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PubMed1996

Growth charts for prepubertal children with chronic renal failure due to congenital renal disorders. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood.

Despite the high prevalence of and therapeutic attention to growth failure in children with chronic renal failure (CRF), systematic evaluations of spontaneous growth in CRF are lacking. Therefore, we collected retrospectively longitudinal growth and biochemical data in 321 prepubertal patients treated for CRF due to congenital renal disorders. Data were recorded at 3-month intervals during the first 2 years of life and 6-monthly thereafter, up to the age of 10 years. Around 100 measurements were available per age interval. Mixed-longitudinal percentile curves of height and height velocity were constructed. Moreover, a statistical comparison with the heights and height velocities of healthy children and an evaluation of the effect of biochemical parameters on growth was performed. The CRF children had normal heights at birth but dropped below the 3rd normal percentile during the first 15 months of life. Thereafter, growth patterns usually were percentile parallel, with a mean height standard deviation score (SDS) of -2.37 +/- 1.6. Height velocities were consistently lower in patients with glomerular filtration rates (GFRs) below one-third of the lower normal limit (25 ml/min per 1.73 m2 for patients > 1 year) than in patients with better renal function. This difference in growth rates resulted in a mean height SDS of -1.65 +/- 1.5 SDS and -2.79 +/- 1.4 SDS (age 1-10 years) in the subgroups with relatively better and worse GFR, respectively. Regression analysis confirmed that GFR was a weak but significant predictor of height velocity SDS in most age groups.

Child↗
PubMed1986

Auditory brainstem responses in the full-term newborn: changes in the first 58 hours of life.

The authors have studied auditory brainstem responses (ABR) in 33 full-term newborns at 0-9, 10-30, 31-58 h, in order to evaluate changes in the first hours after birth, particularly in relation to different repetition rates and recording procedures. The data obtained show that the characteristic newborn 3-peak tracing is observed in almost all the cases at the third recording session while, at the first, wave I is absent in two-thirds of the cases. The most reliable waves at birth are waves III, V and N II, which is often present even when other vertex-positive peaks are absent. Latency values of the considered peaks tend to decrease in a statistically significant way and this decrease is almost complete at the second recording session (30 h), while V-I interval values decrease, especially when the 9 stimuli/s repetition is employed. Stimulus repetition rate affects ABR replicability and synchronization, but it hardly influences latency values. Contralaterally recorded potentials are often absent at birth and become evident 58 h later. The authors conclude that the maturational processes probably affect both peripheral and central auditory structures in the first hours after birth. In this period, increasing repetition rates seem to have a greater effect on wave replicability than on latency values.

Brain Stem↗
PubMed1981

Reproductive performance of gilts bred on first versus third estrus.

Reproductive performance of gilts initially bred on first observed estrus was compared with that of gilts bred on third observed estrus. One-hundred and twelve Yorkshire gilts were used and 106 conceived. Conception rate to initial breeding was lower among gilts bred on first versus third observed estrus (69.6 vs 77.4%). Estrus was observed in some gilts between 140 and 149 days of age; the mean age at estrus for all gilts that were bred was 177.8 days. The mean weight at puberty was 91.7 kilograms. There was a tendency toward increased litter size at birth and weaning when breeding was delayed to third estrus, but the difference was not statistically significant. Live weight of piglets was increased in litters from sows bred initially on third estrus. The weaning-to-estrus or conception interval was not influenced by initial breeding on first or third estrus. Maintaining gilts until third observed estrus required feed and accommodation for approximately 44 additional days before breeding and resulted in 1.4 additional pigs per sow over three parities.

Animals↗
PubMed1996

Menstrual and reproductive factors and hip fractures in post menopausal women.

