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PubMed2002

Risk factors for early onset neonatal group B streptococcal sepsis: case-control study.

OBJECTIVES: To quantify risk factors for and the prevalence of early onset group B streptococcal sepsis in neonates in a geographically defined population. DESIGN: Cases were collected prospectively for two years from April 1998 and compared with four controls each, matched for time and place of delivery. SETTING: The former Northern health region of the United Kingdom. PARTICIPANTS: Infants infected with group B streptococcus in the first week of life. RESULTS: The prevalence of early onset group B streptococcal sepsis was 0.57 per 1000 live births. Premature infants comprised 38% of all cases and 83% of the deaths. Prematurity (odds ratio 10.4, 95% confidence interval 3.9 to 27.6), rupture of the membranes more than 18 hours before delivery (25.8, 10.2 to 64.8), rupture of the membranes before the onset of labour (11.1, 4.8 to 25.9), and intrapartum fever (10.0, 2.4 to 40.8) were significant risk factors for infection. Had the interim recommendations on best practice issued by the Group B Streptococcus Working Group of the Public Health Laboratory Service been uniformly applied to the fetuses alive at the onset of labour, 29 of 37 (78%) might have been given antibiotic prophylaxis during labour. At least 23 of these 29 (79%) could have had antibiotics for four hours or more before delivery. To achieve this, 16% of all women would have been given antibiotics during labour. CONCLUSIONS: Early onset group B streptococcal sepsis remains an important problem in the United Kingdom. Prevention based on risk factors might reduce the prevalence at the cost of treating many women with risk factors. Using rupture of the membranes before the onset of labour as a risk factor might be expected to improve the success of guidelines for prophylaxis.

Antibiotic Prophylaxis↗
PubMed2000

Maximum length sequence brainstem auditory evoked responses in term neonates who have perinatal hypoxia-ischemia.

Maximum length sequence brainstem auditory evoked response (BAER) was studied within the first week after birth in 28 term neonates who had perinatal hypoxia-ischemia, or asphyxia. In the BAER recorded using conventional averaging techniques (click rate 21/s), the only abnormality was a slight increase in III-V interval, in addition to an increase in wave latencies when including those who had an elevated threshold (t test, all p<0.05). In the maximum length sequence BAER, however, both the III-V and I-V intervals in the asphyxiated infants were significantly increased at all the 91/s, 227/s, 455/s, and particularly 910/s click rates (p<0.05-0.001). The I-III interval was also increased significantly at 455/s and 910/s click rates (both p< 0.05). Wave V amplitude was significantly reduced at all the click rates used (ANOVA, p<0.05-0.001), particularly at 910/s, which sometimes was the only abnormality indicative of brain damage. Both the amplitude ratios V/I and V/III were significantly decreased at 455/s and 910/s click rates (p<0.01 or 0.001). A general trend was that BAER abnormalities after hypoxia-ischemia became more prominent as click rate was increased. Significant abnormalities occurred mainly at very high click rates (455/s and 910/s), which can be achieved using the maximum length sequence technique but not by using conventional averaging techniques. Thus, this technique, which can be used at the cribside, appears to be a better method for the early detection of brain damage after hypoxia-ischemia than using conventional averaging techniques, enhancing the diagnostic value of the BAER.

Acoustic Stimulation↗
PubMed2005

Growth, reproduction, and lactation in somatic cell cloned cows with short telomeres.

