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PubMed1993

An epidemiological study of cancer breast in greater Cairo.

This study was carried out to get a picture of risk factors associated with the occurrence of cancer breast. Three hundred and seventy two females (180 breast cancer patients and 192 controls) were selected from Ain Shams and Benha University Hospitals to be the subjects of this study. The results showed that the important risk factors affecting the development of cancer breast were: parity, age at first birth, age of menarche, age of the patient, family history, number of pregnancies and age of natural menopause. Mostly these factors are interrelated to each other.

Adult↗
PubMed1993

The impact of family planning on women's health.

Approximately half a million women in developing countries die each year as a result of complications during pregnancy. Sadly, illegal abortion is one of the five major causes of these deaths. International data suggest that maternal mortality is decreasing in regions where the use of family planning is increasing because of the consequent avoidance of unwanted pregnancies, although accurate data on maternal mortality are difficult to obtain in most developing countries. Use of family planning to delay first births and to increase interpregnancy intervals has the potential to decrease infant mortality by at least 20%. Data from developing countries show that some of this potential has already been realized during the past 20 years, but additional improvement is possible. In countries where maternal mortality is low, women may avoid using contraceptives because of the perceived dangers of the most effective methods. Recent analyses show that cardiovascular risks associated with oral contraceptives are low, and that the net effect of oral contraceptives on cancer of the ovary and endometrium is one of protection. While there remain unanswered questions regarding cervical and breast cancer, the net effect is small at worst.

Abortion, Illegal↗
PubMed1977

A new technique for measuring preferences in demographic studies.

In this article, we introduce an alternative technique to the single-sentence question for measuring preferences for number of children, age at marriage, length of first birth interval, length of employment, and years of schooling. This new measurement procedure utilizes a graphic scale rather than verbal responses, and it places family size decisions within the context of several other major life cycle decisions. One month reliability data for the measurement technique were obtained from a sample of 107 school children. Reliability results are compared to data from a previous study of teenagers.

Adolescent↗
PubMed1993

Neonatal hyperbilirubinemia and long-term outcome: another look at the Collaborative Perinatal Project.

OBJECTIVE: To examine the association between neonatal bilirubin levels and subsequent neurodevelopmental outcome. DESIGN: Prospective cohort study. SETTING: 12 US medical centers from 1959 (first births) to 1974 (last follow-up). PARTICIPANTS: 41,324 singleton white or black infants with birth weight > or = 2500 g who had neonatal bilirubin measurements recorded and survived at least 1 year. MAIN OUTCOME MEASURES: Wechsler Intelligence Scale for Children Intelligence Quotient (IQ) at age 7 years, blinded neurologic examination at age 7 years, and sensorineural hearing loss at age 8 years. RESULTS: There was no association between IQ and bilirubin. For example, comparing children who had maximum bilirubin levels > or = 342 mumol/L (20 mg/dL) with those who had lower bilirubin levels, adjusted mean IQs were 105.0 and 103.4 in whites (difference + 1.6; 95% confidence interval [CI]: -0.4 to +3.5) and 91.0 and 93.3 in blacks (difference -2.3; 95% CI: -4.8 to +0.2). Abnormal neurologic examination results were reported in 12 of 268 children (4.5%) with bilirubin > or = 342 mumol/L (20 mg/dL) compared with 1249 of 33,004 children (3.8%) with lower levels (relative risk [RR] = 1.2; 95% CI: 0.7 to 2.1). The frequency of abnormal or suspicious neurologic examination results increased in a stepwise fashion with increasing bilirubin level (P < .001), from 4346/29,258 (14.9%) of those with bilirubin levels < 171 mumol/L (10 mg/dL) to 60/268 (22.4%) of those with bilirubin levels. > or = 342 mumol/L (20 mg/dL), apparently due to increasing minor motor abnormalities at higher bilirubin levels. Sensorineural hearing loss was not associated with high bilirubin levels (RR = 1.0; 95% CI: 0.3 to 3.0). CONCLUSIONS: Neonatal bilirubin levels seem to have little effect on IQ, definite neurologic abnormalities, or hearing loss. Higher bilirubin levels are associated with minor motor abnormalities, but the clinical importance of this finding is limited by the weakness of the association, the mild nature of the abnormalities, and the lack of evidence that they are prevented by treatment.

Bilirubin↗
PubMed1993

Timing of reproductive life stages.

