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PubMed2002

Prevalence and risk factors for overweight and obesity in children from Seychelles, a country in rapid transition: the importance of early growth.

OBJECTIVES: To establish the prevalence of overweight and obesity and related risk factors in children from Seychelles (Indian Ocean), a country in rapid economic and epidemiological transition. DESIGN: Cross-sectional study with retrospective access to early life data. SUBJECTS: All children from all schools of Seychelles, in four selected school grades (kindergarten, fourth, seventh and tenth year of obligatory school) in 1999. A total of 5514 children aged 4.5-17.4 y were measured, corresponding to 83.5% of the eligible population. MEASUREMENTS: Overweight and obesity, using age- and sex-specific body mass index (BMI) cut-off points as defined by the International Obesity Task Force. RESULTS: Some 12.6% (95% confidence interval: 11.8-13.5%) of the children were overweight and 3.8% (3.3-4.4%) were obese. Weight gain (kg) during the first year of life was strongly associated with subsequent overweight (odds ratio 1.46, 95% confidence interval 1.27-1.67) and obesity (1.59, 1.29-1.97) in childhood, independently of birth weight. Increased maternal BMI (kg/m(2)) was also associated with overweight (1.07, 1.03-1.10) and obesity (1.09, 1.04-1.14) in the offspring. CONCLUSION: Prevalence of overweight and obesity among school children in Seychelles was as high as or higher than in some industrialized countries. If confirmed in other environments, the strong association between weight gain during the first year of life and subsequent obesity in childhood could affect the way optimal infant weight gain is defined in countries where public health priorities are changing.

Adolescent↗
PubMed2003

Rectal analgesia for pain from perineal trauma following childbirth.

BACKGROUND: Perineal pain from a tear and/or surgical cut (episiotomy) is a common problem following vaginal birth. Strategies to reduce perineal trauma and the appropriate repair of any perineal damage sustained are important for avoiding and alleviating pain. Where pain is present, numerous treatments are used in clinical practice, such as local anaesthetics, oral analgesics, therapeutic ultrasound, antiseptics and non-pharmacological applications such as ice packs and baths. This review assesses the evidence for using rectal analgesia for pain relief following perineal trauma. OBJECTIVES: To assess the effectiveness of analgesic rectal suppositories for pain from perineal trauma following childbirth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (July 2002), CENTRAL (The Cochrane Library, Issue 2, 2002), CINAHL (May 2002) and MIDIRS (May 2002). SELECTION CRITERIA: Randomised controlled trials comparing analgesic rectal suppositories with placebo or alternative treatment for the relief of perineal pain. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data independently. MAIN RESULTS: Three trials involving 249 women met the inclusion criteria. Only two of the trials identified for inclusion in this review had data that could be entered in a meta-analysis, with the third not providing data in a useable format. Women were less likely to experience pain at or close to 24 hours after birth if they received non-steroidal anti-inflammatory drugs (NSAID) suppositories compared with placebo (relative risk (RR) 0.37, 95% confidence interval (CI) 0.10 to 1.38, 2 trials, 150 women). Women in the NSAID suppositories group compared with women in the placebo group required less additional analgesia in the first 24 hours after birth (RR 0.31, 95% CI 0.17 to 0.54, 1 trial, 89 women) and this effect was still evident at 48 hours postpartum (RR 0.63, 95% CI 0.45 to 0.89, 1 trial, 89 women). No information was available on pain experienced more than 72 hours after birth or other outcomes of importance to women such as the impact on daily activities, resumption of sexual intercourse and the impact on the mother-baby relationship. REVIEWER'S CONCLUSIONS: NSAID rectal suppositories are associated with less pain up to 24 hours after birth, and less additional analgesia is required. More research is required regarding long-term effects and maternal satisfaction with the treatment.

Administration, Rectal↗
PubMed2000

Is the management of epidural analgesia associated with an increased risk of cesarean delivery?

