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Sample records for age-specific perinatal mortality

  1. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  2. Perinatal mortality in rural Tanzania.

    PubMed

    van Roosmalen, J

    1989-07-01

    Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent prolonged labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).

  3. Perinatal Mortality in the United States, 1950-81.

    ERIC Educational Resources Information Center

    Powell-Griner, Eve

    1986-01-01

    This report describes long-term trends in perinatal mortality in the United States in three basic parts: development of perinatal mortality measures, components of fetal and infant mortality, and trends and differentials in perinatal mortality. Perinatal deaths refer to the sum of spontaneous fetal deaths occurring after 20 weeks gestation plus…

  4. Naturalization of immigrants and perinatal mortality

    PubMed Central

    Englert, Yvon; Buekens, Pierre

    2013-01-01

    Background: Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship status. Methods: This was a population-based study using 2008 data from the Belgian birth register data pertaining to regions of Brussels and Wallonia. Odds ratio (OR) and 95% confidence intervals (95% CIs) for perinatal mortality according to naturalization status were calculated by logistic regression analyses adjusting for parents’ medical and social characteristics. Results: Four hundred and thirty-seven perinatal deaths were registered among 60 881 births (7.2‰). Perinatal mortality rate varied according to the origin of the mother and her naturalization status: among immigrants, non-naturalized immigrants had a higher incidence of perinatal mortality (10.3‰) than their naturalized counterparts (6.1‰) with an adjusted OR of 2.2, 95% CI (1.1–4.5). Conclusion: In a country with a high frequency of naturalization, and universal access to health care, naturalized immigrant mothers experience less perinatal mortality than their not naturalized counterparts. PMID:22490473

  5. Why perinatal mortality cannot be a proxy for maternal mortality.

    PubMed

    Akalin, M Z; Maine, D; de Francisco, A; Vaughan, R

    1997-12-01

    In recent years, the perinatal mortality rate (PNMR) has been proposed as a proxy measure of maternal mortality, because perinatal deaths are more frequent and potentially more easily measured. This report assesses evidence for an association between these two statistics. This study, based upon data from Matlab, Bangladesh, shows that the maternal mortality ratio (MMR) and the PNMR do not vary together over time, and that the PNMR does not reliably indicate either the magnitude or the direction of change in the MMR from year to year. Statistical analysis shows that the correlation between the PNMR and the MMR is not significantly different from zero. An examination of the major causes of maternal and perinatal deaths indicates that the two measures cannot be expected to vary together. Almost half of perinatal deaths result from causes that do not pose a threat to the mother's life, and almost half of maternal deaths result from causes that do not lead to perinatal death. Monitoring of the PNMR can give an inaccurate picture of maternal mortality and should not be used as a proxy.

  6. Action plan to reduce perinatal mortality.

    PubMed

    Bhakoo, O N; Kumar, R

    1990-01-01

    The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

  7. Age-Specific Morbidity and Mortality Rates Among U.S. Navy Enlisted Divers and Controls

    DTIC Science & Technology

    1984-07-01

    The purpose of this study was to compare age-specific hospitalization, disability, and mortality rates for diving-related and stress- induced...actions for stress-related disorders were observed among controls than divers. For both groups, medical board, physical evaluation board, and mortality ... rates increased with age as did hospitalization for musculoskeletal disorders, stress-related disorders, and circulatory diseases. Subsequent research

  8. Diabetes and Perinatal Mortality in Twin Pregnancies

    PubMed Central

    Luo, Zhong-Cheng; Zhao, Yan-Jun; Ouyang, Fengxiu; Yang, Zu-Jing; Guo, Yu-Na; Zhang, Jun

    2013-01-01

    Background Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk “shift” may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths). This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth) in twin pregnancies. Methods This was a retrospective cohort study of twin births using the largest available dataset on twin births (the U.S. matched multiple birth data 1995-2000; 19,676 neonates from diabetic pregnancies, 541,481 from non-diabetic pregnancies). Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR) of perinatal death accounting for twin cluster-level dependence. Results Comparing diabetic versus non-diabetic twin pregnancies, overall perinatal mortality rate was counterintuitively lower [2.1% versus 3.3%, aHR 0.70 (95% confidence intervals 0.63-0.78)]. Individually, both stillbirth and neonatal mortality rates were lower in diabetic pregnancies, but we identified significant differences by gestational age and birth weight. Diabetes was associated with a survival benefit in pregnancies completed before 32 weeks [aHR 0.55 (0.48-0.63)] or with birth weight <1500 g [aHR 0.61 (0.53-0.69)]. In contrast, diabetes was associated with an elevated risk of perinatal death in pregnancies delivered between 32 and 36 weeks [aHR 1.38 (1.10-1.72)] or with birth weight >=2500 g [aHR 2.20 (1.55-3.13)]. Conclusions Diabetes in pregnancy appears to be “protective” against perinatal death in twin pregnancies ending in very preterm or very low birth weight births. Prospective studies are required to clarify whether these patterns of risk are real, or they are artifacts of unmeasured confounders. Additional data correlating these outcomes with the types of diabetes in pregnancy are also needed to distinguish the effects of pre-gestational vs. gestational diabetes

  9. Age-specific measles mortality during the late 19th-early 20th centuries.

    PubMed

    Shanks, G D; Waller, M; Briem, H; Gottfredsson, M

    2015-12-01

    Measles mortality fell prior to the introduction of vaccines or antibiotics. By examining historical mortality reports we sought to determine how much measles mortality was due to epidemiological factors such as isolation from major population centres or increased age at time of infection. Age-specific records were available from Aberdeen; Scotland; New Zealand and the states of Australia at the end of the 19th and beginning of the 20th centuries. Despite the relative isolation of Australia, measles mortality was concentrated in very young children similar to Aberdeen. In the more isolated states of Tasmania, Western Australia and Queensland adults made up 14-15% of measles deaths as opposed to 8-9% in Victoria, South Australia and New South Wales. Mortality in Iceland and Faroe Islands during the 1846 measles epidemic was used as an example of islands isolated from respiratory pathogens. The transition from crisis mortality across all ages to deaths concentrated in young children occurred prior to the earliest age-specific mortality data collected. Factors in addition to adult age of infection and epidemiological isolation such as nutritional status and viral virulence may have contributed to measles mortality outcomes a century ago.

  10. Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh.

    PubMed Central

    Kusiako, T.; Ronsmans, C.; Van der Paal, L.

    2000-01-01

    Very few population-based studies of perinatal mortality in developing countries have examined the role of intrapartum risk factors. In the present study, the proportion of perinatal deaths that are attributable to complications during childbirth in Matlab, Bangladesh, was assessed using community-based data from a home-based programme led by professional midwives between 1987 and 1993. Complications during labour and delivery--such as prolonged or obstructed labour, abnormal fetal position, and hypertensive diseases of pregnancy--increased the risk of perinatal mortality fivefold and accounted for 30% of perinatal deaths. Premature labour, which occurred in 20% of pregnancies, accounted for 27% of perinatal mortality. Better care by qualified staff during delivery and improved care of newborns should substantially reduce perinatal mortality in this study population. PMID:10859856

  11. Age-specific patterns of genetic variance in Drosophila melanogaster. II. Fecundity and its genetic covariance with age-specific mortality

    SciTech Connect

    Tatar, M.; Promislow, D.E.L.; Khazaeli, A.A.; Curtsinger, J.W.

    1996-06-01

    Under the mutation accumulation model of senescence, it was predicted that the additive genetic variance (V{sub A}) for fitness traits will increase with age. We measured age-specific mortality and fecundity from 65,134 Drosophila melanogaster and estimated genetic variance components, based on reciprocal crosses of extracted second chromosome lines. Elsewhere we report the results for mortality. Here, for fecundity, we report a biomodal pattern for V{sub A} with peaks at 3 days and at 17-31 days. Under the antagonistic pleiotropy model of senescence, it was predicted that negative correlations will exist between early and late life history traits. For fecundity itself we find positive genetic correlations among age classes >3 days but negative nonsignificant correlations between fecundity at 3 days and at older age classes. For fecundity vs. age-specific mortality, we find positive fitness correlations (negative genetic correlations) among the traits at all ages >3 days but a negative fitness correlation between fecundity at 3 days and mortality at the oldest ages (positive genetic correlations). For age-specific mortality itself we find overwhelmingly positive genetic correlations among all age classes. The data suggest that mutation accumulation may be a major source of standing genetic variance for senescence. 75 refs., 4 figs., 1 tab.

  12. A medical geography of perinatal mortality in Metropolitan Cape Town.

    PubMed

    Rip, M R; Keen, C S; Kibel, M A

    1986-09-27

    An infant's weight at birth as well as its socio-economic environment are recognized as constituting two of the major risk factors associated with perinatal mortality. Spatial analyses of birth weight, socio-economic status and perinatal mortality in Metropolitan Cape Town for the year 1982 are presented in an attempt to assess the relationship between these variables at the suburb (or community) level. Variations in perinatal mortality for each suburb were found to be highly correlated with variations in the distribution of low birth weights. Overall, it would appear that the geography of the interrelationship between low birth weight and perinatal mortality tends, in part, to mirror long-standing gradients in socio-economic status--particularly for those coloured communities which show high perinatal death rates. To what extent these variations are associated with available antenatal and infant health care services can only be postulated. Points for possible community intervention are suggested.

  13. Method for projecting age-specific mortality rates for certain causes of death

    SciTech Connect

    Leggett, R.W.; Crawford, D.J.

    1981-01-01

    A method is presented for projecting mortality rates for certain causes on the basis of observed rates during past years. This method arose from a study of trends in age-specific mortality rates for respiratory cancers, and for heuristic purposes it is shown how the method can be developed from certain theories of cancer induction. However, the method is applicable in the more common situation in which the underlying physical processes cannot be modeled with any confidence but the mortality rates are approximable over short time intervals by functions of the form a exp(bt), where b may vary in a continuous, predictable fashion as the time interval is varied. It appears from applications to historical data that this projection method is in some cases a substantial improvement over conventional curve-fitting methods and often uncovers trends which are not apparent from observed data.

  14. A method for projecting age-specific mortality rates for certain causes of death

    SciTech Connect

    Leggett, R.W.; Crawford, D.J.

    1981-09-01

    A method is presented for projecting mortality rates for certain causes on the basis of observed rates during past years. This method arose from a study of trends in age-specific mortality rates for respiratory cancers, and for heuristic purposes it is shown how the method can be developed from certain theories of cancer induction. However, the method is applicable in the more common situation in which the underlying physical processes cannot be modeled with any confidence but the mortality rates are approximable over short time intervals by functions of the form a exp(bt), where b may vary in a continuous, predictable fashion as the time interval is varied. It appears from applications to historical data that this projection method is in some cases a substantial improvement over conventional curve-fitting methods and often uncovers trends which are not from observed data.

  15. Age-specific patterns of genetic variance in Drosophila melanogaster. I. Mortality

    SciTech Connect

    Promislow, D.E.L.; Tatar, M.; Curtsinger, J.W.

    1996-06-01

    Peter Medawar proposed that senescence arises from an age-related decline in the force of selection, which allows late-acting deleterious mutations to accumulate. Subsequent workers have suggested that mutation accumulation could produce an age-related increase in additive genetic variance (V{sub A}) for fitness traits, as recently found in Drosophila melanogaster. Here we report results from a genetic analysis of mortality in 65,134 D. melanogaster. Additive genetic variance for female mortality rates increases from 0.007 in the first week of life to 0.325 by the third week, and then declines to 0.002 by the seventh week. Males show a similar pattern, though total variance is lower than in females. In contrast to a predicted divergence in mortality curves, mortality curves of different genotypes are roughly parallel. Using a three-parameter model, we find significant V{sub A} for the slope and constant term of the curve describing age-specific mortality rates, and also for the rate at which mortality decelerates late in life. These results fail to support a prediction derived from Medawar`s {open_quotes}mutation accumulation{close_quotes} theory for the evolution of senescence. However, our results could be consistent with alternative interpretations of evolutionary models of aging. 65 refs., 2 figs., 2 tabs.

  16. Age-specific mortality trends in France and Italy since 1900: period and cohort effects.

    PubMed

    Caselli, G; Vallin, J; Vaupel, J W; Yashin, A

    1987-11-01

    The age/sex-specific mortality trends of France and Italy were studied over the 1899-1979 period in as much detail as possible in an effort to distinguish between cohort effects and those related to period changes. Complete series of mortality data by individual years of age and calendar years were available from 1869 to 1979 for Italy and from 1899 to 1982 for France. For both countries, these data include the military and civil deaths not registered in vital statistics during the war periods. They cover each national territory as defined by its present boundaries. The graphical representation method of mortality surfaces, elaborated by Vaupel, Gambill, and Yashin (1985), was adopted. The age/sex-specific mortality patterns of France and Italy have not followed the same trends, and the differences observed today are not those of 100 years ago. The mean death probabilities for the 1975-79 period were used to illustrate the age-specific patterns of mortality. Although infant mortality was higher in Italy than in France, the death probabilities at ages 1-15 for both sexes were roughly the same for both countries. At ages 15-23, they were much higher in France than in Italy, and they remained considerably higher in France up to age 55. From then on, the sexes differ: for males, the 2 countries showed similar patterns, whereas for females the probabilities were noticeably higher for France. The situation was very different for both countries at the beginning of the century. For both sexes, higher mortality was observed in Italy not only during infancy but throughout childhood and the adolescent years up to age 15. The 2 countries showed similar patterns from 15-25. Above age 25, the 2 countries had similar patterns for females, whereas male mortality was higher in France right up to the old age groups. Such differences in the age-specific mortality trends depend in part on a different development of health and social conditions but also may be due to factors concerning

  17. Levels and risk factors for perinatal mortality in Ahmedabad, India.

    PubMed Central

    Mavalankar, D. V.; Trivedi, C. R.; Gray, R. H.

    1991-01-01

    To estimate levels and determinants of perinatal mortality, we conducted a hospital-based surveillance and case-control study, linked with a population survey, in Ahmedabad, India. The perinatal mortality rate was 79.0 per 1000, and was highest for preterm low-birth-weight babies. The case-control study of 451 stillbirths, 160 early neonatal deaths and 1465 controls showed that poor maternal nutritional status, absence of antenatal care, and complications during labour were independently associated with substantially increased risks of perinatal death. Multivariate analyses indicate that socioeconomic factors largely operate through these proximate factors and do not have an independent effect. Estimates of attributable risk derived from the prevalence of exposures in the population survey suggest that improvements in maternal nutrition and antenatal and intrapartum care could result in marked reductions of perinatal mortality. PMID:1934237

  18. Agricultural pesticide exposure and perinatal mortality in central Sudan.

    PubMed Central

    Taha, T. E.; Gray, R. H.

    1993-01-01

    Hospital- and community-based studies were conducted in central Sudan to investigate the association between pesticide exposure and perinatal mortality. The cases were 197 stillbirths in the hospital and 36 perinatal deaths in the community; the controls were 812 liveborn, normal-birth-weight infants in the hospital, and 1505 liveborn infants who survived for the first 7 days after birth in the community. The odds ratio (OR) of perinatal death associated with pesticide exposure was estimated using multiple logistic regression. There was a consistent and significant association between pesticide exposure and perinatal mortality in the hospital (adjusted OR = 1.9; 95% confidence interval (CI): 1.3-2.8) and the community populations (adjusted OR = 2.7; 95% CI: 1.1-6.4). The OR was significantly higher among women engaged in farming (3.6; 95% CI: 1.6-8.0), but not among women in nonfarming occupations (1.6; 95% CI: 0.8-3.3). The estimated attributable risks of perinatal death owing to pesticide exposure were 22.6% for hospital stillbirths and 15.7% for community perinatal deaths; but among women engaged in farming in the hospital population the attributable risks were substantially higher (34.5%). PMID:8324850

  19. Age-specific mortality among advanced-age Chinese citizens and its difference between the two genders.

    PubMed

    Gan, J; Zheng, Z; Li, G

    1998-01-01

    This study describes the patterns of age-specific mortality among the elderly in China. Data were obtained from the 1990 census. The age groups ending in zero were validated with the Weber Index and found to be of good quality among those aged under 97 years. Differences were found between censuses and genders. The data for the aged were adjusted with 2-year moving averages in order to smooth the data. The end age of interval mortality is used. Tables provide single years of age between 60 years and 104 years by sex for the actual number and the adjusted number of each census year: 1953, 1964, 1982, and 1990. The pattern of change in age specific mortality rates (ASMRs) was similar in all census years. Mortality rates were highest among infants aged under 1 year, declined with increased age, and were lowest among 10 year olds. Mortality rose gradually after 10 years and sharply after 40-50 years. ASMRs were "U" shaped. Age-specific interval mortality rates among the elderly show that mortality increased drastically as it approached 90 years of age and then grew more slowly or declined. The Gompers rule about exponential increases among the extremely old (over 90 years) does not apply. Male mortality was higher than female mortality until the very old ages, which showed lower male mortality. The ratio declined with rising age until the two genders were equal. Mortality rose to a point and then declined to a lesser extent. The peak was 93 years in 1953, with a sex ratio (SR) of 32.48; 90 years in 1964, with an SR of 35.22; 93 years in 1982, with an SR of 35.96; and 95 years in 1990, with an SR of 32.94.

  20. The epidemiology of perinatal mortality in multiple births.

    PubMed Central

    Kiely, J. L.

    1990-01-01

    The epidemiology of perinatal mortality in multiple pregnancies was investigated from data on 16,831 multiple births from New York City's computerized vital records for 1978-1984. Twins had a sixfold higher rate of neonatal death and a threefold higher rate of fetal death during labor than had singleton infants. Much of this excess mortality can be explained by the lower birthweight distribution in twins: between 1,001 and 2,500 grams twins had birthweight-specific death rates equivalent to or substantially less than singletons. However, in infants of normal birthweights, twins had more than three times the mortality risk of singletons. For twins in vertex presentation between 1,001 and 3,000 grams, cesarean section did not appreciably reduce neonatal mortality risk. For twins in vertex presentation who weighted more than 3,000 grams the neonatal mortality rate was more than four times higher in vaginal deliveries than in cesarean sections (exact p = 0.034). Efforts to prevent intrapartum and neonatal mortality in multiple births should aim at reducing the incidence of low birthweight twins. More research is needed on the etiology of perinatal problems in normal birthweight twins (greater than or equal to 2,501 grams), especially on the effects of different modes of delivery. PMID:2282443

  1. Tendency for age-specific mortality with hypertension in the European Union from 1980 to 2011.

    PubMed

    Tao, Lichan; Pu, Cunying; Shen, Shutong; Fang, Hongyi; Wang, Xiuzhi; Xuan, Qinkao; Xiao, Junjie; Li, Xinli

    2015-01-01

    Tendency for mortality in hypertension has not been well-characterized in European Union (EU). Mortality data from 1980 to 2011 in EU were used to calculate age-standardized mortality rate (ASMR, per 100,000), annual percentage change (APC) and average annual percentage change (AAPC). The Joinpoint Regression Program was used to compare the changes in tendency. Mortality rates in the most recent year studied vary between different countries, with the highest rates observed in Slovakia men and Estonia women. A downward trend in ASMR was demonstrated over all age groups. Robust decreases in ASMR were observed for both men (1991-1994, APC = -13.54) and women (1996-1999, APC = -14.80) aged 55-65 years. The tendency of systolic blood pressure (SBP) from 1980 to 2009 was consistent with ASMR, and the largest decrease was observed among Belgium men and France women. In conclusion, SBP associated ASMR decreased significantly on an annual basis from 1980 to 2009 while a slight increase was observed after 2009. Discrepancies in ASMR from one country to another in EU are significant during last three decades. With a better understanding of the tendency of the prevalence of hypertension and its mortality, efforts will be made to improve awareness and help strict control of hypertension.

