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PubMed1979

Cyto- and synaptogenesis in the arcuate nucleus of the rat hypothalamus during fetal and early postnatal life.

Morphogenesis of the arcuate nucleus of the rat from the 15th fetal day to the 6th postnatal day was investigated light and electron microscopically. The arcuate neurons exhibit a gradual development after the 15th fetal day. All cytoplasmic constituents are present in these nerve cells already during the last days of gestation. Nevertheless, they are not fully differentiated at birth. The first synapse-like structures (presynapses) were observed in 17 day-old, the first synapses in 18 day-old fetuses. During the early postnatal period the number of presynapses decreases, but at the same time there is a gradual increase in the number of the relatively mature synapses. This process starts already during the last days of prenatal life. Although all structural elements of the arcuate nucleus of the adult rat appear to be present at birth, the extent of the neuropil area and the number of ther presynapses indicate that the arcuate nucleus is still in a fairly undeveloped stage during the first postnatal days.

Animals↗
PubMedDate not supplied

The pre- and postnatal maturation of the epithelium in the endolymphatic sac. An electron microscopic survey.

The cellular development of the endolymphatic sac was studied in the CBA/CBA mouse, starting from day 10 of gestation following the different stages of maturation up to an adult age of one month. The first immature cylindrical cells lining the future sac in several cell layers are seen at day 12 of gestation. At day 18 of gestation, a true sac appears and a floccular precipitate is frequently found in its lumen together with signs of increased activity in the still immature epithelial cells. Approximately one day before birth the first signs of the future light and dark cells can be distinguished. At day 4 post partum the cells are more differentiated with some showing signs of secretory activity indicating that these cells start to function at this stage. Eight days after birth differentiation into distinguishable almost mature light and dark cells is seen. Two days later these epithelial cells have obtained a fully mature appearance. At 14 days after birth widened lateral intercellular spaces separating the epithelial cells can be visualized and a few free floating cells are found in the sac lumen. The sac epithelium is thus considered to have completed its maturation process at this stage.

Animals↗
PubMedDate not supplied

Tuberous sclerosis with increasing calcification in the brain during a 15-month period: a case report.

We report here a patient with tuberous sclerosis who, over a 15-month period, had markedly increasing brain calcification on CT (computed tomography). When first seen, the 2-month-old boy had a white spot on the right thigh. His mother, maternal uncles, grandfather and great-grandfather had not only white spot but also sebaceous adenoma. Infantile spasms were noted 2 days after birth. His first brain CT at 3 months of age showed a slightly higher than normal density area in the right occipital lobe. Subsequent CT scans at 6 and 18 months of age revealed progressively increasing density in this area (CT number above 60).

Brain Diseases↗
PubMed2004

Economic implications of multiple births: inpatient hospital costs in the first 5 years of life.

OBJECTIVES: To estimate long term health service costs for hospital stays associated with singleton, twin, and higher order multiple births up to 5 years of age. DESIGN: Costs from specialty based data from the English Department of Health's NHS Trust Financial Returns were applied to admissions recorded in the Oxford record linkage study during 1970-1993. SETTING: Oxfordshire and West Berkshire, United Kingdom. SUBJECTS: A total of 276,897 children, of whom 270,428 were singletons, 6284 were twins, and 185 were higher order multiple births. MAIN OUTCOME MEASURES: Duration of hospital admissions during the first 5 years of life. Costs, expressed in pound sterling and valued at 1998-1999 prices, of hospital inpatient services. RESULTS: The total duration of hospital admissions for twins and triplets were respectively twice and eight times that for singletons, once duration of life had been taken into account. Inpatient costs were significantly higher for multiple births than for singletons, with the cost differences concentrated in the first year of life. Over the first 5 years of life, the adjusted mean cost was estimated at 1532 pounds (95% confidence interval (CI) 1516 pounds to 1548 pounds) for singletons, 3826 pounds (95%CI 3724 pounds to 3929 pounds) for twins, and 8156 pounds (95%CI 7559 pounds to 8754 pounds) for higher order multiple births (p < 0.0001). CONCLUSIONS: Multiple births contribute disproportionately to hospital inpatient costs, especially during the children's first year of life.

