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PubMed1987

Tuberculin response of Sri Lankan children after BCG vaccination at birth.

A total of 740 healthy children aged between 3 months and 11 years who had received BCG vaccination in the first month of life were Mantoux tested in Sri Lanka. Despite 97% having a visible scar following vaccination, 80% showed Tuberculin anergy (0-1 mm). Those without a scar showed no response. There was no correlation between scar size and the Mantoux response. A low mean Mantoux reaction was seen at all ages: 3.5 mm at 3 months, 3.2 mm at 18 months, 1.8 mm at 5-7 years and 1.9 mm at 9-11 years. A significant waning of the Mantoux reaction occurred at 5-7 years but there was no significant change at 9-11 years. Children who had received routine revaccination at 10 years, having received the first at birth, had a significantly higher mean Mantoux reaction (9.6 mm) when tested 3 months after revaccination. In 90 bacteriologically proven tuberculous patients, there was a significantly increased Mantoux reaction compared to all other groups. 1 T.U. PPD RT 23 (with tween 80) was used in all instances for Mantoux testing. The present study shows that routine BCG vaccination at birth, using a reduced dose of 0.05 ml, is unlikely to interfere subsequently with the diagnostic value of the Mantoux test. However, revaccination at 10 years may do so.

BCG Vaccine↗
PubMed2004

Atypia in the assessment of breast cancer risk: implications for management.

Proliferative disease accounts for as much as one-third of all biopsies for benign disease and 5-10% of proliferative lesions show atypia ductal or lobular hyperplasia. Nearly 40% of women with a family history of breast cancer and atypical hyperplasia subsequently develop breast cancer. A quantitative model developed by Gail and colleagues estimates the probability of developing breast cancer over time. Risk factors in the model include current age, ages at menarche and first live birth, number of previous biopsies, the presence of cellular atypia, and the number of first-degree relatives with breast cancer. Atypical hyperplasia approximately doubles the risk of developing invasive breast cancer within any quantitative risk profile. Ductal lavage provides a minimally invasive method of collecting breast epithelial cells. The procedure opens the possibility of repeatable tracking of breast cytology over time, but its role as a risk assessment tool remains to be fully defined.

Breast Neoplasms↗
PubMed1987

Prevention of thalassaemia and haemoglobin S syndromes in Greece.

Clinically severe thalassaemia and Hb S syndromes are a major public health problem in Greece. A wide programme aiming at reducing the births of new cases is under way; it comprises (a) carrier identification either at a premarital stage or prior to the birth of first child and (b) prenatal diagnosis. Participation is voluntary and free of charge. Reduction of births of affected children has been obtained to a very large extent.

Anemia, Sickle Cell↗
PubMed2003

The pattern and factors associated with child spacing in eastern Saudi Arabia.

The aim of this cross-sectional study was to determine the patterns of child spacing/birth intervals in the Eastern Province of Saudi Arabia and the socio-economic factors related to them. The study sample comprised nine to 10-year-old Saudi school children randomly selected from 14 schools in Khobar, Thoghba and Dhahran in the Eastern Province of Saudi Arabia. A two-stage sampling technique was applied and yielded a sample of 536 children. The SPSS programme was used for data analysis. The mean preceding and succeeding birth intervals of children in the study were 26.2 +/- 13.7 and 28.2 +/- 12 months respectively. The most important variables that were found to be significantly correlated with the birth intervals were maternal age, level of education, family size and breastfeeding. This is the first time birth intervals were studied for an urban area in Saudi Arabia and the Gulf region. The figures-obtained are essential for any planning of mother and child health interventions. Health team members need to know this information and the variables related to them in order to advise mothers. The figures are also essential in planning measures to reduce infant and child morbidity and mortality.

Birth Intervals↗
PubMed1980

Margaret Sanger: birth control's successful revolutionary.