OBJECTIVE: The aim of this study was to quantify the association of cesarean delivery with epidural analgesia management, specifically with the timing of epidural catheter placement in relation to labor, the type of epidural analgesia, and the use of bolus dosing. STUDY DESIGN: A retrospective cohort design was used to investigate 1561 consecutive nulliparous parturients whose labor occurred between November 1, 1996, and June 30, 1997, at Northwestern Memorial Hospital and who were delivered of term, singleton neonates in a cephalic presentation. The relationship between the management of epidural analgesia and the risk for cesarean delivery was determined with stepwise logistic regression to control for potential confounding variables. RESULTS: There was a significantly increased risk of cesarean delivery associated with decrements in cervical effacement (P =.001), cervical dilatation (P =.001), and fetal station (P =.001) at the time of epidural catheter placement. An increasing number of epidural boluses during the first stage of labor was also associated with increased risk of cesarean delivery (P =.001). After we controlled for maternal age, maternal body mass index, gestational age, infant birth weight, induction of labor, use of magnesium sulfate, and presence of chorioamnionitis, the adjusted odds of cesarean delivery associated with fetal station (odds ratio, 1.45; 95% confidence interval, 1.2-1.7) and epidural boluses (odds ratio, 1.55; 95% confidence interval, 1.3-1.8) during the first stage of labor remained significant. CONCLUSION: The management of epidural analgesia during labor was associated with the potential for increased risk of cesarean delivery. This risk increased with higher stations of the fetal head at the time of epidural catheter placement and with more frequent epidural boluses of local anesthetic during the first stage of labor.

Analgesia, Epidural↗
PubMedDate not supplied

Oculomotor paresis with cyclic spasms. A critical review of the literature and a new case.

Oculomotor paresis with cyclic spasms is a rare syndrome, usually noticeable at birth or developing during the first year of life. On a background of oculomotor paresis, spastic movements occur at regular intervals: about every second minute the lid is raised, the globe wanders toward midline, the pupil contracts, and accomodation increases. These spasms last from 10 to 30 seconds, and then give way again to paresis. Since this phenomenon was first described, opinions were divided about its mechanism and about the site of the responsible defect. Based on a quantitative analysis of a new case, and of all previously published reports, a new theory is proposed which can account for all features of the syndrome.

Adolescent↗
PubMed1995

Effects of PCBs (Aroclor 1254) on reproduction and growth rate in Mongolian gerbils (Meriones unguiculatus).

Groups of female Mongolian gerbils were subcutaneously administered 2mg or 4mg PCBs (Aroclor 1254) in 0.1ml oil or vehicle only after pairing for two days with untreated males. No effects were found on the number of pairs breeding, birth intervals, number of pups per litter or percentage of male offspring. The preweaning growth rates of the PCBs exposed first litter offspring was retarded, but second litters showed no differences compared to controls. No other differences in growth were observed.

Animals↗
PubMed1987

Reproducibility of auditory brain-stem evoked responses as a function of the stimulus, scorer and subject.

The reproducibility of auditory brain-stem evoked response (ABR) measurements was determined in a series of studies. ABRs were recorded from pre-term (32 and 36 weeks) newborns, term newborns, and adults to 3 different stimuli. Records were scored blindly with no knowledge of the subject, stimulus eliciting the response, or other records by that subject. Two scorers (inter-scorer reliability) and a single scorer over time (intra-scorer reliability) could score records using explicit criteria with a high degree of agreement. In contrast variability between replicate records to the same stimulus from the same subject was considerable. Intra-subject variability was not strongly affected by the age of the subject but was a function of the eliciting stimulus (the low intensity and fast repetition rate stimuli elicited more variable responses than loud, slow stimuli) and the wave measured (wave I latency was significantly more variable than the other measurements). Healthy, term newborns were studied to investigate the reproducibility of ABRs in the first few days after birth. There was a rapid reduction in ABR latency in the first 6-12 h after birth and a more gradual reduction thereafter. The prolonged latencies observed immediately after birth were associated with an elevation in ABR threshold. The reduction in latency was observed in vaginal and cesarean deliveries. These same effects were observed for amplitude of the ABR, but the trends were generally not significant. Despite the large changes in ABR latency within the first few days after birth, ABR latencies in response to some stimuli were significantly correlated between sessions separated by all intervals tested, ranging from 2 h to 2 days.