Age Factors↗
PubMed1990

Birth weight outcomes for repeat teenage pregnancy.

To investigate the outcomes for repeat teenage pregnancy and the effect of interpregnancy interval on birth weight, birth certificate data were reviewed from all mothers under 26 years delivering their second baby during 1981-1983 at an urban teaching hospital. Initially, 409 mothers who had delivered their first baby at the same hospital were identified. Mothers were divided into three groups: mothers under 20 years for both births; mothers under 20 years for the first birth, with the second birth delayed until 20 to 25 years; and mothers 20-25 years for both births. Group 1 mothers had high but identical rates of low birth weight (17.5%) for both parities, high rates of very low birth weight infants (less than 1501 g), and no change in mean birth weight between the two pregnancies. Group 2 mothers were older at first birth and had better outcomes for first and second births than group 1 mothers. For group 1 mothers, the initiation of prenatal care was delayed at second pregnancy compared to first pregnancy (46% receiving first trimester care versus 59% at first delivery). In contrast, groups 2 and 3 showed improvement in accessing prenatal care for the second pregnancy. Interpregnancy interval had no influence on the birth weight of the second infant in any group.

Adolescent↗
PubMed2003

Cadherin expression coincides with birth dating patterns in patchy compartments of the developing chicken telencephalon.

Some gray matter regions of the vertebrate brain, e.g., the mammalian striatum, are organized into clusters of functionally similar neurons ("patches") that are surrounded by a gray matter matrix. A similar type of compartmentation recently has been found also in the avian telencephalon, based on two sorts of evidence. First, a birth dating study showed that, in some telencephalic areas, cells born at the same time form "isochronic" cell clusters, which differ in their birth dating pattern from their surrounding tissue. Second, patchy expression was found for different members of the cadherin family of adhesion molecules (R-cadherin, N-cadherin, and/or cadherin-7). The relation between these two findings has remained unclear. Here, we demonstrate a general spatial coincidence between the birth dating patterns and the heterogeneities in cadherin expression. This coincidence is found in areas of the avian ventral and lateral pallium (ventral hyperstriatum, neostriatum, and ectostriatum) and in a part of the archistriatum, which is of pallial origin. For example, in the neostriatum, a part of the ventral pallium, both the cadherin-7-positive patches and their R-cadherin-positive surroundings are born between embryonic day 5 and 7, but the cadherin-7-positive cells are born during a shorter time period than the R-cadherin-positive cells. We propose that the patchy gray matter architecture observed in the mammalian striatum and avian pallium are regulated by a common type of morphogenetic mechanism. This mechanism possibly involves the differential expression of adhesive factors, such as cadherins.

Age Factors↗
PubMed2004

Genetic parameters for calving difficulty, stillbirth, and birth weight for Hereford and Charolais at first and later parities.

The aim of this study was to estimate direct and maternal genetic parameters for calving difficulty score, stillbirth, and birth weight at first and later parities for Charolais and Hereford cattle in Sweden. Calving traits have long been recorded for pure-bred beef cattle in Sweden, but only birth weight has been used in the selection in order to avoid calving difficulties. Linear animal model analyses included records on birth weight for 60,309 Charolais and 30,789 Hereford calves born from 1980 to 1999, and calving traits for 74,538 Charolais and 37,077 Hereford calves born from 1980 to 2001. The frequencies of difficult calvings and stillbirths were approximately 6% at first and 1 to 2% at later parities for both breeds. Fewer than half the stillborn calves were born from difficult calvings. Heritabilities estimated for birth weight in different univariate and bivariate analyses for Charolais and Hereford calves born at first and later parities ranged from 0.44 to 0.51 for direct effects and 0.06 to 0.15 for maternal effects. Heritabilities on the observable scale for calving difficulty score of Charolais and Hereford, scored in three classes, ranged from 0.11 to 0.16 for direct and 0.07 to 0.12 for maternal effects at first parity, and lower at later parities. All estimated heritabilities for stillbirth were very low (0.002 to 0.016 on the observable scale). Direct-maternal genetic correlations were negative, with few exceptions. Genetic correlations between the traits and between parities within traits were generally moderate to high and positive. Calving difficulty score should be included in the genetic evaluation of beef breeds in Sweden, whereas progeny groups in Swedish beef populations are too small for stillbirth to be considered directly.