The year 1979 marked the centennial of Margaret Sanger, birth control pioneer. Sanger worked to secure two new human rights: the right to decide whether to have a child and the right of a child to be wanted. Beginning in 1873, antipornography crusader Anthony Comstock lobbied through Congress and the state legislatures laws forbidding the distribution of contraceptive devices and even information. He equated these with erotic postcards as "obscene, lewd, lascivious, filthy, indecent and disgusting." Sanger's strategy was to challenge the Comstock laws in the courts. She studied birth control methods abroad and published a pamphlet, Family Limitation, in 1914. It was the first modern marriage manual; it was also illegal. The publicity her trial generated was immense and highly sympathetic. The government dropped its case when it saw it could only make her a martyr. An obstetrical nurse, Sanger had seen the plight of factory women in the poorest sections of New York City. In order to provide the medical advice and supplies women clamored for, Sanger opened the first U.S. birth control clinic, in Brooklyn in 1916. The New York City Vice Squad raided and closed it, and jailed Sanger. Margaret Sanger underwent other trials, raids, and harassments, but each time won additional public support for her organization--Planned Parenthood--and her cause.

Contraception↗
PubMed2002

[Modalities of treatment local and general, medicamentous or not, controlling neonate suspected to be infected/contaminated by HSV1 or HSV2].

Neonatal herpes infection is secondary to pre/perinatal viral contamination from mother by HSV2 (70 p. 100) or HSV1 (30 p. 100). Incidence in French population is closed to 3/100,000 live births corresponding to 20 cases per year. Risk for maternal viral transmission to the neonate is 30 p. 100 with genital herpetic primo infection and 3 p. 100 in recurrence. However, in 70 p. 100 of cases, maternal history is not contributive. Three main clinical presentations are described However atypical symptoms - as isolated fever - can be a telltale sign. Mean clinical delay from birth to first clinical symptoms is 6 to 12 days and neonate is usually symptom - free at birth. Viral cultures from pharynx, stools, cutaneous lesions and specific PCR in blood and cerebrospinal fluid confirm the diagnosis. Curative treatment is acyclovir at high dosage - 60 mg/kg/d - during 14 days for localized forms and 21 days for neurological and disseminated diseases. Compared to conventional dosages, this treatment leads to a reduction in mortality which however remains high in disseminated forms, 31 p. 100 and 6 to 11 p. 100 in CNS infection. Morbidity is also high in survived patients, 17 p. 100 and 31 p. 100 respectively. Efficacy of prophylactic viral decontamination by anti-herpetic eye drops and cutaneous polyvidone iodine bath, which is largely used at birth in France, has never been evaluated.

Acyclovir↗
PubMed1993

Fertility in cryptorchidism. Does treatment make a difference?

The testis which remains nonscrotal beyond puberty will not produce sperm. While much of the data presented imply that therapy of cryptorchidism during childhood will decrease the likelihood of infertility, the available data do not substantiate this. There are also inadequate data to indicate whether treatment at very young ages in childhood decreases the risk of infertility. In fact, it is not clear that fertility rates among males who were unilaterally cryptorchid is different than that of the unaffected male population! Therefore, verification is needed to determine whether or not fertility is decreased in cryptorchidism. Paternity is a better index for verification than sperm counts since it is known that men with subnormal sperm counts may have normal paternity rates. Such verification using paternity may require more than fathering a child, such as the age of the father at the birth of the first child, length of marriage or partnership before birth of the first or subsequent children, or duration of intercourse without contraception to birth. Because of the multiple etiologies of the cryptorchid state, factors such as the relative size of the testis before treatment, and the position of the testis and the histology of the testis need to be considered since the small testis, the abdominal testis and the testis with the most histologic changes would appear to be at the greatest risk for defects in spermatogenesis. Until these data become available, most physicians are likely to recommend treatment of the undescended testis when detected if the child is older than six months. However, it must be remembered that there are no data to indicate benefit of early treatment. Before treatment is initiated, the physician must be careful to rule out a retractile testis. Also, the possibility of ascent of the testis which may occur during midchildhood, the age of physiologically normal hypogonadotropism, must be remembered. The testis which was previously normally descended but resides much of the time during midchildhood years within the inguinal canal may be a variant of normal and not require therapy. The approach to the patient with cryptorchidism must involve a careful history and repeated examinations looking for a cause and for accurate position of the testis. If the testis can be moved from the nonscrotal position into the scrotum, the potential function of the testis should not be harmed.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1999

Thyroid function in very preterm newborns: possible implications.