OBJECTIVE: To identify typical ages at which women pass through reproductive transitions and to ascertain whether they differ by poverty status, race, and ethnicity, and from men's transition ages. METHODS: Using the 1982 and 1988 National Surveys of Family Growth, the 1988 National Survey of Young Men, and the March 1988 Current Population Survey, the timing of transitions between stages was measured by the ages at which respondents had passed specific milestones. RESULTS: By age 17.4, half of the young women surveyed and by age 16.6, half of the young men had had intercourse. The length of time the typical woman spent being sexually active before marriage increased by more than 1.5 years, to nearly 7 years, between 1982 and 1988. Half of all women surveyed had become mothers by age 26 and by age 30 half intended to have no more children; half were sterile for contraceptive or noncontraceptive reasons by age 35.7. Non-Hispanic white and higher-income women typically married before their first birth, whereas half of black women became mothers almost 6 years before a similar proportion had married. Lower-income and Hispanic women demonstrated smaller but similar gaps. CONCLUSIONS: Differences among subgroups and the broad age ranges at which women move between stages highlight the importance of focusing service delivery and education according to the stage of a woman's reproductive life, not just her age. Current patterns of timing are not prescriptive, but provide a framework for directing efforts to provide women and men with needed information and services and to assess the possible effects.

Adolescent↗
PubMedDate not supplied

Pregnancy termination in relation to risk of breast cancer.

OBJECTIVE: To evaluate the association between pregnancy terminations and risk of breast cancer. DESIGN AND SETTING: Population-based case-control study in Wisconsin, Massachusetts, Maine, and New Hampshire. STUDY PARTICIPANTS: Cases were women younger than 75 years with a new diagnosis of breast cancer (n = 6888), identified from statewide tumor registries. Controls younger than 65 years (n = 9529) were randomly selected from lists of licensed drivers, or for older subjects, from lists of Medicare beneficiaries. EXPOSURES AND OUTCOMES: Breast cancer risk in relation to spontaneous or induced abortions. RESULTS: After adjustment for parity, age at first birth, and other risk factors, pregnancy termination (induced or spontaneous) was associated with a relative risk (RR) of breast cancer of 1.12 (95% confidence interval [CI], 1.04 to 1.21), compared with the risk among women who had never had a termination. Induced terminations were associated with a RR of 1.23 (95% CI, 1.00 to 1.51), which was somewhat greater than the risk associated with spontaneous terminations (RR, 1.11; 95% CI, 1.02 to 1.20). The association with induced abortions was stronger for those performed before legalization of abortion in 1973 (RR, 1.35; 95% CI, 1.01 to 1.80) than after this time (RR, 1.12; 95% CI, 0.84 to 1.49), suggesting a bias in reporting this sensitive procedure. CONCLUSIONS: A weak positive association was observed between abortion--whether induced or spontaneous--and risk of breast cancer. The increase in risk of breast cancer was somewhat greater among women with a history of induced terminations. However, this association may be due to reporting bias and was not significantly different than the slight risk for spontaneous terminations.

Abortion, Induced↗
PubMed1996

Impact of the social environment on blood pressure in women.

A remarkable increase in life expectancy, a decrease in fertility and delayed first birth as well as increased literacy have all contributed to major changes in women's lifestyles and their social environment. Several factors such as level of education, unemployment and low income have been associated in epidemiological studies with elevations in blood pressure. Social support appears to be an important buffer modulating the cardiovascular effects of a variety of stressors. Studies to date suggest that there may be important gender differences in the way socioenvironmental factors affect blood pressure, thus warranting development of intervention strategies directed uniquely at women.

Female↗
PubMedDate not supplied

Do adolescent pregnancy and childbearing affect younger siblings?

To understand the consequences of adolescent pregnancy and childbearing on siblings, a study compares 309 younger brothers and sisters of pregnant, parenting and never-pregnant teenagers. Compared with the younger siblings of never-pregnant teenagers, the younger sisters of pregnant teenagers see school and career as less important, are more accepting of adolescent childbearing, perceive younger ages as appropriate for first intercourse, marriage and childbearing and engage in more problem behavior. The younger sisters of parenting teenagers are more accepting of teenage childbearing than are younger sisters of never-pregnant teenagers and have more definite intentions of having a child at a young age. Compared with boys who have a never-pregnant older sister, younger brothers of pregnant and parenting teenagers are more accepting of nonmarital childbearing, ascribe more importance to childbearing, perceive fewer problems related to early childbearing, have lower self-esteem and report engaging in more drug use and partying behavior.