  2. Tendency for age-specific mortality with hypertension in the European Union from 1980 to 2011

    PubMed Central

    Tao, Lichan; Pu, Cunying; Shen, Shutong; Fang, Hongyi; Wang, Xiuzhi; Xuan, Qinkao; Xiao, Junjie; Li, Xinli

    2015-01-01

    Tendency for mortality in hypertension has not been well-characterized in European Union (EU). Mortality data from 1980 to 2011 in EU were used to calculate age-standardized mortality rate (ASMR, per 100,000), annual percentage change (APC) and average annual percentage change (AAPC). The Joinpoint Regression Program was used to compare the changes in tendency. Mortality rates in the most recent year studied vary between different countries, with the highest rates observed in Slovakia men and Estonia women. A downward trend in ASMR was demonstrated over all age groups. Robust decreases in ASMR were observed for both men (1991-1994, APC = -13.54) and women (1996-1999, APC = -14.80) aged 55-65 years. The tendency of systolic blood pressure (SBP) from 1980 to 2009 was consistent with ASMR, and the largest decrease was observed among Belgium men and France women. In conclusion, SBP associated ASMR decreased significantly on an annual basis from 1980 to 2009 while a slight increase was observed after 2009. Discrepancies in ASMR from one country to another in EU are significant during last three decades. With a better understanding of the tendency of the prevalence of hypertension and its mortality, efforts will be made to improve awareness and help strict control of hypertension. PMID:25932090

  3. Age-Specific Variation in Adult Mortality Rates in Developed Countries

    PubMed Central

    Zheng, Hui; Yang, Y. Claire; Land, Kenneth C.

    2016-01-01

    This paper investigates historical changes in both single-year-of-age adult mortality rates and variation of the single-year mortality rates around expected values within age intervals over the past two centuries in 15 developed countries. We apply an integrated Hierarchical Age-Period-Cohort—Variance Function Regression Model to data from the Human Mortality Database. We find increasing variation of the single-year rates within broader age intervals over the life course for all countries, but the increasing variation slows down at age 90 and then increases again after age 100 for some countries; the variation significantly declined across cohorts born after the early 20th century; and the variation continuously declined over much of the last two centuries but has substantially increased since 1980. Our further analysis finds the recent increases in mortality variation are not due to increasing proportions of older adults in the population, trends in mortality rates, or disproportionate delays in deaths from degenerative and man-made diseases, but rather due to increasing variations in young and middle-age adults. PMID:28133402

  4. Labour complications remain the most important risk factors for perinatal mortality in rural Kenya.

    PubMed Central

    Weiner, Renay; Ronsmans, Carine; Dorman, Ed; Jilo, Hilton; Muhoro, Anne; Shulman, Caroline

    2003-01-01

    OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). METHODS: A cross-sectional study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. FINDINGS: The perinatal mortality rate was 118 per 1000 births. Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting. PMID:14576887

  5. Avian growth and development rates and age-specific mortality: the roles of nest predation and adult mortality.

    PubMed

    Remes, V

    2007-01-01

    Previous studies have shown that avian growth and development covary with juvenile mortality. Juveniles of birds under strong nest predation pressure grow rapidly, have short incubation and nestling periods, and leave the nest at low body mass. Life-history theory predicts that parental investment increases with adult mortality rate. Thus, developmental traits that depend on the parental effort exerted (pre- and postnatal growth rate) should scale positively with adult mortality, in contrast to those that do not have a direct relationship with parental investment (timing of developmental events, e.g. nest leaving). I tested this prediction on a sample of 84 North American songbirds. Nestling growth rate scaled positively and incubation period duration negatively with annual adult mortality rates even when controlled for nest predation and other covariates, including phylogeny. On the contrary, neither the duration of the nestling period nor body mass at fledging showed any relationship. Proximate mechanisms generating the relationship of pre- and postnatal growth rates to adult mortality may include increased feeding, nest attentiveness during incubation and/or allocation of hormones, and deserve further attention.

  6. Age-specific mortality during the 1918 influenza pandemic: unravelling the mystery of high young adult mortality.

    PubMed

    Gagnon, Alain; Miller, Matthew S; Hallman, Stacey A; Bourbeau, Robert; Herring, D Ann; Earn, David J D; Madrenas, Joaquín

    2013-01-01

    The worldwide spread of a novel influenza A (H1N1) virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889-90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics.

  7. Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality

    PubMed Central

    Gagnon, Alain; Miller, Matthew S.; Hallman, Stacey A.; Bourbeau, Robert; Herring, D. Ann; Earn, David JD.; Madrenas, Joaquín

    2013-01-01

    The worldwide spread of a novel influenza A (H1N1) virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889–90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics. PMID:23940526

  8. Perinatal Morbidity and Mortality in Offsprings of Diabetic Mothers in Qatif, Saudi Arabia.

    ERIC Educational Resources Information Center

    Al-Dabbous, Ibrahim A. Al-; And Others

    1995-01-01

    Studied perinatal and neonatal morbidity and mortality of diabetic mothers and their offspring in Qatif, Saudi Arabia. Suggests diabetes mellitus in pregnancy may be a common problem in Saudi Arabia, as poor maternal diabetic control results in high perinatal morbidity and mortality. Results suggest that health education and improved coverage of…

  9. Assesment of perinatal mortality in two different periods: results of a single center

    PubMed Central

    Duran, Serdar Sadık; Kavuncuoğlu, Sultan; Sarı, Ferhat; Aldemir, Esin Yıldız; Kavçık, Nazlı; Demir, Ferhat

    2016-01-01

    Aim: This study aimed to investigate the perinatal mortality rate with 37 864 deliveries which occured in two different periods in a single center, to compare the components of perinatal mortality and affecting factors with the results of the study related with perinatal mortality which we conducted in 1999 and to emphasize the precautions directed to reduce mortality rates. Material and Methods: All live births and stillbirths which occurred in Bakırköy Obstetrics and Pediatrics Training and Research Hospital between January 2007 and December 2007 were evaluated. The results were compared with the results of the study conducted in 1999. Newborns with a weight above five hundred grams and a gestational age above 22 weeks were enrolled in the study. The stillbirth rate, early neonatal mortality rate, late neonatal mortality rate, perinatal mortality rate and corrected perinatal mortality rate were calculated. Modified Wigglesworth Classification was used for evaluating the perinatal mortality and the subjects were examined in 7 groups. The characteristics belonging to the years of 2007 and 1999 were examined, the differences were recorded and the results were discussed. When the two periods were compared, it was observed that the perinatal mortality rate increased from 23.5‰ to 26‰. Result: When the causes were investigated, it was observed that the stillbirth rate was increased in 2007 (84%) and especially congenital anomalies had an important role in this increment. The early neonatal mortality rate declined from 0.8% in 1999 to 0.4% in 2007. It was found that especially the premature mortality rate (Group 3) and the mortality rate related with perinatal asphyxia (Group 4) were significantly decreased. Conclusion: The decrease in early neonatal mortality rate could be best explained by productive operation of the new neonatal intensive care unit which had been established after 2002. PMID:27738396

  10. Analysis of policy towards improvement of perinatal mortality in the Netherlands (2004-2011).

    PubMed

    Vos, Amber A; van Voorst, Sabine F; Steegers, Eric A P; Denktaş, Semiha

    2016-05-01

    Relatively high perinatal mortality and morbidity rates(2) in the Netherlands resulted in a process which induced policy changes regarding the Dutch perinatal healthcare system. Aims of this policy analysis are (1) to identify actors, context and process factors that promoted or impeded agenda setting and formulation of policy regarding perinatal health care reform and (2) to present an overview of the renewed perinatal health policy. The policy triangle framework for policy analysis by Walt and Gilson was applied(3). Contents of policy, actors, context factors and process factors were identified by triangulation of data from three sources: a document analysis, stakeholder analysis and semi-structured interviews with key stakeholders. Analysis enabled us to chronologically reconstruct the policy process in response to the perinatal mortality rates. The quantification of the perinatal mortality problem, the openness of the debate and the nature of the topic were important process factors. Main theme of policy was that change was required in the entire spectrum of perinatal healthcare. This ranged from care in the preconception phase through to the puerperium. Furthermore emphasis was placed on the importance of preventive measures and socio-environmental determinants of health. This required involvement of the preventive setting, including municipalities. The Dutch tiered perinatal healthcare system and divergent views amongst curative perinatal health care providers were important context factors. This study provides lessons which are applicable to health care professionals and policy makers in perinatal care or other multidisciplinary fields.

  11. A multilayered approach for the analysis of perinatal mortality using different classification systems.

    PubMed

    Gordijn, Sanne J; Korteweg, Fleurisca J; Erwich, Jan Jaap H M; Holm, Jozien P; van Diem, Mariet Th; Bergman, Klasien A; Timmer, Albertus

    2009-06-01

    Many classification systems for perinatal mortality are available, all with their own strengths and weaknesses: none of them has been universally accepted. We present a systematic multilayered approach for the analysis of perinatal mortality based on information related to the moment of death, the conditions associated with death and the underlying cause of death, using a combination of representatives of existing classification systems. We compared the existing classification systems regarding their definition of the perinatal period, level of complexity, inclusion of maternal, foetal and/or placental factors and whether they focus at a clinical or pathological viewpoint. Furthermore, we allocated the classification systems to one of three categories: 'when', 'what' or 'why', dependent on whether the allocation of the individual cases of perinatal mortality is based on the moment of death ('when'), the clinical conditions associated with death ('what'), or the underlying cause of death ('why'). A multilayered approach for the analysis and classification of perinatal mortality is possible by using combinations of existing systems; for example the Wigglesworth or Nordic Baltic ('when'), ReCoDe ('what') and Tulip ('why') classification systems. This approach is useful not only for in depth analysis of perinatal mortality in the developed world but also for analysis of perinatal mortality in the developing countries, where resources to investigate death are often limited.

  12. Perinatal mortality in relation to birthweight and gestational age: a registry-based comparison of Northern Norway and Murmansk County, Russia.

    PubMed

    Anda, Erik Eik; Nieboer, Evert; Wilsgaard, Tom; Kovalenko, Anton Alexandrovich; Odland, Jon Øyvind

    2011-05-01

    The objective was to explore how perinatal mortality relates to birthweight, gestational age and optimal perinatal survival weight for two Arctic populations employing an existing and a newly established birth registry. A medical birth registry for all births in Murmansk County of North-West Russia became operational on 1st January 2006. Its primary function is to provide useful information for health care officials pertinent to improving perinatal care. The cohort studied consisted of 17,302 births in 2006-07 (Murmansk County) and 16,006 in 2004-06 (Northern Norway). Birthweight probability density functions were analysed, and logistic regression models were employed to calculate gestational-age-specific mortality ratios. The perinatal mortality rate was 10.7/1000 in Murmansk County and 5.7/1000 in Northern Norway. Murmansk County had a higher proportion of preterm deliveries (8.7%) compared to Northern Norway (6.6%). The odds ratio (OR) of risk of mortality (Northern Norway as the reference group) was higher for all gestational ages in Murmansk County, but the largest risk difference occurred among term deliveries (OR 2.45, 95% confidence interval 1.45, 4.14) which hardly changed on adjustment for maternal age, parity and gestation. Proportionately, more babies were born near (± 500 g) the optimal perinatal survival weight in Murmansk County (67.2%) than in Northern Norway (47.6%). The observed perinatal mortality was higher in Murmansk County at all birthweight strata and at gestational ages between weeks 25 and 42, but the adjusted risk difference was most significant for term deliveries.

  13. Long-term mortality in mothers with perinatal losses and risk modification by surviving children and attained education: a population-based cohort study

    PubMed Central

    Halland, Frode; Morken, Nils-Halvdan; DeRoo, Lisa A; Klungsøyr, Kari; Wilcox, Allen J; Skjærven, Rolv

    2016-01-01

    Objective To assess the association between perinatal losses and mother's long-term mortality and modification by surviving children and attained education. Design A population-based cohort study. Setting Norwegian national registries. Participants We followed 652 320 mothers with a first delivery from 1967 and completed reproduction before 2003, until 2010 or death. We excluded mothers with plural pregnancies, without information on education (0.3%) and women born outside Norway. Main outcome measures Main outcome measures were age-specific (40–69 years) cardiovascular and non-cardiovascular mortality. We calculated mortality in mothers with perinatal losses, compared with mothers without, and in mothers with one loss by number of surviving children in strata of mothers’ attained education (<11 years (low), ≥11 years (high)). Results Mothers with perinatal losses had increased crude mortality compared with mothers without; total: HR 1.3 (95% CI 1.3 to 1.4), cardiovascular: HR 1.8 (1.5 to 2.1), non-cardiovascular: HR 1.3 (1.2 to 1.4). Childless mothers with one perinatal loss had increased mortality compared with mothers with one child and no loss; cardiovascular: low education HR 2.7 (1.7 to 4.3), high education HR 0.91 (0.13 to 6.5); non-cardiovascular: low education HR 1.6 (1.3 to 2.2), high education HR 1.8 (1.1 to 2.9). Mothers with one perinatal loss, surviving children and high education had no increased mortality, whereas corresponding mothers with low education had increased mortality; cardiovascular: two surviving children HR 1.7 (1.2 to 2.4), three or more surviving children HR 1.6 (1.1 to 2.4); non-cardiovascular: one surviving child HR 1.2 (1.0 to 1.5), two surviving children HR 1.2 (1.1 to 1.4). Conclusions Irrespective of education, we find excess mortality in childless mothers with a perinatal loss. Increased mortality in mothers with one perinatal loss and surviving children was limited to mothers with low education. PMID:27884847

  14. Improvement in Infant and Perinatal Mortality in the United States, 1965-1973.

    ERIC Educational Resources Information Center

    Information Sciences Research Inst., Washington, DC.

    Changes in United States infant and perinatal mortality during the period 1965-1973 are examined by race, age at death or length of gestation, and degree of urbanization. Several improvements in mortality rates are identified and discussed in relation to changes in the United States which have occurred in economic conditions and standards of…

  15. [The role of maternal care in reducing perinatal and neonatal mortality in developing countries].

    PubMed

    Nicolau, S; Teodoru, G; Popa, I; Nicolescu, S; Feldioreanu, E

    1989-01-01

    Neonatal and perinatal mortality is directly linked to the health of the mother immediately after birth. Numerous international scientific meetings among them the 45th session of the Mixed Committee of WHO in January 1985, have dealt with this issue. Maternal mortality is defined as the death of the mother 42 days after delivery. Perinatal mortality includes delayed fetal death and early neonatal death. Delayed fetal death often occurs in newborns weighing under 1000 gm. Usually perinatal mortality is defined as the number of delayed fetal deaths and early neonatal deaths among those weighing over 1000 gm/1000 live births. The neonatal mortality level corresponds to the number of deaths of children born alive at 4 weeks/1000 live births. Postnatal mortality means the death of children born live up to 1 year of age. Infant death means death under age 1. Infant mortality level is defined as deaths of infants that survive for a whole year. The major problems of infant health include diarrheal diseases normally requiring vaccination and malnutrition during the first month of life. In Bangladesh, Lesotho, and Mexico, the mortality level ranges between 32.8 to 135/1000 live births. Neonatal mortality makes u 42-63% of infant mortality. The perinatal period comprises the period between 28th week of pregnancy and the 7th day of life. Diarrhea and respiratory infections contribute to perinatal mortality. In developing countries, maternal mortality related to pregnancy of women aged 15-45 occurs most often. 2-10 maternal deaths/1000 live births to as high as 20/1000 are current estimates. In Nigeria, among adolescents, the rate is 50-70 deaths/1000 live births. 124 perinatal deaths that occurred in 1970 and 1973 in India were analyzed yielding these percentages: insufficient birth weight 32%, asphyxia 19%, obstetrical trauma 18%, congenital anomalies 7%, tetanus of the newborn 3%, and others 21%. In Africa and Southeast Asia tetanus-related neonatal mortality amounts to 10

  16. Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010

    PubMed Central

    Xiao, Lin; Zhang, Dan-Li; Torrie, Jill; Auger, Nathalie; McHugh, Nancy Gros-Louis; Luo, Zhong-Cheng

    2016-01-01

    Background Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. Methods This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996–2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. Results Macrosomia (birth weight for gestational age >90th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98) and 1.34 (1.10, 1.64) times higher, and infant mortality rates 2.27 (1.71, 3.02) and 1.49 (1.16, 1.91) times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity), but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age). Conclusions Cree communities had greater risk elevations in perinatal and infant mortality than other First Nations relative to non-Aboriginal communities in Quebec. High prevalence of macrosomia did not explain the elevated risk of perinatal and infant mortality in Cree communities. PMID:27517613

  17. Population attributable risks of patient, child and organizational risk factors for perinatal mortality in hospital births.

    PubMed

    Poeran, Jashvant; Borsboom, Gerard J J M; de Graaf, Johanna P; Birnie, Erwin; Steegers, Eric A P; Bonsel, Gouke J

    2015-04-01

    The main objective of this study was to estimate the contributing role of maternal, child, and organizational risk factors in perinatal mortality by calculating their population attributable risks (PAR). The primary dataset comprised 1,020,749 singleton hospital births from ≥22 weeks' gestation (The Netherlands Perinatal Registry 2000-2008). PARs for single and grouped risk factors were estimated in four stages: (1) creating a duplicate dataset for each PAR analysis in which risk factors of interest were set to the most favorable value (e.g., all women assigned 'Western' for PAR calculation of ethnicity); (2) in the primary dataset an elaborate multilevel logistic regression model was fitted from which (3) the obtained coefficients were used to predict perinatal mortality in each duplicate dataset; (4) PARs were then estimated as the proportional change of predicted- compared to observed perinatal mortality. Additionally, PARs for grouped risk factors were estimated by using sequential values in two orders: after PAR estimation of grouped maternal risk factors, the resulting PARs for grouped child, and grouped organizational factors were estimated, and vice versa. The combined PAR of maternal, child and organizational factors is 94.4 %, i.e., when all factors are set to the most favorable value perinatal mortality is expected to be reduced with 94.4 %. Depending on the order of analysis, the PAR of maternal risk factors varies from 1.4 to 13.1 %, and for child- and organizational factors 58.7-74.0 and 7.3-34.3 %, respectively. In conclusion, the PAR of maternal-, child- and organizational factors combined is 94.4 %. Optimization of organizational factors may achieve a 34.3 % decrease in perinatal mortality.

  18. Risk factors associated with the different categories of piglet perinatal mortality in French farms.

    PubMed

    Pandolfi, F; Edwards, S A; Robert, F; Kyriazakis, I

    2017-02-01

    We aimed to identify mortality patterns and to establish risk factors associated with different categories of piglet perinatal mortality in French farms. At farm level, the analyses were performed on data from 146 farms that experienced perinatal mortality problems. At piglet level, the analyses were performed on data from 155 farms (7761 piglets). All data were collected over a period of 10 years (2004-14) by a consulting company, using a non-probability sampling at farm level and a random sampling at sow level. Six main categories of mortality, determined by standardised necropsy procedure, represented 84.5% of all the perinatal deaths recorded. These six categories were, in order of significance: Death during farrowing, Non- viable, Early sepsis, Mummified, Crushing and Starvation. At farm level, the percentage of deaths due to starvation was positively correlated to the percentage of deaths due to crushing and the percentage of deaths during farrowing (r>0.30, P<0.05) .The percentage of deaths due to crushing was negatively correlated to the percentage of deaths due to early sepsis (r<-0.30, P<0.05) and positively correlated to the deaths due to acute disease (r>0.30, P<0.05). Patterns of perinatal mortality at farm level were identified using a principal component analysis. Based on these, the farms could be classified, using ascending hierarchical classification, into three different clusters, highlighting issues that underlie farm differences. Risk factors were compared at piglet level for the different categories of death. Compared to other categories of death, deaths during farrowing were significantly fewer during the night than during the day. Compared to other categories of death, the likelihood of non-viable piglets tended to be higher in summer than other seasons. A smaller number of deaths in the litter was also identified for the piglets classified as non-viable or mummified. For the six main categories of perinatal mortality, the piglets which died

  19. Biodemographic Analysis of Factors Related to Perinatal Mortality in Portugal (1988–2011)

    PubMed Central

    2016-01-01

    Background. The purpose of this paper is to determine the relative mortality risks at delivery and during the first week of life with regard to maternal and foetal characteristics. Methods. Yearly individual digital records on live births and early neonatal mortality were used to infer the possible factors involved in perinatal deaths. Results. The results show that the number of births per year declined with time throughout the period studied. At the same time, rates decreased in 66.4% for stillbirths and in 70.2% for early neonatal mortality. Logistic regressions modelled the interaction of the two mortality indicators and covariables such as birth weight and the duration of gestation. Conclusions. This research provides a first biodemographic approach to the knowledge of factors influencing perinatal mortality in Portugal based on a set of foetal and maternal variables. Although the magnitude of the different perinatal mortality rates may be affected by the criteria used for selecting cases (multiple-singletons; minimum birth weight or minimum duration of gestation), one of the conclusions of the present analysis is that the relationship among the maternal and foetal variables that determine the relative risk remains unaltered. Certain resemblance with the factors determining negative birth outcomes in Spain is appreciated. PMID:27867399

  20. Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels

    PubMed Central

    Hounton, Sennen; Byass, Peter; Brahima, Bassane

    2009-01-01

    Background Reducing maternal and perinatal mortality in sub Saharan Africa remains challenging and requires effective and context specific interventions. Objective The aims of this paper were to demonstrate the impact of the community mobilisation of the Skilled Care Initiative (SCI) in reducing maternal and perinatal mortality and to describe the concept and implementation in order to guide replication and scaling up. Designs A quasi experimental design was used to assess the extent to which the SCI was associated with increased institutional births, maternal and perinatal mortality reduction in an intervention (Ouargaye) versus a comparison (Diapaga) district. A geo-referenced census was conducted to retrospectively assess changes in outcomes and process measures. A detailed description of activities, rationale and timing of implementation were gathered from the SCI project officers and summarised. Data analyses included descriptive statistics and multivariate analyses. Results At macro level, the main significant difference between Ouargaye and Diapaga districts was the scope and intensity of the community-based interventions implemented in Ouargaye. There was a temporal association relationship before and after the implementation of the demand-driven interventions and a remarkable 30% increase in institutional births in the intervention district compared to 10% increase in comparison district. There was a significant reduction of perinatal mortality rates (OR =0.75, CI 0.70–0.80) in intervention district and a larger decrease in maternal mortality ratios in intervention district, although statistical significance was not reached. A comprehensive framework of community mobilisation strategy is proposed to improve maternal and child health in poorest communities. Conclusion Controlling for the availability and quality of health services, working in partnership and effectively with communities, and not for them – hence characterising communities as not being

  1. Birth rate and perinatal mortality in Italy during the years 1964 through 1986.

    PubMed

    Pecorari, D; Diani, F; Tanganelli, E

    1989-01-01

    "Between 1964 and 1986 the number of births in Italy declined from over one million per year to little more than half a million per year. The perinatal mortality rate declined from 37.3/1,000 to 12.8/1,000. Using the year 1964 as [the] reference year, the total number of babies who were saved from perinatal death by socio-economic and medical improvements during the 22 years between 1965 and 1986 can be calculated as 435,005."