Thyroid hormones are essential for brain maturation. Very preterm infants, who are at risk of neurodevelopmental disabilities also have low thyroxine (T4) and free thyroxine (FT4) values in the first weeks after birth. This transient hypothyroxinemia may in part be causal to the neurodevelopmental problems. We have carried out a randomized, double-blind, placebo-controlled trial with T4 in 200 infants less than 30 weeks gestation. T4 (or placebo) was given in fixed dose of 8 microg/kg birth weight per day during the first 6 weeks after birth. It resulted in a significant increase of T4, FT4, and reverse triiodothyronine (rT3). Thyrotropin (TSH) secretion was suppressed, and, probably as a result of TSH suppression, triodothyronine (T3) levels were decreased in the T4 group. Mortality was 14% in the T4 group and 21% in the placebo group (NS). No effect was found on morbidity. Heart rate was significantly higher in T4-treated infants less than 28 weeks gestation, but not in T4-treated infants 28 weeks or more, who had the highest FT4 levels. In the study groups as a whole, no clear effect of T4 administration was found on neurodevelopmental outcome. However, there was a strong trend toward improvement of adverse outcome, defined as death or abnormal developmental outcome at 2 years of age. In addition, mental outcome in a subgroup of T4-treated infants less than 27 weeks' gestation was significantly better than in placebo infants of the same age group. In conclusion, this trial does not clearly have conclusive results. New trials of thyroid hormone treatment should be carried out in preterm infants, in order to investigate whether indeed T4 supplementation is required in preterm infants less than 27 or 28 weeks gestation. Addition of T3 to the treatment schedule needs to be considered.

Blood Proteins↗
PubMed1981

Trends and differentials in breast feeding: an update.

Analysis of the 1973 National Survey of Family Growth shows a continued downward trend in breast feeding by successive cohorts of American mothers. The downward trend is evident in both measures of incidence (ever-breast feeding) and duration of breast feeding for first and higher-order births. For all cohorts higher-order births are less likely to be breast fed than first births. However, breast feeding of higher-order births is typically of a longer duration. Differentials in breast feeding reveal strong associations with indicators of social class; women who are college graduates, who work as professionals, and who are married to professional husbands are most likely to breast-feed their infants. Differentials in average duration of breast feeding are often reversed from differentials in ever-breast feeding.

Adult↗
PubMed1991

[[A hazard analysis of birth timing in Japan since the 1960s]].

"This paper carried out a multivariate hazard analysis of the first, second and third birth timings by applying [a] log-logistic model. The results are as follows: (1) When wives are employed, the first, second and third birth hazards are all smaller than others....(2) Coresiding with couple's parents is likely to raise the first, second and third birth hazards irrespective of wife's employment status; (3) Wives with tertiary level education are accompanied by a smaller first birth hazard compared with others, while wife's educational attainment does not show any effect on the second and third birth hazards; (4) White-collar husbands are associated with a smaller first birth hazard when their wife is employed; (5) Even after controlling for several background variables, the first, second and third birth timings were accelerated in the cohorts of the late 1960s. This result suggests that the birth timing change in the late 1960s was caused by some heterogeneity which is not considered in this study." An English summary is available from the author.

Asia↗
PubMed1996

Myelin/oligodendrocyte glycoprotein (MOG) expression is associated with myelin deposition.

We investigated the onset of expression of the myelin/oligodendrocyte glycoprotein (MOG) mRNA and protein in the developing mouse central nervous system. In situ hybridization on brain sections at different stages of embryonic and postnatal development showed that MOG transcripts were first detected at birth in the medulla oblongata. During the first week after birth, cells expressing MOG mRNA were located in the ventral longitudinal funiculus. During the second postnatal week, the pattern of MOG mRNA expression extended rostrally to the mid-forebrain regions and reached completion by the beginning of the third week. MOG transcription was delayed by several days with respect to myelin basic protein (MBP), and it appeared that while the MBP probe labeled both non-myelinating and myelinating oligodendrocytes, only the latter were MOG-positive. In vitro, immunocytochemical analysis of MOG protein expression, performed on myelinating cultures derived from mouse brain embryos at 15 days of gestation, confirmed the strict restriction of MOG expression to myelinating oligodendrocytes. In particular, oligodendrocytes lining up their processes along axons, but not yet having started to deposit a myelin sheath, were still MOG negative. However, in the same cultures, pseudo-myelinating oligodendrocytes (i.e., cells not associated with neurites, but forming whorls of myelin-like figures) were MOG positive. Similarly, rat CG4 cells, an oligodendrocyte-like cell line, expressed MOG only after they had extended sheet-like processes, which suggested that the activation of MOG transcription depends more on an intrinsic oligodendroglial maturation program of myelination than on a neuronal signal.

