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Effect of bovine viral diarrhea virus infection on fertility of dairy heifers.

A prospective field study in heifers from birth to first breeding was undertaken on two commercial dairies to assess the effect of bovine viral diarrhea virus (BVDV) congenital and post-natal infection (PNI) on fertility. A high BVDV Type 2 antibody titer (1:4096) at 10 months of age was associated with 32 more days to conceive, compared with a low titer (1:128). Conversely, infection with BVDV by 5-6 months of age and high BVDV Type 2 titers 1 month before conception or breeding was associated with improved fertility. Heifers with evidence of congenital BVDV infection had lower fertility than non-infected heifers (15-42 days longer time-to-first AI), which depended on BVDV Type 2 titers at 10 months of age. Neospora caninum infection was associated with additional services per conception (SPC) and Leptospira interrogans infection was associated with a delay in the time-to-first breeding. It appears that under field conditions, the effect of subclinical BVDV infection on subsequent heifer fertility may be due to a complex of interrelationships among multiple BVDV infections that depend on the type and timing of infection relative to reproductive development and events.

Animals↗

[Prevalence of urinary incontinence in Moroccan women. Report of 1,000 cases].

An inquiry concerning the prevalence of urinary incontinence for the moroccan women has been archived about 1000 women aged more than 18 years to study prevalence, epidemiology and risk factors of urinary incontinence. 271 women among the 1000 women said that they had suffered from the mictional disorder at least one time during the last month, let 27.1%; 48.7% of the incontinent women are from 30 to 60 years; 22.5% are less than 30 years old, and 8.85% are more than 75 years old. Among these 271 women, 49.44% suffered from leakage after making an effort; 42.80% an imperiosity, and 7.76% spontaneous leakage. Seventy per cent among these women had level of study at least medium; 85.97% among these women suffered the discomfort; but 8.48% of them had been consulted for this disorder, 78.96% are able to consult a medical and to have a clinical or paraclinical exams. The elements who are responsible of this disorder are: menopause, parity, the use of forceps, the weight of first child birth over 3.5 kg, the perineal tearing. Among the medical antecedents we find: chronic bronchitis, urinary infections, chronic constipation, diabetes, and in the other way among surgical antecedents are: hysterectomy and prolapsus cure.

Adult↗

Mobility challenges and solutions for fibrodysplasia ossificans progressiva.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by progressive soft tissue ossification. Although signs may be present at birth, the first appearance of ectopic bone typically occurs in early childhood. The primary target is the axial musculature. Eventually ectopic bone also occurs in ligaments, fascia, aponeurosis, tendons, and joint capsules of the appendicular skeleton with a proximal to distal predilection. As the disease advances, mobility becomes restricted, and affected individuals are typically limited to bed or chair by their early 30s. This report describes a 30-year-old woman with advanced FOP. She had a fused spine and a fixed pelvis, with hips and knees locked in flexion and feet in plantarflexion. Her upper limb mobility was similarly restricted. She was not able to stand upright or sit independently. The modification of a commercially available power wheelchair that allowed the patient to maintain her employment as a preschool teacher and custom shoes are described. Creative physiatric intervention is essential to liberate human potential for people with FOP.

Activities of Daily Living↗

Oral contraceptives and breast disease.

Epidemiologic data support the hypothesis that the types of OCs used before the mid-1970s protected against most forms of benign breast disease. It is unclear whether current low-dose progestogen OCs will confer the same protection. Further studies are necessary to clarify this. For breast cancer, the relationship is more complex. It is possible that prolonged use of high-dose OCs exert a small increased risk for breast cancer development in women before age 45. Furthermore, prolonged use before a first term pregnancy may result in a small increase in risk for breast cancer before age 45. Studies evaluating the effect of current low-dose OCs are necessary to elucidate what, if any, effect they may have on breast cancer development. Furthermore, as our population ages, studies will be able to determine what effect, if any, may be present in women over age 60, those women with the highest underlying risk of breast cancer. And finally, more research of basic breast tissue physiology and the effect of endogenous and exogenous hormones on this complex organ is needed.