OBJECTIVES: We analyzed the relationship between menstrual and reproductive history and risk of hip fractures in post-menopausal women using data from an Italian case-control study. METHODS: Cases were 206 post-menopausal women admitted for fractures of the hip proximal femur to a network of teaching and general hospitals in Milan, Italy. The comparison group consisted of 590 post-menopausal women admitted to the same network of hospitals for acute, non-neoplastic, non-hormone-related conditions, other than traumatic or orthopedic disorders. Odds ratios (OR) of hip fracture were derived from unconditional multiple logistic regression. RESULTS: No relation emerged between risk of hip fractures and age at menarche, lifelong menstrual cycle pattern and age at menopause. In comparison with women with age at menopause > or = 53 years, the multivariate OR of hip fractures were 1.2, 1.1, 1.2 and 0.5 in women with menopause at 50-52, 45-49, 40-44 and before 40 years (X2(1) trend 0.21). In comparison with nulliparae, the estimated age-adjusted OR was 0.6 (95% confidence interval, CI, 0.4-0.9) for parous women, but the multivariate estimate was not significant (OR 0.8, 95% CI 0.6-1.3) and the multivariate trend in risk with number of births was not significant either. No relation emerged between hip fractures and age at first and last birth, and history of abortions. CONCLUSIONS: This study found no relevant influence of menstrual and reproductive factors on the risk of hip fractures in post-menopausal women. However, this is not in contrast with the observation of a short-term effect of menopause and more in general. female hormone levels on osteoporosis and hence on hip fractures.

Abortion, Induced↗
PubMed1990

Syphilis intervention in pregnancy: Zambian demonstration project.

Despite availability of simpler serologic tests for syphilis and near cure with penicillin, unacceptably high prevalence of infectious maternal syphilis exist in many developing countries, including Zambia. It is the foremost risk factor for mid-trimester abortions, stillbirths, prematurity and morbidity and mortality among infants born with congenital syphilis in Zambia. An intervention project was conducted in Lusaka aimed at demonstrating the effectiveness of new health education methods and prenatal screening for syphilis in reducing the adverse outcomes during pregnancy. During pre-intervention phase, approximately 150 consecutive pregnant women from each of the three study and the three control centres were recruited when they presented in labour at the University Teaching Hospital. The intervention phase lasted for one year at the three study centres during which new methods of health education were introduced to improve early attendances during pregnancy. Also, on-site syphilis screening was performed twice during pregnancy and seroreactive women, and in many cases their sexual partners, were treated by the existing prenatal clinic staff. During the post-intervention phase the steps of pre-intervention phase were repeated to evaluate the impact of intervention. Overall, 8.0% of women were confirmed seroreactive for syphilis; there was no difference between the study and the control centres (p greater than 0.05). Fifty seven percent (132/230) of syphilitic pregnancies ended with an adverse outcome, that is, abortion (RR 5.0), stillbirth (RR 3.6), prematurity (RR 2.6) and low birth weight (RR 7.8). The overall risk of adverse outcomes due to syphilis was 8.29 (95% confidence interval 6.53, 10.53). The new methods of health education were effective and the percentage of women who had their first prenatal visit under 16 weeks of gestation improved from 9.4 to 42.5. Although screening and treatment during intervention was suboptimal, the adverse outcomes attributable to syphilis were reduced to 28.3%; this is almost a two-third reduction when compared with 72.4% of adverse outcomes at control centres (p < less than 0.001). The intervention is culturally and politically acceptable in Zambia. The cost of each prenatal screening is US$0.60 and of averting each adverse outcome US$12. In countries with high rates of syphilis, there is an urgent need for STD control and Maternal and Child Health (MCH) programmes to pool their resources together to revitalise the prenatal care.

Adult↗
PubMed1998

Tuberculosis exposure and control in an urban emergency department.