  2. Telemedicine Collaboration Improves Perinatal Regionalization and Lowers Statewide Infant Mortality

    PubMed Central

    Kim, Elizabeth W.; Teague-Ross, Terri J.; Greenfield, William W.; Williams, D. Keith; Kuo, Dennis; Hall, Richard W.

    2014-01-01

    OBJECTIVES We assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth-weight (VLBW, <1500 grams) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality. STUDY DESIGN This prospective study used obstetrical and neonatal interventions through TM consults, education, and census rounds with 9 hospitals from July 1, 2009 – March 31, 2010. Using a generalized linear model, Medicaid data compared VLBW birth sites, mortality, and morbidity before and after TM use. Arkansas Health Department data and chi square analysis were used to compare infant mortality. RESULTS Deliveries of VLBW neonates in targeted hospitals decreased from 13.1% to 7.0% (p=0.0099); deliveries of VLBW neonates in remaining hospitals was unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (p=0.043). CONCLUSIONS TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.. PMID:23579490

  3. Increases in perinatal mortality in prefectures contaminated by the Fukushima nuclear power plant accident in Japan

    PubMed Central

    Scherb, Hagen Heinrich; Mori, Kuniyoshi; Hayashi, Keiji

    2016-01-01

    Abstract Descriptive observational studies showed upward jumps in secular European perinatal mortality trends after Chernobyl. The question arises whether the Fukushima nuclear power plant accident entailed similar phenomena in Japan. For 47 prefectures representing 15.2 million births from 2001 to 2014, the Japanese government provides monthly statistics on 69,171 cases of perinatal death of the fetus or the newborn after 22 weeks of pregnancy to 7 days after birth. Employing change-point methodology for detecting alterations in longitudinal data, we analyzed time trends in perinatal mortality in the Japanese prefectures stratified by exposure to estimate and test potential increases in perinatal death proportions after Fukushima possibly associated with the earthquake, the tsunami, or the estimated radiation exposure. Areas with moderate to high levels of radiation were compared with less exposed and unaffected areas, as were highly contaminated areas hit versus untroubled by the earthquake and the tsunami. Ten months after the earthquake and tsunami and the subsequent nuclear accident, perinatal mortality in 6 severely contaminated prefectures jumped up from January 2012 onward: jump odds ratio 1.156; 95% confidence interval (1.061, 1.259), P-value 0.0009. There were slight increases in areas with moderate levels of contamination and no increases in the rest of Japan. In severely contaminated areas, the increases of perinatal mortality 10 months after Fukushima were essentially independent of the numbers of dead and missing due to the earthquake and the tsunami. Perinatal mortality in areas contaminated with radioactive substances started to increase 10 months after the nuclear accident relative to the prevailing and stable secular downward trend. These results are consistent with findings in Europe after Chernobyl. Since observational studies as the one presented here may suggest but cannot prove causality because of unknown and uncontrolled factors or

  4. Epidemiologic factors involved in perinatal lamb mortality on four range sheep operations.

    PubMed

    Rowland, J P; Salman, M D; Kimberling, C V; Schweitzer, D J; Keefe, T J

    1992-02-01

    Four shed-lambing operations in western Colorado were monitored during the 1984 spring lambing season to determine the causes and rates of perinatal lamb mortality. The number of lambing ewes per flock ranged from 513 to 1,712, and lambing percentages ranged from 131 to 180%. Overall perinatal lamb mortality ranged from 8.2 to 12.2%. Most lamb deaths occurred during parturition or within 24 hours after parturition. More than 85% of all lamb deaths were in lambs born to ewes having 2 or more lambs. The leading causes of lamb death were starvation, dystocia, stillbirth (unknown cause), and infectious diseases. A wheel model was used to categorize factors causing lamb deaths into 4 groups: physical, social, host, and biological, and to present data on perinatal lamb mortality in a simple visual model. In all flocks, social and biological factors resulted in most of the lamb deaths. On the basis of our findings, we suggest that interventions designed to improve ewe-lamb bonding and to reduce infectious agents and the incidence of prolonged parturition may reduce lamb mortality.

  5. [Infectious causes of perinatal mortalities in ruminants (author's transl)].

    PubMed

    Coetzer, J A; Schutte, A P

    1978-07-01

    The advantages and disadvantages of the different diagnostic techniques e.g. pathological and microbiological studies, immunoglobulin and specific antibody determinations and fluorescent antibody studies in relation to these mortalities are discussed. The most important pathological lesions in the placentas and foetuses are described.

  6. Disparities in perinatal medicine: preterm birth, stillbirth, and infant mortality.

    PubMed

    Spong, Catherine Y; Iams, Jay; Goldenberg, Robert; Hauck, Fern R; Willinger, Marian

    2011-04-01

    Infant mortality, stillbirths, and preterm births are major public health priorities with significant disparities based on race and ethnicity. Interestingly, when evaluating the rates over the past 30 to 50 years, the disparity persists in all three and is remarkably consistent. In the United States, the infant mortality rate is 6.7 deaths per 1,000 live births, the stillbirth rate is 6.2 per 1,000 deliveries, and the preterm birth rate is 12.8% of live births. The rates among non-Hispanic African Americans are dramatically higher, nearly double the infant mortality at 13.4 infant deaths per 1,000 live births, nearly double the stillbirth rate at 11.1 stillbirths per 1,000 deliveries, and one third higher with preterm births at 18.4% of live births. Despite numerous conferences, workshops, articles, and investigators focusing on this line of work, the disparities persist and, in some cases, are growing. In this article, we summarize a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop that focused on these disparities to identify the associated factors to determine their relative contributions, identify gaps in knowledge, and develop specific strategies to address the disparities in the short-term and long-term.

  7. Chromosomal variation and perinatal mortality in San Diego zoo Soemmerring's gazelles.

    PubMed

    Steiner, Cynthia C; Charter, Suellen J; Goddard, Natalie; Davis, Heidi; Brandt, Margot; Houck, Marlys L; Ryder, Oliver A

    2015-01-01

    Chromosomal translocations play a fundamental role in the evolution and speciation of antelopes (Antilopinae, Bovidae), with several species exhibiting polymorphism for centric fusions. For the past 35 years, the San Diego Zoo Global (SDZG) captive population of Soemmerring's gazelles has revealed complex karyotypes resulting from chromosomal translocations with diploid numbers ranging from 34 to 39. Poor reproductive performance of this species in captivity and elevated mortality the first month of life (perinatal) has been attributed to this chromosomal dynamism. We have extended the studies of karyotypic variation in the SDZG Soemmerring's gazelle population and analyzed the effect of chromosomal and genetic variation upon perinatal mortality. Karyotypes from 149 captive Soemmerring's gazelles were evaluated revealing two unreported autosomal combinations, now constituting a total of 15 distinct karyotypes for the 3 Robertsonian centric fusions originally described for this population. Among SDZG founders, distinct chromosomal variation and nuclear and mitochondrial genetic structure were detected corresponding to the institution of origin of the founders. Low levels of genetic distance and nucleotide diversity among individuals, in addition to high relatedness values, suggested that outbreeding is less of a concern than inbreeding for maintaining a sustainable captive population. Finally, analysis of karyotypes of offspring born into the SDZG Soemmerring's gazelle herds, in conjunction with the maternal karyotype showed association of chromosomal makeup with perinatal mortality. This supports the importance of continuing cytogenetic screening efforts, particularly to evaluate the presence of deleterious chromosomal rearrangements in stillborns.

  8. Regression analysis of time trends in perinatal mortality in Germany 1980-1993.

    PubMed Central

    Scherb, H; Weigelt, E; Brüske-Hohlfeld, I

    2000-01-01

    Numerous investigations have been carried out on the possible impact of the Chernobyl accident on the prevalence of anomalies at birth and on perinatal mortality. In many cases the studies were aimed at the detection of differences of pregnancy outcome measurements between regions or time periods. Most authors conclude that there is no evidence of a detrimental physical effect on congenital anomalies or other outcomes of pregnancy following the accident. In this paper, we report on statistical analyses of time trends of perinatal mortality in Germany. Our main intention is to investigate whether perinatal mortality, as reflected in official records, was increased in 1987 as a possible effect of the Chernobyl accident. We show that, in Germany as a whole, there was a significantly elevated perinatal mortality proportion in 1987 as compared to the trend function. The increase is 4.8% (p = 0.0046) of the expected perinatal death proportion for 1987. Even more pronounced levels of 8.2% (p = 0. 0458) and 8.5% (p = 0.0702) may be found in the higher contaminated areas of the former German Democratic Republic (GDR), including West Berlin, and of Bavaria, respectively. To investigate the impact of statistical models on results, we applied three standard regression techniques. The observed significant increase in 1987 is independent of the statistical model used. Stillbirth proportions show essentially the same behavior as perinatal death proportions, but the results for all of Germany are nonsignificant due to the smaller numbers involved. Analysis of the association of stillbirth proportions with the (137)Cs deposition on a district level in Bavaria discloses a significant relationship. Our results are in contrast to those of many analyses of the health consequences of the Chernobyl accident and contradict the present radiobiologic knowledge. As we are dealing with highly aggregated data, other causes or artifacts may explain the observed effects. Hence, the findings

  9. Determinants of IDDM and perinatal mortality in children of diabetic mothers.

    PubMed

    Warram, J H; Krolewski, A S; Kahn, C R

    1988-10-01

    Offspring of women with insulin-dependent diabetes mellitus (IDDM) have a lower risk of developing IDDM than offspring of men with IDDM (1). To determine whether the risk of diabetes in offspring of diabetic mothers has changed after dramatic improvements in perinatal survival of these infants, we undertook a follow-up study of 1602 pregnancies of 739 women with IDDM who were patients at the Joslin Diabetes Center. Improvements in perinatal survival were abrupt rather than gradual. During the two decades before 1961, perinatal mortality was stable around 23%. After a sudden drop in 1961, it stabilized around 14% until 1975, when it was brought down to 4%, where it has remained. Of the 1391 offspring who survived the neonatal period, IDDM has developed in 21, a cumulative risk of 2.1 +/- 0.5% (SE) by age 20 yr. This is one-third the risk previously reported for offspring of fathers with IDDM and is independent of the calendar time of the births (1). The risk of diabetes in offspring of diabetic mothers is increased in young mothers and is otherwise independent of risk factors for perinatal mortality in this series. We conclude that there is no evidence that selective loss of diabetes-susceptible fetuses in perinatal deaths is a mechanism for the lower incidence of IDDM in the offspring of mothers with IDDM than in those of fathers with IDDM. The principal alternative mechanism is that exposure in utero to an affected mother can protect a fetus from developing IDDM later in life. Induction of immunologic tolerance to the autoantigens of the beta-cells is a plausible mechanism for this protective effect.

  10. Perinatal mortality in caribou from the Porcupine herd, Alaska.

    PubMed

    Roffe, T J

    1993-04-01

    During the 1989 caribou (Rangifer tarandus) calving season on the Arctic National Wildlife Refuge, Alaska (USA), 61 calf carcasses were examined for cause of death and associated pathology. Dead calves were located by low-level aerial searches with two fixed-wing aircraft and a helicopter over high density calving areas between the Hulahula and Aichilik rivers. Primary diagnoses included emaciation (39%), malnutrition (8%), stillbirth (21%), trauma (16%), other primary causes (7%), and undetermined causes (8%). Twenty calves had contributory renal tubular degeneration. The findings indicate that factors contributing to nutritional deprivation in calves were the major cause of neonatal mortality; however, factors affecting stillbirth, abortion, or the urogenital system may have major effects on neonatal caribou and warrant further investigation.

  11. Perinatal mortality in caribou from the Porcupine herd, Alaska

    USGS Publications Warehouse

    Roffe, T.J.

    1993-01-01

    During the 1989 caribou (Rangifer tarandus) calving season on the Arctic National Wildlife Refuge, Alaska (USA), 61 calf carcasses were examined for cause of death and associated pathology. Dead calves were located by low-level aerial searches with two fixed-wing aircraft and a helicopter over high density calving areas between the Hulahula and Aichilik rivers. Primary diagnoses included emaciation (39%), malnutrition (8%), stillbirth (21%), trauma (16%), other primary causes (7%), and undetermined causes (8%). Twenty calves had contributory renal tubular degeneration. The findings indicate that factors contributing to nutritional deprivation in calves were the major cause of neonatal mortality; however, factors affecting stillbirth, abortion, or the urogenital system may have major effects on neonatal caribou and warrant further investigation.

  12. Mothers' and fathers' birth characteristics and perinatal mortality in their offspring: a population-based cohort study.

    PubMed

    Nordtveit, Tone I; Melve, Kari K; Skjaerven, Rolv

    2010-05-01

    There is increasing interest in the associations between parental birthweight and gestational age with their perinatal outcomes. We investigated perinatal mortality risk in offspring in relation to maternal and paternal gestational age and birthweight. We used population-based generational data from the Medical Birth Registry of Norway, 1967-2006. Singletons in both generations were included, forming 520,794 mother-offspring and 376,924 father-offspring units. Perinatal mortality in offspring was not significantly associated with paternal gestational age or birthweight, whereas it was inversely associated with maternal gestational age. A threefold increased risk in perinatal mortality was found among offspring of mothers born at 28-30 weeks of gestation relative to offspring of mothers born at term (37-43 weeks) (relative risk: 2.9, 95% CI 1.9, 4.6). There was also an overall association between maternal birthweight and offspring perinatal mortality. Relative risk for mothers whose birthweight was <2000 g was 1.5 (95% CI 1.1, 1.9), relative to mothers whose birthweight was 3500-3999 g. However, confined to mothers born at >or=34 weeks of gestation, the birthweight association was not significant. Weight-specific perinatal mortality in offspring was dependent on the birthweight of the mother and the father, that is, offspring who were small relative to their mother's or father's birthweight had increased perinatal mortality. In conclusion, a mother's gestational age, and not her birthweight, was significantly associated with perinatal mortality in the offspring, while there was no such association for the father.

  13. Statistically tested comparisons of the accuracy of forecasting methods for age-specific and sex-specific mortality and life expectancy.

    PubMed

    Shang, Han Lin

    2015-01-01

    Although there are continuing developments in the methods for forecasting mortality, there are few comparisons of the accuracy of the forecasts. The subject of the statistical validity of these comparisons, which is essential to demographic forecasting, has all but been ignored. We introduce Friedman's test statistics to examine whether the differences in point and interval forecast accuracies are statistically significant between methods. We introduce the Nemenyi test statistic to identify which methods give results that are statistically significantly different from others. Using sex-specific and age-specific data from 20 countries, we apply these two test statistics to examine the forecast accuracy obtained from several principal component methods, which can be categorized into coherent and non-coherent forecasting methods.

  14. Perinatal Mortality in Southern Nigeria; less than half a decade to the Millennium Developmental Goals

    PubMed Central

    Ibekwe, PC; Ugboma, HU; Onyire, N; Muoneke, U

    2011-01-01

    Background: Perinatal mortality is one of the essential indicators of the health status of a country and by extension its state of development. Reduction in perinatal mortality rate is an important aspect of the MDGs. Objectives: To determine the perinatal mortality rate (PMR) in 2 tertiary institutions in Southern Nigeria and the factors responsible for the deaths. Methods: This was a retrospective, observational study conducted amongst 2 groups of subjects (A and B) located in 2 tertiary hospitals in Southern Nigeria over a 2-year period (1st Jan 2004 to 31st Dec. 2005). Variables such as maternal age, socio-economic status of the parents, sex, gestational age at delivery, mode of delivery, birth-weight, and age of baby before death and probable cause of death were recorded. Results: During the period, the perinatal mortality rate of 62.7/ 1000 live-births was recorded. The individual contributions to this rate were 22.1/1000 live births and 40.6/1000 live births for A and B respectively. The common causes of death in the study subjects were unbooked maternal status, fresh/macerated still births, low birth weight /premature babies and severe birth asphyxia. The mean gestational age for group A was 34.7 ± 6.50 wks and 33± 1.20 wks for group B, while the mean maternal ages were 27.3± 5.75yrs and 28.6 ± 5.1yrs respectively. Majority of the deliveries were by Spontaneous Vertex Delivery (SVD), accounting for 49.4% and 56% of the total deliveries in the two groups respectively. Furthermore, the male: female ratio was 0.85: 1.0 and 0.9: 1.0, the mean birth weights were 2.60 ± 1.87kg and 2.88 ±2.08kg and the unbooked cases were 61.9% and 70.6% respectively for group A and B. Conclusion: There is high rate of perinatal deaths in Southern Nigeria. This is associated with high rates of unbooked pregnancies resulting in difficult labours, ruptured uterus, chorio-amnionitis, preterm/low-birtthweight babies and severe neonatal asphyxia. PMID:23209977

  15. Pre-Calving and Calving Management Practices in Dairy Herds with a History of High or Low Bovine Perinatal Mortality

    PubMed Central

    Mee, John F.; Grant, Jim; Sánchez-Miguel, Cosme; Doherty, Michael

    2013-01-01

    Simple Summary Mortality of full-term calves at calving is an increasing problem in dairy industries internationally. Multiple herd management factors contribute to such losses. This case-control study identified factors which differed between herds with high and low calf mortality. These included breeding, dietary, health and calving factors. It was concluded that calving, not pre-calving, management appears to be the most important area of concern in herds with high perinatal mortality. This indicates that farmers and their veterinarians need to focus on calving management when investigating such problems and when attempting to reduce losses in herds with high rates of bovine perinatal mortality. Abstract Bovine perinatal mortality is an increasing problem in dairy industries internationally. The objective of this study was to determine the risk factors associated with high and low herd-level calf mortality. Thirty herds with a history of either high (case) or low (control) calf mortality were recruited. A herd-level questionnaire was used to gather information on management practices likely to impact bovine perinatal mortality. The questionnaire was divided into four subsections dealing with pre-calving (breeding, diet and body condition score, endemic infectious diseases) and calving factors. Most of the significant differences between case and control herds were found in calving management. For example, in case herds, pregnant cattle were less likely to be moved to the calving unit two or more days and more likely to be moved less than 12 hours pre-calving, they were also less likely to calve in group-calving facilities and their calves were more likely to receive intranasal or hypothermal resuscitation. These management procedures may cause social isolation and periparturient psychogenic uterine atony leading to dystocia, more weak calves requiring resuscitation and high perinatal calf mortality. The key finding is that calving, not pre-calving, management

  16. Spatial Approach of Perinatal Mortality in São Paulo State, 2003-2012.

    PubMed

    Venâncio, Taís Siqueira; Tuan, Tássia Soldi; Vaz, Fernanda Pires Cecchetti; Nascimento, Luiz Fernando Costa

    2016-10-01

    Objectives To identifying spatial patterns in the distribution of perinatal mortality in the state of São Paulo from 2003 to 2012. Methods An ecological and exploratory study with data on perinatal mortality rates of every thousand live births, which were registered on the digital database containing 645 municipalities in the state of São Paulo within the periods of 2003 to 2007 and 2008 to 2012. The spatial analysis provided Moran's index (MI) and thematic maps of rates, and the Moran maps of both periods were drawn. The average rates were compared by Student's t test. The TerraView 4.2.2 software (INPE, S. José dos Campos, Brazil) was also used. Results There were 49,485 perinatal deaths during the first period, at a rate of 17.90 deaths/1,000 live births (standard deviation [SD] = 7.0; MI = 0.14; p = 0.01), and 44,582 perinatal deaths during the second period, at a rate of 16.40 deaths/1,000 live births (SD = 11.14; MI = 0.04; p = 0.03). These rates are statistically different (p < 0.01). There was a decrease in these rates in 413 municipalities when comparing the two periods. The Moran map has identified 35 municipalities that require special attention, which are located in the Eastern, Southwestern, Western and Northwestern regions of São Paulo state. Conclusion The study provides municipal managers with subsidies so they can minimize these rates by implementing public policies and taking better care of pregnant women and newborns.

