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At least 73 records · Page 4Linked to original sources

An assessment of spatial clustering of leukaemias and lymphomas among young people in New Zealand.

STUDY OBJECTIVE: To assess spatial clustering of childhood leukaemias and lymphomas in New Zealand, using a national dataset from a country with no nuclear installations. DESIGN: New Zealand Map Grid coordinates, derived from the birth addresses of cases and controls were used in clustering analyses that applied Cuzick and Edwards' method. SETTING: The whole of New Zealand. PARTICIPANTS: The cases were ascertained from the New Zealand Cancer Registry. They were diagnosed with leukaemia or lymphoma at ages 0-14 years during the period 1976 to 1987. For Hodgkin's disease, the age range was extended to include those aged from 0-24 years. The cancer registrations were linked with national birth records, to obtain the birth addresses of the cases. The controls were selected at random from birth records, with matching to cases (1:1) on age and sex. The analyses included 600 cases and 600 controls. MAIN RESULTS: There was no statistically significant spatial clustering for any tumour group overall, including acute lymphoblastic leukaemia, acute nonlymphoblastic leukaemia, other leukaemias, non-Hodgkin's lymphomas, Hodgkin's disease, and all these combined. Significant clustering was found in a sub-analysis for one of three age specific subgroups of acute lymphoblastic leukaemia (ages 10-14 years, p = 0.003). CONCLUSION: The subgroup finding may have been real or a chance association, as several comparisons were made. This study found little evidence for spatial clustering of leukaemias or lymphomas in a population with no nuclear installations.

Adolescent↗

Variations in low birth weight and preterm delivery among blacks in relation to ancestry and nativity: New York City, 1998-2002.

OBJECTIVES: Black women in the United States are more likely to give birth to preterm and low birth-weight infants than their white counterparts, but little is known about variation in birth outcomes within the black population. This study aimed to test the hypothesis that the risk of low birth weight and preterm birth within the black population varies by maternal ancestry and nativity. POPULATION AND METHODS: We conducted a retrospective cohort study using New York City birth records. All of the recorded live births to black women occurring in New York City between January 1, 1998, and December 31, 2002 (N = 168,039), were divided into the following self-reported ancestry groups: African, American, Asian, Cuban, European, Puerto Rican, South and Central American (excluding Brazilian), and West Indian and Brazilian. To estimate adjusted risk ratios for low birth weight (weight at birth <2500 g) and preterm birth (gestational age at delivery <37 weeks, based on clinical estimate), we ran 3 models for each outcome, using negative binomial regression and Poisson regression with robust SE estimation. All of the models used blacks reporting American ancestry as the reference group. The first model included ancestry as the primary exposure variable along with covariates that included maternal age, parity, smoking, and education, as well as paternal education and race. Nativity (US- or foreign-born) was included in the second model, and terms representing interaction effects between ancestry and nativity were included in the third model. RESULTS: There was substantial variation in risks of preterm birth and low birth weight among the black subgroups, with all of the groups having lower risks than the American black reference group, even after adjusting for maternal risk factors and other covariates. Risk ratios for low birth weight ranged from 0.55 among South/Central Americans to 0.91 among Cubans; risk ratios for preterm birth showed a similar pattern. Nativity was also associated with low birth weight and preterm birth; births to foreign-born women were less likely to be preterm or low birth weight than births to US-born women. Furthermore, nativity effects varied by ancestry group, with foreign-born status inversely associated with poor birth outcomes among South/Central Americans but not among West Indians/Brazilians. CONCLUSIONS: Important health differences may be masked in studies that treat black women in America as a homogeneous group and do not take ethnic variation and nativity into account.

Adult↗

The reliability of hand-written and computerised records of birth data collected at Baragwanath hospital in Soweto.

This study examined the reliability of hand written and computerised records of birth data collected during the Birth to Ten study at Baragwanath Hospital in Soweto. The reliability of record-keeping in hand-written obstetric and neonatal files was assessed by comparing duplicate records of six different variables abstracted from six different sections in these files. The reliability of computerised record keeping was assessed by comparing the original hand-written record of each variable with records contained in the hospital's computerised database. These data sets displayed similar levels of reliability which suggests that similar errors occurred when data were transcribed from one section of the files to the next, and from these files to the computerised database. In both sets of records reliability was highest for the categorical variable infant sex, and for those continuous variables (such as maternal age and gravidity) recorded with unambiguous units. Reliability was lower for continuous variables that could be recorded with different levels of precision (such as birth weight), those that were occasionally measured more than once, and those that could be measured using more than one measurement technique (such as gestational age). Reducing the number of times records are transcribed, categorising continuous variables, and standardising the techniques used for measuring and recording variables would improve the reliability of both hand-written and computerised data sets.