Breast↗

The association between smoking and female infertility as influenced by cause of the infertility.

Smoking histories were compared in 901 women with infertility of different types and 1264 women admitted for delivery at seven collaborating hospitals. The relative risk for infertility associated with cigarette smoking prior to the infertility diagnosis for nulliparous cases or first live birth for controls was calculated using a multivariate logistic-regression model to control for potential confounding factors, including center, age, religion, education, number of sexual partners, and contraceptive use. The adjusted risk for infertility attributed primarily to cervical factor (n = 96) was 1.7 (P = 0.04), to tubal disease unrelated to endometriosis (n = 225) was 1.6 (P = 0.009), to ovulatory factor (n = 389) was 1.0 (not significant [NS]), and to endometriosis (n = 191) was 0.9 (NS). The authors conclude that cigarette smoking is significantly associated only with certain types of primary female infertility.

Adult↗

The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery.

OBJECTIVE: To describe the appearance and occurrence of abnormalities in the levator ani muscle seen on magnetic resonance imaging (MRI) in nulliparous women and in women after their first vaginal birth. METHODS: Multiplanar proton density magnetic resonance images were obtained at 0.5-cm intervals from 80 nulliparous and 160 vaginally primiparous women. These had been previously obtained in a study of stress incontinence, and half the primiparas had stress incontinence. All scans were reviewed independently by at least two examiners blinded to parity and continence status. RESULTS: No levator ani defects were identified in nulliparous women. Thirty-two primiparous women (20%) had a visible defect in the levator ani muscle. Defects were identified in the pubovisceral portion of the levator ani in 29 women and in the iliococcygeal portion in three women. Within the pubovisceral muscle, both unilateral and bilateral defects were found. The extent of abnormality varied from one individual to the next. Of the 32 women with defects, 23 (71%) were in the stress incontinent group. CONCLUSION: Abnormalities in the levator ani muscle are present on MRI after a vaginal delivery but are not found in nulliparas.

Adult↗

Temporal and behavioral patterning of parturition in rabbits and rats.

Although the rabbit (Oryctolagus cuniculus) continues to play an important role in the study of parturitional processes, a detailed behavioral description of birth in this species, necessary for accurately assessing the effects of experimental manipulation, is lacking. It is the aim of this report to provide such a description and to compare it with corresponding behavior in the better-studied rat. Ten pregnant chinchilla-breed rabbits and 10 pregnant Wistar rats were placed in glass-bottomed observation cages 2 days before term, and their behavior recorded on closed-circuit video, viewing the animals from below. All aspects of parturition were accomplished much faster in rabbits than rats; latency to birth of first pup, rate of delivery, duration of vaginal retention, time spent by mothers eating placentas, and in licking and nursing pups. In contrast to rat pups, rabbits were usually born separated from the placenta and already free from membranes. They were much more active, and well able to cast off any remaining membranes, suckle, and survive, whether directly attended to by the mother or not. We conclude that the tight temporal organization of events in the rabbit provides an unusually sensitive assay for investigating mechanisms underlying mammalian parturition.

Animals↗

Developmental changes in binding sites and reactivity for CGRP and VIP in porcine pulmonary arteries.

During postnatal adaptation pulmonary arteries dilate. CGRP and VIP are pulmonary vasodilators. In this report, porcine lungs from newborn to adult were studied. Radiolabeled ligand binding and autoradiography showed CGRP binding sites on the endothelium of pulmonary arteries and veins, which increased postnatally, and VIP binding sites on smooth muscle, which decreased. Isolated conduit arteries relaxed normally (initially endothelium dependent) in response to CGRP from birth. VIP first caused relaxation at 10 days and was endothelium dependent. Age-related changes in receptor binding density were not always reflected in an appropriate alteration in pharmacological response.

Adaptation, Physiological↗

18Fluoro-2-deoxyglucose (18FDG) PET scan of the brain in propionic acidemia: clinical and MRI correlations.

