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Congenital abnormalities in newborns of consanguineous and nonconsanguineous parents.

The aim of this study was to determine the types, patterns, and frequencies of congenital anomalies among newborns of both consanguineous and nonconsanguineous parents in southern Iran. From 9526 consecutive pregnancies observed, 9623 newborns resulted (9431 singleton and 95 sets of multiple gestation). There were 7261 newborns from nonconsanguineous parents and 2362 (24.5%) babies from consanguineous marriages. Of the total pregnancies, 1.54% resulted in malformed children (1.53% of singleton and 2.1% of multiple gestations). The incidence of congenital abnormalities in newborns of nonconsanguineous parents was 1.66% as compared to 4.02% for newborns of the consanguineous group. Major and multiple malformations were found to be slightly more common in the consanguinous group. Prematurity, prenatal mortality rate, and congenital abnormalities were more common in the consanguineous group. Probably the closer the familial relationship of the parents, the greater the chances of congenital abnormalities.

Abnormalities, Multiple↗

Extramarital relations and perceptions of HIV/AIDS in Nigeria.

Data from a 1991 survey of five Nigerian towns are used to examine currently married men's and women's perceptions of AIDS which, together with other socioeconomic factors, are then related to extramarital sexual behaviour. An overwhelming majority of the respondents have accurate information about AIDS. In particular, most associate HIV/AIDS transmission with multiple sexual partners, though only one-third of them think that the fear of AIDS has limited casual sex in their communities. About 54 per cent of men and 39 per cent of women have had extramarital relations, with 18 per cent of men and 11 per cent of women having done so in the previous week. The incidence of extramarital relations varies considerably by respondents' level of education, type of marriage, religion, and spousal closeness. More importantly, knowledge of multiple sexual partners as a risk factor for HIV/AIDS is inversely related to extramarital affairs. The study underscores the link between knowledge and behaviour, and calls for a well-articulated campaign designed to educate the populace about the threat of AIDS, with the aim of modifying both premarital and extramarital sexual behaviour, thereby reducing the risk factor for HIV through heterosexual relations which is the main mode of transmission in Nigeria.

Adult↗

Factors associated with the risk of second primary breast cancer: an analysis of data from the Connecticut Tumor Registry.

To examine further the epidemiology of contralateral primary breast cancer, a case-control analysis, utilizing information available from the Connecticut Tumor Registry, was conducted. Recent cases of second primary breast cancer were compared to control women who had survived a first breast cancer but had not developed a second. Three hundred and thirty eight incident cases of contralateral breast cancer diagnosed between 1979 and 1982 were identified and compared with an equal number of randomly selected controls and 336 controls frequency matched to the cases on the basis of age at initial cancer diagnosis and the calendar time elapsing since that diagnosis. Risk of second primary breast cancer was found to be significantly elevated among women whose initial cancer was lobular carcinoma and during the first year following diagnosis of the initial primary. Additionally, for women initially treated with radiotherapy, risk of a contralateral primary increased for 10-14 years following treatment, after which it declined. Among young women, having never married was protective whereas the opposite was found among older women. These findings and the methods used are discussed in the context of the epidemiology of both contralateral and initial breast primaries.

Adult↗

Focal dermal hypoplasia (Goltz syndrome).

A 7-year-old girl born of non-consanguineous marriage was evaluated for facial dysmorphism. She had multiple skeletal anomalies like hypoplasia of the right mandible, narrow nasal bridge with broad tip and unilateral notching of the right ala nasi, concomitant squint and low set ears. She also had generalized hypopigmented, atrophic linear macules, multiple papillomas, fat herniations, umbilical hernia, hypoplastic nails, cicatricial alopecia, mild mental retardation, 'lobster-claw' hand and osteopathia striata of long bones, pointing to a diagnosis of Goltz syndrome. The unusual features noted were absence of the left first rib and aortic regurgitation.

Abnormalities, Multiple↗

Risk factors in breast cancer.