  17. Influence of socioeconomic and health care development on infant and perinatal mortality in Spain 1975-86.

    PubMed Central

    Lardelli, P; Blanco, J I; Delgado-Rodríguez, M; Bueno, A; de Dios Luna, J; Gálvez, R

    1993-01-01

    STUDY OBJECTIVE--This study aimed to analyse the influence of social, economic, and health development on infant and perinatal mortality in Spain between 1975 and 1986, and to identify possible changes in these relationships over time. DESIGN--Study of the association between mortality and a range of variables. SETTING--50 Spanish provinces. MEASUREMENTS AND MAIN RESULTS--Mean infant and perinatal mortality were estimated for two periods--1975-8 and 1983-6. Social, economic, and health care indicators were collected as independent variables for these two periods. The rates of variation between periods were estimated for each variable. Multiple linear regression models were used to define the association between infant and perinatal mortality and their respective rate of variation with the former indicators. Mean familial income was the main predictive factor for infant and perinatal mortality in the first period but in the second period health care indicators were more relevant. CONCLUSIONS--The reduction in Spanish infant and perinatal mortality over the period can be attributed mainly to the improvement in prenatal and neonatal health care in Spain in recent years, while economic factors seem less important. PMID:8228758

  18. Mortality Trends in the US Perinatal AIDS Collaborative Transmission Study (1986–2004)

    PubMed Central

    Soe, Minn M.; Nesheim, Steven R.; Abrams, Elaine J.; Carter, Rosalind J.; Farley, John; Palumbo, Paul; Koenig, Linda J.; Bulterys, Marc

    2011-01-01

    (See the Editorial Commentary by Nachman, on pages 1035–6.) Background. Highly active antiretroviral therapy (HAART) has improved human immunodeficiency virus (HIV)–associated morbidity and mortality. The bimodal mortality distribution in HIV-infected children makes it important to evaluate temporal effects of HAART among a birth cohort with long-term, prospective follow-up. Methods. Perinatal AIDS Collaborative Transmission Study (PACTS)/PACTS–HIV Follow-up of Perinatally Exposed Children (HOPE) study was a Centers for Disease Control and Prevention–sponsored multicenter, prospective birth cohort study of HIV-exposed uninfected and infected infants from 1985 until 2004. Mortality was evaluated for the no/monotherapy, mono-/dual-therapy, and HAART eras, that is, 1 January 1986 through 31 December 1990, from 1 January 1991 through 31 December 1996, and 1 January 1997 through 31 December 2004. Results. Among 364 HIV-infected children, 56% were female and 69% black non-Hispanic. Of 98 deaths, 79 (81%) and 61 (62%) occurred in children ≤3 and ≤2 years old, respectively. The median age at death increased significantly across the eras (P < .0001). The average annual mortality rates were 18 (95% confidence interval [CI], 11.6–26.8), 6.9 (95% CI, 5.4–8.8), and 0.8 (95% CI, 0.4–1.5) events per 100 person-years for the no/monotherapy, mono-/dual-therapy and HAART eras, respectively. The corresponding 6-year survival rates for children born in these eras were 57%, 76%, and 91%, respectively (P < .0001). Among children who received HAART in the first 6 months of age, the probability of 6-year survival was 94%. Ten-year survival rates for HAART and non-HAART recipients were 94% and 45% (P < .05). HAART-associated reductions in mortality remained significant after adjustment for confounders (hazard ratio, 0.3; 95% CI, .08–.76). Opportunistic infections (OIs) caused 31.8%, 16.9%, and 9.1% of deaths across the respective eras (P = .051). Conclusions

  19. Temporal and spatial relations between age specific mortality and ambient air quality in the United States: regression results for counties, 1960–97

    PubMed Central

    Lipfert, F; Morris, S

    2002-01-01

    Objective: To investigate longitudinal and spatial relations between air pollution and age specific mortality for United States counties (except Alaska) from 1960 to the end of 1997. Methods: Cross sectional regressions for five specific periods using published data on mortality, air quality, demography, climate, socioeconomic status, lifestyle, and diet. Outcome measures are statistical relations between air quality and county mortalities by age group for all causes of death, other than AIDS and trauma. Results: A specific regression model was developed for each period and age group, using variables that were significant (p<0.05), not substantially collinear (variance inflation factor <2), and had the expected algebraic sign. Models were initially developed without the air pollution variables, which varied in spatial coverage. Residuals were then regressed in turn against current and previous air quality, and dose-response plots were constructed. The validity of this two stage procedure was shown by comparing a subset of results with those obtained with single stage models that included air quality (correlation=0.88). On the basis of attributable risks computed for overall mean concentrations, the strongest associations were found in the earlier periods, with attributable risks usually less than 5%. Stronger relations were found when mortality and air quality were measured in the same period and when the locations considered were limited to those of previous cohort studies (for PM2.5 and SO42-). Thresholds were suggested at 100–130 µg/m3 for mean total suspended particulate (TSP), 7–10 µg/m3 for mean sulfate, 10–15 ppm for peak (95th percentile) CO, 20–40 ppb for mean SO2. Contrary to expectations, associations were often stronger for the younger age groups (<65 y). Responses to PM, CO, and SO2 declined over time; responses in elderly people to peak O3 increased over time as did responses to NO2 for the younger age groups. These results generally agreed

  20. The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006

    PubMed Central

    2011-01-01

    Background In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015. Objective To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality. Methods Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05. Results Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal

  1. Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality - United States, 1999-2014.

    PubMed

    Richardson, Lisa C; Henley, S Jane; Miller, Jacqueline W; Massetti, Greta; Thomas, Cheryll C

    2016-10-14

    Breast cancer continues to be the most commonly diagnosed cancer and the second leading cause of cancer deaths among U.S. women (1). Compared with white women, black women historically have had lower rates of breast cancer incidence and, beginning in the 1980s, higher death rates (1). This report examines age-specific black-white disparities in breast cancer incidence during 1999-2013 and mortality during 2000-2014 in the United States using data from United States Cancer Statistics (USCS) (2). Overall rates of breast cancer incidence were similar, but death rates remained higher for black women compared with white women. During 1999-2013, breast cancer incidence decreased among white women but increased slightly among black women resulting in a similar average incidence at the end of the period. Breast cancer incidence trends differed by race and age, particularly from 1999 to 2004-2005, when rates decreased only among white women aged ≥50 years. Breast cancer death rates decreased significantly during 2000-2014, regardless of age with patterns varying by race. For women aged ≥50 years, death rates declined significantly faster among white women compared with black women; among women aged <50 years, breast cancer death rates decreased at the same rate among black and white women. Although some of molecular factors that lead to more aggressive breast cancer are known, a fuller understanding of the exact mechanisms might lead to more tailored interventions that could decrease mortality disparities. When combined with population-based approaches to increase knowledge of family history of cancer, increase physical activity, promote a healthy diet to maintain a healthy bodyweight, and increase screening for breast cancer, targeted treatment interventions could reduce racial disparities in breast cancer.

  2. Lesser than diabetes hyperglycemia in pregnancy is related to perinatal mortality: a cohort study in Brazil

    PubMed Central

    2011-01-01

    Background Gestational diabetes related morbidity increases along the continuum of the glycemic spectrum. Perinatal mortality, as a complication of gestational diabetes, has been little investigated. In early studies, an association was found, but in more recent ones it has not been confirmed. The Brazilian Study of Gestational Diabetes, a cohort of untreated pregnant women enrolled in the early 1990's, offers a unique opportunity to investigate this question. Thus, our objective is to evaluate whether perinatal mortality increases in a continuum across the maternal glycemic spectrum. Methods We prospectively enrolled and followed 4401 pregnant women attending general prenatal care clinics in six Brazilian state capitals, without history of diabetes outside of pregnancy, through to birth, and their offspring through the early neonatal period. Women answered a structured questionnaire and underwent a standardized 2-hour 75-g oral glucose tolerance test (OGTT). Obstetric care was maintained according to local protocols. We obtained antenatal, delivery and neonatal data from hospital records. Odds ratios (OR) were estimated using logistic regression. Results We ascertained 97 perinatal deaths (67 fetal and 31 early neonatal). Odds of dying increased according to glucose levels, statistically significantly so only for women delivering at gestational age ≥34 weeks (p < 0.05 for glycemia-gestational age interaction). ORs for a 1 standard deviation difference in glucose, when analyzed continuously, were for fasting 1.47 (95% CI 1.12, 1.92); 1-h 1.55 (95% CI 1.15, 2.07); and 2-h 1.53 (95% CI 1.15, 2.02). The adjusted OR for IADPSG criteria gestational diabetes was 2.21 (95% CI 1.15, 4.27); and for WHO criteria gestational diabetes, 3.10 (95% CI 1.39, 6.88). Conclusions In settings of limited detection and treatment of gestational diabetes mellitus, women across a spectrum of lesser than diabetes hyperglycemia, experienced a continuous rise in perinatal death with

  3. [Premature rupture of membranes: maternal - perinatal morbidity and mortality in the Dominican Republic].

    PubMed

    Garrido Calderon, G; Perdomo, E M; Perez Vilorio, J B; Caputo Antonio, A

    1990-01-01

    Premature rupture of membranes is defined as expulsion of the amniotic liquid occurring at least 1 hour before initiation of uterine contractions and without apparent cervical changes. According to the literature, premature rupture of membranes occurs in 2-15% of all pregnancies, with an average of 10%. The etiology is considered multifactorial, and treatment remains controversial. A retrospective review was conducted to determine the occurrence of maternal or perinatal morbidity and mortality in 230 cases of premature rupture of membranes in a social security hospital in Santo Domingo, Dominican Republic, observed between 1983-88. Premature rupture occurred in 3.5% of cases according to the records. 37.4% of affected mothers were 21-25 years old and 69.6% were 21.30. 62.9% of the women were nulliparas. 2.2% had had no prenatal care, 59.1% had insufficient prenatal care, defined as 1-5 visits and only 36.1% had 6 or more visits. 81.3% of ruptures occurred at 37-42 weeks of gestation. In 64.8% of cases the pregnancy was terminated within 1-24 hours and 35.2% were considered prolonged. Prematurity and low birth weight was the most common perinatal disorders, affecting 10.9%. Respiratory difficulty syndrome affected 4.3%. 60% of infants with respiratory problems were born at less than 37 weeks gestation. Neonatal sepsis occurred in 3% of cases and prolapse of the umbilical cord in 1.3%. Perinatal mortality averaged 2.6%. Prematurity was a factor in all cases. Respiratory distress syndrome and neonatal sepsis were each present in 50% of cases and hyperbilirubinemia in 33%. 8.7% of the mothers developed chorioamnionitis. Only 23.9% terminated their pregnancies spontaneously. Oxytocin was used to induce labor in 30.4% and cesareans were performed in 44.8%.

  4. Risk factors for perinatal mortality in Murmansk County, Russia: a registry-based study

    PubMed Central

    Usynina, Anna A.; Grjibovski, Andrej M.; Krettek, Alexandra; Odland, Jon Øyvind; Kudryavtsev, Alexander V.; Anda, Erik Eik

    2017-01-01

    ABSTRACT Background: Factors contributing to perinatal mortality (PM) in Northwest Russia remain unclear. This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry. Objective: This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry. Methods: The study population consisted of all live- and stillbirths registered in the Murmansk County Birth Registry during 2006–2011 (n = 52,806). We excluded multiple births, births prior to 22 and after 45 completed weeks of gestation, infants with congenital malformations, and births with missing information regarding gestational age (a total of n = 3,666) and/or the studied characteristics (n = 2,356). Possible associations between maternal socio-demographic and lifestyle characteristics, maternal pre-pregnancy characteristics, pregnancy characteristics, and PM were studied by multivariable logistic regression. Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results: Of the 49,140 births eligible for prevalence analysis, 338 were identified as perinatal deaths (6.9 per 1,000 births). After adjustment for other factors, maternal low education level, prior preterm delivery, spontaneous or induced abortions, antepartum hemorrhage, antenatally detected or suspected fetal growth retardation, and alcohol abuse during pregnancy all significantly increased the risk of PM. We observed a higher risk of PM in unmarried women, as well as overweight or obese mothers. Maternal underweight reduced the risk of PM. Conclusions: Our results suggest that both social and medical factors are important correlates of perinatal mortality in Northwest Russia. PMID:28156197

  5. Perinatal morbidity and mortality in offspring of diabetic mothers in Qatif, Saudi Arabia.

    PubMed

    al-Dabbous, I A; Owa, J A; Nasserallah, Z A; al-Qurash, I S

    1996-04-01

    Diabetic mothers and their offspring were prospectively studied. Perinatal and neonatal morbidity and mortality data were analysed. Out of 11,677 deliveries in the hospital, 133 (1.14%) were delivered by diabetic mothers. They were made up of six (4.5%) stillbirths and 127 (95.5%) live births. Seventy-seven (57.9%), 55 (41.3%) and 1 (0.8%) were large, appropriate and small for gestational age, respectively. Hypoglycemia occurred in 49 (38.6%) of the 127 infants. Other associated problems were bacterial infections, congenital anomalies, birth trauma, preterm delivery, respiratory distress, polycythaemia and anaemia. Only 52 (39.1%) of the mothers received appropriate treatment for their diabetes during pregnancy. Poor maternal diabetic control resulted in high perinatal morbidity and mortality in the offspring. In order to improve the outcome in offspring of diabetic mothers in Qatif and probably Saudi Arabia as a whole, health education and improved care of the diabetic mothers during pregnancy urgently needed. This may be true of other developing countries where data on diabetes in pregnancy are scarce.

  6. Predictors of Perinatal Mortality Associated with Placenta Previa and Placental Abruption: An Experience from a Low Income Country

    PubMed Central

    Berhan, Yifru

    2014-01-01

    A retrospective cohort study design was used to assess predictors of perinatal mortality in women with placenta previa and abruption between January 2006 and December 2011. Four hundred thirty-two women (253 with placenta previa and 179 with placental abruption) were eligible for analysis. Binary logistic regression, Kaplan-Meier survival curve, and receiver operating characteristic (ROC) curve were used. On admission, 77% of the women were anaemic (<12 gm/dL) with mean haemoglobin level of 9.0 ± 3.0 gm/dL. The proportion of overall severe anaemia increased from about 28% on admission to 41% at discharge. There were 50% perinatal deaths (neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation). In the adjusted odds ratios, lengthy delay in accessing hospital care, prematurity, anaemia in the mothers, and male foetuses were independent predictors of perinatal mortality. The haemoglobin level at admission was more sensitive and more specific than prematurity in the prediction of perinatal mortality. The proportion of severe anaemia and perinatal mortality was probably one of the highest in the world. PMID:25002975

  7. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts

    PubMed Central

    Coombs, Ngaire; Stamatakis, Emmanuel; Biddulph, Jane P

    2015-01-01

    Objectives To examine the suitability of age specific limits for alcohol consumption and to explore the association between alcohol consumption and mortality in different age groups. Design Population based data from Health Survey for England 1998-2008, linked to national mortality registration data and pooled for analysis using proportional hazards regression. Analyses were stratified by sex and age group (50-64 and ≥65 years). Setting Up to 10 waves of the Health Survey for England, which samples the non-institutionalised general population resident in England. Participants The derivation of two analytical samples was based on the availability of comparable alcohol consumption data, covariate data, and linked mortality data among adults aged 50 years or more. Two samples were used, each utilising a different variable for alcohol usage: self reported average weekly consumption over the past year and self reported consumption on the heaviest day in the past week. In fully adjusted analyses, the former sample comprised Health Survey for England years 1998-2002, 18 368 participants, and 4102 deaths over a median follow-up of 9.7 years, whereas the latter comprised Health Survey for England years 1999-2008, 34 523 participants, and 4220 deaths over a median follow-up of 6.5 years. Main outcome measure All cause mortality, defined as any death recorded between the date of interview and the end of data linkage on 31 March 2011. Results In unadjusted models, protective effects were identified across a broad range of alcohol usage in all age-sex groups. These effects were attenuated across most use categories on adjustment for a range of personal, socioeconomic, and lifestyle factors. After the exclusion of former drinkers, these effects were further attenuated. Compared with self reported never drinkers, significant protective associations were limited to younger men (50-64 years) and older women (≥65 years). Among younger men, the range of protective effects was

  8. Perinatal and infant mortality and low birth weight among residents near cokeworks in Great Britain

    SciTech Connect

    Dolk, H.; Pattenden, S.; Vrijheid, M.; Thakrar, B.; Armstrong, B.

    2000-02-01

    With growing evidence of the adverse health effects of air pollution--especially fine particulates--investigators must concentrate on the fetus, neonate, and infant as potentially vulnerable groups. Cokeworks are a major source of smoke and sulfur dioxide. In the current study, the authors investigated whether populations residing near cokeworks had a higher risk of adverse perinatal and infant outcomes. Zones of 7.5-km radius around 22 cokeworks in Great Britain were studied, within which the authors assumed that exposure declined from highest levels within 2 km to background levels. Routinely recorded birth and death data for Great Britain during the period 1981--1992 were analyzed. Each individual record had a postcode that referred to a small geographical area of typically 15--17 addresses. The authors calculated expected numbers on the basis of regional rates, stratified by year, sex, and a small-area socio-economic deprivation score. For all cokeworks combined, the observed/expected ratio within 2 km of cokeworks was 1.00 for low-birth-weight infants; 0.94 for still births; 0.95 for infant mortality; 0.86 for neonatal mortality; 1.10 for postneonatal mortality; 0.79 for respiratory postneonatal mortality; and 1.07 for postneonatal Sudden Infant Death Syndrome. Respiratory postneonatal mortality was low throughout the entire 0--7.5-km study area. There was no statistically significant decline in risk with distance from cokeworks for any of the outcomes studied. The authors concluded that there was no evidence of an increased risk of low birth weight, stillbirths, and/or neonatal mortality near cokeworks, and there was no strong evidence for any association between residence near cokeworks and postneonatal mortality. One must remember, however, the limited statistical power of the study to detect small risks.

  9. Repeat caesarean delivery as a risk factor for abnormal blood loss, blood transfusion and perinatal mortality.

    PubMed

    Saidu, R; Bolaji, B O; Olatinwo, A W O; McIntosh, C M; Alio, A P; Salihu, H M

    2011-11-01

    We reviewed 450 cases of caesarean delivery (January-December 2009) at the University of Ilorin Teaching Hospital in Nigeria. We analysed the association between caesarean delivery status (primary or previous) and the following outcomes: abnormal blood-loss, blood transfusion and perinatal mortality. Although significant differences were observed between primary and previous caesarean delivery groups in regards to maternal age, urgency of the caesarean delivery, booking status, and cadre of birth attendant staff, no association was noted between caesarean delivery status and any of the three outcomes. Further analyses identified parity as an important predictor for blood transfusion and abnormal blood loss. In addition, we found a dose?response relationship between parity and abnormal blood loss (< 0.05). Also, mothers with an emergency caesarean delivery of the index pregnancy were more than twice as likely to have a blood transfusion as compared with those with an elective caesarean delivery.