STUDY OBJECTIVE: To measure tuberculosis (TB) conversion rates among staff of an urban emergency department compared with other hospital employees (OHEs) and to evaluate the effectiveness of new TB control measures. METHODS: A prospective interventional cohort study was performed in an academic adult 1,000-bed urban hospital, with more than 6,000 employees, and an annual ED census of 43,000. As part of a hospital-wide program, all employees were screened for tuberculin reactivity (Siebert purified protein derivative [PPD] of tuberculin) annually during a 3 1/2-year period. Additional information collected on each employee included country of birth, ethnicity, history of bacille Calmette-Gúerin (BCG) vaccination, length and site of employment, and age. At the end of the second year, TB control measures including construction of a new ED facility with TB respiratory isolation rooms, nonrecirculated air, and droplet shields for registrars were implemented. Relative risk (RR) and 95% confidence intervals (CIs) were calculated. RESULTS: During the first screening cycle, PPD status was obtained on 5,697 hospital employees, 88 of whom worked primarily in the ED. Baseline status was 81% PPD- (induration <5 mm), 9% PPD+ (induration > or =10 mm), and 10% refused skin testing. ED staff did not differ from OHEs with regard to PPD status, age, ethnicity, BCG history, foreign birth, residing in a county with high TB prevalence, or length of employment. During the second cycle, 6 of 50 (12%) previously PPD- ED staff and 51 of 2,514 (2%) previously PPD OHEs converted to PPD+ status (RR=5.9; 95% CI 2.7,13.1). After implementing TB control measures, the conversion rate during the third year dropped to 0 for ED staff, whereas the OHEs had a conversion rate of 1.2% during that cycle. CONCLUSION: TB conversion rates were 5.9 times greater in ED staff members than OHEs before engineering controls were implemented. The ED TB conversion rate fell dramatically in the year following new TB controls. Many EDs are high-risk sites for TB exposure and may benefit from similar measures.

Adult↗
PubMed1996

Marital status and births after losing a baby from sudden infant death.

UNLABELLED: To describe the change in marital status and subsequent live births of mothers who have lost a baby from sudden infant death (SID or cot death), a postal questionnaire was sent to European mothers who had been interviewed approximately 3.7 years (range 2.2-5.2 years) previously as part of a nationwide case-control study. Mothers of 105 (60.3%) cases and 828 (76.9%) controls replied. Changes in marital status between the time of interview and the time of the postal questionnaire did not differ between mothers of cases and that of controls when adjusted for marital status at the time of death/nominated date for controls. Cases were more likely to have further children than controls (P < 0.001) and had them sooner after the death than after the nominated date for control babies (P < 0.001). Case mothers were more likely than controls to have a second child after the death/nominated date, however the interval between the first and second child after the death/nominated date was the same as that for controls. CONCLUSIONS: Although the death of an infant is a major stress on marital relationships, at approximately 3.7 years marital breakdown is no higher than in the control population. After the death of her baby the mother "replaces" the child by having more children than control mothers and having the first one earlier than control mothers. Mothers who lose a baby from SID are more fertile than the control population both before and after the death.

Adult↗
PubMed2001

Risks of hypertensive disorders in the second pregnancy.

This study examined the incidence of and risk factors for recurrent and newly developed hypertensive disorders in the second pregnancy. We analysed data on 1641 women who had both the first and second pregnancies in the Collaborative Perinatal Project, a large prospective cohort study at 12 hospitals in the US. Nineteen per cent [95% CI 14%, 24%] of women who had gestational hypertension in the first pregnancy, 32% [95% CI 17%, 48%] of those with pre-eclampsia and 46% [95% CI 32%, 60%] of patients with gestational hypertension or pre-eclampsia superimposed on chronic hypertension, had recurrent hypertensive disorders in the second pregnancy. Risk factors for recurrence included history of chronic hypertension and thromboembolism, early onset of hypertension in the first pregnancy or persistent hypertension after 5 weeks postpartum and high baseline blood pressure in the second pregnancy. Women with a normotensive first pregnancy but a severe small-for-gestational-age birth had twice the risk of developing hypertension in the second pregnancy (RR = 2.1, 95% CI, 1.1, 4.0). In summary, hypertensive disorders have a 20--50% recurrence rate in the second pregnancy. The earlier the onset of hypertension in the first pregnancy, the higher the overall recurrence rate. Intrauterine growth restriction of the first birth is an independent risk factor for hypertension in the second pregnancy.

Cohort Studies↗
PubMedDate not supplied

Changes in sibling configurations for American preschool children.

