritional state and thus increases the maternal death rate. Strategies to prevent maternal deaths at the Mikumi Health Center include measures to raise awareness about consequences of poor maternal health, to improve general education especially for young women, to increase the number of professional birth attendants in the region, to improve family planning services and sexual education with special reference to HIV/AIDS. Additionally, improvement of the first referral facilities around the Mikumi Health Center according to the "essential obstetric functions" recommended by the WHO seems crucial.

Adolescent↗
PubMed2004

Chronic caregiver stress and IgE expression, allergen-induced proliferation, and cytokine profiles in a birth cohort predisposed to atopy.

BACKGROUND: Psychologic stress modifies immune function and cytokine production. OBJECTIVE: We examined relationships between caregiver stress on the following markers of early childhood immune response: (1) IgE expression (n=215); (2) mitogen-induced and allergen-specific (Dermatophagoides farinae [Der f 1] and cockroach [Bla g 2]) proliferative response (n=114); and (3) subsequent cytokine expression (INF-gamma, TNF-alpha, IL-10, and IL-13) in a prospective birth cohort predisposed to atopy. METHODS: Caregiver stress was measured at 2-month intervals for the first 2 years of life and yearly thereafter by using the Perceived Stress Scale. A subsequent blood sample obtained from the children (median age, 2.1 years; range, 18-32 months) was analyzed for total serum IgE level and allergen-induced proliferation quantified as the stimulation index (SI; mean thymidine incorporation of the stimulated sample divided by that of the unstimulated sample). The relationship between stress and the proliferative response (SI >3 vs SI < or =3), and total IgE level (< or =100 IU/mL vs >100 IU/mL) was examined by using logistic regression. The relationship between cytokine levels and stress was analyzed by using linear regression. RESULTS: In adjusted analyses higher caregiver stress in the first 6 months after birth was associated with a Der f 1 SI of greater than 3 (odds ratio [OR], 1.5; 95% CI, 1.0-2.3) and nominally associated with a Bla g 2 SI of greater than 3 (OR, 1.13; 95% CI, 0.7-1.8). Higher stress between ages 6 and 18 months was associated with a high total IgE level (OR, 2.03; 95% CI, 1.1-3.6). Higher stress was significantly associated with increased production of TNF-alpha, with a suggested trend between higher stress and reduced INF-gamma production. CONCLUSION: Increased stress in early childhood was associated with an atopic immune profile in these children predisposed to atopy-asthma.

Allergens↗
PubMed1989

Son preference and child replacement in Bangladesh: a new look at the child survival hypothesis.

Birth history data from women in the 1975-76 Bangladesh Fertility Survey were used to search for intentions to replace dead children. The median intervals between successive births of orders (i) and (i + 1) were not shorter when some siblings of orders below (i) had died. Nor was the median duration between the death of a child and the first posthumous birth shorter when the dead child was a boy or when it was survived by fewer than two brothers. The median intervals were generally shorter when the mother lived in an urban rather than a rural area but this difference was attributable only to the shorter duration of breast-feeding by urban women. These results disputed the notions that the timing of births was deliberately quicker to replace a dead child, that attempts at replacement were sex-selective, or that child replacement intentions were stronger in urban than in rural populations.

Adult↗
PubMed1968

Oxygen consumption in normally grown, small-for-dates and large-for-dates new-born infants.

1. Serial measurements of minimal oxygen consumption (V(O2)) have been obtained from nineteen healthy new-born infants in order to find out how body weight, gestational age and age after birth affected V(O2). The first measurement of V(O2) was done within 12 hr of birth, and further measurements were made at intervals until the baby left hospital.2. The majority of the infants (seventeen) weighed less than 2.5 kg at birth, and were ;premature' according to international definition. Gestational age, calculated from the mother's last menstrual period, was corroborated by clinical data and obstetrical history. The babies were divided into four groups according to birth weight and gestational age combined (see Table 1). Babies in the first two groups were the appropriate weight for dates (i.e. normally grown), babies in the other two groups were either small-for-dates or large-for-dates.3. At birth minimal V(O2) was closely correlated with birth weight in all babies and appeared to be directly proportional to it. The value for V(O2)/kg was similar in all groups. V(O2) was not related to gestational age per se. However, in the two normally grown groups V(O2) was roughly related to gestational age because birth weight was related to gestational age.4. In all babies minimal V(O2) rose progressively with increasing age after birth; a marked increase in V(O2) occured in the first week of life, despite a small decline in body weight.5. At a given age after birth differences in V(O2)/kg between the four groups were mostly less than 10%, and in general the differences were not statistically significant. Values for minimal V(O2) in all four groups were roughly:5 ml. O(2)/kg.min at < 12 hr of age.7 ml. O(2)/kg.min at 7-14 days of age.9 ml. O(3)/kg.min at about 2 months of age.6. It is concluded that:(a) At birth minimal V(O2) is largely determined by birth weight. V(O2)/kg is little affected by either rate of growth in utero or gestational age.(b) Minimal V(O2) is a function of age after birth as well as of body weight, and the value for V(O2)/kg increases as the baby gets older.

Age Factors↗
PubMed2005

Physical exertion at work and the risk of preterm delivery and small-for-gestational-age birth.

OBJECTIVE: To assess whether exposure to standing, lifting, night work, or long work hours during 3 periods of pregnancy are associated with an increased risk of preterm or small-for-gestational-age birth. METHODS: The Pregnancy, Infection and Nutrition study is a prospective cohort with a nested case-control component that was conducted through clinic and hospital settings in Central North Carolina. A total of 1,908 women pregnant with a singleton gestation were recruited during prenatal visits from January 1995 through April 2000 and provided information during telephone and face-to-face interviews about physical exertion for the 2 longest-held jobs during pregnancy. RESULTS: No significant elevations in preterm delivery were observed among women who lifted repeatedly or stood at least 30 hours per week, with no changes in risk estimates over the course of pregnancy. A 50% elevation in the risk of preterm delivery (relative risk 1.5, 95% confidence interval 1.0-2.0; first trimester) was observed among women who reported working at night (10:00 PM to 7:00 AM), whereas a 40% reduction in risk was observed among women working at least 46 hours per week (relative risk 0.6, 95% confidence interval 0.4-0.9; first trimester), regardless of period of exposure. No elevations in small-for-gestational-age birth were observed among women exposed to any of the 4 types of occupational exertion. CONCLUSION: Physically demanding work does not seem to be associated with adverse pregnancy outcomes, whereas working at night during pregnancy may increase the risk of preterm delivery. Studies to examine the effect of shift work on uterine activity would help to clarify the possibility of a causal effect on preterm birth.

Adult↗