Adult↗
PubMed2001

Varicella vaccine exposure during pregnancy: data from the first 5 years of the pregnancy registry.

OBJECTIVE: To assess the risks of congenital varicella syndrome and other birth defects in offspring of women who inadvertently received varicella vaccine during pregnancy or within 3 months of conception. METHODS: Pregnant women inadvertently exposed to varicella vaccine, reported voluntarily, were enrolled in the Pregnancy Registry for VARIVAX (Merck & Co., Inc., West Point, PA). The pregnancies were monitored and the outcomes ascertained from questionnaires completed voluntarily by the health care providers. The rates of congenital varicella syndrome and congenital anomalies were calculated for seronegative women prospectively reported to the registry. RESULTS: From March 17, 1995 through March 16, 2000, 362 pregnancy outcomes were identified from prospective reports. Ninety-two women were known to be seronegative to varicella, of whom 58 received their first dose of vaccine during the first or second trimester. No cases of congenital varicella syndrome were identified among 56 live births (rate 0%, 95% confidence interval [CI] 0, 15.6). Among all the prospective reports of live births, five congenital anomalies were reported. No specific pattern was identified in either the susceptible cohort or the sample population as a whole. CONCLUSION: No abnormal features have been reported that suggested the occurrence of congenital varicella syndrome or other birth defects related to vaccine exposure during pregnancy. Because of the small numbers, this study has limited precision, so continued surveillance is warranted. However, these results should provide some assurance to health care providers and women with inadvertent exposure before or during pregnancy.

Adolescent↗
PubMed1973

Heterologous antilymphocyte serum hastens the growth of 7,12-dimethylbenz(alpha)anthracene induced tumours in mice.

The present paper describes the effects of repeated administration of rabbit anti-mouse lymphocyte serum (ALS) or normal rabbit serum (NRS) on tumours induced in Charles-River mice by 7,12-dimethylbenz(α)anthracene (DMBA) given at birth. ALS or NRS were given either at the time of DMBA administration and subsequently at weekly intervals for the first 10 weeks of life, or at daily intervals for 7 days during the first, second, third or fourth week of life. The incidence and histology of the tumours were studied. It was found that treatment of very young mice with ALS greatly reduced the mean survival time of mice and significantly increased the incidence of malignant lymphoma. The incidence of lung tumours was found to be significantly increased in the animals injected with ALS during the second week of life.Treatment with ALS in the other experimental groups gave results essentially similar to those observed in DMBA control and NRS treated mice.

Animals↗
PubMed1990

Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura.

BACKGROUND AND METHODS: The optimal management of immune thrombocytopenic purpura during pregnancy remains controversial because the risk of severe neonatal thrombocytopenia remains uncertain. We studied the outcome of the index pregnancy in 162 women with a presumptive diagnosis of immune thrombocytopenic purpura to determine the frequency of neonatal thrombocytopenia and to determine whether neonatal risk could be predicted antenatally by history or platelet-antibody testing. RESULTS: Two maternal characteristics were identified as predicting a low risk of severe neonatal thrombocytopenia: the absence of a history of immune thrombocytopenic purpura before pregnancy, and the absence of circulating platelet antibodies in the women who did have a history of the condition. Eighteen of 88 neonates (20 percent; 95 percent confidence interval, 13 to 30 percent) born to women with a history of immune thrombocytopenic purpura had severe thrombocytopenia (platelet count less than 50 x 10(9) per liter at birth), as compared with 0 of 74 (0 percent; 95 percent confidence interval, 0 to 5 percent) born to women first noted to have thrombocytopenia during pregnancy (P less than 0.0001). Among the women with a history of immune thrombocytopenic purpura, 18 of 70 neonates (26 percent; 95 percent confidence interval, 16 to 38 percent) born to those with circulating platelet antibodies had severe thrombocytopenia, as compared with 0 of 18 infants (0 percent; 95 percent confidence interval, 0 to 18.5 percent) born to those without circulating antibodies (P less than 0.02). Thus, the risk of severe neonatal thrombocytopenia in the offspring of women without a history of immune thrombocytopenic purpura before pregnancy and of women with a history of the condition in whom circulating platelet antibodies are not detected was 0 percent (95 percent confidence intervals, 0 to 5 and 0 to 18.5 percent, respectively). CONCLUSIONS: The absence of a history of immune thrombocytopenic purpura or the presence of negative results on circulating-antibody testing in pregnant women indicates a minimal risk of severe neonatal thrombocytopenia in their offspring.