Animals↗
PubMedDate not supplied

The effectiveness of the Gail model in estimating risk for development of breast cancer in women under 40 years of age.

Epidemiologic studies have provided information on risk factors for breast cancer. Gail and associates identified five risk factors using the Breast Cancer Detection Demonstration Project (BCDDP) population and developed a model to calculate a composite relative risk (RR). This model is commonly used to counsel women regarding their risk for breast cancer and was used by the National Surgical Adjuvant Breast Project (NSABP) for eligibility for the Breast Cancer Prevention Trial. Because the BCDDP population was composed almost entirely of women 40 years of age or older, our purpose was to evaluate the effectiveness of the Gail model in estimating the risk of breast cancer for women under 40 in the clinical setting. The Gail risk factors were assessed for 124 patients under the age of 40 treated for either ductal carcinoma in situ (DCIS) or invasive breast cancer at the Lahey Hitchcock Medical Center between 1983 and 1995. The RR was calculated using the Gail model. For comparison, two cohorts of women under the age of 40 were used: 107 randomly selected patients who underwent a breast biopsy because of a benign condition and 129 nurses from our institution who responded to a questionnaire that included reproductive and family history information as used in the Gail model. The RR calculated was the RR that existed at the time of the surgical consultation for a suspicious breast lesion. The Tarone-Ware method was used to analyze statistical significance of differences between distribution. Contingency tables were analyzed using Miettinen's modification of Fisher's exact test. No differences were found between the median RR for all groups. Only 2 of the 124 patients with breast cancer had a RR of 5 or more (the RR required to enter the Breast Cancer Prevention Trial). The distribution of age at menarche (AGEMEN) was the same for each group. No difference was found for the distribution of age at first live birth (AGEFLB) between those with breast cancer and those with a benign biopsy or the control group. The number of breast biopsies (NBIOPS) was higher in patients with a benign breast biopsy. No difference was found in the distribution of number of first-degree relatives with breast cancer (NUMREL). Overall the Gail model failed to differentiate those women about to have cancer diagnosed from two control populations. The Gail model is not useful in identifying immediate risk of breast cancer in women under 40 and should not be used for that purpose.

Adult↗
PubMed1988

Risk factors for adenocarcinoma of the cervix: a case-control study.

To assess risk factors for cervical adenocarcinoma data were collected in a case-control study of 39 cases and 409 controls conducted in the greater Milan area. Questions were asked about personal characteristics and habits, gynaecologic and obstetric data, history of lifetime use of oral contraceptives and other female hormones, and general indicators of sexual habits (age at first intercourse and total number of sexual partners). The relative risk of cervical adenocarcinoma increased with number of births and abortions, early age at first birth and early age at first intercourse. These estimates did not materially change after adjustment for the potential reciprocal confounding effect. Further, there was a positive association with overweight, but an apparent association with lower education was not significant. No relationship emerged with oral contraceptive use. Thus, despite the similarities with the epidemiology of squamous cell cancer, reproductive patterns and other factors related to the risk of endometrial cancer (i.e., overweight) seem to play an important role in the risk of adenocarcinoma of cervix uteri.

Abortion, Spontaneous↗
PubMed2001

Time since last birth and the risk of ovarian cancer.