The clinical data and the imaging findings of the positron emission tomography (PET) and the magnetic resonance imaging (MRI) studies in five patients, previously diagnosed to have propionic acidemia, were retrospectively reviewed. The patients were all normal at birth. The first clinical signs, typically hypotonia and failure to thrive, appeared during the first 2 years of life. With progression of the disease, the neurological findings consisted of variable degrees of dementia and extrapyramidal symptoms, notably dystonia, choreoathetosis and rigidity of variable degrees. Initial cerebral PET and MRI studies were normal. Follow-up MRI examinations showed progressive basal ganglia degeneration, with evidence of atrophy and signal abnormalities within the caudate nuclei and the putamina. The thalamic structures were normal. The PET studies demonstrated increased uptake in the basal ganglia and thalami, followed by decreased uptake in the basal ganglia at a later stage of the disease. The structural (MRI) and the functional (PET) studies of the brain were found to be complementary in the evaluation of propionic acidemia, and were in good correlation with the clinical findings.

Brain↗

Interaction fallacy.

We define interaction fallacy as the situation in which heterogeneity of odds ratios suggests an interaction that does actually not exist among the corresponding risk ratios. We provide a hypothetical example of interaction fallacy between the presence of the germ-line BRCA1 mutation, age at first live birth, and breast cancer risk based on data from the literature. More generally, we present a set of hypothetical conditions under which interaction fallacy may occur.

Adult↗

Sexual behaviour in pregnancy, after childbirth and during breast-feeding.

Sexual and marital relationships change throughout marriage and the transition to parenthood can be seen as a psychosocial crisis. Recent studies do not support the finding of Masters and Johnson (1966) that there is a mid-trimester rise in sexual responsiveness. Sexual behaviour decreases towards the end of pregnancy and a number of studies have found that in the majority of mothers there is only a slow return to pre-pregnancy levels in the first postnatal year. Some of the factors influencing the rate of return are discussed. Breast-feeding is important because of the hormonal changes it produces and it has been said to stimulate sexual feelings in both mother and baby. There is some evidence that breast-feeding has an adverse effect on sexuality in the first postnatal year. It is not clear whether this could be related to differences in hormone levels or differences in feeding behaviour. Fatigue and contraception have largely been ignored in studies of factors influencing postnatal sexual behaviour. Women who went on to breast-feed were found to be very similar on antenatal measures of sexual behaviour to those who went on to bottle-feed. The method of feeding is the major influence on the hormonal status, and the experience of painful intercourse reported by breast-feeding mothers may be related to low oestrogen levels. Breast-feeding persistence is influenced by both social and psychological factors and its effect on sexual behaviour is discussed.

Breast Feeding↗

Risk estimation for breast cancer development; a clinical perspective.

Breast cancer is the commonest cancer among women and the second highest cause of cancer death. It remains a significant health problem and represents a significant worry for many women and their physician. During the last years, intensive research has been focused on accurate risk estimation for breast cancer development. The aim of these efforts is to identify the "high-risk" group of women for breast cancer development. Preventive strategies (including intensive surveillance, chemoprevention, or prophylactic mastectomy) may be applied for the women at high risk for breast cancer development. Given the many management options, it seems reasonable that management of the high-risk woman be tailored to the level of risk she is willing to accept. In estimating the risk for breast cancer development, several factors should be taken into account (including age, reproductive factors, such as age at menarche and age at menopause or pregnancy and age at first live birth, history of benign breast lesions or breast cancer in situ [LCIS/DCIS], prior history of breast cancer, history of familiar or hereditary breast cancer, and environmental and lifestyle factors). Recently, quantitative risk estimation is possible by combining multiple risk factors into a comprehensible risk expression; this is of significant clinical importance, since it will reduce the considerable variation in management among health care providers. The Gail and the Claus model are the most widely used models for quantitative risk estimation. However, the clinician should understand that all models have some limitations that should be recalled as they are applied. It should be emphasized that risk assessment is a serious undertaking and should only be performed by those who have in-depth knowledge about risk factors, family pedigree analysis, comparative statistics, genetics susceptibility testing and the science of probability.

Anticarcinogenic Agents↗

Laparoscopic tubal anastomosis.