We previously showed that telomere lengths of 10 somatic cell cloned cows were significantly shorter than normal. In this study, we investigated growth, reproduction, and lactation in these animals to determine if shortened telomeres have any effect on these characteristics. Six Holstein and 4 Jersey cloned cows, derived from oviduct cells, were reared under general group feeding. Body weights were recorded from birth to 48 mo of age. A number of reproductive characteristics were screened during the prepubertal, postpubertal, and postpartum periods. After parturition, milk yields were recorded daily and percentages of milk fat, proteins, and solids-not-fat were measured at monthly intervals. These data were used to estimate production of milk components over a 305-d period. Overall, the cloned heifers exceeded standard growth rates for each breed. The cows were inseminated at the first estrus after they reached 450 d of age, and delivered normal calves except for one stillbirth in the Holstein group. They were inseminated at postpartum estrus to provide second and third parturitions and, again, these pregnancies were normal. Gestational periods and birth weights of the calves were both within the normal range. The average total milk yield per cow in Holstein group clones was less than that of the original cow, whereas Jersey group clones showed a higher average milk yield than the original cow. In both groups of cloned cows, inter-individual variation in milk production was relatively large; however, the coefficient of variation was less than 10%. Our results suggest that the cloned cows have normal growth, reproductive, and lactation characteristics, and thus normal productivity, despite having reduced telomere lengths.

Animals↗
PubMed1990

[Observed effects of the mass screening program for breast cancer in Nijmegen in 1975-1986].

Since January 1975, the start of the screening programme for breast cancer in the city of Nijmegen, The Netherlands, over 14 years have elapsed. Data up to the end of 1986 have been processed and are presented in this article. The younger the birth cohort, the higher the attendance rate. In the course of the screening programme, attendance rates decline. Referral rates are highest in the first screening round and for the eldest birth cohort. Detection rates increased during the most recent screening rounds, after an initial decrease during the earliest rounds. They are higher for the eldest birth cohort also. The relative number of interval carcinomas is highest among younger women (as related to the screening-detected carcinomas).

Adult↗
PubMed1993

Determinants of the geographic variation of invasive cervical cancer in Costa Rica.

The incidence of cervical cancer in Costa Rica is about twice as high in the coastal regions as in the interior. To study these regional variations, we used data from a 1986-1987 case-control study of 192 Costa Rican women with invasive cervical cancer and 372 controls. Risk factors identified included the following: The study participant's (1) number of sexual partners, (2) age at first sexual intercourse, (3) number of live births, (4) presence of type 16/18 human papillomavirus (HPV) DNA, (5) venereal disease (VD) history, (6) Pap smear history, and (7) socioeconomic status. The adjusted relative risks (RR) and 95% confidence intervals (CI) for each of these risk factors were as follows: (1) > or = 4 vs. 1 sexual partner: RR = 2.0, 95% CI = 1.1-3.5; (2) age of initiation < or = 15 vs. > or = 18 years: RR = 1.5, 95% CI = 0.9-2.5; (3) > or = 6 vs. < or = 1 live birth: RR = 1.7, 95% CI = 0.7-3.9; (4) HPV 16/18 DNA in cervix: RR = 2.8, 95% CI = 1.9-4.2; (5) VD history: RR = 2.2, 95% CI = 1.2-4.0; (6) no Pap smear: RR = 2.4, 95% CI = 1.5-3.8; and (7) low socioeconomic status: RR = 2.0, 95% CI = 1.2-3.2. The population-attributable risks related to HPV detection, four or more sexual partners, six or more live births, no prior Pap smear, and low socioeconomic status were 39%, 38%, 29%, 23%, and 22%, respectively. Several of the sexual and reproductive risk factors were relatively more prevalent in the high-risk region, but Pap screening and detection of HPV were equally prevalent in the high-risk and low-risk regions. Though differences in screening quality (laboratory and follow-up) may have been involved, we conclude that the observed regional differences reflect behavioral more than screening differences. This suggests that screening programs should be more aggressive in the high-risk area, given the more frequent occurrence of the disease there. Failure to detect a higher prevalence of HPV in the high-risk region could reflect weaknesses in the in situ hybridization test employed. Alternatively, cofactors may have to be present in order for HPV to exert its role in cervical carcinogenesis.

Adult↗
PubMed2000

Exposure to HIV-1 during delivery and mother-to-child transmission.