OBJECTIVES: While parity is a protective factor in ovarian cancer, the role of time factors of pregnancy and birth is still controversial. We considered therefore the role of birth timing in the risk in ovarian cancer from a large case-control study. METHODS: Cases were 971 women (age range 22-74 years, median age 54) with histologically confirmed, incident epithelial ovarian cancer, interviewed between 1983 and 1991 in a network of hospitals in Milan, Italy. Controls were 2758 women (age range 23-74 years, median age 52) admitted to the same hospitals where cases were identified for acute, nonneoplastic conditions. RESULTS: In comparison with nulliparous women, the multivariate odds ratios (OR) were 0.8 for women reporting one or two and 0.6 for those with three or more births. No clear association emerged between time since last birth and ovarian cancer. Compared to women who had last given birth since > or =20 years, a moderately increased risk of ovarian cancer was observed in the first 10 years after last birth, with an OR of 1.7 (95% confidence interval, CI 1.0-2.9). When we considered only multiparous women and included in the multivariate analysis allowance for age at first birth, the OR decreased to 1.2 (95% CI 0.6-2.4). No consistent pattern of trends was observed > or =10 years since last pregnancy. CONCLUSIONS: This study confirms the protective effect of parity on ovarian carcinogenesis, but shows no consistent pattern of risk across time since last birth.

Adult↗
PubMed1996

Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis.

STUDY OBJECTIVE: To ascertain, from the published reports to date, whether or not a significantly increased risk of breast cancer is specifically attributable to a history of induced abortion, independent of spontaneous abortion and age at first full term pregnancy (or first live birth); to establish the relative magnitude of such risk increase as may be found, and to ascertain and quantify such risk increases as may pertain to particular subpopulations of women exposed to induced abortion; in particular, nulliparous women and parous women exposed before compared with after the first full term pregnancy. INCLUDED STUDIES: The meta-analysis includes all 28 published reports which include specific data on induced abortion and breast cancer incidence. Since some study data are presented in more than one report, the 28 reports were determined to constitute 23 independent studies. Overall induced abortion odds ratios and odds ratios for the different subpopulations were calculated using an average weighted according to the inverse of the variance. An overall unweighted average was also computed for comparison. No quality criteria were imposed, but a narrative review of all included studies is presented for the reader's use in assessing the quality of individual studies. EXCLUDED STUDIES: All 33 published reports including data on abortion and breast cancer incidence but either pertaining only to spontaneous abortion or to abortion without specification as to whether it was induced or spontaneous. These studies are listed for the reader's information. RESULTS: The overall odds ratio (for any induced abortion exposure; n = 21 studies) was 1.3 (95% confidence interval of 1.2, 1.4). For comparison, the unweighted overall odds ratio was 1.4 (1.3,1.6). The odds ratio for nulliparous women was 1.3 (1.0,1.6), that for abortion before the first term pregnancy in parous women was 1.5 (1.2,1.8), and that for abortion after the first term pregnancy was 1.3 (1.1,1.5). CONCLUSIONS: The results support the inclusion of induced abortion among significant independent risk factors for breast cancer, regardless of parity or timing of abortion relative to the first term pregnancy. Although the increase in risk was relatively low, the high incidence of both breast cancer and induced abortion suggest a substantial impact of thousands of excess cases per year currently, and a potentially much greater impact in the next century, as the first cohort of women exposed to legal induced abortion continues to age.

Abortion, Induced↗
PubMed1992

Prenatal ultrasonography and early surgery for congenital cystic disease of the lung.

With the recent advent of prenatal ultrasound as a routine screening procedure, diagnosis of congenital cystic lung disease has been made in utero, raising the possibility of elective surgery for these lesions early in infancy before the patient develops respiratory distress or potentially life-threatening infection. From 1979 to 1989 six cases of congenital lung cyst were diagnosed in utero by prenatal ultrasound and followed during pregnancy. Two of the six were not confirmed after birth because the mothers preferred an abortion. The remaining four cases were studied periodically during gestation by ultrasonography. At birth, the first infant developed respiratory distress and underwent urgent left upper lobectomy and left lower segmentectomy at age 18 hours. The other three underwent elective lobectomy at age 10 days, 3 months, and 7 months, respectively. The fourth infant had a normal chest x-ray and ultrasound at birth, and the congenital cysts were confirmed by computed tomography scan. The pathological diagnosis in all four cases was cystic adenomatoid malformation. In two cases, intraoperative measurement of pulmonary function demonstrated significant improvement after resection of the affected lobe. We conclude that congenital lung cysts can be accurately diagnosed by prenatal ultrasound "screening" as early as 18 to 24 weeks' gestation. Advantages of early diagnosis include the option of moving the mother and unborn child to a high-risk obstetrical center for urgent operation on the newborn infant if necessary. Otherwise, once the diagnosis is confirmed, surgical correction can be performed electively and safely before respiratory distress or pulmonary infection complicates the infant's growth and development.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2003

Use of healthcare resources, family function, and socioeconomic support during the first four years after preterm birth.