Data Collection↗

Effect of a statewide neonatal resuscitation training program on Apgar scores among high-risk neonates in Illinois.

OBJECTIVE: The national Neonatal Resuscitation Program (NRP), started in 1987, provided training to hospital delivery room personnel to standardize knowledge and skills to reduce neonatal morbidity and mortality and increase successful resuscitation during the first few critical minutes after birth. The Apgar score continues to be used as the best established index of immediate postnatal health. The purpose of this study was to evaluate the impact of the NRP instruction in Illinois hospitals by examining Apgar scores among high-risk infants who are likely to benefit from the NRP. METHODS: A retrospective 3-time period cohort design was used (before the introduction of the NRP, 1985-1988; transition when NRP training occurred, 1989-1990; and after NRP training was completed at least once for some delivery room personnel in each Illinois hospital, 1991-1995). Illinois computerized birth certificate files on a selected group of 636 429 high-risk neonates provided information on Apgar scores and maternal characteristics. The American Academy of Pediatrics provided instructor lists to determine when NRP training started and when it was fully implemented in Illinois. Illinois Department of Public Health provided data to categorize hospitals into levels based on type and intensity of neonatal services (Level I, II, II+, III). High-risk neonates were defined as meeting 1 of the following criteria: maternal age <20 years old or >35 years old, birth weight <2500 g or >4000 g, presence of a maternal medical risk factor, and no prenatal care or prenatal care started after the first trimester. Several exclusion criteria were applied including the following: birth records with missing data, multiple birth or congenital anomaly, and hospital information that indicate no birth deliveries in 1 of the 11 study years or delivery outside of a hospital. One-minute and 5-minute Apgar scores were divided into categories for analysis (0-3, 4-6, 7-10). No change or a decrease in a low (0-6) 1-minute Apgar when compared with the 5-minute Apgar was a primary measure to evaluate effect of NRP resuscitation. Variables examined included the following: race/ethnicity, maternal age, level of education, presence of maternal medical risk factor, trimester started prenatal care, complications of labor and delivery, and a low birth weight. Analysis consisted of chi(2) tests, relative risk calculations, and logistic regression to reveal independent associations with no change in low 1-minute Apgar score or continued low (0-6) 5-minute Apgar. RESULTS: A total of 636 429 high-risk birth records was selected for detailed analyses out of 2 077 533 births in Illinois between 1985 and 1995 for 193 hospitals. The number of active NRP instructors in Illinois changed dramatically during the study period; for example, 1 to 6 between 1987 and 1988 to 1096 to 1242 between 1991 and 1995. The percentage of neonates reported to have low (<7) 1-minute Apgar score decreased in 1991 to 1995 overall and for each of 4 hospital levels. Overall and by hospital level, there was a statistically significant lower proportion of high-risk newborns who showed a decrease or no change in their 5-minute Apgar scores after the NRP instruction. After adjusting for several maternal characteristics, logistic regression analysis revealed that high-risk newborns with a low 1-minute Apgar were more likely to increase their 5-minute Apgar after the NRP instruction in 1991 to 1995. Additional analyses indicated that very low birth weight and low birth weight newborns benefited the most from NRP instruction. CONCLUSION: Although previous research has shown that the NRP instruction improves knowledge and skill among health care personnel in the delivery room, both short-term and long-term, there has been little evidence to demonstrate NRP impact on infant morbidity. Several strategies were used in this study to control for bias and to adjust for secular trends in decreased infant morbidity during the study period. This study demonstrated sufficient support for the hypothesis that a significant improvement occurred among neonates in their Apgar score after the NRP instruction in Illinois. Empirical support is provided for the clinical effectiveness of NRP instruction.

Apgar Score↗

Determinants of the availability and accuracy of self-reported birth weight in middle-aged and elderly women.