  10. Reproductive pattern, perinatal mortality, and sex preference in rural Tamil Nadu, south India: community based, cross sectional study.

    PubMed Central

    Nielsen, B. B.; Liljestrand, J.; Hedegaard, M.; Thilsted, S. H.; Joseph, A.

    1997-01-01

    OBJECTIVES: To study reproductive pattern and perinatal mortality in rural Tamil Nadu, South India. DESIGN: Community based, cross sectional questionnaire study of 30 randomly selected areas served by health subcentres. SETTING: Rural parts of Salem District, Tamil Nadu, South India. SUBJECTS: 1321 women and their offspring delivered in the 6 months before the interview. MAIN OUTCOME MEASURES: Number of pregnancies, pregnancy outcome, spacing of pregnancies, sex of offspring, perinatal and neonatal mortality rates. RESULTS: 41% of the women (535) were primiparous; 7 women (0.5%) were grand multiparous (> 6 births). The women had a mean age of 22 years and a mean of 2.3 pregnancies and 1.8 live children. The sex ratio at birth of the index children was 107 boys per 100 girls. The stillbirth rate was 13.5/1000 births, the neonatal mortality rate was 35.3/1000, and the perinatal mortality rate was 42.0/1000. Girls had an excess neonatal mortality (rate ratio 3.42%; 95% confidence interval 1.68 to 6.98; this was most pronounced among girls born to multiparous women with no living sons (rate ratio 15.48 (2.04 to 177.73) v 1.87 (0.63 to 5.58) in multiparous women with at least one son alive). CONCLUSIONS: In this rural part of Tamil Nadu, women had a controlled reproductive pattern. The excess neonatal mortality among girls constitutes about one third of the perinatal mortality rate. It seems to be linked to a preference for sons and should therefore be addressed through a holistic societal approach rather than through specific healthcare measures. PMID:9169399

  11. High birth weight and perinatal mortality among siblings: A register based study in Norway, 1967-2011

    PubMed Central

    Keyes, Katherine M.; Susser, Ezra; Corbett, Karina; Irgens, Lorentz M.

    2017-01-01

    Background Perinatal mortality according to birth weight has an inverse J-pattern. Our aim was to estimate the influence of familial factors on this pattern, applying a cohort sibling design. We focused on excess mortality among macrosomic infants (>2 SD above the mean) and hypothesized that the birth weight-mortality association could be explained by confounding shared family factors. We also estimated how the participant’s deviation from mean sibling birth weight influenced the association. Methods and findings We included 1 925 929 singletons, born term or post-term to mothers with more than one delivery 1967–2011 registered in the Medical Birth Registry of Norway. We examined z-score birth weight and perinatal mortality in random-effects and sibling fixed-effects logistic regression models including measured confounders (e.g. maternal diabetes) as well as unmeasured shared family confounders (through fixed effects models). Birth weight-specific mortality showed an inverse J-pattern, being lowest (2.0 per 1000) at reference weight (z-score +1 to +2) and increasing for higher weights. Mortality in the highest weight category was 15-fold higher than reference. This pattern changed little in multivariable models. Deviance from mean sibling birth weight modified the mortality pattern across the birth weight spectrum: small and medium-sized infants had increased mortality when being smaller than their siblings, and large-sized infants had an increased risk when outweighing their siblings. Maternal diabetes and birth weight acted in a synergistic fashion with mortality among macrosomic infants in diabetic pregnancies in excess of what would be expected for additive effects. Conclusions The inverse J-pattern between birth weight and mortality is not explained by measured confounders or unmeasured shared family factors. Infants are at particularly high mortality risk when their birth weight deviates substantially from their siblings. Sensitivity analysis suggests

  12. Reasons for Persistently High Maternal and Perinatal Mortalities in Ethiopia: Part II-Socio-Economic and Cultural Factors

    PubMed Central

    Berhan, Yifru; Berhan, Asres

    2014-01-01

    Background The major causes of maternal and perinatal deaths are mostly pregnancy related. However, there are several predisposing factors for the increased risk of pregnancy related complications and deaths in developing countries. The objective of this review was to grossly estimate the effect of selected socioeconomic and cultural factors on maternal mortality, stillbirths and neonatal mortality in Ethiopia. Methods A comprehensive literature review was conducted focusing on the effect of total fertility rate (TFR), modern contraceptive use, harmful traditional practice, adult literacy rate and level of income on maternal and perinatal mortalities. For the majority of the data, regression analysis and Pearson correlation coefficient were used as a proxy indicator for the association of variables with maternal, fetal and neonatal mortality. Results Although there were variations in the methods for estimation, the TFR of women in Ethiopia declined from 5.9 to 4.8 in the last fifteen years, which was in the middle as compared with that of other African countries. The preference of injectable contraceptive method has increased by 7-fold, but the unmet contraceptive need was among the highest in Africa. About 50% reduction in female genital cutting (FGC) was reported although some women's attitude was positive towards the practice of FGC. The regression analysis demonstrated increased risk of stillbirths, neonatal and maternal mortality with increased TFR. The increased adult literacy rate was associated with increased antenatal care and skilled person attended delivery. Low adult literacy was also found to have a negative association with stillbirths and neonatal and maternal mortality. A similar trend was also observed with income. Conclusion Maternal mortality ratio, stillbirth rate and neonatal mortality rate had inverse relations with income and adult education. In Ethiopia, the high total fertility rate, low utilization of contraceptive methods, low adult

  13. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial

    PubMed Central

    2013-01-01

    Background In 2001, the WHO Antenatal Care Trial (WHOACT) concluded that an antenatal care package of evidence-based screening, therapeutic interventions and education across four antenatal visits for low-risk women was not inferior to standard antenatal care and may reduce cost. However, an updated Cochrane review in 2010 identified an increased risk of perinatal mortality of borderline statistical significance in three cluster-randomized trials (including the WHOACT) in developing countries. We conducted a secondary analysis of the WHOACT data to determine the relationship between the reduced visits, goal-oriented antenatal care package and perinatal mortality. Methods Exploratory analyses were conducted to assess the effect of baseline risk and timing of perinatal death. Women were stratified by baseline risk to assess differences between intervention and control groups. We used linear modeling and Poisson regression to determine the relative risk of fetal death, neonatal death and perinatal mortality by gestational age. Results 12,568 women attended the 27 intervention clinics and 11,958 women attended the 26 control clinics. 6,160 women were high risk and 18,365 women were low risk. There were 161 fetal deaths (1.4%) in the intervention group compared to 119 fetal deaths in the control group (1.1%) with an increased overall adjusted relative risk of fetal death (Adjusted RR 1.27; 95% CI 1.03, 1.58). This was attributable to an increased relative risk of fetal death between 32 and 36 weeks of gestation (Adjusted RR 2.24; 95% CI 1.42, 3.53) which was statistically significant for high and low risk groups. Conclusion It is plausible the increased risk of fetal death between 32 and 36 weeks gestation could be due to reduced number of visits, however heterogeneity in study populations or differences in quality of care and timing of visits could also be playing a role. Monitoring maternal, fetal and neonatal outcomes when implementing antenatal care protocols is

  14. Perinatal neuroprotection

    PubMed Central

    Jelin, Angie C.; Thiet, Mari-Paule

    2014-01-01

    Fetal or neonatal brain injury can result in lifelong neurologic disability. The most significant risk factor for perinatal brain injury is prematurity; however, in absolute numbers, full-term infants represent the majority of affected children. Research on strategies to prevent or mitigate the impact of perinatal brain injury (“perinatal neuroprotection”) has established the mitigating roles of magnesium sulfate administration for preterm infants and therapeutic hypothermia for term infants with suspected perinatal brain injury. Banked umbilical cord blood, erythropoietin, and a number of other agents that may improve neuronal repair show promise for improving outcomes following perinatal brain injury in animal models. Other preventative strategies include delayed umbilical cord clamping in preterm infants and progesterone in women with prior preterm birth or short cervix and avoidance of infections. Despite these advances, we have not successfully decreased the rate of preterm birth, nor are we able to predict term infants at risk of hypoxic brain injury in order to intervene prior to the hypoxic event. Further, we lack the ability to modulate the sequelae of neuronal cell insults or the ability to repair brain injury after it has been sustained. As a consequence, despite exciting advances in the field of perinatal neuroprotection, perinatal brain injury still impacts thousands of newborns each year with significant long-term morbidity and mortality. PMID:24592318

  15. Fetal distress and in utero pneumonia in perinatal dolphins during the Northern Gulf of Mexico unusual mortality event.

    PubMed

    Colegrove, Kathleen M; Venn-Watson, Stephanie; Litz, Jenny; Kinsel, Michael J; Terio, Karen A; Fougeres, Erin; Ewing, Ruth; Pabst, D Ann; McLellan, William A; Raverty, Stephen; Saliki, Jeremiah; Fire, Spencer; Rappucci, Gina; Bowen-Stevens, Sabrina; Noble, Lauren; Costidis, Alex; Barbieri, Michelle; Field, Cara; Smith, Suzanne; Carmichael, Ruth H; Chevis, Connie; Hatchett, Wendy; Shannon, Delphine; Tumlin, Mandy; Lovewell, Gretchen; McFee, Wayne; Rowles, Teresa K

    2016-04-12

    An unusual mortality event (UME) involving primarily common bottlenose dolphins Tursiops truncatus of all size classes stranding along coastal Louisiana, Mississippi, and Alabama, USA, started in early 2010 and continued into 2014. During this northern Gulf of Mexico UME, a distinct cluster of perinatal dolphins (total body length <115 cm) stranded in Mississippi and Alabama during 2011. The proportion of annual dolphin strandings that were perinates between 2009 and 2013 were compared to baseline strandings (2000-2005). A case-reference study was conducted to compare demographics, histologic lesions, and Brucella sp. infection prevalence in 69 UME perinatal dolphins to findings from 26 reference perinates stranded in South Carolina and Florida outside of the UME area. Compared to reference perinates, UME perinates were more likely to have died in utero or very soon after birth (presence of atelectasis in 88 vs. 15%, p < 0.0001), have fetal distress (87 vs. 27%, p < 0.0001), and have pneumonia not associated with lungworm infection (65 vs. 19%, p = 0.0001). The percentage of perinates with Brucella sp. infections identified via lung PCR was higher among UME perinates stranding in Mississippi and Alabama compared to reference perinates (61 vs. 24%, p = 0.01), and multiple different Brucella omp genetic sequences were identified in UME perinates. These results support that from 2011 to 2013, during the northern Gulf of Mexico UME, bottlenose dolphins were particularly susceptible to late-term pregnancy failures and development of in utero infections including brucellosis.

  16. Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996–2010

    PubMed Central

    Chen, Lu; Xiao, Lin; Auger, Nathalie; Torrie, Jill; McHugh, Nancy Gros-Louis; Zoungrana, Hamado; Luo, Zhong-Cheng

    2015-01-01

    Background Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. Methods We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996–2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Results Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively) births (all p<0.001). Compared to non-Aboriginal births, preterm birth rates were persistently (1.7–1.8 times) higher in Inuit, large-for-gestational-age birth rates were persistently (2.7–3.0 times) higher in First Nations births over the study period. Between 1996–2000 and 2006–2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times) in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times) or First Nations (from 3.76 to 4.25 times) infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence) attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively), infant mortality (3.66 and 1.47 times, respectively) and postneonatal

  17. [SOCIODEMOGRAPHIC FACTORS AND ADEQUACY OF PRENATAL CARE ASSOCIATED PERINATAL MORTALITY IN COLOMBIAN PREGNANT WOMEN].

    PubMed

    Flores Navarro-Pérez, Carmen; González-Jiménez, Emilio; Schmidt-RioValle, Jacqueline; Meneses-Echávez, José Francisco; Martínez-Torres, Javier; Ramírez-Vélez, Robinson

    2015-09-01

    Introducción: el adecuado seguimiento clínico y el cumplimiento de los requerimientos nutricionales, son aspectos esenciales para el adecuado desarrollo fetal y la culminación exitosa del embarazo. El objetivo de este estudio fue determinar la asociación entre los factores sociodemográficos y el seguimiento prenatal asociados a la mortalidad perinatal en gestantes de Colombia. Material y métodos: estudio descriptivo y transversal secundario a la información obtenida en la Encuesta Nacional de la Situación Nutricional 2010 (ENSIN 2010) y la Encuesta Nacional de Demografía y Salud (ENDS 2010), en 14.754 mujeres gestantes de entre 13 y 44 años de edad. Los factores sociodemográficos: sexo del recién nacido, región geográfica (atlántica, oriental, central, pacífica, Bogotá, territorios nacionales), nivel socioeconómico- Sisbén (I al VI) y área geográfica (cabecera municipal, centro poblado, población dispersa), el seguimiento prenatal (control de peso, altura uterina, presión arterial, fetocardia, bioquímica sanguínea, análisis de orina) y la suplementación con hierro, calcio y ácido fólico se recogieron a través de una encuesta estructurada. Se establecieron asociaciones mediante la construcción de modelos de regresión logística binaria simple y multivariable. Resultados: de las variables sociodemográficas, residir en centros poblados, región oriental o pacífica, y pertenecer al nivel Sisbén I, son las que mostraron mayor frecuencia de muerte perinatal, con valores de 1,7%, 1,5%, 1,4% y 1,4%, respectivamente. Tras ajustar por sexo del recién nacido, área, región geográfica y puntaje de Sisbén, se encontró que un inadecuado seguimiento en el control del peso (OR 5,12), la presión arterial (OR 5,18), la bioquímica sanguínea (OR 2,19) y la suplementación con hierro (OR 2,09), calcio (OR 1,73) y ácido fólico (OR 2,73) se asociaron como factores predisponentes a la mortalidad perinatal. Conclusiones: la mortalidad perinatal

  18. Increases in perinatal mortality in prefectures contaminated by the Fukushima nuclear power plant accident in Japan: A spatially stratified longitudinal study.

    PubMed

    Scherb, Hagen Heinrich; Mori, Kuniyoshi; Hayashi, Keiji

    2016-09-01

    Descriptive observational studies showed upward jumps in secular European perinatal mortality trends after Chernobyl. The question arises whether the Fukushima nuclear power plant accident entailed similar phenomena in Japan. For 47 prefectures representing 15.2 million births from 2001 to 2014, the Japanese government provides monthly statistics on 69,171 cases of perinatal death of the fetus or the newborn after 22 weeks of pregnancy to 7 days after birth. Employing change-point methodology for detecting alterations in longitudinal data, we analyzed time trends in perinatal mortality in the Japanese prefectures stratified by exposure to estimate and test potential increases in perinatal death proportions after Fukushima possibly associated with the earthquake, the tsunami, or the estimated radiation exposure. Areas with moderate to high levels of radiation were compared with less exposed and unaffected areas, as were highly contaminated areas hit versus untroubled by the earthquake and the tsunami. Ten months after the earthquake and tsunami and the subsequent nuclear accident, perinatal mortality in 6 severely contaminated prefectures jumped up from January 2012 onward: jump odds ratio 1.156; 95% confidence interval (1.061, 1.259), P-value 0.0009. There were slight increases in areas with moderate levels of contamination and no increases in the rest of Japan. In severely contaminated areas, the increases of perinatal mortality 10 months after Fukushima were essentially independent of the numbers of dead and missing due to the earthquake and the tsunami. Perinatal mortality in areas contaminated with radioactive substances started to increase 10 months after the nuclear accident relative to the prevailing and stable secular downward trend. These results are consistent with findings in Europe after Chernobyl. Since observational studies as the one presented here may suggest but cannot prove causality because of unknown and uncontrolled factors or confounders

  19. The Quality and Completeness of 2008 Perinatal and Under-five Mortality Data from Vital Registration, Jamaica

    PubMed Central

    McCaw-Binns, A; Mullings, J; Holder, Y

    2015-01-01

    ABSTRACT Objective: To evaluate the completeness and timeliness of registration of stillbirths and under-five deaths and the validity of the certification and coding process. Subjects and Methods: Registered stillbirths and under-five deaths occurring in 2008 were compared to hospital, police, forensic pathologist and coroner's records. Missed cases and new information such as birthweight, gestation and date of birth were added to the database. A 10% random sample was evaluated to measure the quality of certification and coding. Results: Of 646 stillbirths [≥ 1000 g] and 933 under-five deaths, 69% and 79%, respectively were registered by December 31, 2009, for inclusion in the 2008 final demographic returns. Non-reporting of stillbirths was associated with infant gender, region and place of death [seven of 21 public hospitals accounted for 96% of unregistered stillbirths). Among under-five deaths, age at death, region, place and cause of death were important. Injury and community deaths increased with age. Registration delays including non-registration were associated with coroner's inquests. Most (80%) stillbirth certificates lacked usable cause of death data. Neonatal deaths due to prematurity and perinatal asphyxia were often misclassified by coders. The stillbirth (≥ 1000 g), infant and under-five mortality rates were 15, 20 and 22/1000 births/live births, respectively. Conclusions: While registration of stillbirths and under-five deaths improved between 1998 and 2008, persistent under-reporting reduced official rates by 20–31%. A new perinatal death certificate documenting maternal and fetal causes of death and risk factors such as birthweight, gestation and age at death would improve stillbirth and neonatal death (0–28 days) data quality. PMID:26035810

  20. Perinatal Mortality Associated with Positive Postmortem Cultures for Common Oral Flora

    PubMed Central

    Migliori, Alison R.; Lauro, Patricia; Sung, C. James; Pinar, Halit

    2017-01-01

    Introduction. To investigate whether maternal oral flora might be involved in intrauterine infection and subsequent stillbirth or neonatal death and could therefore be detected in fetal and neonatal postmortem bacterial cultures. Methods. This retrospective study of postmortem examinations from 1/1/2000 to 12/31/2010 was searched for bacterial cultures positive for common oral flora from heart blood or lung tissue. Maternal age, gestational age, age at neonatal death, and placental and fetal/neonatal histopathological findings were collected. Results. During the study period 1197 postmortem examinations (861 stillbirths and 336 neonatal deaths) were performed in our hospital with gestational ages ranging from 13 to 40+ weeks. Cultures positive for oral flora were identified in 24 autopsies including 20 pure and 8 mixed growths (26/227, 11.5%), found in 16 stillbirths and 8 neonates. Microscopic examinations of these 16 stillbirths revealed 8 with features of infection and inflammation in fetus and placenta. The 7 neonatal deaths within 72 hours after birth grew 6 pure isolates and 1 mixed, and 6 correlated with fetal and placental inflammation. Conclusions. Pure isolates of oral flora with histological evidence of inflammation/infection in the placenta and fetus or infant suggest a strong association between maternal periodontal conditions and perinatal death. PMID:28325959

  1. An international delphi study of the causes of death and the criteria used to assign cause of death in bovine perinatal mortality.

    PubMed

    Mee, J F; Sanchez-Miguel, C; Doherty, M

    2013-08-01

    The objective of the present study was to elicit opinion from two groups of veterinarians [subject matter experts and non-subject matter experts] about the causes of bovine perinatal mortality and the criteria used to assign such causes. The subject matter experts were selected on the basis of their scientific publications or experience of working in a veterinary diagnostic or research laboratory in the area of bovine perinatal mortality. The non-subject matter experts were self-selected as cattle veterinarians without particular expertise in bovine perinatology. A total of 74 veterinarians (46 subject matter experts and 28 non-subject matter experts) from 23 countries responded. The study was conducted using Delphi methodology over seven rounds. Respondents were asked to agree the causes of bovine perinatal mortality and for each cause to agree the supporting diagnostic criteria. There was a close agreement between groups on 16 causes of death apart from intra-uterine growth retardation (IUGR) and micronutrient imbalances which were accepted by fewer subject matter experts. There was inter-group consensus on the criteria to diagnose accidents, congenital defects, dystocia, hyperthermia, infections, premature placental separation, prematurity and prolonged calving. There was inter-group consensus on the criteria to diagnose anoxia, apart from gingival cyanosis; on haemorrhage, apart from haemorrhagic anaemia; on IUGR, apart from organ weights; and on iodine imbalance, apart from goitre and thyroid iodine content. The results from this study highlighted the current lack of standardization of the criteria used to define the cause of death for bovine perinatal mortality and the need for such standardization.

  2. Investigation of stillbirths, perinatal mortality and weakness in beef calves with low-selenium whole blood concentrations.