Adolescent↗
PubMed1996

Association of risk factors for cervical cancer and human papilloma viruses in invasive cervical cancer.

Our study was carried out on 70 patients with invasive squamous carcinoma of the uterine cervix (CC) or invasive adenocarcinoma of the uterine cervix at all stages, admitted to the University Department of Gynecology and/or to the Institute of Oncology in Ljubljana. The patients were not selected by age. A questionnaire on known risk factors in CC was filled in for each of the 70 patients, and two tumor smears were taken for the determination of human papilloma viruses (HPV) 16 and 18 by means of in situ hybridization and polymerase chain reaction (PCR). Each patient also had the serum level of vitamin A determined. The results of our study revealed a correlation between HPV 16 or 18 infection (60:40) and CC. When analysing some already known risk factors, no statistically significant difference could be established for any of the factors studied, except for the age at first birth.

Adenocarcinoma↗
PubMed1996

[Postpartum psychoses. A case report].

The puerperal period is a critical one in the life of a woman, due to the numerous changes which occur at biological and psychological levels and also at the level of relationships. Various disturbances of a psychiatric nature may emerge during this period which represents a "risky" phase from a psycho-pathological point of view. Among some of these disturbances, so-called "puerperal psychoses", there is an uncertain nosographic connection. According to some authors, these psychoses could be distinct nosographic events, while others prefer to include them in psychotic disturbances which have already been classified. From this point of view the puerperal period would be a stressful event. Risk factors would be a first birth, previous psychotic puerperal episodes, inherited serious psychiatric disturbances and caesarean section. The therapy used in the case of such disturbances must take into account many aspects and implications which don't exclusively concern the new mother but which also look significantly at the newborn baby, and the patient's family circumstances. All this implies the necessity for a close collaboration between specialists in different medical areas (psychiatry and obstetrics). Particular attention should be given to the type of disturbed relationship which can occur between the mother and the new born child. The analysis of our case has stimulated many reflections from a clinical, therapeutic and prognostic point of view, and as a result we tent to agree with published material on the subject.

Adult↗
PubMed1996

[Pregnancy in women over 35 years of age. What risk?].

A retrospective study of women who are delivered at the Dept. of Obstetrics and Gynecology at the University of Bari, in the period 1991-1994, was performed to evaluate if over 20 week pregnancies in women aged 35 years and over were at higher risk for maternal and neonatal complications than pregnancy in women aged 20 to 29 years. The results of these 4 years show that pregnancy in women aged 35 and over is burdened with a greater incidence of maternal complications and cesarean sections, but age is not a risk for neonatal outcomes. Moreover, most working women were obliged to delay the first birth child, but work does not increase the number of complications.

Adult↗
PubMed1997

Characteristics of women with and without breast augmentation.

OBJECTIVE: To compare selected characteristics of women with and without augmentation mammaplasty to identify differences between these 2 groups of women. DESIGN AND STUDY PARTICIPANTS: White women identified as controls in previously conducted population-based, case-control studies formed the study population for the present cross-sectional analysis (N=3570). MAIN OUTCOME MEASURE: Interview information on selected characteristics was compared between women who had received augmentation mammaplasty (n=80) and other women (n=3490) using the prevalence odds ratio (pOR) as the measure of association. RESULTS: Women with breast implants were more likely to drink a greater average number of alcoholic drinks per week (for > or =7 drinks vs 0 drinks: pOR=2.9, 95% confidence interval [CI]=1.5-5.5), be younger at first pregnancy (for age <20 years vs age 20-29 years: pOR=1.6, 95% CI=1.0-2.7), be younger at first birth (for age <20 years vs age 20-29 years: pOR=1.9, 95% C1=1.1-3.3), have a history of terminated pregnancies (for > or =1 termination vs 0 terminations: pOR=2.0, 95% CI=1.2-3.4), have ever used oral contraceptives (pOR=2.2, 95% CI=1.0-4.7), have ever used hair dyes (pOR=4.5, 95% CI=1.3-15.4), and have had a greater lifetime number of sexual partners (for > or =14 partners vs < or =4 partners: pOR=8.9, 95% CI=3.1-25.5) than other women. A history of smoking, lactation, high blood pressure, or thyroid disorders, as well as the number of pregnancies, full-term births, or miscarriages, differed little between women with and without implants. Women with breast augmentation were much less likely to be heavy than other women (for > or =74 kg vs <56 kg: pOR=0.1, 95% CI=0.03-0.3). CONCLUSION: The differences we found between women with and without breast implants suggest that consideration and evaluation of confounding factors in future studies will help to clarify some of the long-term health consequences of having breast implants.