Autoantibodies↗
PubMed2003

Stability of serotypes during nasopharyngeal carriage of Streptococcus pneumoniae.

Serotype changes among natural isolates of Streptococcus pneumoniae are well documented and occur by recombinational exchanges at the capsular biosynthetic locus. However, the frequency with which this phenomenon occurs within the nasopharynx of children is not clear and is likely to be highest in the nasopharynx of children, who have high rates of pneumococcal carriage. A birth cohort of 100 infants was studied, and pneumococci were recovered from nasopharyngeal samples taken at monthly intervals during the first 6 months of life and then at 2-monthly intervals until the age of 2 years. Among the 1,353 nasopharyngeal samples were 523 that contained presumptive pneumococci, and three colonies from each were serotyped. A total of 333 isolates, including all isolates of differing serotypes from the same child, were characterized by multilocus sequence typing. Sixty-eight children carried multiple serotypes during the first 2 years of life. Two children carried a typeable and a nonserotypeable pneumococcus of identical genotype, and five children carried genetically indistinguishable isolates of serotypes 15B and 15C. These isolates were considered, respectively, to be due to loss of capsule expression and the known ability of serotype 15B and 15C pneumococci to interconvert by loss or gain of an acetyl group on the capsular polysaccharide. In all other cases, isolates from the same children that differed in serotype also differed in genotype, indicating the acquisition of a different pneumococcal strain rather than a change in capsular type. There was therefore no evidence in this study for any change of serotype due to recombinational replacements at the capsular locus among the pneumococci carried within the nasopharynges of the children.

Carrier State↗
PubMed1978

Establishing demand feeding in hospital.

In the summer of 1975 demand feeding was introduced for all babies born at the John Radcliffe Hospital, where previously babies were fed according to a rigid schedule to fit in with ward routine--clock feeding. Over a 10-day period before demand feeding was introduced details were collected about infant feeds concerning 42 normal babies whose mothers had decided to breast feed. 2 weeks after the introduction of demand feeding similar details were collected about 43 normal breast-fed babies. At the time of the observations 65% of all babies born in this hospital were being breast fed. Comparing breast feeding patterns, there was a wider scatter of interfeed time intervals in the demand-fed group than in the clock-fed group, over the first 2 days after birth. By the end of the first week these differences were no longer present. The introduction of demand feeding presented no problems in ward management and is now the established routine in this maternity hospital.

Birth Weight↗
PubMed2001

Inferring speciation rates from phylogenies.

It is possible to estimate the rate of diversification of clades from phylogenies with a temporal dimension. First, I present several methods for constructing confidence intervals for the speciation rate under the simple assumption of a pure birth process. I discuss the relationships among these methods in the hope of clarifying some fundamental theory in this area. Their performances are compared in a simulation study and one is recommended for use as a result. A variety of other questions that may, in fact, be the questions of primary interest (e.g., Has the rate of cladogenesis been declining?) are then recast as biological variants of the purely statistical question-Is the birth process model appropriate for my data? Seen in this way, a preexisting arsenal of statistical techniques is opened up for use in this area: in particular, techniques developed for the analysis of Poisson processes and the analysis of survival data. These two approaches start from different representations of the data--the branch lengths in the tree--and I explicitly relate the two. Aiming for a synoptic account of useful theory in this area, I briefly discuss some important results from the analysis of two distinct birth-death processes: the one introduced into this area by Hey (1992) is refitted with some powerful statistical tools.