    PubMed

    Davis, Anthony J; Myburgh, Jan G

    2016-07-15

    In this on-farm investigation, we report on stillbirths, weakness and perinatal mortality seen in calves on a commercial beef farm in the Roossenekal area, Mpumalanga province, South Africa. Post-mortem examination of these calves and histopathological examination of organ and tissue samples did not indicate an infectious aetiology. Affected calves had marginal to deficient whole blood selenium concentrations. Whole blood samples collected from adult cattle on this farm and five neighbouring farms were deficient in selenium. The potential contributions of other minerals to the symptoms seen are a subject of ongoing investigation, but selenium deficiency was marked in this herd and required urgent correction. Methods to correct the deficiency included the use of injectable products, and an oral selenium supplement chelated to methionine. Selenium availability to plants is primarily determined by the selenium content of the parent bedrock, the presence of other minerals and the pH of the soil. The apparent sudden onset of this problem implicates a soil factor as being responsible for reducing selenium's bioavailability in this area. Selenium deficiency can have a significant impact on human health. HIV and/or AIDS, various forms of cancer and several specific clinical syndromes are associated with selenium deficiency in humans, and the impact on human health in this area also requires further investigation.

  3. [Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic].

    PubMed

    León Carmona, Julio César; Hernández Alvarez, Luis Alfredo Ignacio; Hernández Hernández, Ma Adriana Cecilia

    2002-07-01

    This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1: 1. 71.950% of participants were married, 22.62% in free union, 4.98% single and 0.45% separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95% confidence limits: 0.40 < OR < 1.03, p = 0.0510600) concerning desired

  4. [Potential role of prenatal care in reducing maternal and perinatal mortality in sub-Saharan Africa].

    PubMed

    Prual, A; De Bernis, L; El Joud, D Ould

    2002-02-01

    Prenatal care has been implemented in developing countries according to the same mode as applied in industrialized countries without considering its real effectiveness in reducing maternal and neonatal mortality. Several recent studies suggest that the goals should be revisited in order to implement a program of prenatal care based on real scientific evidence. Based on the current literature, we propose a potentially effective content for prenatal care adapted to the context of developing countries. Four antenatal consultations would be enough if appropriately timed at 12, 26, 32 and 36 weeks pregnancy. The purpose of these consultations would be: 1) to screen for three major risk factors, which, when recognized, lead to specific action: uterine, scare, malpresentation, premature rupture of the membranes; 2) to prevent and/or detect (and treat) specific complications of pregnancy: hypertension, infection (malaria, venereal disease, HIV, tetanus, urinary tract infection); anemia and trace element deficiencies, gestational diabetes mellitus; 3) to provide counseling, support and information for pregnant women and their families (including the partner) concerning: severe signs and symptoms of pregnancy and delivery, community organization of emergency transfer, delivery planning. These potentially effective actions can only have a real public health impact if implemented within an organized maternal health system with a functional network of delivery units, if truly quality care is given, and if the relationships between health care providers and the population are based on mutual respect. Sub-Saharan African women use prenatal care extensively when it is accessible; this opportunity must be used to implement evidence-based actions with appropriate and realistic goals.

  5. A new plan for the 800-pound Gorilla (Guerrilla): perinatal mortality in Afghanistan: a 21st century counterinsurgency model for Afghanistan.

    PubMed

    Johnson, Thomas C

    2011-01-01

    Afghanistan has the highest perinatal mortality rate in the entire world. One Afghani woman dies every 30 minutes from perinatal- related event. One of eight Afghani women will die from perinatal events. Maternal mortality is (use percentage, not fractions) 1600/100,000 vs 13 /100,000 in the United States. Afghanistan is one of the only countries in the world in which the average woman?s life expectancy is shorter than a males- despite the active, nationwide combat fought primarily by Afghani males. Meaning, women in Afghanistan are not routinely involved in combat, yet are more likely to die than a man of the same age. This article presents an alternative model Medical Seminar (MEDSEM) for a successful Special Forces (SF) medical counterinsurgency (COIN) plan that can obtain real results by addressing the mission of the Afghan Ministry of Health versus clinging to old notions. This model forms around the medical capabilities of the SF Operational Detachment (ODA)- Alpha (A) and preventinmaternal-infant complications.

  6. A Bayesian threshold-linear model evaluation of perinatal mortality, dystocia, birth weight, and gestation length in a Holstein herd.

    PubMed

    Johanson, J M; Berger, P J; Tsuruta, S; Misztal, I

    2011-01-01

    The objective of this research was to estimate genetic parameters for a multiple-trait evaluation of dystocia (DYS), perinatal mortality (PM), birth weight (BWT), and gestation length (GL) in Holsteins. The data included 5,712 calving records collected between 1968 and 2005 from the Iowa State University dairy breeding herd in Ankeny. The incidence of PM was 8.8% and that of DYS 28.8%; mean BWT was 40.5 kg, and GL was 279 d. A threshold-linear animal model included the effects of year, season, sex of calf, parity, sire group, direct genetic, maternal genetic, and maternal permanent environment. Direct heritabilities for DYS, PM, BWT, and GL were 0.11 (0.04), 0.13 (0.05), 0.26 (0.04), and 0.51 (0.05), respectively. Maternal heritabilities were 0.14 (0.04), 0.15 (0.03), 0.08 (0.01), and 0.08 (0.02), for DYS, PM, BWT, and GL, respectively. The heritabilities are the posterior means of the Gibbs samples with their standard deviations in parentheses. The direct genetic correlation between PM and DYS was estimated at 0.67 (0.19), whereas the maternal genetic correlation was 0.45 (0.16). Direct and maternal PM and DYS are partially controlled by the same genes. Selection on only calving ease is not sufficient to control PM. With moderate genetic correlations between all 4 traits, BWT and GL should be included with DYS and PM in an evaluation of calving performance.

  7. Effectiveness of Continuum of Care—Linking Pre-Pregnancy Care and Pregnancy Care to Improve Neonatal and Perinatal Mortality: A Systematic Review and Meta-Analysis

    PubMed Central

    Kikuchi, Kimiyo; Okawa, Sumiyo; Zamawe, Collins O. F.; Shibanuma, Akira; Nanishi, Keiko; Iwamoto, Azusa; Saw, Yu Mon; Jimba, Masamine

    2016-01-01

    In an era of Sustainable Development Goals, maternal, newborn, and child health still require improvement. Continuum of care is considered key to improving the health status of these populations. The continuum of care is a series of care strategies starting from pre-pregnancy to motherhood-childhood. The effectiveness of such linkage between the pregnancy, birth, and postnatal periods has been demonstrated. However, almost no study has assessed the impact of linkage that starts from pre-pregnancy to pregnancy care on maternal and child health. The present study attempts to fill this gap by assessing the effectiveness of the care linkage between pre-pregnancy and pregnancy care for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. We performed a systematic review and meta-analysis of randomized and quasi-randomized controlled trials in low- and middle-income countries. The outcome variables were neonatal, perinatal, and maternal mortality. We searched databases such as PubMed/Medline, POPLINE, EBSCO/CINAHL, and ISI Web of Science for the period 2000–2014, using broad search terms (e.g., pre-pregnancy OR adolescent OR mother), combined with search terms specific for interventions, (e.g., family planning OR contraception OR spacing). From the 1,325 retrieved articles, five studies were finally analyzed. The meta-analysis showed that interventions linking pre-pregnancy and pregnancy care effectively reduced neonatal mortality (risk ratio [RR]: 0.79; 95% confidence interval [CI]: 0.71–0.89, I2 = 62%) and perinatal mortality (RR: 0.84; 95% CI: 0.75–0.94, I2 = 73%), but did not show an effect on maternal mortality. Neonatal and perinatal mortality could be reduced by linking pre-pregnancy and pregnancy care. This linkage of pre-pregnancy and pregnancy cares is an essential component of continuum of care to improve newborn health. Review Registration PROSPERO International prospective register of systematic reviews (CRD

  8. Birthweight by gestational age and its effect on perinatal mortality in white and in Punjabi births: experience at a district general hospital in West London 1967-1975.

    PubMed

    Dawson, I; Golder, R Y; Jonas, E G

    1982-11-01

    At Hillingdon Hospital in West London two main ethnic groups: 'UK' (i.e. white European) and 'Indian' (i.e. Punjabi) account for the bulk of obstetric work load. Birthweight by gestational age graphs were calculated for some 6000 Indian and 18000 UK infants born between 1967 and 1975 inclusive. A mean weight difference at term favoured UK male babies by 240 g and UK female babies by 230 g. Though the crude perinatal results in the two populations were not significantly different, the perinatal mortality of infants less than 2500 g in birthweight was lower in the Indian than the UK population, particularly in the 1500-2400 g group. This is attributed to a levelling off in intrauterine growth from 36 to 37 weeks gestation onwards in Indian compared with UK pregnancies, so that they were more mature than UK births of the same weight. However light-for-dates births, defined as birthweights below the 10th centile of weight-for-gestational age on their own ethnic and sex specific standards pose problems, irrespective of ethnic background.

  9. A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol

    PubMed Central

    2013-01-01

    Background Maternal and perinatal mortality continue to be a high priority problem on the health agendas of less developed countries. Despite the progress made in the last decade to quantify the magnitude of maternal mortality, few interventions have been implemented with the intent to measure impact directly on maternal or perinatal deaths. The success of interventions implemented in less developed countries to reduce mortality has been questioned, in terms of the tendency to maintain a clinical perspective with a focus on purely medical care separate from community-based approaches that take cultural and social aspects of maternal and perinatal deaths into account. Our innovative approach utilizes both the clinical and community perspectives; moreover, our study will report the weight that each of these components may have had on reducing perinatal mortality and increasing institution-based deliveries. Methods/Design A matched pair cluster-randomized trial will be conducted in clinics in four rural indigenous districts with the highest maternal mortality ratios in Guatemala. The individual clinic will serve as the unit of randomization, with 15 matched pairs of control and intervention clinics composing the final sample. Three interventions will be implemented in indigenous, rural and poor populations: a simulation training program for emergency obstetric and perinatal care, increased participation of the professional midwife in strengthening the link between traditional birth attendants (TBA) and the formal health care system, and a social marketing campaign to promote institution-based deliveries. No external intervention is planned for control clinics, although enhanced monitoring, surveillance and data collection will occur throughout the study in all clinics throughout the four districts. All obstetric events occurring in any of the participating health facilities and districts during the 18 months implementation period will be included in the analysis

  10. Antenatal exposure to doxylamine succinate and dicyclomine hydrochloride (Benedectin) in relation to congenital malformations, perinatal mortality rate, birth weight, and intelligence quotient score.

    PubMed

    Shapiro, S; Heinonen, O P; Siskind, V; Kaufman, D W; Monson, R R; Slone, D

    1977-07-01

    In a prospective cohort study of 20, 282 gravidas and their offspring, congenital malformation rates were similar in the children of over 1,000 women exposed and those not exposed to two components of Bendectin (doxylamine succinate and dicyclomine hydrochloride) during the first four lunar months of pregnancy. In a cohort reduced to 41,337 mother-child pairs for technical reasons, mean birth weight and perinatal mortality rates were similar according to exposure or nonexposure to either drug, as were intelligence quotient scores measured at four years of age in 28,358 of the children. Control of potential confounding factors with a variety of multivariate techniques did not materially alter these findings.

  11. Effects of quality improvement in health facilities and community mobilization through women’s groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial

    PubMed Central

    Colbourn, Tim; Nambiar, Bejoy; Bondo, Austin; Makwenda, Charles; Tsetekani, Eric; Makonda-Ridley, Agnes; Msukwa, Martin; Barker, Pierre; Kotagal, Uma; Williams, Cassie; Davies, Ros; Webb, Dale; Flatman, Dorothy; Lewycka, Sonia; Rosato, Mikey; Kachale, Fannie; Mwansambo, Charles; Costello, Anthony

    2016-01-01

    Background Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. Methods We evaluated a rural participatory women’s group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14 576 and 20 576 births were recorded during baseline (June 2007–September 2008) and intervention (October 2008–December 2010) periods. Results For control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60–1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72–0.97). We did not observe any intervention effects on maternal mortality. Conclusions Despite implementation problems, a combined community and facility approach using participatory women’s groups and quality improvement at health centres reduced newborn mortality in rural Malawi. PMID:24030269

  12. Integrated approaches to improve birth outcomes: perinatal periods of risk, infant mortality review, and the Los Angeles Mommy and Baby Project.

    PubMed

    Chao, Shin Margaret; Donatoni, Giannina; Bemis, Cathleen; Donovan, Kevin; Harding, Cynthia; Davenport, Deborah; Gilbert, Carol; Kasehagen, Laurin; Peck, Magda G

    2010-11-01

    This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders' commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the

  13. Of sick turkeys, kwashiorkor, malaria, perinatal mortality, heroin addicts and food poisoning: research on the influence of aflatoxins on child health in the tropics.

    PubMed

    Hendrickse, R G

    1997-10-01

    Similarities between the geographical and climatic prevalences of kwashiorkor and of exposure to dietary aflatoxins, and between the biochemical, metabolic and immunological derangements in kwashiorkor and those in animals exposed to aflatoxins, prompted investigation of the associations between kwashiorkor and aflatoxins. Studies in Africa in the 1980s indicated a role for these toxins in the pathogenesis of the disease. Paediatric cases of kwashiorkor are less prone to severe Plasmodium falciparum malaria than normal children. In mice infected with P. berghei, aflatoxin exposure inhibits parasite growth and ameliorates morbidity. Aflatoxins occur in < or = 40% of samples of breast milk from tropical Africa, usually as low concentrations of the relatively non-toxic derivatives of aflatoxin B1 (AFB1) but sometimes as high concentrations of the very toxic AFB1. This could explain kwashiorkor in breast-fed babies. Aflatoxin exposure occurs in > or = 30% of pregnancies in tropical Africa and the toxins are often in cord blood, sometimes at extremely high concentrations. Aflatoxins are now incriminated in neonatal jaundice and there is circumstantial evidence that they cause perinatal death and reduced birthweight. Aflatoxin-induced immunosuppresion may explain the aggressive behaviour of HIV infection in Africa. There are similarities between observations on HIV cases in Africa and those on heroin addicts in Europe, where 'street' heroin is frequently contaminated with aflatoxin. Aflatoxins were found in 20% of random urine samples from heroin addicts in the U.K. and the Netherlands. Aflatoxins have also been incriminated in episodes of food poisoning which have been associated with serious morbidity and mortality, particularly among young children.

  14. Perinatal Natural History of the Ts1Cje Mouse Model of Down Syndrome: Growth Restriction, Early Mortality, Heart Defects, and Delayed Development

    PubMed Central

    Ferrés, Millie A.; Bianchi, Diana W.; Siegel, Ashley E.; Bronson, Roderick T.; Huggins, Gordon S.; Guedj, Faycal

    2016-01-01

    Background The Ts1Cje model of Down syndrome is of particular interest for perinatal studies because affected males are fertile. This permits affected pups to be carried in wild-type females, which is similar to human pregnancies. Here we describe the early natural history and growth profiles of Ts1Cje embryos and neonates and determine if heart defects are present in this strain. Methods Pups were studied either on embryonic (E) day 15.5, or from postnatal (P) day 3 through weaning on P21. PCR amplification targeting the neomycin cassette (present in Ts1Cje) and Sry (present in males) was used to analyze pup genotypes and sex ratios. Body weights and lengths, as well as developmental milestones, were recorded in Ts1Cje mice and compared to their wild-type (WT) littermates. Histological evaluations were performed at E15.5 to investigate the presence or absence of heart defects. Pups were divided into two groups: Ts1Cje-I pups survived past weaning and Ts1Cje-II pups died at some point before P21. Results Ts1Cje mouse embryos showed expected Mendelian ratios (45.8%, n = 66 for Ts1Cje embryos; 54.2%, n = 78 for WT embryos). Histological analysis revealed the presence of ventricular septal defects (VSDs) in 21% of Ts1Cje E15.5 embryos. After weaning, only 28.2% of pups were Ts1Cje (185 Ts1Cje out of 656 total pups generated), with males predominating (male:female ratio of 1.4:1). Among the recovered dead pups (n = 207), Ts1Cje (63.3%, n = 131, p<0.01) genotype was found significantly more often than WT (36.7%, n = 76). Retrospective analysis of Ts1Cje-II (pre-weaning deceased) pups showed that they were growth restricted compared to Ts1Cje-I pups (post-weaning survivors). Growth restriction correlated with statistically significant delays in achieving several neonatal milestones between P3 and P21 compared to Ts1Cje-I (post-weaning survivors) neonates and WT littermates. Conclusions Ts1Cje genotype is not associated with increased early in utero mortality. Cardiac

  15. Age-Specific Morbidity among Navy Pilots

    DTIC Science & Technology

    1983-10-01

    categories. Younger pilots have the highest rates for disorders of tooth development and eruption and accidental ...rates among aviation officers for accidental injuries were attributed prim.arily to athletic or sports activities. Comparisons of hospitalizations...important age-specific health problems (i.e., accidental injuries among young pilots and cardiovascular conditions among older pilots). In order for

  16. Age-specific breeding in Emperor Geese

    USGS Publications Warehouse

    Schmutz, J.A.

    2000-01-01

    I studied the frequency with which Emperor Geese (Chen canagica) of known age were observed breeding on the Yukon-Kuskokwim Delta, Alaska. No one- or two-year old geese were observed on nests. Three-year old geese bred at a lower rate than four-year old geese. These data suggest that patterns of age-specific breeding in Emperor Geese are similar to other sympatrically nesting, large bodied geese [Greater White-fronted Geese (Anser albifrons)] but delayed relative to smaller bodied geese [Cackling Canada Geese (Branta canadensis minima) and Pacific Black Brant (B. bernicla nigricans)].

  17. Age-Specific Correlates of Child Growth.

    PubMed

    Rieger, Matthias; Trommlerová, Sofia Karina

    2016-02-01

    Growth faltering describes a widespread phenomenon that height- and weight-for-age of children in developing countries collapse rapidly in the first two years of life. We study age-specific correlates of child nutrition using Demographic and Health Surveys from 56 developing countries to shed light on the potential drivers of growth faltering. Applying nonparametric techniques and exploiting within-mother variation, we find that maternal and household factors predict best the observed shifts and bends in child nutrition age curves. The documented interaction between age and maternal characteristics further underlines the need not only to provide nutritional support during the first years of life but also to improve maternal conditions.

  18. Behind international rankings of infant mortality: how the United States compares with Europe.

    PubMed

    MacDorman, Marian F; Mathews, T J

    2009-11-01

    Infant mortality is an important indicator of the health of a nation, and the recent stagnation (since 2000) in the U.S. infant mortality rate has generated concern among researchers and policy makers. The percentage of preterm births in the United States has risen 36% since 1984 (1). In this report we compare infant mortality rates between the United States and Europe. We also compare two factors that determine the infant mortality rate-gestational age-specific infant mortality rates and the percentage of preterm births. U.S. data are from the Linked Birth/Infant Death Data Set (2,3), and European data for 2004 are from the recently published European Perinatal Health Report (4). We also examine requirements for reporting a live birth among countries to assess the possible effect of reporting differences on infant mortality data.

  19. The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project

    PubMed Central

    2012-01-01

    Background Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses). Methods/design This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation. Discussion Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will

  20. Is there an association between female circumcision and perinatal death?

    PubMed Central

    Essen, Birgitta; Bodker, Birgit; Sjoberg, N-O; Gudmundsson, Saemundur; Ostergren, P-O; Langhoff-Roos, Jens

    2002-01-01

    OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women. PMID:12219153

  1. Deriving age-specific incidence from prevalence with an ordinary differential equation.

    PubMed

    Brinks, Ralph; Landwehr, Sandra; Icks, Andrea; Koch, Michael; Giani, Guido

    2013-05-30

    This article describes new relationships between the age-specific incidence of, the prevalence of and mortality from a chronic disease. We express these relationships in terms of an ordinary differential equation and form the methodological basis for a novel approach to estimating incidences from age-specific prevalence data. We examine practical aspects of the relationships and a comparison with a known stochastic method in a simulation study. Finally, we apply the novel method to a data set of renal replacement therapy recorded from patients with chronic kidney failure in a region of Germany with approximately 310,000 inhabitants from 2002 to 2010.