This paper uses data drawn from the 1940 through 1980 Public Use Microdata Samples of the U.S. Census of Population to document sibling configurations from the child's perspective. Changes in four aspects of siblings are examined for five cohorts of white and black preschool-aged children: number, birth order distributions, spacing intervals, and sex composition. Changes in fertility behavior of adults in the post-war era had a profound effect on the structure of sibling systems experienced by children. Successive cohorts of preschool children show a rise in number of siblings through the early post-war years before showing sharp declines in number of siblings through the 1960's and 1970's. These shifts in size of sibling sets are reflected in changes in the proportion of each cohorts who are first born and only children, both of which have increased substantially by the 1980 cohort. The 1940 and 1980 cohorts have similar proportions of children with short intervals. However, the middle cohorts show the effects of the quickened pace of fertility with substantial proportions of children with comparatively short birth intervals. Finally, substantial shifts across cohorts in several measures of sex composition of children are observed. Most significantly, there is a marked decline in the proportion of children experiencing an opposite-sex older sibling.

Birth Order↗
PubMed1996

Negative effect of a short interpregnancy interval on birth weight following loss of an infant to sudden infant death syndrome.

It was hypothesized that a short interpregnancy interval immediately following the birth of an infant that had succumbed to sudden infant death syndrome (SIDS) (and no other cause of death) would be associated with a reduced mean birth weight in the next infant. Mothers who had given birth to two children in the state of Oregon between 1975 and 1984 and whose first child had died in infancy from either SIDS (n = 84) or some other cause (n = 305) were identified from vital records. A multiple regression analysis in which adjustment was made for possible confounding variables (including the birth weight of the deceased child) was conducted. When the firstborn child had succumbed to SIDS, the mean birth weight of the next baby was 314 g (2,978 g vs. 3,292 g, p = 0.04) lower when the interpregnancy interval was less than 6 months versus greater than 6 months. In contrast, a less-than-6-month interval had a slightly positive effect (60 g) on the mean birth weight of the next baby when the firstborn child had died due to a cause other than SIDS. These results suggest that parents who have lost a child to SIDS may wish to delay a new pregnancy for at least 6 months.

Adult↗
PubMed1986

Causes of preweaning mortality on a large intensive piggery.

Causes of preweaning mortality were examined on a large intensive piggery. Diagnosis was made using comprehensive clinical histories combined with post-mortem data. Two thousand four hundred and twenty-six piglets were born in 238 litters. Pre-parturient and parturient losses were 2.9% and 5.4% of the total numbers of piglets born. Birth to weaning mortality was 11.3%. Among piglets born alive, overlaying was the most frequent cause of death (2.1%), followed by deaths due to diarrhoea (1.7%), anaemia (1.2%), savaging (1.1%) and losses of small weak piglets (0.9%). Most deaths, including stillbirths, were associated with below average birth weight, and two-thirds of all deaths of liveborn pigs occurred within 4 days of birth. Increased litter size resulted in decreased birth weights, an increased percentage of stillborn piglets and mummified foetuses, but duration of parturition was not affected. Stillborn piglets were born late in the litter and after a longer interval between pigs born (interpig interval). Over 70% of deaths due to overlay were in previously healthy piglets, but some were associated with illness of the sow (18%) or both sow and piglet (3%). Savaging was confined mainly to first parity sows and was responsible for 20% of all deaths in these litters. Sixty-two per cent of all piglets with a birth weight of less than 800g were stillborn or died before weaning compared with 18.7% mortality for all piglets. Anaemia in piglets was considered to be due to umbilical haemorrhage. Anaemic piglets had a 36% mortality to weaning compared with 10% for non-anaemic piglets.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Veterinary↗
PubMed2003

Air emissions from sour-gas processing plants and dairy-cattle reproduction in Alberta, Canada.