Animals↗
PubMed1985

Lifetime parental productivity in twenty-seven crosses of mice. I. Birth traits.

Twenty-seven crosses derived from three random-mating, unselected strains of mice (SWO, J, PGH) with 16 matings/pureline or cross were cohabited continuously and monogamously for 365 d to evaluate long-term reproductive performance of the parents. Data from 3,249 litters born were analyzed to study the effects of parity (number of litters) and type of cross (pureline, two-way, backcross, three-way) on the following traits: 1) continuity of reproduction (COR), 2) litter size at birth (LSB), 3) age at first litter (AFL), 4) fraction alive at birth-the ratio of number born alive to LSB (FAB), 5) birth to birth interval (BBI) and 6) reproductive rate-the ratio of number born alive to birth to birth interval (RRT). Reproductive rate was also studied in a cumulative manner rather than on a per parity basis by regressing cumulative number born alive on cumulative birth to birth interval. Parity effects were important (P less than .01) for all traits measured. Differences among cross-types were highly significant for COR, LSB and RRT. Three-way crosses were more productive than backcrosses, and both were superior to two-way and pureline matings. Uniformity was greater among three-way crosses for all traits except COR. Cross-types differed importantly in the pattern of change in performance over parities for COR, LSB, FAB, RRT and cumulative number of live young (P less than .01). Number of parities were most important for variation in longevity of reproduction (COR) and somewhat for litter size (LSB). Mean and cumulative reproductive rates were influenced more by longevity and litter size than by interval between births.

Animals↗
PubMedDate not supplied

[Effect of an alphavirus infection in pregnant mice on the susceptibility of their progeny to homologous infection in the postnatal period].

Infection of random-bred mice with Sindbis virus at various intervals of pregnancy results in increased resistance of their offsprings to infection with this virus in the first days after birth. Antibodies present in the colostrum and milk of immunized females play an important role in decreasing the susceptibility of sucklings to alphavirus infection.

Animals↗
PubMed1995

[20-year national screening for phenylketonuria in The Netherlands. National Guidance Commission PKU].

OBJECTIVE: Evaluation of the Dutch national screening programme for phenylketonuria (PKU). DESIGN: Descriptive. SETTING: Nationwide. METHODS: Data on the screening were obtained from the laboratories, from the registration offices of vaccination and screening results and from the paediatricians to whom infants with positive screening values were referred, during the period from September 1st, 1974 to December 31st, 1993. RESULTS: During the study period 3,481,738 infants were screened in the Netherlands (99.4% of all live births). The sensitivity of the programme was 98%, the specificity 99.99% and the positive predictive value 50%. The prevalence of PKU varied considerably between regions, e.g. from 1:33,600 in Zuid-Holland to 1:8,250 in Limburg (average in the Netherlands 1:18,000). The percentage of patients treated before the age of 22 days was 84% in the period from 1974 to 1988 and 95% in the period from 1989 to 1993 (p = 0.04). Birth weight in patients with PKU was 141 g (95% confidence interval: 66-216) less than the expected birth weight in the Netherlands. Furthermore, a slight growth retardation occurred in the first three years of life in early treated patients. The percentage of patients following special education was twice as high as in the general population (p < 0.001). CONCLUSION: The screening procedure for PKU is functioning at a high level. Despite early treatment development of patients with PKU is slightly below normal.

Child↗
PubMed1999

Serum concentrations of organochlorine compounds and the subsequent development of breast cancer.