  2. Recent advances of perinatal medicine in China.

    PubMed

    Zhou, Z

    1995-05-01

    Perinatal medicine has been practiced for only 30 years. The basis for such medicine is perinatal health care and the main theme is systemic monitoring and management of high-risk pregnancies. China has offered such practice since 1979, with the perinatal health care system derived from the former health care system for pregnant women. The rate of maternal mortality in China had fallen to 94.7/100,000 by 1989, while the perinatal mortality rate was 51.8/1000 as of 1986. Comparable rates for 1993 in the Shanghai area were 19.95/100,000 and 10.6/1000, respectively. A group of Baby Friendly Hospitals was formally approved by the Ministry of Health and the WHO-UNICEF joint committee. In Shanghai, 11 such maternity hospitals received this status in 1993, and 27 more in 1994. Recently, the social model of perinatal health care, as proposed by WHO-EURO, has been adopted in Shanghai, providing the mother the rights and freedom to choose appropriate health care management on her own. It is gaining emphasis in Shanghai that both medical and social models are mandatory in perinatal health care.

  3. The Application of Age-Specific Rates to Divorce

    ERIC Educational Resources Information Center

    England, J. Lynn; Kunz, Phillip R.

    1975-01-01

    Age-Specific divorce rates and weighted divorce rates are evaluated in comparison with several traditional rates. The analysis reversals of the ranking of some states in comparison with rankings based on other divorce rates, and the age-specific rates for young married couples is lower than expected. (Author)

  4. Association Between Isolated Single Umbilical Artery and Perinatal Outcomes: A Meta-Analysis.

    PubMed

    Xu, Yajuan; Ren, Lidan; Zhai, Shanshan; Luo, Xiaohua; Hong, Teng; Liu, Rui; Ran, Limin; Zhang, Yingying

    2016-04-30

    BACKGROUND To evaluate the association between the isolated single umbilical artery (iSUA) and perinatal outcomes, including pregnancy outcomes and perinatal complications. MATERIAL AND METHODS We performed a meta-analysis of 15 eligible studies regarding the relationship between the iSUA and perinatal outcomes, including gestational age at delivery, nuchal cord, placental weight, small for gestational age (SGA), oligohydramnios, polyhydramnios, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preeclampsia, and perinatal mortality. The overall odds ratios (OR) or standardized mean difference (SMD) were calculated. RESULTS The occurrence of nuchal cord was not found to be different between an iSUA and a three-vessel cord (TVC) fetus. For perinatal complications, the SGA, oligohydramnios, polyhydramnios, GDM, and perinatal mortality showed dramatic difference between women with an iSUA and women with a TVC fetus, which implied that the presence of iSUA significantly increased the risk of perinatal complications. For other perinatal complications, such as PIH and preeclampsia, no significant association was detected. CONCLUSIONS Our meta-analysis suggests that the presence of iSUA would increase the risk of perinatal complications such as SGA, oligohydramnios, polyhydramnios, GDM, and perinatal mortality. Therefore, pregnant women with an iSUA fetus have poorer perinatal outcomes and more attention should be given to the management of their pregnancy compared to women with a TVC fetus.

  5. Fetal and perinatal consequences of maternal obesity.

    PubMed

    Vasudevan, Chakrapani; Renfrew, Mary; McGuire, William

    2011-09-01

    In many industrialised countries, one in five women booking for antenatal care is obese. As well as affecting maternal health, maternal obesity may have important adverse consequences for fetal, neonatal and long-term health and well-being. Maternal obesity is associated with a higher risk of stillbirth, elective preterm birth and perinatal mortality. The incidence of severe birth defects, particularly neural tube and structural cardiac defects, appears to be higher in infants of obese mothers. Fetal macrosomia associated with maternal obesity and gestational diabetes predisposes infants to birth injuries, perinatal asphyxia and transitional problems such as neonatal respiratory distress and metabolic instability. Maternal obesity may also result in long-term health problems for offspring secondary to perinatal problems and to intrauterine and postnatal programming effects. Currently, the available interventions to prevent and treat maternal obesity are of limited proven utility and further research is needed to define the effects of maternal weight management interventions on fetal and neonatal outcomes.

  6. The age-specific force of natural selection and biodemographic walls of death

    PubMed Central

    Wachter, Kenneth W.; Evans, Steven N.; Steinsaltz, David

    2013-01-01

    W. D. Hamilton’s celebrated formula for the age-specific force of natural selection furnishes predictions for senescent mortality due to mutation accumulation, at the price of reliance on a linear approximation. Applying to Hamilton’s setting the full nonlinear demographic model for mutation accumulation recently developed by Evans, Steinsaltz, and Wachter, we find surprising differences. Nonlinear interactions cause the collapse of Hamilton-style predictions in the most commonly studied case, refine predictions in other cases, and allow walls of death at ages before the end of reproduction. Haldane’s principle for genetic load has an exact but unfamiliar generalization. PMID:23657010

  7. Neonatal–perinatal medicine in a transitional period in China

    PubMed Central

    Sun, Bo; Shao, Xiaomei; Cao, Yun; Xia, Shiwen; Yue, Hongni

    2013-01-01

    With an annual birth rate of 12‰, or 16 millions, of all population (1.34 billions), and an implementation of universal healthcare policy for all rural residents in recent years, China is undergoing a dramatic and profound transition in perinatal and neonatal healthcare as a part of the global campaign for reduction in mortality of children under 5 years old. This review describes recent development in neonatal–perinatal medicine, with special emphasis on general neonatal–perinatal care, respiratory and intensive care, neurological and infectious diseases, for a comprehensive view of the trend and challenge in relation with problems and solutions of the field. PMID:23759518

  8. [Recommendations for perinatal transport].

    PubMed

    Esqué Ruiz, M; Figueras Aloy, J; García Alix, A; Alomar Ribes, A; Blanco Bravo, D; Ferández Lorenzo, J R

    2001-08-01

    Perinatal transport should be integrated into a system of perinatal care within a regional health care program and should be planned according to the healthcare map of each community. We describe the various types of transport, their advantages and disadvantages, the resources required, and the protocol that should be followed in perinatal transfer. We highlight the importance of maternal and neonatal transport. The organization of transfers receives special attention, and we discuss the different functions of the coordinating, referral and receiving centers as well as those of the transport assistance team. We also discuss ethical-legal questions.

  9. Highly improved perinatal states in Japan.

    PubMed

    Maeda, Kazuo

    2014-08-01

    To report on improved perinatal states in Japan, governmental and United Nations Children's Fund reports were analyzed. Initial maternal mortality, which was 409.8 in 1899, decreased to 4.1 in 2010, with a reduction rate of 409.8/4.1 (102.4) in 111 years: 2.5 in the initial 50 years in home delivery and 39.3 in the later 60 years in hospital births. The difference between 2.5 versus 39.3 was attributed to the medicine and medical care provided in hospital births. The total reduction of neonatal mortality was 77.9/1.1 (70.8), and the rate in the initial 50 versus later 60 years was 2.8/25. Also, there was a big difference after introduction of extensive neonatal care. Virtual perinatal mortality after 22 weeks was estimated to be 428 in 1000 births in 1900 (i.e. those infants born at 22-28 weeks were unlikely to survive at that time), while the perinatal mortality was reported to be 22 weeks or more in 1979 (i.e. premature babies born at ≥22 weeks survived in 1979 because of the improved neonatal care). Actually, 60% of premature infants of 400-500 g survived in the neonatal intensive care unit. In a recent report, 36% of infants born at 22 weeks survived to 3 years. Although there were neurodevelopmental impairments, outcomes were improved. In conclusion, perinatal states have remarkably improved in Japan.

  10. Age-specific MRI templates for pediatric neuroimaging

    PubMed Central

    Sanchez, Carmen E.; Richards, John E.; Almli, C. Robert

    2012-01-01

    This study created a database of pediatric age-specific MRI brain templates for normalization and segmentation. Participants included children from 4.5 through 19.5 years, totaling 823 scans from 494 subjects. Open-source processing programs (FSL, SPM, ANTS) constructed head, brain and segmentation templates in 6 month intervals. The tissue classification (WM, GM, CSF) showed changes over age similar to previous reports. A volumetric analysis of age-related changes in WM and GM based on these templates showed expected increase/decrease pattern in GM and an increase in WM over the sampled ages. This database is available for use for neuroimaging studies (blindedforreview). PMID:22799759

  11. Perinatal pathology: practice suggestions for limited-resource settings.

    PubMed

    Roberts, Drucilla J

    2013-06-01

    The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

  12. Body growth considerations in age-specific dosimetry. Final report

    SciTech Connect

    Eckerman, K.F.

    1993-09-30

    This report describes the manner in which the age-specific dosimetric calculations of the International Commission on Radiological Protection (ICRP) addressed changes in organ size that occur with age. The approach involves an interpolation of dosimetric information derived for six reference individuals using the inverse of the total body mass as the interpolation variable. An alternative formulation is investigated that employs a functional representation of the organ mass as a function of age in conjunction with an explicit formulation of the dosimetric factors in terms of organ mass. Using an exponential-logistic growth function as suggested by Walker, this report demonstrates, through application to the dosimetry of radioiodines in the thyroid, that the alternative formulation can be formulated and implemented. Although either approach provides a workable basis for age-specific dosimetry, it is clear that the functional representation of organ growth has some attractive features. However, without question, the major difficulty is the quality and quantity of data available to address the age- and gender-specific parameters in the dosimetric formulations.

  13. Pregnancy & perinatal transmission update.

    PubMed

    Denison, R

    1998-09-01

    According to a June 1998 report from UNAIDS, the majority of children infected with HIV acquired it from their mothers during or near birth. One way to prevent perinatal transmission of HIV is to increase prevention efforts for women. Other ways to prevent perinatal transmission include using AZT treatment, avoiding breastfeeding, and choosing a C-section delivery instead of a vaginal delivery. One important study, called the Thai study, promoted a shorter course of AZT therapy that was less expensive, more accessible, and still prevented transmission in many cases. Several reasons are cited for why some women continue breastfeeding, despite the increased risk of transmitting HIV to their babies. An important factor in preventing perinatal transmission is the overall health of the mother, and her ability to maintain her health and treatment regimen while caring for a newborn.

  14. Country- and age-specific optimal allocation of dengue vaccines.

    PubMed

    Ndeffo Mbah, Martial L; Durham, David P; Medlock, Jan; Galvani, Alison P

    2014-02-07

    Several dengue vaccines are under development, and some are expected to become available imminently. Concomitant with the anticipated release of these vaccines, vaccine allocation strategies for dengue-endemic countries in Southeast Asia and Latin America are currently under development. We developed a model of dengue transmission that incorporates the age-specific distributions of dengue burden corresponding to those in Thailand and Brazil, respectively, to determine vaccine allocations that minimize the incidence of dengue hemorrhagic fever, taking into account limited availability of vaccine doses in the initial phase of production. We showed that optimal vaccine allocation strategies vary significantly with the demographic burden of dengue hemorrhagic fever. Consequently, the strategy that is optimal for one country may be sub-optimal for another country. More specifically, we showed that, during the first years following introduction of a dengue vaccine, it is optimal to target children for dengue mass vaccination in Thailand, whereas young adults should be targeted in Brazil.

  15. Spin on perinatal testicular torsion.

    PubMed

    Samnakay, Naeem; Tudehope, David; Walker, Rosslyn

    2006-11-01

    We describe a recent case of perinatal testicular torsion at our institution. The presentation, management and outcome of perinatal testicular torsion are quite different to testicular torsion in the general paediatric population. The literature describes a variety of management options for perinatal testicular torsion and these are briefly reviewed. In cases of unilateral perinatal testicular torsin, there is controversy over whether surgery to fix the contralateral testis is required, and if so, the appropriate timing for the surgery. A good understanding of the issues unique to perinatal torsion will facilitate appropriate counseling of parents of affected neonates.

  16. Modeling age-specific cancer incidences using logistic growth equations: implications for data collection.

    PubMed

    Shen, Xing-Rong; Feng, Rui; Chai, Jing; Cheng, Jing; Wang, De-Bin

    2014-01-01

    Large scale secular registry or surveillance systems have been accumulating vast data that allow mathematical modeling of cancer incidence and mortality rates. Most contemporary models in this regard use time series and APC (age-period-cohort) methods and focus primarily on predicting or analyzing cancer epidemiology with little attention being paid to implications for designing cancer registry, surveillance or evaluation initiatives. This research models age-specific cancer incidence rates using logistic growth equations and explores their performance under different scenarios of data completeness in the hope of deriving clues for reshaping relevant data collection. The study used China Cancer Registry Report 2012 as the data source. It employed 3-parameter logistic growth equations and modeled the age-specific incidence rates of all and the top 10 cancers presented in the registry report. The study performed 3 types of modeling, namely full age-span by fitting, multiple 5-year- segment fitting and single-segment fitting. Measurement of model performance adopted adjusted goodness of fit that combines sum of squred residuals and relative errors. Both model simulation and performance evalation utilized self-developed algorithms programed using C# languade and MS Visual Studio 2008. For models built upon full age-span data, predicted age-specific cancer incidence rates fitted very well with observed values for most (except cervical and breast) cancers with estimated goodness of fit (Rs) being over 0.96. When a given cancer is concerned, the R valuae of the logistic growth model derived using observed data from urban residents was greater than or at least equal to that of the same model built on data from rural people. For models based on multiple-5-year-segment data, the Rs remained fairly high (over 0.89) until 3-fourths of the data segments were excluded. For models using a fixed length single-segment of observed data, the older the age covered by the corresponding

  17. Fourth goal of perinatal medicine.

    PubMed Central

    Ounsted, C; Roberts, J C; Gordon, M; Milligan, B

    1982-01-01

    Reduction in maternal mortality, infant mortality, and infant morbidity have been successively the goals of perinatal medicine. The fourth is to reduce bonding failure. In July 1978 a preventive service was started in the John Radcliffe Maternity Hospital. A twice-weekly round is made. Midwives refer families who cause them concern. In the first year the referral rate ws 20.5 per 1000 liveborn babies. The referred sample differed from the hospital population in terms of maternal psychiatric history, marital state and babies' admission to special care. The main reasons for referral were: doubt about parenting ability (27%), psychiatric history (15%), disturbed behaviour in hospital (14%), and diffuse social and medical problems (17%). Long-term care was needed for only 14% of families. At their first birthdays, six babies were placed away from their natural parents; the sample had had a slightly higher than expected admission rate to hospital; the distribution of weights did not differ from the expected; doctors and health visitors were still concerned about one-quarter of the families. Seven cases of screening failure were found among those not referred to our service, but only one was seriously abused. No child referred in the first year has been seriously neglected or abused. PMID:6802338

  18. An Atypical Age-Specific Pattern of Hepatocellular Carcinoma in Peru: A Threat for Andean Populations

    PubMed Central

    Loli, Sebastian; Moura, Julien; Zimic, Mirko; Deharo, Eric; Ruiz, Eloy

    2013-01-01

    Background In South America, the highest incidence of primary liver cancer is observed in Peru. However, national estimations on hepatocellular carcinoma incidence and mortality are approximated using aggregated data from surrounding countries. Thus, there is a lack of tangible information from Peru that impairs an accurate description of the local incidence, presentation, and outcomes of hepatocellular carcinoma. The present study attempts to fill this gap and assesses the clinical epidemiology of hepatocellular carcinoma in this country. Methods A retrospective cohort study was conducted by analysing the medical charts of 1,541 patients with hepatocellular carcinoma admitted between 1997 and 2010 at the Peruvian national institute for cancer. The medical records including liver function, serologic status, and tumor pathology and stage were monitored. Statistical analyses were performed in order to characterize tumor presentation according to demographic features, risk factors, and regional origin. Results Surprisingly, the age distribution of the patient population displayed bimodality corresponding to two distinct age-based subpopulations. While an older group was in keeping with the age range observed for hepatocellular carcinoma around the world, a younger population displayed an abnormally juvenile mean age of 25.5 years old. In addition, each subpopulation displayed age-specific pathophysiological and clinical characteristics. Conclusions The analysis suggests two different age-specific natural histories of hepatocellular carcinoma in the Peruvian patient population. This otherwise unusual tumor process that is ongoing in younger patients leads to the hypothesis that there may be a Peru-endemic risk factor driving hepatocarcinogenesis in the local population. PMID:23840771

  19. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

    PubMed

    Kendig, Susan; Keats, John P; Hoffman, M Camille; Kay, Lisa B; Miller, Emily S; Simas, Tiffany A Moore; Frieder, Ariela; Hackley, Barbara; Indman, Pec; Raines, Christena; Semenuk, Kisha; Wisner, Katherine L; Lemieux, Lauren A

    2017-04-06

    Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary work group to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

  20. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

    PubMed

    Kendig, Susan; Keats, John P; Hoffman, M Camille; Kay, Lisa B; Miller, Emily S; Moore Simas, Tiffany A; Frieder, Ariela; Hackley, Barbara; Indman, Pec; Raines, Christena; Semenuk, Kisha; Wisner, Katherine L; Lemieux, Lauren A

    Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

  1. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

    PubMed

    Kendig, Susan; Keats, John P; Hoffman, M Camille; Kay, Lisa B; Miller, Emily S; Moore Simas, Tiffany A; Frieder, Ariela; Hackley, Barbara; Indman, Pec; Raines, Christena; Semenuk, Kisha; Wisner, Katherine L; Lemieux, Lauren A

    2017-03-01

    Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

  2. Perinatal grief in Latino parents.

    PubMed

    Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

    2010-01-01

    Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based on research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

  3. Perinatal Grief in Latino Parents

    PubMed Central

    Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

    2013-01-01

    Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory-making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based upon research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture. PMID:20975393

  4. Standardization of age-adjusted mortality rates

    SciTech Connect

    Selvin, S.; Sacks, S.T.; Merrill, D.W.

    1980-02-01

    Because age is a significant variable in the occurrence and frequency of human disease, any comparison of disease or mortality rates, to be useful, must be age-specific or age-adjusted. Age-specific comparisons are not always appropriate or possible, however. A common method of eliminating the influence of age in comparing mortality rates from one community to another is to employ statistical methods of age-adjustment. While a variety of methods will accomplish this task, most are weighted averages of the age-specific rates. Two widely used adjustment procedures are direct and indirect age-adjustment.

  5. Age-specificity of black-capped chickadee survival rates: Analysis of capture-recapture data

    USGS Publications Warehouse

    Loery, G.; Pollock, K.H.; Nichols, J.D.; Hines, J.E.

    1987-01-01

    The ornithological literature indicates a widespread belief in two generalizations about the age-specificity of avian survival rates: (1) survival rates of young birds for some period following fledging are lower than those of adults, and (2) after reaching adulthood survival rates are constant for birds of all ages. There is a growing body of evidence in support of the first generalization, although little is known about how long the survival difference between young and adults lasts. This latter question can be addressed with capture-recapture or band recovery studies based on birds marked in the winter, but the inability to determine age in many species during winter has prevented the use of standard methods. There is very little evidence supporting the second generalization, and we are in need of methods and actual analyses that address this question. In the present paper we restate the two generalizations as hypotheses and test them using data from a wintering Black-capped Chickadee (Parus atricapillus) population in Connecticut, which has been studied by Loery for 26 yr. We use a cohort-based Jolly-Seber approach, which should be useful in other investigations of this nature. We found strong evidence of lower survival rates in 1st-yr birds than in adults, but could not determine whether this was the result of higher mortality rates, higher emigration rates, or a combination of the two. We also found evidence that survival rates of adult birds were not constant with age but decreased at a rate of ? 3.5%/yr. As adult birds are very faithful to their wintering areas, we believe that almost all this decrease can be attributed to an increase in mortality with age. Simulation results suggest that heterogeneity of capture probabilities could not explain the magnitude of the decrease in survival with age. Age-dependent tag loss is also discussed as an alternative explanation, but is dismissed as very unlikely in this situation. This analysis thus provides some of the

  6. Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.

    PubMed

    Djelmis, J

    1998-01-01

    At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary.

  7. Perinatal programming prevention measures.

    PubMed

    Larguía, A Miguel; González, María Aurelia; Dinerstein, Néstor Alejandro; Soto Conti, Constanza

    2015-01-01

    Over the past 10 years, there has been outstanding scientific progress related to perinatal programming and its epigenetic effects in health, and we can anticipate this trend will continue in the near future. We need to make use and apply these achievements to human neurodevelopment via prevention interventions. Based on the concept of the interaction between genome and ambiome, this chapter proposes low-cost easy-implementation preventive strategies for maternal and infant health institutions.Breastfeeding and human milk administration are the first preventive measures, as has been reviewed in the policy statement of the American Academy of Pediatrics. Another strategy is the Safe and Family-Centered Maternity Hospitals initiative that promotes and empowers the inclusion of the families and the respect for their rights, especially during pregnancy and birth. (This change of paradigm was approved and is recommended by both United Nations Children's Fund, UNICEF, and Pan American Health Organization, PAHO.) Then, there is also an important emphasis given to the sacred hour-which highlights the impact of bonding, attachment, and breastfeeding during the first hour of life-the pain prevention and treatment in newborns, the control of the "new morbidity" represented by late preterm infants, and finally, the importance of avoiding intrauterine and extrauterine growth restriction. (However, there are not yet clear recommendations about nutritional interventions in order to diminish the potential metabolic syndrome consequence in the adult.).