The dispersion of air pollutants from all 231 licensed sour-gas processing plants in Alberta, Canada, was modeled on a monthly basis over a 10-year period (1985-1994). Exposure estimates for sulfur dioxide (SO(2)-used as a surrogate for exposure to combusted emissions) then were assigned to 1382 provincial dairy farms using a geographical-information system. Individual average and peak exposure for periods prior to each of 15 months of age and conception (four exposure-averaging periods for each of two dispersion models) were estimated for 163,988 primiparous female dairy-cattle between 1986 and 1994. Monthly or annual average farm-site exposure estimates likewise were assigned to associated herd-level data sets for the biologically relevant period of interest for each of three additional reproductive outcomes: monthly herd-average calving interval, stillbirth risk, and twinning risk. In one of the main-effects models, the maximum (i.e., peak) monthly sour-gas exposure experienced by individual-animals from birth to conception was associated with an increased time to first-calving in the very-highest exposure category (hazard ratio=0.86, 95% CI=0.80, 0.92). This equates to a decreased hazard (lambda) of calving (in each month subsequent to 22 months of age) for the highest-exposure animals (lambda=0.170) versus the zero-exposure animals (lambda=0.198) in a model with referent values for agro-ecological region and season of birth. The dose-response was not consistent across the full range of exposure categories. There was significant (P=0.003) interaction of emissions with agro-ecological region. After accounting for the interaction, a more-consistent dose-response was evident for some (but not all) agro-ecological regions. This suggests that any effect of emissions on dairy-heifer reproduction is subject to modification by features of soil type, vegetative cover, and/or climate. The increase in monthly herd-average calving interval on farms exposed to the very-highest levels of emissions appeared quite small and of limited practical importance within the range of expected exposures. There was no association between exposure and the risk for twinning. Herds exposed to higher emissions exhibited a slight decrease in risk for stillbirth.

Aging↗
PubMed1989

Ethnic differentials in early childhood mortality in Nepal.

This paper investigates the association of early childhood mortality (between birth and second birthday) with ethnicity in Nepal, based on data from the 1976 Nepal Fertility Survey, which was part of the World Fertility Survey. The approach is through a series of hazard models, which incorporate ethnicity, year of birth, mother's illiteracy, father's illiteracy, rural-urban residence, region, sex, maternal age, survival of previous birth, previous birth interval, and breast-feeding as covariates. Ethnic differentials in early childhood mortality are not explained by the other socioeconomic and demographic covariates, except for a modest effect of illiteracy, but the remaining covariates explain a great deal of variability in early childhood mortality itself. Analysis using an improved specification of breast-feeding as an age-varying covariate indicates, on average, that breast-feeding, relative to not breast-feeding, reduces age-specific mortality risks during the first 2 years of life by 76%, a very large effect.

Adolescent↗
PubMed1995

Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease.

OBJECTIVE: To assess the role of specific risk factors that may predispose preterm infants with mild or no initial respiratory distress syndrome to the development of chronic lung disease (CLD). STUDY DESIGN: Clinical data were collected prospectively from 119 ventilator-supported preterm infants with birth weights between 500 and 1000 gm, who survived more than 28 days and required fewer than 3 days of treatment with fraction of inspired oxygen > 25% during the first 5 days of life. Logistic regression analysis was used in a multivariate assessment of risk factors for CLD. RESULTS: Chronic lung disease occurred in 44 of the patients (37%). The analysis showed that low birth weight, patent ductus arteriosus (PDA), and sepsis were significant risk factors for CLD. The corresponding odds ratios for CLD and their 95% confidence intervals (CI) were as follows: 2.9 per 100 gm birth weight decrement (CI, 1.7 to 4.8); 6.2 (CI, 2.1 to 18.4) for PDA; and 4.4 (CI, 1.3 to 14.5) for sepsis. When sepsis and PDA occurred simultaneously, the odds ratio for CLD increased to 48.3 (CI, 6.3 to > 100) in comparison with infants without these conditions. Episodes of PDA were categorized as either early (occurring during the first week of life) or late (after the first week), and the respective odds ratios for CLD were 2.8 (CI, 0.8 to 9.4) and 21.1 (CI, 5.6 to 80) in comparison with infants without PDA. For the duration of symptomatic PDA, the odds ratio for CLD was 3.5 per week that the PDA remained open (CI, 1.9 to 6.5). CONCLUSION: CLD is a frequent sequela in very low birth weight infants with mild or no respiratory distress syndrome. In this population, the development of late episodes of PDA, usually in association with a nosocomial infection, seems to play a primary role in the pathogenesis of CLD.

Chronic Disease↗
PubMed1990

Number of children and death from hormone-dependent cancers.