Animals↗
PubMed1999

Risk factors for the increasing caesarean section rate in Southeast Brazil: a comparison of two birth cohorts, 1978-1979 and 1994.

BACKGROUND: Brazil has the highest caesarean section (CS) rate in the world (36.4% in 1996). METHODS: Risk factors for increasing CS rate were studied in two population-based cohorts of singleton live births in families residing in the municipality of Ribeirao Preto, State of Saõ Paulo, Southeast Brazil. The first comprised births from June 1978 to May 1979 (6750 births-one-year survey) and the second births from May to August 1994 (2846 births-4-month survey). Multiple unconditional logistic regression modelling was used to control for confounding. RESULTS: The CS rate rose from 30.3% in 1978-1979 to 50.8% in 1994. In 1978-1979, socioeconomic, reproductive and demographic variables, and health service factors were associated with CS rate. In 1994, only reproductive, demographic and health service factors remained associated, e.g. hour of delivery (from 7 a.m. to 12 p.m.), attendance by the same physician for prenatal care and delivery, > or =4 prenatal visits, maternal age > or =30 years, 1-3 previous live births and birthweight 3500-3999 g. CONCLUSION: Caesarean section in Brazil is widely performed for non-medical reasons in which physician convenience plays an important role. There is an urgent need for public health interventions to reduce the CS rate in Brazil, mainly directed towards cultural beliefs and physician behaviour.

Adult↗
PubMed2005

Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries.

OBJECTIVE: To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals. DESIGN: Cost effectiveness analysis. SETTING: Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality. DATA SOURCES: Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantities came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database. MAIN OUTCOME MEASURES: Cost per disability adjusted life year (DALY) averted in year 2000 international dollars. RESULTS: The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths. CONCLUSION: Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well.

Africa South of the Sahara↗
PubMed1992

Reproductive factors and risk of myocardial infarction.

The relation of reproductive factors to risk of myocardial infarction in women aged 45-69 years was examined in a case-control interview study carried out in Massachusetts from 1986 to 1990. Each of 858 cases of first myocardial infarction was age-matched with a control from the same precinct of residence. Conditional logistic regression was used to control the matching factors and the major known and suspected risk factors for coronary heart disease. For parous women compared with nulliparous women, the estimated relative risk of myocardial infarction was 1.8 (95% confidence interval (CI) 1.0-3.3). Among parous women, the relative risk estimate for five or more births relative to fewer births was 1.4 (95% CI 1.0-2.0); the estimate for a first birth before age 20 relative to a later age at first birth was 1.7 (95% CI 1.1-2.6). The greatest increase in risk was observed for women who had both an early age at first birth and five or more children. However, confounding by factors related to socioeconomic status may have contributed to the results. Compared with women who had a natural menopause at age 50 or older, women who reached the menopause before age 45 were at increased risk regardless of type of menopause: The estimated relative risks were 2.1 (95% CI 1.3-3.2), 1.7 (95% CI 1.0-2.7), and 1.7 (95% CI 1.0-2.8) for early natural menopause, bilateral oophorectomy, and hysterectomy with retention of one or both ovaries, respectively. These results suggest that early cessation of ovulatory function, whether due to natural causes or to surgery, increases the risk of myocardial infarction. Age at menarche was not related to myocardial infarction risk.

Aged↗
PubMed1987

Comparative analysis of the effectiveness of the diaphragm and birth control pill during the first year of use among suburban adolescents.