BACKGROUND: The correlation between the presence of HIV-1 in maternal cervicovaginal secretions and in the infant's oro-pharyngal secretions at birth, and mother-to-child HIV transmission (MTCT) were examined to obtain a better understanding of its mechanism. METHODS: Women without medical and obstetrical complications, living within a reasonable distance of the government hospital in Mombasa, Kenya, were recruited after informed consent. Maternal and infant characteristics were collected. Polymerase chain reaction was used to detect HIV-1 in cervico-vaginal and oro-pharyngal secretions. Infants were tested for HIV-1 by polymerase chain reaction within 48 h and at 6 weeks after delivery. RESULTS: Between April 1998 and April 1999, 228 woman-infant pairs were included in the study. HIV-1 DNA in cervico-vaginal secretions was independently associated with HIV-1 maternal viral load and with infant birth-weight, whereas HIV-1 RNA was associated with maternal viral load and maternal age. HIV-1 DNA in the oropharyngal secretions was also independently associated with maternal viral load. MTCT rate at the age of 6 weeks was 23.6%. Intrapartum and early postpartum HIV transmission was independently associated with maternal viral load [adjusted odds ratio (OR), 1.6; 95% confidence interval (CI),1.0-2.7], detection of HIV-1 RNA in cervico-vaginal secretions (adjusted OR, 3.2; 95% CI, 1.5-7.3) and of HIV-1 DNA in oro-pharyngeal secretions (adjusted OR, 3.2; 95% CI, 1.1-9.0). DISCUSSION: As far as is known, this is the first study showing that infant exposure to HIV-1 in the birth canal and the presence of HIV-infected cells in the infant's oropharyngeal cavity are independently associated with intrapartum and early postpartum MTCT. It supports the hypothesis that MTCT could occur through the oral route.

Bodily Secretions↗
PubMed1994

Intermittent versus continuous electronic monitoring in labour: a randomised study.

OBJECTIVE: To compare the efficacy in detecting signs of fetal hypoxia in labour of intermittent (I-group) versus continuous (C-group) electronic fetal monitoring in women with low or moderate risk factors for fetal distress. DESIGN: A prospective, randomised study. SETTING: A tertiary referral centre. SUBJECTS: Four thousand and forty-four parturients at low risk for obstetric complications with a reactive fetal heart rate admission test at arrival in labour. During the study period (October 5 1989 to May 31 1991), 5647 women were delivered in the labour ward. Of these, 1178 women (20.9%) were excluded because of high risk factors in pregnancy or at admission for labour, including women undergoing elective caesarean section. Of the remaining 4469 women 4044 (90.5%) were randomised to either intermittent (n = 2015) or continuous monitoring (n = 2029) during the first stage of labour. METHODS: In the C-group the fetal heart rate was recorded continuously with electronic fetal monitoring during the first stage of labour. In the I-group the fetal heart rate was recorded with electronic fetal monitoring for 10 to 30 min every 2 to 2.5 h during the first stage of labour, and the fetal heart rate was auscultated every 15 to 30 min in between recording periods. If complications occurred, recording was changed to continuous. In the second stage of labour all the women were monitored continuously. Umbilical cord artery acid-base status was assessed at birth. MAIN OUTCOME MEASURES: Duration of electronic fetal monitoring, rates of abnormal fetal heart rate patterns, caesarean section for fetal distress, acidosis in umbilical cord arterial blood at birth, Apgar scores of less than 7 at 1 or 5 min, and referrals to the neonatal intensive care unit. RESULTS: There were no significant differences between the study groups in the incidence of ominous fetal heart rate recordings: 6.3% (I-group) versus 6.6% (C-group), or the interval from arrival to first detected abnormal fetal heart rate, although the number of suspicious fetal heart rate patterns was higher in the C-group (28.6%) than in the I-group (24.6%). In the I-group electronic fetal monitoring was performed for (median monitoring time) 38.8% of the first stage of labour as compared with 78.6% in the C-group. The incidence of caesarean section for fetal distress was similarly low in both groups: 1.2% versus 1.0%. There were no significant differences in the immediate neonatal outcome in terms of umbilical artery pH, Apgar scores, or admissions to the neonatal care unit. CONCLUSIONS: Intermittent use of electronic fetal monitoring at regular intervals (with stethoscopic auscultation in between) appears to be as safe as continuous electronic fetal monitoring in low risk labours.