Associations have been found between birth weight and many diseases in adult life. In most countries, few birth records exist for older adults; therefore, birth weight is usually obtained by maternal recall or self-report. This study examined determinants of the availability and accuracy of self-report in middle-aged and elderly women. Birth weights, recorded at the time of birth, were found in 1999 for a subset of 363 women participating in a long-running cancer research study in the United Kingdom. Questionnaires were sent to the surviving 286 women requesting information on their birth weight and other factors related to their birth family. Twenty-five percent of the 244 respondents were able to report their birth weight to within 4 ounces (113.4 g) of that listed in birth records, 28% reported it inaccurately, and 47% did not know their birth weight. The most important factors determining the availability of self-reported birth weight were having a living mother and a low birth weight (< or = 6 pounds (2,722 g)). The most important determinants of accuracy, for those who provided a report, were being younger and the eldest child. Research studies relying on self-reported birth weight should take these factors into account.

Adult↗

Precancerous changes in the cervix and risk of subsequent preterm birth.

OBJECTIVE: The aims of this study were (i) to examine whether women referred for assessment of precancerous changes in the cervix had higher rates of preterm birth compared with those in the general population and (ii) to compare preterm birth rates for treated and untreated women adjusting for possible confounding factors. DESIGN: Retrospective cohort design. SETTING: Teaching hospital. POPULATION: All women referred to the Royal Women's Hospital, Melbourne (1982-2000), who subsequently had a birth recorded on the Victorian Perinatal Data Collection system (n = 5548). METHODS: Record linkage of hospital dysplasia clinic records and population-based birth records. MAIN OUTCOME MEASURES: Total preterm delivery (<37 weeks of gestation) and subtypes. RESULTS: Both treated and untreated women were at a significantly increased risk for preterm birth compared with those in the general population: treated--standardised prevalence ratio (SPR) 2.0, 95% CI 1.8-2.3 and untreated--SPR 1.5, 95% CI 1.4-1.7. Within the cohort, the treated women were significantly more likely to give birth preterm (adjusted OR 1.23, 95% CI 1.01-1.51). An increased risk of preterm birth was also associated with a history of induced or spontaneous abortions, illicit drug use during pregnancy or a major maternal medical condition. Cone biopsy, loop electrosurgical excision procedure and diathermy were associated with preterm birth. After adjusting for possible confounding factors, only diathermy remained significant (adjusted OR 1.72, 95% CI 1.36-2.17). Women treated using laser ablation were not at an increased risk for preterm birth (adjusted OR 1.1, 95% CI 0.8-1.4). CONCLUSIONS: Diagnosis of precancerous changes in the cervix (regardless of the treatment) was associated with an increased risk of preterm birth. Consideration should be given to the preferential use of ablative treatments.

Adult↗

Control selection strategies in case-control studies of childhood diseases.

To address concerns regarding the representativeness of controls in case-control studies, two selection strategies were evaluated in a study of childhood leukemia, which commenced in California in 1995. The authors selected two controls per case: one from among children identified by using computerized birth records and located successfully, the other from a roster of friends; both were matched on demographic factors. Sixty-four birth certificate-friend control pairs were enrolled (n = 128). Additionally, 192 "ideal" controls were selected without tracing from the birth records. Data on parental ages, parental education, mother's reproductive history, and birth weight were obtained from the birth certificates of all 320 subjects. For all variables except birth weight, the differences between birth certificate and ideal controls were smaller than those between friend and ideal controls. None of the differences between birth certificate and ideal controls was significant, whereas two factors were significantly different between friend and ideal controls. These findings suggest that friend controls may be less representative than birth certificate controls. Despite difficulty in tracing and a seemingly low participation rate (49.0% for 560 enrolled birth certificate controls), using birth records to recruit controls appears to provide a representative sample of children and an opportunity to assess the representativeness of controls.

Adolescent↗

[Semiautomatic procedure for the investigation of synchronized activity of EEG and heart rate--examination of preterm births].

Recordings of the electroencephalogram (EEG) and of the heart rate variability (HRV) of preterm neonates can give important information on the actual state of the nervous system. Both signals, EEG and HRV, are affected by parameters such as gestational age, stage of maturation and behavioral state. This work describes a method for automatic detection of slow wave EEG-bursts and a tool to average changes in the EEG and the corresponding heart rate. The detection is based on the hjorth activity (HA), calculated from the EEG. HA spikes (HAS) are identified by the determination of the beginning and end of existing spikes. HAS maxima and the time between two consecutive HAS are the basis for the triggering of the bursts. EEG power and time synchronized HR changes are averaged with a time window length of 20 s. Resultant, HR increase and duration are determined. These parameters, obtained by the automatic detection, proved to be comparable to the results of an expert.