Various factors have been found to be predictors of the relative risk of breast cancer (Table 2). Epidemiologic variables influencing breast cancer risk include age, marital status, geographic location, racial or ethnic extraction, and socioeconomic status. The risk of developing mammary carcinoma is increased with advancing age, among unmarried women, in the United States and Europe, and among women of higher socioeconomic classes. Conversely, a decreased breast cancer risk is observed among fertile married women in Asian countries, among Oriental women, and in lower socioeconomic classes. Reproductive history plays an important role in determining breast cancer risk. The risk of developing mammary carcinoma is increased by an early menarche and decreased by delayed first menses. A late natural menopause increases breast cancer risk while an early oophorectomy offers protection. Hormonal factors are thought to play important roles in the etiology of breast cancer, but the contributions of estrogenic and androgenic influences to mammary neoplasia have not been delineated. Certain estrogen fractions have been implicated as mammary carcinogens, while certain adrenal androgenic steroids have been shown to be promotors of breast cancers. Chronic cystic mastitis is associated with an increased breast cancer risk. A positive family history increases the risk of developing mammary carcinoma and a past history of breast cancer markedly increases the possibility of subsequent breast neoplasia.

Age Factors↗

The relationship between marital breakdown and childbearing in England and Wales.

"The paper uses data on women from the General Household Surveys for 1986-89 [for England and Wales] to form combined multiple decrement tables on the transitions from first marriage through childbearing, divorce and remarriage. It shows that ultimately women who experience one marital breakdown tend to have around the same number of children...as those who remain married. However, their time to complete childbearing is rather longer with this extra time being concentrated largely in the birth interval in which the marital breakdown takes place. The group of women who experience more than one marital breakdown tend to have more children and consequently shorter birth intervals."

Birth Intervals↗

Family dynamics and attitudes toward marriage.

To examine our hypothesis that family experiences would be associated with attitudes toward marriage, we administered the Family Environment Scale (FES; Moos & Moos, 1986) and a Marriage Attitudes Questionnaire (MAQ; adapted from Long, 1987) to 40 unmarried college students. Correlational analyses indicated that for the conflict subscale of the FES, only two of the six marital expectation questions approached significance. However, family expressiveness (another subscale of the FES) was significantly correlated with three of the marital expectation questions and approached significance with a fourth question. These results indicated that higher expressiveness in the family was significantly related to positive attitudes toward marriage. We concluded that family dynamics need to be studied from multiple perspectives to identify factors that influence marital expectations.

Age Factors↗

Cohabitation, marriage, and 'sexual monogamy' in Nairobi's slums.

The current study investigates the extent to which sexual exclusivity--the restriction of one's sexual engagements to a single partner--prevails across various marital status, union type, and co-residence categories among Nairobi's poorest residents, slum dwellers. This question is central to the spread of HIV in the increasingly urban and poor, high prevalence countries of sub-Saharan Africa, where transmission is primarily via heterosexual sex. In many circles, sexual exclusivity is considered a prominent feature of the marriage institution. Yet, marriage and cohabitation are often not easily distinguishable in sub-Saharan Africa, meaning that the frequent use, as a proxy, of the "in union" category, which includes married as well as cohabiting persons can, at best, be considered tenuous. Using the 2000 Nairobi Cross-Sectional Slum Survey (NCSS), this paper confirms that marriage is associated with higher reports of sexual exclusivity even in settings where poverty provokes risky behavior. The finding, here, is of lower risk of HIV infection for married respondents, with a smaller effect observed among non-married cohabiters. Converse to the implied benefits of marriage, though, women with co-wives are more likely to report multiple partners. The implications of these findings are discussed.

Adolescent↗

The marital relationship and health in women with chronic fatigue and immune dysfunction syndrome: views of wives and husbands.

The purpose of this study was to describe the association between the marital relationship and the health of the wife with chronic fatigue and immune dysfunction syndrome (CFIDS). The convenience sample of 131 wives with CFIDS and their spouses reported their marital relationships similarly, but the wives reported higher CFIDS symptom scores. Marital adjustment scores, wives' conflict scores, and husbands' self-empathy scores were associated with wives' CFIDS symptom scores. Hierarchical multiple regression models showed wives with higher education, lengthier marriages, dyads with higher marital adjustment, and wives with less conflict and less support were predictive of lower problematic CFIDS symptoms.