Adult↗
PubMed1997

Induced abortions in Denmark.

BACKGROUND: A law on Induced Abortion on Request came into force in Denmark in 1973. During the first years the rate of abortion increased but since the early 1980s the rate has been rather constant. The paper reviews recent findings concerning induced abortion and discusses its role in controlling fertility. METHODS: Trends in induced abortion is described from routine statistics while information on the aborting women are taken both from a survey and from a register based study of fertility- and abortion-pattern among a cohort of women. RESULTS: Fertility trends in Denmark are characterized by an increasing age at first birth. Half of the aborters to day have no children before and 10% had given birth less than 18 months earlier. Among aborters a higher proportion than among parturients were still under education and a higher proportion were single with no steady partner. Half of the aborters became pregnant in spite of contraceptive use, indicating a need for better contraceptives. CONCLUSIONS: Induced abortion has become a generally accepted form of birth control in Denmark and the decision to terminate a pregnancy is influenced by many factors including the woman's conjugal--and educational situation. A strategy for prevention of induced abortion must take into consideration the social circumstances of women and for families with children.

Abortion, Induced↗
PubMed1997

Urinary estrogen metabolites and breast cancer: a case-control study.

Preliminary studies suggest that the estrogen metabolite 16 alpha-hydroxyestrone is associated with breast cancer, whereas 2-hydroxyestrone is not. However, epidemiological studies evaluating this relationship and taking established risk factors for breast cancer into account are lacking. The purpose of this study was to examine the association of the ratio of the urinary estrogen metabolites (2-hydroxyestrone and 16 alpha-hydroxyestrone) and of the individual metabolites with breast cancer. A spot urine sample, a brief history, and clinical data were collected from breast cancer cases (n = 42) and from women coming to the hospital for a routine mammogram or attending a free breast cancer screening (n = 64). 2-Hydroxyestrone and 16 alpha-hydroxyestrone were measured by enzyme immunoassay, and the estrogen metabolite ratio (EMR; 2-hydroxyestrone:16 alpha-hydroxyestrone) was computed. Cases and controls were similar in terms of age (mean age of cases, 53.8 +/- 15.1 years, versus 54.2 +/- 10.4 years for controls; P = 0.9) and demographics. Mean EMR was not associated with breast cancer overall (1.67 +/- 0.80 versus 1.72 +/- 0.66; P = 0.7). However, in postmenopausal women, the mean EMR was significantly lower in cases compared to controls (1.41 +/- 0.73 versus 1.81 +/- 0.71; P = 0.05). The multivariate adjusted odds ratios for the intermediate and lowest tertiles of the EMR relative to the highest among postmenopausal women were 9.73 (95% confidence interval, 1.27-74.84) and 32.74 (95% confidence interval, 3.36-319.09), respectively. The test for trend was highly significant (P = 0.003). Analyses of the individual metabolites indicated that 16 alpha-hydroxyestrone was a strong risk factor. The EMR did not show any consistent associations with age, race/ethnicity, age at first birth, parity, body mass index, family history of breast cancer, smoking, or alcohol intake. These data suggest a strong, inverse association of the EMR and a strong positive association of 16 alpha-hydroxyestrone with breast cancer in postmenopausal women. Larger studies are needed to confirm these results and to assess the relationship of the EMR and of the individual metabolites with breast cancer, with attention to menopausal status and clinical factors and with adjustment for known breast cancer risk factors.

Adult↗
PubMedDate not supplied

Age greater than thirty-four years is an independent pregnancy risk factor in nulliparous women.