Algorithms↗

Occupational working conditions as risk factors for preterm birth in Benin, West Africa.

BACKGROUND: Although many studies from developed countries have established a relationship between various occupational working conditions during pregnancy and preterm birth, there is little data available in developing countries where both maternal physical labor during pregnancy and preterm birth are common. The aim of this study was to examine the association between difficult occupational working conditions of pregnant women and premature births in the Republic of Benin in West Africa. METHOD: The case-control study included 99 women with preterm babies and 104 women with full-term babies. The participants were residents of the Republic of Benin who delivered between May 1, 2000 and April 30, 2002. Preterm delivery was defined as delivery prior to 37 completed weeks of gestation. The study sample was selected randomly from birth records. Data were collected both reviewing birth records and conducting semi-structured personal interviews with mothers. Logistic regression models were adjusted for mother's age, mother's education, health problems during pregnancy, and twin birth. RESULTS: Although working state of mother during pregnancy did not increase the risk for preterm delivery, carrying heavy loads more than 5 days per week was significantly associated with having a preterm baby (adjusted OR: 5.0; 95% CI: 1.38-18.8; P=0.018). Carrying heavy loads and having worked a lot more than 5 days per week was also significantly associated with preterm birth (adjusted OR: 6.88; 95% CI: 1.45-32.2; P=0.015). CONCLUSION: Reducing heavy loads carrying during pregnancy may also prevent preterm delivery in developing countries. Though replication of these data using a prospective design is needed, our results suggest that educating women about the risks associated with heavy labor during pregnancy is indicated.

Adult↗

What is the infant mortality rate in South Africa? The need for improved data.

OBJECTIVE: To review recent infant mortality and birth registration data in South Africa and to investigate geographical differences. OUTCOME MEASURES: Estimates of infant mortality rates, proportion of births not registered, and proportion of births recorded in health services. METHODS: 1. Published infant mortality data for South Africa were collated. Demographic data from national household surveys (1993 and 1994 October Household Surveys and the 1993 Poverty Survey by the Southern African Labour and Development Research Unit (SALDRU) at UCT) were analysed using the indirect method developed by Brass. 2. Birth registration data were analysed and compared with the estimated number of births to identify regions with greater under-registration. The number of births recorded in the health services was analysed by province in order to assess and explore alternatives within health authorities that could complement the existing system. RESULTS: 1. Published estimates of infant mortality for the period from 1990 range from 40 to 71/1,000 births and estimates based on national household surveys conducted in this period from 11 to 81/1,000 births. 2. Completeness of birth registration in the nine provinces ranges from less than 10% in the Eastern Cape, North West and Northern Province to 60% in the Western Cape. An overall improvement from 19% to 60% could be achieved if births recorded through the health services were included in the vital registration system. CONCLUSIONS: The infant mortality rate in South Africa is not known with any certainty. The extent of completeness of the birth registration system was 19%, which indicates a need for urgent improvement in order to provide key health status indicators. This study indicates that there is some potential for improving the extent of birth registration if it could be facilitated through the health service. However, this alone would not achieve complete registration. RECOMMENDATIONS: Surveys will have to be relied upon until such time as routinely available statistics are accurate. The October Household Survey conducted annually by the Central Statistical Service as potentially an important source of health status information. It is imperative that either the design of the birth history questionnaire be improved or that it be replaced by a less frequent but more specialised demographic and health survey.

Female↗

Characteristics of first pregnancy in relation to early breast cancer. A case-control study.

We examined some characteristics of first pregnancy in 314 female breast cancer patients whose disease was diagnosed at < 45 years of age and who were identified through a population-based cancer registry in New York State and in 314 control women identified through birth records. Preeclampsia was reported less frequently on the birth records of the first recorded pregnancy in the cases than in those of the controls, with a relative risk of 0.28 (0.05 < p < 0.10, from logistic model). We examined this finding on preeclampsia with particular reference to immunologic mechanisms, but further studies are needed on larger samples. Twinning and maternal Rh factor, also relevant to immunologic factors, were not significantly associated with a higher risk of breast cancer. Among the women whose first pregnancy resulted in a live birth, length of gestation (which is correlated with maternal estriol levels) did not differ between the cases and controls.