Apgar Score↗
PubMed1994

Elevated arterial blood pressure is associated with peri-intraventricular haemorrhage.

UNLABELLED: In a prospective study, brain ultrasound scans were performed in 42 newborns (median birth weight 1700 g, range 1020-3720 g; gestational age 32 weeks, 26-36) to reveal peri-intraventricular haemorrhage (PIVH) (grades I-IV) as well as echodensities (ED) and/or periventricular leucomalacia (PVL). ECG and arterial blood pressure were recorded on magnetic tape at 8-h intervals during the first 24 h of life for further computer analysis. Heart rate (HR) and its variability (HRV) indices RMSM (long-term variability) and RMSSD (short-term variability), together with their coefficients of variation, were computed. Systolic (SBP), diastolic (DBP), and mean blood pressures (MBP) were detected as average values for 2-min stationary segments together with the respective minima and maxima. The indices of variability and their coefficients of variation were computed for the arterial pressure. PIVH was found in 12 newborns and ED in 8 (of whom two developed PVL). The remaining 22 served as controls. Neither HR, HRV nor BP variability differed between the groups. DBP was higher in the group with PIVH (39 mmHg) when compared to both the controls (33 mmHg, P < 0.05) and the ED group (32 mmHg, P < 0.01). MBP behaved respectively (45 mmHg, 38 mmHg, 37 mmHg, P < 0.01). SBP behaved also similarly when gestational age and birth weight were used as covariates (57 mmHg, 48 mmHg, 47 mmHg, P < 0.01). CONCLUSION: Our results suggest that elevated diastolic, mean and systolic blood pressure are significantly associated with peri-intraventricular haemorrhage in preterm newborn infants.

Blood Pressure↗
PubMed2004

Maternal smoking in pregnancy, fetal development, and childhood asthma.

OBJECTIVES: We examined the relationships among maternal smoking in pregnancy, fetal development, and the risk of asthma in childhood. METHODS: We conducted a population-based cohort study, where all 58 841 singleton births were followed for 7 years using nationwide registries. RESULTS: Maternal smoking increased the risk of asthma (adjusted odds ratio = 1.35; 95% confidence interval = 1.13, 1.62 for high exposure). Low birthweight and preterm delivery increased the risk of asthma at the age of 7, whereas being small for gestational age did not. CONCLUSIONS: Maternal smoking in pregnancy increases the risk of asthma during the first 7 years of life, and only a small fraction of the effect seems to be mediated through fetal growth.

Adolescent↗
PubMed1995

Estimated timing of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission by use of a Markov model. The HIV Infection in Newborns French Collaborative Study Group.

It has been shown that mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission can occur both during pregnancy and at delivery, but the respective frequencies in these periods are unknown. Moreover, it is difficult to determine the timing of mother-to-child HIV-1 transmission by direct sampling. The use of an elaborate statistical method is therefore necessary. The authors studied 495 consecutive infants born between May 1988 and August 1991 who were included, at birth, in the French Prospective Study on Pediatric HIV Infection. At least one blood sample was obtained from every infant during the first 14 days of life. All samples obtained within 3 months of birth were tested by at least two of the following methods: viral culture, polymerase chain reaction (PCR), and antigenemia, as well as by Western blot test. Data for the 95 infected infants (those seropositive at 18 months and those who died of HIV disease before this age), and who were exclusively bottle-fed, were analyzed in a Markov model to estimate the timing of viral transmission, the time from birth to the emergence of detectable virus, and the time from birth to seroconversion. The model indicated that one-third of the infants were infected in utero, less than 2 months before delivery (95th percentile). In the remaining 65% of cases (95% confidence interval (CI) 22-92), the date of infection was estimated as the day of birth. The estimated median period between birth and the emergence of viral markers was 10 days (95% CI 6-14) and the 95th percentile was estimated at 56 days. These results support the view that HIV infection can be diagnosed during the first 3 months of life. The authors conclude that mother-to-child HIV-1 transmission appears to occur late in pregnancy or at delivery.