OBJECTIVE: To compare quantitative pregnancy risk of nulliparous women 35 years and older with nulliparous women 25 to 29 years old. STUDY DESIGN: Maternal records for first births at three suburban hospitals from July 1, 1986, to June 30, 1990, were studied, risk-assessed retrospectively according to a group-specific risk-scoring system, and compared statistically according to age and quantitative pregnancy risk. RESULTS: The older women were more likely to be high risk (score > or = 10) prepregnancy (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.9 to 4.5), antepartum (OR 1.6, 95% CI 1.3 to 2.0), intrapartum (OR 2.2, 95% CI 1.8 to 2.6), and cumulatively (OR 2.6, 95% CI 2.2 to 3.2) when compared with younger women. They were also more likely to be very high risk (score > or = 20) antepartum (OR 1.8, 95% CI 1.1 to 2.9), intrapartum (OR 2.1, 95% CI 1.5 to 2.8), and cumulatively (OR 2.5, 95% CI 2.0 to 3.2). Risk increased progressively through pregnancy, revealing the intrapartum period as the time interval of maximum risk. Based on cumulative risk scoring, 64.9% of the older women were at least high risk, compared with 41.3% of the younger women (OR 2.6, 95% CI 2.2 to 3.2). CONCLUSION: Nulliparous women 35 years and older from a predominantly middle-class, white population had a significantly higher quantifiable pregnancy risk than a similar group of women age 25 to 29, suggesting that age greater than 34 years is an independent pregnancy risk factor.

Adult↗
PubMed1997

Reproductive history, use of exogenous hormones, and risk of colorectal adenomas.

Evidence suggests a role for reproductive and hormonal factors in the etiology of colorectal cancer. Investigation of adenomas, the presumed precursors of cancer, and reproductive characteristics may place such associations within a particular stage of carcinogenesis. We examined parity, age at first birth, age at menopause, and age at menarche as well as contraceptive and noncontraceptive hormone use in a case-control study of 347 women (115 cases with adenomas and 232 controls) conducted in North Carolina. Using unconditional logistic regression analysis, increasing age at menopause was found to be associated with a reduction in the risk of adenomas [odds ratio (OR), 0.26; 95% confidence interval (CI), 0.10-0.68]. An increased risk for adenomas was found for women undergoing surgical menopause as compared with women undergoing natural menopause (OR, 2.10; 95% CI, 1.05-4.21). Our results suggest a reduced risk of adenomas associated with noncontraceptive hormone use that was limited to a subgroup of women with natural menopause or bilateral oophorectomy (OR, 0.39; 95% CI, 0.15-0.97). No associations were seen between other reproductive characteristics and adenomas. These results suggest protective effects for both endogenous and exogenous female hormones that operate early in the process of carcinogenesis. Alternatively, lifestyle factors or other correlates of exogenous hormone use and delayed menopause could play a role in reduced adenoma risk.

Adenoma↗
PubMed1996

[Biliary tract tumors].

Biliary tract cancers are rare neoplasms including gallbladder cancer (the commonest), extrahepatic biliary tract cancer and cancer of the ampulla of Vater. Descriptive epidemiology of biliary tract cancers as a whole has two peculiarities: incidence and mortality rates are higher for women than men, and in some specific populations. Mortality rates are highest among New Mexico American Indian women, in Chile and Japan, lowest in Great Britain and Greece. Mortality trends vary widely: the largest increases have been observed in Japan, Hong-Kong and Spain and the largest decreases in the Anglo-Saxon populations. Our knowledge of biliary tract cancer etiology is limited. Defined risks include genetic factors (family history of biliary tract cancers, ethnicity), history of gallbladder disease, and cholelithiasis. Risk factors reported in some studies, on which, however, information is not consistent and which need further study, include overweight, some menstrual and reproductive factors (multiparity, young age at first birth, late menopause), low education, cigarette smoking, selected bacterial infections, some intestinal diseases and diabetes.

Adolescent↗
PubMed1997

[Epidemiology of cervical and endometrial cancer].

In 1995, in France, the estimation of the cervix cancer incidence, with 3,300 new cases, is of 10.3 per 100,000, and the incidence of the endometrial cancer with 3,268 new cases, is of 13.8 per 100,000. The decrease of the incidence of the cervical cancer is of more than 50%, in 1975, the incidence was of 22.4 per 100,000. For the endometrial cancer, the decrease is insignificant, as in 1975, the incidence was of 14.4 per 100,000. This phenomenon has been observed in most european countries. The incidence of the adenocarcinoma of the cervix remains stable. The relative survival at 5 years, at all ages in the French cancer registry of Bas-Rhin is of 65% for the cervical cancer and of 73% for the corpus uteri cancer. However, no improvement has been observed since 1975. The risk factors are quite well-known concerning the cervical cancer, there is a strong correlation with the sexual activities, age at first intercourse, the multiplicity of the partners, which clearly shows that the cervical cancer is a sexually transmitted disease. Concerning the endometrial cancer, the risk factors are mostly linked with the reproductive life: age at menarche, parity, age at first birth, menstrual irregularities, infertility and menopause.

Adult↗