Adult↗

Is there an association between maternal ABO and rhesus blood groups and the first-trimester serum markers free beta-hCG and PAPP-A used for the detection of fetal aneuploidy?

OBJECTIVES: To evaluate whether first-trimester levels of PAPP-A and serum free-beta-human chorionic gonadotrophin (free beta-hCG) vary with maternal blood group and rhesus status and to assess whether this has implications for first-trimester screening for chromosomal anomalies. METHODS: Blood group and rhesus status information was extracted from birth records for women undergoing first-trimester screening. The birth records were combined with prenatal screening records by an in-house developed record linkage software. In 2252 singleton pregnancies of normal obstetric outcome, the median weight-corrected, ethnicity-corrected and smoking-corrected MoM were compared in the various blood groups, using t-tests after log10 transformation of the marker MoM against the whole study group. RESULTS: Only those women with a B rhesus positive blood group had statistically significant higher MoM levels of PAPP-A (0.995 v 0.937). CONCLUSIONS: A larger study is required to establish the validity of this increase in PAPP-A in the B rhesus positive group. If this can be substantiated, the elevation in PAPP-A in this group may require correction when screening for chromosomal anomalies.

ABO Blood-Group System↗

Case-control differences in the reliability of reporting a history of induced abortion.

The authors investigated the possibility that, in interview-based case-control studies, controls are more likely than cases to underreport a history of induced abortion. A case-control study was conducted in White women under 45 years of age who had given birth in Washington State during 1984-1994. The cases were women in three metropolitan counties of Washington State diagnosed with invasive breast cancer during 1984-1994; controls were selected through random digit dialing. A history of induced abortion among study participants was compared between interview data and information collected on the birth record of the last child to whom they gave birth (225 cases, 303 controls). Among women with a prior induced abortion recorded on the birth record, 14.0% of the 43 cases and 14.9% of the 47 controls did not report an induced abortion at interview (difference = -0.9%, 95% confidence interval of the difference: -15, 14). The authors' data do not suggest that controls are more reluctant to report a history of induced abortion than are women with breast cancer.

Abortion, Induced↗

Tay-Sachs disease in persons of French-Canadian heritage in northern New England.

This study sought to determine whether persons of French-Canadian heritage in northern New England are at high risk for the lethal infantile form of Tay-Sachs disease. In order to accomplish this, death records and laboratory diagnostic records were surveyed to ascertain Tay-Sachs deaths in a cohort of 372,000 live births between 1977-1986. The proportion of the total population with French-Canadian or Jewish heritage was determined from census and birth records, and the ethnic background of Tay-Sachs cases was determined from the corresponding birth records. In 1,860 births, both parents were of Ashkenazi Jewish heritage. One of those children was diagnosed with Tay-Sachs disease. In 41,000 births, both parents were of French-Canadian heritage, and in an additional 93,000 births, one parent was of French-Canadian heritage. No cases of Tay-Sachs disease were identified in the offspring of those individuals. Approximately 14 cases (95% confidence interval 8-20) would be expected, if the gene frequency approximated that reported for individuals of Ashkenazi Jewish heritage. Based on the results of this study, routine testing for Tay-Sachs disease heterozygosity is not indicated for persons of French-Canadian heritage in northern New England. This conclusion may not necessarily be valid for persons of French-Canadian heritage residing in other states. Further studies of Tay-Sachs disease mutations and prevalence among persons of French-Canadian heritage will be important to determine possible regional variations in gene frequencies.

Child↗

The Walker Project: a longitudinal study of 48,000 children born 1952-1966 (aged 36-50 years in 2002) and their families.

The Walker cohort is a database of over 48,000 birth records that has recently become available. It contains meticulously recorded details of pregnancy, labour, birth and care before discharge for babies born in hospital in Dundee, Scotland between 1952 and 1966. These babies accounted for 75% of all births in Dundee at this time. Over 34,000 (73%) of these subjects can be identified and this presents the opportunity to link this birth information with a large number of current health-outcome databases covering both primary and secondary care. Further, it allows linkage of records across siblings and over two and, in future, three generations. The number of birth records available and linkage to current databases make this a unique birth cohort with huge potential for the investigation of the fetal origins of adult disease.

Adult↗