OBJECTIVES: To assess the use of healthcare resources for preterm infants and to evaluate family function and socioeconomic support in a defined population from birth to 4 years of age. METHODS: In a prospective case-control study, 39 singleton preterm infants without prenatal abnormalities born during an 18 month period were studied together with their families. The population consisted of 19 very preterm infants (less than 32 weeks) and 20 randomised moderate preterm infants (32-35 weeks), and the control group comprised 39 full term infants. Contacts with medical services, child health services, and the social welfare system were registered, and family function and life events were studied. RESULTS: The preterm children were more often readmitted to hospital (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.0 to 22.1) and had more outpatient attendances (OR 5.6, 95% CI 2.1 to 15.0) during their first year of life. Mothers in the preterm group more often used temporary parental allowance than the control mothers (p < 0.001). The number of contacts with the child health services and the social welfare system did not differ significantly from the controls. Neither was there any significant difference with regard to family function or life events at 4 years of age. CONCLUSIONS: A large proportion of the premature children used specialist care during the first years of life. However, the families of the preterm infants were socially well adapted up to four years after birth compared with the control families.

Adult↗
PubMedDate not supplied

Responding to depression in parents.

Pediatric professionals may naturally view themselves as gatekeepers or facilitators of access to mental health services for children, but may not see themselves as the first line of "defense" for parents with mental health issues. However, about two thirds of women who meet criteria for affective disorders, and slightly more than half of the men who do, are parents. Given that the average age of onset for affective disorders is several years after the birth of first children, parental depression may initially come to the attention of pediatric providers, the most likely professionals with whom parents have contact prior to children starting school. The health and well-being of parents and children are intimately intertwined. Simple screening, education, and support strategies for parents and referral to specialty services, when appropriate, have the potential for positive impact on all family members.

Adult↗
PubMed1979

Recognizing a child at increased risk of abuse.

Data from two studies are presented. Both highlight characteristics which help identify children at increased risk of child abuse. The first study demonstrates that the abused child when compared with unharmed children in the same family is more likely to have been the product of an abnormal pregnancy, labor, delivery and neonatal period. He is more likely to have been separated from his mother and to have been ill in the first year of life. His mother too is more likely to have been sick during that year. The second study shows that it is possible to identify 'at risk' families around the time the baby is born. When compared with controls, five factors are more common: mother aged under 20 at birth of first child, evidence of emotional disturbance, referral to the social worker, admission of baby to special care nursery, and early concern over mothering.

Child↗
PubMed1990

Oral contraceptive use does not protect against large bowel cancer.

The association between oral contraceptive (OC) use and colorectal cancer was examined in 190 female colorectal cancer cases and 200 age-matched female controls in data derived from a population-based study of large bowel cancer, "The Melbourne Colorectal Cancer Study" conducted in Melbourne, Australia. There were 47 cases (24 colon cancer, 23 rectal cancer cases) and 39 controls, who were past OC users. After adjustment was made for the confounding factors of age, number of children and age at birth of first child, a statistically significant risk was found among rectal cancer OC users, but not among colon cancer OC users (RR rectal cancer = 2.04, 95% CI = 1.00-4.14, p = 0.04; RR colon cancer = 1.17, 95% CI = 0.59-2.29, p = 0.60). These risks were not affected by adjustment for socioeconomic level, country of birth, religion, previous diet and family history of colorectal cancer. Rectal cancer risk was higher among those OC users who were also beer drinkers (RR = 6.96, 95% CI 2.09-23.1, p = 0.001).

Australia↗