Little attention has been paid to the diaphragm as a contraceptive option for adolescents. To compare diaphragm and birth control pill use by adolescents, 124 females (aged 13-20 years) in a suburban-based adolescent health service were interviewed at least one year after receiving a contraceptive prescription. The 73 diaphragm choosers did not differ from the 51 pill choosers in age, race, or reason for their original visit to the health service. Diaphragm choosers, however, were better students, of higher socioeconomic status, and had had fewer prior pregnancies. In the year following prescription, continuous use for 12 months was reported by 43% of diaphragm choosers and 45% of pill choosers, with significantly more pill (26%) than diaphragm (8%) choosers reporting discontinued use for at least one month while remaining sexually active. Regular use (diaphragm every intercourse, missing less than or equal to 1 pill/month) was reported by 36% of diaphragm choosers compared to 88% of pill choosers; and at least one pregnancy during the year was reported by 15% of diaphragm choosers and 18% of pill choosers. At follow-up interviews, diaphragm subjects disliked the immediate annoyances of the diaphragm, and pill users expressed concern about the potential side effects of the pill. No single factor or set of factors correlated with continuous and regular use of either method. Because both methods present specific problems for certain patients, we suggest that in addition to the pill, the diaphragm should receive serious consideration as a contraceptive option for adolescents.

Adolescent↗
PubMed2002

Does birth center care during a woman's first pregnancy have any impact on her future reproduction?

BACKGROUND: Women's experiences of childbirth may affect their future reproduction, and the model of care affects their experiences, suggesting that a causal link may exist between model of care and future reproduction. The study objective was to examine whether the birth center model of care during a woman's first pregnancy affects whether or not she has a second baby, and on the spacing to the next birth. METHODS: Between October 1989 and July 1993, a total of 1860 women at low medical risk in early pregnancy, who participated in a randomized controlled trial of in-hospital birth center care versus standard care, gave birth. The 1063 primiparas in the trial, 543 in the birth center group and 520 in the standard care group, were included in a secondary analysis in which women's personal identification codes were linked to the Swedish National Birth Register, which included information about their subsequent birth during the following 7 to 10 years. Time to an event curves were constructed by means of the Kaplan Meier method. RESULTS: The observation period after the first birth was on average 8.8 years in the birth center group and 8.7 years in the standard care group. No statistical difference was found between the groups in time to second birth, which was 2.85 and 2.82 years, respectively (median; log-rank 1.26; p=0.26). CONCLUSION: A woman's model of care, such as birth center care, during her first pregnancy does not seem to be a sufficiently important factor to affect subsequent reproduction in Sweden.

Adult↗
PubMedDate not supplied

[Associations between birth weight and placental volume in the first trimester].

INTRODUCTION: Associations between the size of the placenta and birth weight have been described before. This connection has also been found in (sonographically estimated) second trimester placental size. The aim of this study was to find out if there are any differences in first trimester placental volume between various birth weight groups. METHODS: Placental volume was obtained from non-smoking women at the end of the first trimester during a period of eight months. After birth, the newborns were divided into four groups: below the 10th, 10th to 50th 50th to 90th and above the 90th centile. As is known from previous research, placenta size changes in proportion to crown-rump-length. Therefore, the medians of the "placenta quotients" (placental volume/CRL) of each group were compared in order to correct for differences in gestational age. RESULTS: Data from 1476 pregnancies could be evaluated. The overall median of the placenta quotient was 0.98. It was 0.85 in the group below the 10th, 0.92 between 10th and 50th, 1.02 between 50th and 90th and 1.10 above the 90th centile (p < 0.0001, median test). DISCUSSION: The finding of associations between early pregnancy placental size and birth weight at term gives hope for the development of new diagnostic methods for the recognition of placenta-associated problems. Further research is required to estimate the clinical possibilities for the detection of pregnancies at risk of severe growth retardation and other conditions.

Austria↗
PubMed2002

A population study of first exposure to community antibacterials in children and the suitability of routine urine samples for study of the acquisition of drug resistance.

The study objectives were to measure time from birth to first exposure to antibacterials in children and compare the characteristics of children who submit urine samples with the general population. Antibacterials were dispensed to 63% of children within 1 year of birth, increasing to 75% within 2 years after birth. Boys had earlier exposure to antibacterials than girls. Children submitting urine samples were more likely to be socio-economically deprived, have prior exposure to antibacterials and have prior hospital admission. In conclusion, urine samples are unsuitable for a prospective cohort study of the relationship between antibacterial exposure and resistance in children.

Adolescent↗