A nested case-control study was conducted to examine the association between serum concentrations of 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), the primary metabolite of 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT), and polychlorinated biphenyls (PCBs) and the development of breast cancer up to 20 years later. Cases (n = 346) and controls (n = 346) were selected from cohorts of women who donated blood in 1974, 1989, or both, and were matched on age, race, menopausal status, and month and year of blood donation. Analyses were stratified by cohort participation because median DDE and PCB concentrations among the controls were 59 and 147% higher in 1974 than 1989, respectively. Median concentrations of DDE were lower among cases than controls in both time periods [11.7% lower in 1974 (P = 0.06) and 8.6% lower in 1989 (P = 0.41)]. Median concentrations of PCBs were similar among cases and controls [P = 0.21 for 1974 and P = 0.37 for 1989 (Wilcoxon signed rank test)]. The risk of developing breast cancer among women with the highest concentrations of DDE was roughly half that among women with the lowest concentrations, whether based on concentrations in 1974 [odds ratio (OR), 0.50; 95% confidence interval (CI), 0.27-0.89; P(trend) = 0.02] or in 1989 (OR, 0.53; 95% CI, 0.24-1.17; P(trend) = 0.08). The associations between circulating concentrations of PCBs and breast cancer were less pronounced but still in the same direction (1974: OR, 0.68; 95% CI, 0.36-12.9; P(trend) = 0.2; and 1989: OR, 0.73; 95% CI, 0.37-1.46; P(trend) = 0.6). Adjustment for family history of breast cancer, body mass index, age at menarche or first birth, and months of lactation did not materially alter these associations. These associations remained consistent regardless of lactation history and length of the follow-up interval, with the strongest inverse association observed among women diagnosed 16-20 years after blood drawing. Results from this prospective, community-based nested case-control study are reassuring. Even after 20 years of follow-up, exposure to relatively high concentrations of DDE or PCBs showed no evidence of contributing to an increased risk of breast cancer.

Adult↗
PubMed1972

Studies on diarrhea in neonatal calves: the plasma proteins of normal and diarrheic calves during the first ten days of age.

The concentration of serum proteins and plasma fibrinogen were determined in 151 normal and 49 diarrheic calves at intervals from birth to ten days of age. There were significant differences in the concentrations of the various serum proteins in normal calves when the results were analysed at six age intervals. There was no significant relationship between the concentration of the various proteins and the season of the year. Of the diarrheic calves, those that died had significantly lower gamma globulin concentrations than the other calves. Severely diarrheic and dehydrated calves had significantly increased serum albumin and alpha glabulin concentrations and decreased gamma globulin concentrations. No significant variation occurred in total serum protein concentration. Plasma fibrinogen concentrations were similar in normal and diarrheic calves.

Alpha-Globulins↗
PubMed2006

Risk of congenital anomalies in pregnant users of non-steroidal anti-inflammatory drugs: A nested case-control study.

BACKGROUND: Many women take non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy but the risks for the infant remain controversial. We carried out a study to quantify the association between those women prescribed NSAIDs in early pregnancy and congenital anomalies. METHODS: A population-based pregnancy registry was built by linking data from three administrative databases in Quebec between 1997-2003. The inclusion criteria were mothers of live singleton infants, between 15-45 years of age, covered by the RAMQ drug plan > or =12 months before and during pregnancy, and prescribed an NSAID or other medications during pregnancy. We selected as cases infants with any congenital anomaly (ICD-9; 740-759) diagnosed in the first year of life. Up to 10 controls, defined as infants with no congenital anomalies detected were selected for each case. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. RESULTS: Within the registry, 36,387 pregnant women met the inclusion criteria. We identified 93 births with congenital anomalies in 1056 women (8.8%) who filled prescriptions for NSAIDs in the first trimester of pregnancy, compared to 2478 in 35,331 (7%) women who did not. The adjusted OR for any congenital anomalies for women who filled a prescription for NSAIDs in the first trimester was 2.21 (95% CI = 1.72-2.85). The adjusted OR for the anomalies related to cardiac septal closure was 3.34 (95% CI = 1.87-5.98). There were no significant associations with anomalies of other major organ systems. CONCLUSIONS: Our study suggests that women prescribed NSAIDs during early pregnancy may be at a greater risk of having children with congenital anomalies, specifically cardiac septal defects.

Abnormalities, Drug-Induced↗