We conducted a retrospective chart review of 22 laparoscopic tubal anastomoses performed between May 1987 and May 1991. The procedures were modeled after the two-stitch technique of Swolin. Overall fertility rates were disappointing in this small series, although the first live birth has occurred. The two-stitch method and available laparoscopic suture needles and needle holders limited the surgical results. Modifications of technique and instrumentation should improve fertility outcome.

Adult↗

Psychosocial factors and obstetric complications.

A number of studies have attempted to explain obstetric difficulties on the basis of psychosocial conditions which exist during pregnancy. In addition, recent research in the field of life event stress has indicated that life experiences occurring prior to a pregnancy may influence pregnancy outcome. The present study examines the ability of life event stress as well as a variety of medical, social and psychological variables to predict complications of pregnancy. In contrast to previous small-sample research, the present study examines 782 subjects. Multivariate statistical techniques are employed to analyse the numerous variables measured. Results suggest that 'age at birth of first child', 'education level', 'menstrual history', 'attitudes to pregnancy' and 'age at menstruation' best predict obstetric difficulties. However, only a small percentage of the variance of pregnancy complication scores is explained by these factors.

Adolescent↗

Genetic influences on post-natal depressive symptoms: findings from an Australian twin sample.

BACKGROUND: Conflicting evidence exists on causes of vulnerability to post-natal depression. We investigated genetic and environmental influences on variation in post-natal depressive symptoms (PNDS) following first live birth, and sources of covariation with the personality trait Neuroticism and lifetime major depression occurring post-natally (DEP-PN) and at other times (DEP-XPN) to test for shared genetic influences. METHOD: Retrospective interview and questionnaire data from 838 parous female twin pairs (539 monozygotic, 299 dizygotic) from the Australian National Health and Medical Research Council volunteer adult twin register were used for multivariate genetic model-fitting. Data on PNDS were evaluated for consistency with diagnostic interview assessment. RESULTS: Genetic factors explained 38% of variance in PNDS (95% confidence interval 26-49%) and 25% of the variance in interview-assessed DEP-PN. The genetic correlation between PNDS and lifetime major depression (DEP-PN and DEP-XPN) was low (r(g) = 0.17, 95% confidence interval = 0.09-0.28), suggesting that the questionnaire was measuring a construct other than postnatally occurring major depression, possibly post-natal dysphoria. Associations between PNDS and obstetric factors were very modest. CONCLUSIONS: Findings suggest modest genetic influences on major depression occurring postnatally. Independent and stronger genetic influences identified for post-natal symptomatology or dysphoria (PNDS) justify further investigation.

Adult↗

The birth of a specialty: the first ten thousand patients of an old age psychiatry service.

BACKGROUND: Old age psychiatry as a clinical specialty emerged in the 1970s and modern, open-access multidisciplinary services started in the mid-1980s in South London. There are few accounts of referrals to old age psychiatry services and no quantitative accounts of the referral patterns to such teams. We report on the first 10,000 patients newly referred to the first such service in the world. METHODS: Observational study on routinely gathered data on age, gender, referral source, discipline of team member involved, diagnosis and duration of contact. Data validation was by iterative feedback to clinicians. RESULTS: Ten thousand patients were referred between December 1983 and March 2000. Missing data rates were low. The overall referral rate was 21.0 per 1000 population over 65 per annum, with the highest rate in those 85+ years old, in whom there was a marked rise over time. The rise in referral rate compensated for a decline in the population over 65 so that the numbers of referrals rose. Although there was a rise in the rate of referral of people with an organic diagnosis over time, this was not statistically significant. Organic patients constituted 50-60% of referrals but had shorter contact times than functional ones. Cause for concern included a low rate of referral from care homes, and a high proportion of possibly inappropriate referrals from medical and general psychiatry services. We were pleased to see no excess of such referrals from open-access sources, confirming earlier work. CONCLUSIONS: Descriptive data on referrals and workload of the first open-access multidisciplinary old age psychiatry service have generated cause for both celebration and concern.

Aged↗