Adult↗
PubMed2006

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants.

CONTEXT AND OBJECTIVE: There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS: Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS: Ninety-seven newborn infants (mean birth weight: 1113 g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS: Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

Brazil↗
PubMed2004

Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses' Health Study.

OBJECTIVE: To explore the contribution of female hormonal factors occurring prior to the onset of rheumatoid arthritis (RA), such as age at menarche, parity, age at first birth, breast-feeding, use of oral contraceptives (OCs), irregular menstrual cycles, and postmenopausal hormone (PMH) use, to the subsequent development of RA in a large female cohort. METHODS: We studied female reproductive and hormonal risk factors for RA in a cohort of 121,700 women enrolled in the longitudinal Nurses' Health Study. The diagnosis of incident RA (between 1976 and 2002) in 674 women was confirmed by a connective tissue disease screening questionnaire and blinded medical record review for American College of Rheumatology criteria. Sixty percent of the patients with RA were rheumatoid factor positive. The relationship between potential risk factors, including age, age at menarche, parity, age at first birth, total lifetime history of breast-feeding, use of OCs, and irregular menstrual cycles and the multivariate-adjusted risk of RA was estimated using Cox proportional hazards models. RESULTS: Using a multivariate model that adjusted for age, body mass index, smoking, parity, and other hormonal factors, we observed a strong trend for decreasing risk of RA with increasing duration of breast-feeding (P for trend = 0.001). For women who breast-fed (compared with parous women who did not breast-feed), the risk ratios (RRs) and 95% confidence intervals (95% CIs) were as follows: breast-feeding for < or =3 total months, RR 1.0 (95% confidence interval [95% CI] 0.8-1.2); for 4-11 total months, RR 0.9 (95% CI 0.7-1.1); for 12-23 total months, RR 0.8 (95% CI 0.6-1.0); and for > or =24 total months, RR 0.5 (95% CI 0.3-0.8). Very irregular menstrual cycles were associated with an increased risk of RA (RR 1.4, 95% CI 1.0-2.0). Age at menarche < or =10 years was associated with an increased risk of seropositive RA (RR 1.6, 95% CI 1.1-2.4) but not significantly associated with risk of RA. Parity, total number of children, age at first birth, and OC use were not associated with an increased risk of RA in this cohort. CONCLUSION: In this large cohort, breast-feeding for >12 months was inversely related to the development of RA. This apparent effect was dose-dependent, with a significant trend toward lower risk with longer duration of breast-feeding. Irregular menstrual cycles and earlier age at menarche increased the risk of RA. Other reproductive hormonal factors were not associated with RA risk.

Adult↗
PubMed1994

Birth events, birth experiences and social differences in postnatal depression.

A postal survey of all women who gave birth in Victoria in one week in 1989 was used to assess the contribution of birth events, satisfaction with care and social differences to depression after birth. The questionnaire was mailed to women eight to nine months after birth. The survey response was 71.4 per cent (790/1107) with underrepresentation of young women, single women and women of non-English-speaking background. Assessment of depression was made using the Edinburgh Postnatal Depression Scale, with a score of 13 or more indicating probable clinical depression. The point prevalence of depression was 15.4 per cent (95 per cent confidence interval 12.8 to 18.0). In the final logistic model two factors were associated with lower odds of depression: nonmetropolitan residence and maternal age over 34. Factors associated with increased odds of depression in the model were having a first child over the age of 34, assisted delivery (caesarean, forceps, vacuum extraction), bottle feeding, dissatisfaction with antenatal care, having unwanted people present at the birth and lacking confidence to look after the baby at the time of leaving hospital. When those factors were taken into account, being unmarried, being born overseas of non-English-speaking background, being dissatisfied with care in labour and after birth, and not having an active say in decision making, all of which were significantly associated with depression in univariate analyses, did not make any additional contribution to the model.