The association between number of children of current marriage reported by 431,604 women aged 45-74 years at the Norwegian Census in 1970 and mortality, at follow-up through 1985, from hormone-dependent cancers, i.e., cancers of breast, corpus uteri and ovary combined, has been investigated. The reduction in age-adjusted mortality was 9.6% (95% confidence interval; 8.3-10.9%) for each child with no deviation from linearity. Women with 8-11 children had a relative risk of 0.34 (0.25-0.47) compared to nullipara. Adjustment for age at first birth slightly changed the effect of number of children on mortality to 9.3% per child. The reduction in mortality per child was for cancer of the breast 7.2%, corpus uteri 12.2% and ovary 12.7%. Our findings indicate that having few children is a major risk factor for death from the 3 hormone-dependent cancers combined.

Age Factors↗
PubMed1992

Substance P and neurokinin A immunoreactive nerve fibres in the developing salivary glands of the rat.

The time of appearance and distribution of substance P (SP) and neurokinin A (NKA) immunoreactive nerve fibres in developing salivary glands of the rat were studied by the use of indirect immunohistochemical methods. The glands were examined at daily intervals from the 15th day in utero (i.u.) until birth, and subsequently on the 2nd, 5th, 7th, 12th, 16th and 30th postnatal day. The findings were compared to samples from adult. The first SP- and NKA-immunoreactive (IR) nerve fibres appeared on the 19th day i.u. in the parotid and submandibular glands and were abundantly distributed around developing ductal branches. In the mesenchyme around the developing ductal branches of the parotid gland the fibres appeared on the 20th day i.u. In the submandibular gland NKA-IR fibres appeared in the mesenchyme surrounding the developing ductal branches on the 19th day i.u. and SP-IR fibres on the 21st day i.u. Around blood vessels of both glands, SP- and NKA-IR fibres made their appearance only much later, on the second postnatal day. The number of SP- and NKA-IR nerve fibres in the developing salivary glands was already high on the 19th day i.u. when they were first detected. From this point up to the 16th postnatal day the glands were richly innervated by the fibres, but later the numbers slowly decreased to adult levels. The abundance of SP- and NKA-IR nerve fibres especially around the ductal branches and secretory structures in the developing salivary glands suggests a role in the functional maturation of salivary glands.

Adsorption↗
PubMed1992

Reproduction of pigs in the hills of eastern Nepal.

A survey of 101 farmers with sows was conducted in the Koshi Hills of Nepal. Estimates of those reproductive traits which did not differ significantly between local and Pakhribas crossbred sows, are farrowing interval 7.4 months, litter size at birth 8.3, age of piglets at weaning 2.2 months and total number of farrowings 13.2. Local pigs reach sexual maturity sooner than Pakhribas crossbreds; age at first farrowing for the two genotypes is 10.7 and 12.0 months (P < 0.05), and age at first mating of boars is 6.5 and 7.4 months (P < 0.05). Sows farrow throughout the year and there is no clearly defined best season for farrowing. Pre-weaning mortality rates are estimated to be 22% for local piglets and 15% for Pakhribas crossbreds. Almost all farmers practise controlled mating in which either the sow is taken to the boar or the boar is brought to the sow. The proportion of farmers (with sows) who own a boar is only about 5 per cent.

Animal Husbandry↗
PubMed1990

National General Practice Study of Epilepsy: recurrence after a first seizure.

In the National General Practice Study of Epilepsy 564 patients classified as having definite seizures have been followed up for 2-4 years. 67% (95% confidence interval 63-71%) had a recurrence within 12 months of the first seizure, and 78% (74-81%) had a recurrence within 36 months. Seizures associated with a neurological deficit presumed present at birth had a high rate of recurrence (100% by 12 months), whereas seizures that occurred within 3 months of an acute insult to the brain, such as head injury or stroke, or in the context of an acute precipitant such as alcohol, carried a much lower risk of recurrence (40% [29-51%] by 12 months). Other factors affecting the risk of recurrence were age-the highest risk being for patients under the age of 16 (83% [77-89%] by 36 months) or over the age of 59 (83% [76-90%] by 36 months-and type of first seizure-the risk of recurrence being much higher for patients with simple partial or complex partial seizures (94% [90-99%] by 36 months) than for those with generalised tonic clonic seizures (72% [67-77%] by 36 months).

Actuarial Analysis↗