Adaptation, Psychological↗

Clinical social work roles in an integrative, interdisciplinary team: enhancing parental compliance.

This paper is directed toward those attempting to develop effective social work functions within an interdisciplinary treatment team and utilizes a specialized group as a demonstration model. The Inborn Errors of Metabolism Team at the University of Tennessee Child Development Center deals with children whose genetic disorders require precise dietary management for the prevention of various handicapping conditions including mental retardation. Representatives of the six disciplines forming the core team recognize that professional interdependence must combine with parental cooperation if the program is to succeed. The clinical social worker is a permanent member of the team and focuses on the family during the years each child is followed. Social work roles are multiple and include those of crisis interventionist, family therapist, marriage counselor, patient advocate, and team interpreter. Such social work involvement is essential in the holistic approach to long-term patient care which recognizes that no disorder exists apart from the patient, nor the patient from his family.

Child↗

Premarital fertility in Namibia: trends, factors and consequences.

Premarital fertility, defined as fertility before first marriage, was found to be highly prevalent in Namibia. According to data from the 1992 and 2000 DHS surveys, the proportion of premarital births was 43% for all births, and 60% for the first birth. This seemed to be primarily due to a late mean age at first marriage (26.4 years) and low levels of contraception before first marriage. Data were analysed using a variety of demographic methods, including multiple decrement life table and multivariate logistic models. Major variations were found by ethno-linguistic groups: Herero and Nama/Damara had the highest levels of premarital fertility (above 60%); Ovambo and Lozi had intermediate levels of premarital fertility (around 40%); Kavongo and San appeared to have kept a more traditional behaviour of early marriage and low levels of premarital fertility (around 20%). The largest ethno-linguistic group, the Ovambo, were in a special situation, with fast increasing age at marriage and average level of premarital fertility. Whites and mixed races also differed, with Afrikaans-speaking groups having a behaviour closer to the average, whereas other Europeans had less premarital fertility despite an average age at marriage. Ethnic differences remained stable after controlling for various socioeconomic factors, such as urbanization, level of education, wealth, access to mass media, and religion. Results are discussed in light of the population dynamics and political history of Namibia in the 20th century.

Adolescent↗

Social support among persons with multiple sclerosis.

The source and magnitude of perceived social support functions and structure were examined in relation to illness duration, gender, and presence or absence of spouses among 200 persons with multiple sclerosis. The associations between social support variables and a health index, ADL level of functioning, also were examined. Significant gender differences were shown for perceived availability of affect, affirmation, and aid functions. A significant change in the network property, average frequency of relationships, occurred over the chronic illness trajectory. Low to moderate correlations were observed between a number of activities of daily living and both perceived social support functions and network size, particularly for women. Implications for professional staff who provide health services for persons with MS are presented. Further study regarding lower levels of perceived social support in women than men and low levels of informational support in both men and women is suggested.

Activities of Daily Living↗

Endogamy, consanguinity and community genetics.

The population of India is composed of many thousands of subpopulations, divided by geography, language, religion and caste or biraderi (patrilineage) boundaries, with endogamous marriage the norm. The net effect has been the creation of multiple genetic isolates with individual mutation profiles, but to date the clinical consequences of this highly complex differentiation have been largely ignored. In contrast, the topic of consanguinity continues to attract attention among medical and population geneticists, clinicians and social scientists. The significant progress made in India in improving childhood nutritional status and combating infectious disease means that genetic disorders have assumed ever-increasing importance. In populations where consanguineous marriage is widely practised, recessive genetic disorders will continue to gain greater prominence in the overall spectrum of ill health. At the same time this increase will in part be negated by urbanization and the move to smaller family sizes, which predictably will result in a decline in the prevalence of consanguineous unions. Developing an understanding of these changes will require a wide-ranging and multidisciplinary investigative approach for which community genetics is ideally suited.

Consanguinity↗