Adolescent↗
PubMed1996

Neonatal mortality and length of newborn hospital stay.

OBJECTIVE: To investigate the effect of hospital discharge time on neonatal mortality of term newborns. DESIGN: Infants who were discharged home at 5 days of age of younger and who subsequently died were compared with control infants using a retrospective case-control design. Descriptive information was collected from records of infants who were not discharged home from the hospital of birth (because of death or transfer to a tertiary care hospital) to determine the age at which their illnesses presented. METHODS: We reviewed death certificates for all infants with birth weights of 2500 g or greater born at 37 weeks' gestational age or greater who died in the first 28 days of life and who were born in one of four Utah counties (1985 through 1989). Of the 109,256 eligible births, 115 infants were found who had died in the neonatal period. Eighty-four infants had not been discharged home from the hospital of birth, 5 infants had had hospital stays of more than 5 days, 9 records could not be located, 17 presumed healthy infants were discharged from the hospital at 5 days of age or younger. These 17 infants were each matched with 3 control infants. Newborn nursery charts were reviewed to determine hospital discharge times for case and control infants. Descriptive information regarding the time of presentation of illness was collected for the other 89 infants. RESULTS: The mean age of hospital discharge was 43 +/- 21 hours for the 17 case infants and 47 +/- 25 hours for the 51 control infants. The odds ratio for neonatal mortality for discharge at less than 24 hours was 1.65 (95% confidence interval, 0.42 to 3.34) and for discharge at less than 48 hours was 1.16 (95% confidence interval, 0.4 to 3.34). Of the 84 infants who were not discharged home from the hospital of birth, 93% had been symptomatic by 12 hours of age, and 99% were symptomatic by 18 hours. CONCLUSIONS: Most full-term infants who die in the neonatal period are symptomatic within the first 18 hours after birth. We could not demonstrate an association between early hospital discharge and neonatal mortality in those infants who died after discharge home.

Age of Onset↗
PubMed1979

Machakos Project Studies: agents affecting health of mother and child in a rural area of Kenya. XVI. The outcome of pregnancy.

The outcome of pregnancy of all women belonging to the study population of the Machakos project studies who delivered during 1975 and 1976 is presented. The birth-rate was 43.0 per 1,000 population per year, the fertility rate was 235 per 1,000 women 15--44 years of age per year. Unexpected low mortality rates were found; stillbirths, neonatal and infant death rates were respectively 29.8 per 1,000 total births and 22.5 and 50.0 per 1,000 live births. One maternal death occurred among the 2,223 deliveries. Maternal age of less than 25 and over 34 years, a history of previous perinatal death and breech delivery were associated with higher perinatal mortality. Parity, marital status, birth-interval and maternal height were not associated with a difference in outcome of pregnancy. The stillbirth rate among the children born in hospital (26.4%) was 4.4% compared with 2.4% among the children born at home, neonatal and infant death rates were the same. Half of all perinatal deaths were caused by either prematurity or birth trauma, 75% of all infant deaths after the first week of life were caused by infections.

Adolescent↗
PubMed1997

Temperance board registration for alcohol abuse in a national sample of Swedish male twins, born 1902 to 1949.

BACKGROUND: Temperance boards were established in Sweden to register and follow up individuals who were seen in legal or medical settings with problems of alcohol abuse. These records, available in a large epidemiologic twin population, have provided an objective and validated measure of alcohol abuse. METHODS: We examined Swedish temperance board registrations from 1929 to 1974 (n = 2516 individual twins) in all male-male Swedish twin pairs of known zygosity from the population-based Swedish Twin Registry; these twin pairs were born from 1902 to 1949 (n = 8935 pairs). RESULTS: The lifetime prevalence and probandwise concordance rates for temperance board registrations were 13.2% and 47.9%, respectively, in monozygotic twins and 14.6% and 32.8%, respectively, in dizygotic twins. Model fitting suggested that genetic and familial-environmental risk factors accounted for 54% (95% confidence interval [CI], 47%-61%) and 14% (95% CI, 8%-19%) of the liability to temperance board registration, respectively; these estimates were stable across birth cohorts. High genetic liability was reflected by large numbers of temperance board registrations and registrations for criminal alcohol use. Elevated familial-environmental liability was indicated by an early age at first registration. CONCLUSIONS: Genetic factors are of major etiologic importance for alcohol abuse in men, while familial environmental factors play a significant but less important role. The etiologic importance of these factors has remained constant in Sweden for men who were born in the first half of the 20th century.

Adult↗
PubMed2005

Vitamin C supplementation in very preterm infants: a randomised controlled trial.

OBJECTIVE: To determine whether regulating vitamin C (ascorbic acid: AA) intake to achieve higher or lower plasma concentrations was associated with improved clinical outcome. DESIGN: A double blind, randomised controlled trial. SETTING: Neonatal intensive care unit at Christchurch Women's Hospital. PATIENTS: Infants with birth weight <1500 g or gestation <32 weeks, admitted to the unit within 48 hours of birth. INTERVENTION: Infants were randomised to one of three protocols with regard to AA supplementation for the first 28 days of life: group LL received low supplementation throughout; group LH received low until day 10 and then high: group HH received high throughout. MAIN OUTCOME MEASURES: Primary outcome measures were oxygen requirement at 28 days and 36 weeks postmenstrual age, total days supplemental oxygen, and retinopathy of prematurity. AA concentrations were measured at study entry (day 2), and days 10, 21, and 28. RESULTS: A total of 119 infants were enrolled over 24 months (mean gestation 28.4 weeks; birth weight 1161 g). Six infants died, and these had significantly higher AA concentrations before randomisation than surviving infants (116 micromol/l (95% confidence interval 90 to 142) v 51 micromol/l (45 to 58), p<0.0001). There were no significant differences in primary outcomes between the groups. However, the proportion of surviving infants with an oxygen requirement at 36 weeks postmenstrual age in group HH (19%) was half that in group LL (41%) (p=0.06). CONCLUSIONS: In a randomised controlled trial, no significant benefits or harmful effects were associated with treatment allocation to higher or lower AA supplementation throughout the first 28 days of life.

Ascorbic Acid↗
PubMed1997

The relationship of calfhood morbidity with survival after calving in 25 New York Holstein herds.

The association of owner-diagnosed calfhood diseases with the length of herd life after calving was evaluated using data collected prospectively over a ten-year period in 25 New York Holstein dairy herds. Herds selected for the study were milking between 35 and 200 Holstein cows, used dairy herd improvement records, bred cows by artificial insemination unless they needed three or more services, and had regularly-scheduled herd health visits by clinicians from the Cornell University College of Veterinary Medicine. Owners recorded occurrences of dullness, respiratory disease, and scours from birth through 90 days of age for all heifer calves that lived at least 24 h and were to be kept as replacements. Milking herd life was measured as the difference between the age at first calving and the age at death or sale. Data on cows sold when the herd went out of business or still in the herd at the end of the study were censored observations. Cox's proportional hazards model was used for statistical analysis of the data. Controlling for age at first calving, study month of birth, and sire predicted difference for milk, there was no statistically significant association of calfhood morbidity with length of herd life. The estimated hazard rate ratios for leaving the milking herd and 95% confidence intervals for dullness, respiratory disease, and scours within 90 days of birth were 1.3 (0.9, 1.9), 0.9 (0.6, 1.3), and 1.0 (0.8, 1.3), respectively. Dullness was the only disease category with an estimated hazard rate ratio greater than 1, and although it was not statistically significant, may warrant evaluation in future studies of long term effects of calfhood morbidity.

Animals↗