  8. Perinatal grief and mourning.

    PubMed

    Menke, J A; McClead, R E

    1990-01-01

    The grief and mourning that parents experience following a perinatal loss is as devastating as the loss of an older loved one. The pattern of mourning can be anticipated and interventions can be implemented. With proper help, the parents can pass through this catastrophic time in their lives with a minimum of scars. If the physician stops, reaches out, listens, and supports the parents, he or she can have a dramatic effect on the lives of these parents. In the same manner in which we started this paper, we close with a quotation from another parent who suffered a loss: Daughters may die, But why? For even daughters can't live with half a heart. Three days isn't much a life. But long enough to remember thin blue lips, uneven gasps in incubators, Racking breaths that cause a pain to those who watched. Long enough to remember I never held her Or felt her softness Or counted her toes. I didn't even know the color of her eyes. Dead paled hands not quite covered by the gown she Was to go home in. Moist earth smell. One small casket. And the tears. You see, I hold in my hand but souvenirs of an occasion. A sheet of paper filled with statistics, A certificate with smudged footprints, A tiny bracelet engraved "Girl, Smith." You say that you are sorry That you know how I feel. But you can't know because I don't feel. Not yet.

  9. Provision of a community perinatal service in a developing country.

    PubMed

    van Coeverden de Groot, H A

    1993-08-01

    In 1980, a community perinatal service (CPS) facility was developed by the University of Cape Town in South Africa. This Peninsula Maternal and Neonatal Service (PMNS) is a model for understanding the objectives and essential requirements for the provision of a CPS. The goals of a CPS are to 1) use a single authority to provide integrated perinatal and family planning (FP) services for all women in a defined geographic area, 2) reduce infant morbidity and mortality to acceptable levels, 3) promote FP and a 2-child norm, and 4) provide education to staff, patients, and the community. A CPS must have a tiered system of perinatal care which has midwife obstetric units (MOUs) as the first level, secondary hospitals as the second, and tertiary hospitals as the third. The MOUs are centered around midwives, with a doctor available as a consultant to the midwives and as a provider of continuing education (CE) to the staff and patients. Staff CE takes place in perinatal mortality meetings, case discussions, orientation classes, refresher courses, outreach programs, and formal CE programs and journals. A loose-leaf, self-instructional perinatal education program is being developed to provide up-to-date information for every midwife and doctor. The midwives also may attend triennial congresses in Cape Town. The objective of patient education is to develop mothers as monitors of their own health and that of their fetuses and newborns. Patient education is achieved through the use of posters, lectures, and audiovisual programs. A CPS also needs appropriate equipment (a list is available from the World Health Organization). The CPS comprehensive referral system must cover all criteria and be respected throughout the region. The criteria must be updated regularly. Adequate communication channels and transportation facilities are also necessary to insure that a patient is transferred under the best conditions. Regular audits are essential and require accurate record keeping

  10. Perinatal Depression – the Fourth Inflammatory Morbidity of Pregnancy? Theory and Literature Review

    PubMed Central

    Osborne, Lauren M.; Monk, Catherine

    2015-01-01

    Perinatal depression is one of the leading causes of maternal morbidity and mortality. The biological etiology of this disorder remains in question, despite considerable research into the contributions of hormonal imbalance, the role of monoamines, and dysregulation of the HPA axis. Because inflammation is known to be associated with major depression in men and non-perinatal women as well as with other important morbidities of pregnancy (such as preeclampsia, preterm birth, and gestational diabetes), and because these morbidities may correlate with perinatal depression, inflammation may be a common physiological pathway that can also help explain perinatal depression. In this paper, we review the theoretical background of inflammation in perinatal depression and then review the literature concerning immune and inflammatory factors in the etiology and course of perinatal depression. We close with recommendations for future studies in this still relatively unexplored area. Identification and understanding of a common pathophysiology between other pregnancy morbidities and perinatal depression would link physical and mental well-being, likely leading to better treatment and prevention. PMID:23608136

  11. Inter-provincial migration in Spain: temporal trends and age-specific patterns.

    PubMed

    Garcia Coll, A; Stillwell, J

    1999-01-01

    "This paper provides interpretation of the changing patterns of internal migration in Spain at the inter-provincial scale, and new analysis of age-specific migration during the 1980s using a 10% sample of anonymised records from the 1991 census. Schedules of age-specific gross migration rates are constructed and classified according to their shape and level relative to the national schedule, and the relationships between in-migration and out-migration rates are examined for four selected age groups to demonstrate how aggregate patterns of inter-provincial migration conceal a wide diversity of age specific experience."

  12. [Perinatal obsessive-compulsive disorder].

    PubMed

    Mavrogiorgou, P; Illes, F; Juckel, G

    2011-09-01

    A perinatal obsessive-compulsive disorder (OCD) is defined as an illness exhibiting first symptoms in the context of pregnancy and the postpartal period. There are no valid data up to date concerning the incidence of OCD, which might be of multifactorial origin, in this period in which females are highly vulnerable for psychiatric diseases. From a clinical point of view, obsessions and compulsions are mainly related to the well-being of the foetus or newborn baby. Differential diagnosis of perinatal OCD including pregnancy psychosis and post-partum depression is often difficult. Concerning treatment, non-pharmacological approaches should be preferred. Administration of SSRIs should be strongly restricted. However, there are no controlled therapy studies in patients with perinatal OCD. Furthermore, current knowledge about these patients is still limited. The aim of this review article is the presentation of phenomenology, pathogenesis, differential diagnosis and treatment of perinatal OCD. The mental situation of the female patients can be improved and stabilised if early diagnosis of a perinatal OCD leads to early initiation of an adequate therapy. This will then enable a good and stable mother-child relationship to develop.

  13. Linkages among reproductive health, maternal health, and perinatal outcomes.

    PubMed

    Bhutta, Zulfiqar A; Lassi, Zohra S; Blanc, Ann; Donnay, France

    2010-12-01

    packages, emergency obstetrical care, elective induction for postterm delivery, Cesarean delivery for breech presentation, and prophylactic corticosteroids in preterm labor reduce perinatal mortality; and early initiation of breastfeeding and birth and newborn care preparedness through community-based intervention packages reduce neonatal mortality. This review demonstrates that RHMNH are inextricably linked, and that, therefore, health policies and programs should link them together. Such potential integration of strategies would not only help improve outcomes for millions of mothers and newborns but would also save scant resources. This would also allow for greater efficiency in training, monitoring, and supervision of health care workers and would also help families and communities to access and use services easily.

  14. Biplot models applied to cancer mortality rates.

    PubMed

    Osmond, C

    1985-01-01

    "A graphical method developed by Gabriel to display the rows and columns of a matrix is applied to tables of age- and period-specific cancer mortality rates. It is particularly useful when the pattern of age-specific rates changes with time. Trends in age-specific rates and changes in the age distribution are identified as projections. Three examples [from England and Wales] are given."

  15. Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries

    PubMed Central

    Vogel, Joshua P.; Torloni, Maria Regina; Seuc, Armando; Betrán, Ana Pilar; Widmer, Mariana; Souza, João Paulo; Merialdi, Mario

    2013-01-01

    Background Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins. Methods We examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes. Results 279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95% CI 1.60–2.14) and perinatal mortality (AOR 2.46, 95% CI 1.40–4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95–6.62) and stillbirth (AOR 1.22, 95% CI 0.58–2.57) did not reach significance. Amongst twins alone, maternal age <18, poor education and antenatal care, nulliparity, vaginal bleeding, non-cephalic presentations, birth weight discordance >15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective. Conclusions Twin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby. PMID:23936446

  16. A theory of the cancer age-specific incidence data based on extreme value distributions

    NASA Astrophysics Data System (ADS)

    Soto-Ortiz, Luis; Brody, James P.

    2012-03-01

    The incidence of cancers varies with age, if normalized this is called the age-specific incidence. A mathematical model that describes this variation should provide a better understanding of how cancers develop. We suggest that the age-specific incidence should follow an extreme value distribution, based on three widely accepted assumptions: (1) a tumor develops from a single cell, (2) many potential tumor progenitor cells exist in a tissue, and (3) cancer is diagnosed when the first of these many potential tumor cells develops into a tumor. We tested this by comparing the predicted distribution to the age-specific incidence data for colon and prostate carcinomas collected by the Surveillance, Epidemiology and End Results network of 17 cancer registries. We found that colon carcinoma age-specific incidence data is consistent with an extreme value distribution, while prostate carcinomas age-specific incidence data generally follows the distribution. This model indicates that both colon and prostate carcinomas only occur in a subset of the population (22% for prostate and 13.5% for colon.) Because of their very general nature, extreme value distributions might be applicable to understanding other chronic human diseases.

  17. Does use of computer technology for perinatal data collection influence data quality?

    PubMed

    Craswell, Alison; Moxham, Lorna; Broadbent, Marc

    2016-06-01

    Population health data, collected worldwide in an effort to monitor mortality and morbidity of mothers and babies, namely, perinatal data, are mandated at a federal level within Australia. The data are used to monitor patterns in midwifery, obstetric and neonatal practice, health outcomes, used for research purposes, funding allocation and education. Accuracy in perinatal data is most often reported via quantitative validation studies of perinatal data collections both internationally and in Australia. These studies report varying levels of accuracy and suggest researchers need to be more aware of the quality of data they use. This article presents findings regarding issues of concern identified by midwives relating to their perceptions of how technology affects the accuracy of perinatal data records. Perinatal data records are perceived to be more complete when completed electronically. However, issues regarding system functionality, the inconsistent use of terminology, lack of data standards and the absence of clear, written records contribute to midwives' perceptions of the negative influence of technology on the quality of perinatal data.

  18. Basis and implications of the CAP88 age-specific dose coefficients

    SciTech Connect

    Leggett, Richard Wayne; Scofield, Patricia A; Eckerman, Keith F

    2013-01-01

    Recent versions of CAP88 incorporate age-specific dose coefficients based on biokinetic and dosimetric models applied in Federal Guidance Report 13, Cancer Risk Coefficients for Environmental Exposure to Radionuclides (EPA 1999). With a few exceptions the models are those recommended in a series of reports by the International Commission on Radiological Protection (ICRP) on estimation of doses to the public from environmental radionuclides. This paper describes the basis for the ICRP s age-specific biokinetic and dosimetric models and examines differences with age in the derived dose coefficients and in estimates of dose per unit exposure based on those coefficients.

  19. Tobacco control policies and perinatal health: a national quasi-experimental study

    PubMed Central

    Peelen, Myrthe J.; Sheikh, Aziz; Kok, Marjolein; Hajenius, Petra; Zimmermann, Luc J.; Kramer, Boris W.; Hukkelhoven, Chantal W.; Reiss, Irwin K.; Mol, Ben W.; Been, Jasper V.

    2016-01-01

    We investigated whether changes in perinatal outcomes occurred following introduction of key tobacco control policies in the Netherlands: smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign (January-February 2004); and extension of the smoke-free law to the hospitality industry, accompanied by another tax increase and mass media campaign (July 2008). This was a national quasi-experimental study using Netherlands Perinatal Registry data (2000–2011; registration: ClinicalTrials.gov NCT02189265). Primary outcome measures were: perinatal mortality, preterm birth, and being small-for-gestational age (SGA). The association with timing of the tobacco control policies was investigated using interrupted time series logistic regression analyses with adjustment for confounders. Among 2,069,695 singleton births, there were 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births. The 2004 policies were not associated with significant changes in the odds of developing any of the primary outcomes. After the 2008 policy change, a -4.4% (95% CI -2.4; -6.4, p < 0.001) decrease in odds of being SGA was observed. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to bars and restaurants in conjunction with a tax increase and mass media campaign. PMID:27103591

  20. Intermittent hepatic porphyria in pregnancy with good perinatal outcome.

    PubMed

    Vidosavljević, Domagoj; Sijanović, Siniša; Rubin, Mirjana; Košuta Petrović, Maja; Abičić Žuljević, Kristina; Simić, Ivana

    2012-02-01

    Porphyrias are rare metabolic diseases caused by enzymatic defects of the haeme biosynthesis. Association of pregnancy and acute porphyria is rare, but mortality rate among pregnant women from acute attack has been reported up to 42%. This paper presents a patient with pregnancy complicated by intermittent hepatic porphyria with good perinatal outcome. The pattern of the attack in pregnancy varies individually and it makes porphyric pregnancies a challenge. Previously diagnosed porphyria patients should be closely monitored during pregnancy and diagnosis of acute porphyria must be also considered in all pregnant women with unexplained abdominal pain.

  1. The challenges of success: adolescents with perinatal HIV infection.

    PubMed

    Mofenson, Lynne M; Cotton, Mark F

    2013-06-18

    The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults.

  2. The challenges of success: adolescents with perinatal HIV infection

    PubMed Central

    Mofenson, Lynne M; Cotton, Mark F

    2013-01-01

    The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults. PMID:23782484

  3. Estimating risks of perinatal death.

    PubMed

    Smith, Gordon C S

    2005-01-01

    The relative and absolute risks of perinatal death that are estimated from observational studies are used frequently in counseling about obstetric intervention. The statistical basis for these estimates therefore is crucial, but many studies are seriously flawed. In this review, a number of aspects of the approach to the estimation of the risk of perinatal death are addressed. Key factors in the analysis include (1) the definition of the cause of the death, (2) differentiation between antepartum and intrapartum events, (3) the use of the appropriate denominator for the given cause of death, (4) the assessment of the cumulative risk where appropriate, (5) the use of appropriate statistical tests, (6) the stratification of analysis of delivery-related deaths by gestational age, and (7) the specific features of multiple pregnancy, which include the correct determination of the timing of antepartum stillbirth and the use of paired statistical tests when outcomes are compared in relation to the birth order of twin pairs.

  4. Basis for the ICRP`s age-specific biokinetic model for uranium

    SciTech Connect

    Leggett, R.W.

    1994-12-01

    In an effort motivated largely by the Chernobyl nuclear accident, the International Commission on Radiological Protection (ICRP) is developing age-specific biokinetic models and dose coefficients for environmentally important radionuclides. This paper describes the ICRP`s age-specific biokinetic model for uranium. The model is constructed within a physiologically based framework originally developed for application to the alkaline earth elements but sufficiently general to apply to the larger class of bone-volume-seeking elements. Transfer rates for a reference adult are based mainly on: (1) measurements of uranium in blood and excreta of several human subjects who were intravenously injected with uranium; (2) postmortem measurements of uranium in tissues of some of those subjects; (3) postmortem measurements of uranium in tissues of occupationally and non-occupationally exposed subjects; (4) data on baboons, dogs, and smaller laboratory animals exposed to uranium for experimental purposes; and (5) consideration of the physiological processes thought to control retention and translocation of uranium in the body. Transfer rates for the adult are extended to children by application of a set of generic assumptions applied by the ICRP to calcium-like elements. These assumptions were derived mainly from observations of the age-specific biokinetics of the alkaline earth elements and lead in humans and laboratory animals but are consistent with available age-specific biokinetic data on uranium. 82 refs., 17 figs., 8 tabs.

  5. Senescence and age-specific trade-offs between reproduction and survival in female Asian elephants.

    PubMed

    Robinson, Matthew R; Mar, Khyne U; Lummaa, Virpi

    2012-03-01

    Although studies on laboratory species and natural populations of vertebrates have shown reproduction to impair later performance, little is known of the age-specific associations between reproduction and survival, and how such findings apply to the ageing of large, long-lived species. Herein we develop a framework to examine population-level patterns of reproduction and survival across lifespan in long-lived organisms, and decompose those changes into individual-level effects, and the effects of age-specific trade-offs between fitness components. We apply this to an extensive longitudinal dataset on female semi-captive Asian timber elephants (Elephas maximus) and report the first evidence of age-specific fitness declines that are driven by age-specific associations between fitness components in a long-lived mammal. Associations between reproduction and survival are positive in early life, but negative in later life with up to 71% of later-life survival declines associated with investing in the production of offspring within this population of this critically endangered species.

  6. The Age Specific Incidence Anomaly Suggests that Cancers Originate During Development

    NASA Astrophysics Data System (ADS)

    Brody, James P.

    The accumulation of genetic alterations causes cancers. Since this accumulation takes time, the incidence of most cancers is thought to increase exponentially with age. However, careful measurements of the age-specific incidence show that the specific incidence for many forms of cancer rises with age to a maximum, and then decreases. This decrease in the age-specific incidence with age is an anomaly. Understanding this anomaly should lead to a better understanding of how tumors develop and grow. Here we derive the shape of the age-specific incidence, showing that it should follow the shape of a Weibull distribution. Measurements indicate that the age-specific incidence for colon cancer does indeed follow a Weibull distribution. This analysis leads to the interpretation that for colon cancer two subpopulations exist in the general population: a susceptible population and an immune population. Colon tumors will only occur in the susceptible population. This analysis is consistent with the developmental origins of disease hypothesis and generalizable to many other common forms of cancer.

  7. Trends in age-specific cerebrovascular disease in the European Union

    PubMed Central

    Wang, Hui; Sun, Wei; Ji, Yue; Shi, Jing; Xuan, Qinkao; Wang, Xiuzhi; Xiao, Junjie; Kong, Xiangqing

    2014-01-01

    Although the mortality of cerebrovascular disease (CVD) has been steadily declined in the European Union (EU), CVD remains among the major causes of death in EU. As risk factors such asobesity and diabetes mellitus are increasing, the trends of European CVD mortality remains unknown. To understand the variation in CVD mortality of different EU countries, we studied the trends in CVD mortality in EU countries over the last three decades between males and females. Age- and sex-specific mortality rates between 1980 and 2011 were calculated by data from the WHO mortality database. Joinpoint software was used to calculate annual percentage changes and to characterize trends in mortality rates over time. Our study showed that between 1980 and 2011, CVD mortality significantly decreased in both men and women across all age groups. The specific mortality trends varied largely between EU countries. The plateau trend was observed in little regions at different age groups, however, the EU as a whole displayed declined trend CVD mortality. During the last three decades, CVD mortality decreased substantially in the entire population of EU. However, despite this overall decline in CVD mortality, several areas were identified as having no change in their CVD mortality rates at different period. The whole EU needs to establish strict prevention measures toreduce the incidence of CVD risk factors. PMID:25550927

  8. Medical innovation and age-specific trends in health care utilization: findings and implications.

    PubMed

    Wong, Albert; Wouterse, Bram; Slobbe, Laurentius C J; Boshuizen, Hendriek C; Polder, Johan J

    2012-01-01

    Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981-2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.

  9. Mortality rates decline in Malaysia.

    PubMed

    1991-11-01

    Experiencing remarkable decreases in mortality rates over the past 3 decades, Malaysia currently has one of the lowest mortality rates among developing countries, a rate that compares favorably with those of developed countries. Between 1957 and 1989, the crude death rate dropped from 12.4/1000 population to 4.6. Over the same period, Malaysia recorded even greater decreases in the infant mortality rate, from 75.5/1000 births to 15.2. The Maternal mortality rate also declined from 1.48 in 1970 to 0.24 in 1988. The data indicates that mortality rates vary from state to state, and that rural areas have a higher mortality than urban areas. According to a study by the National Population and Family Development Board, the use of maternal and child health services has played an important role in reducing neonatal, perinatal, infant, child, and maternal mortality rates. Nearly all women in Malaysia receive antenatal services. While the country has achieved great gains on mortality rates, programs focusing on specific age and socioeconomic groups could lead to even greater reductions. The Minister for National Unity and Social Development, Dato Napsiah Omar, has called for the development of programs designed to improve the population's quality of life.

  10. A Systematic Review of the Physical, Mental, Social, and Economic Problems of Immigrant Women in the Perinatal Period in Japan.

    PubMed

    Kita, Sachiko; Minatani, Mariko; Hikita, Naoko; Matsuzaki, Masayo; Shiraishi, Mie; Haruna, Megumi

    2015-12-01

    The perinatal mortality of immigrants in Japan is higher than that of Japanese women. However, details of the problems of immigrant perinatal women that contribute to worsening of their health are still unknown. This review describes the physical, psychological, social, and economic problems of immigrant women during the perinatal period in Japan. Medline, CINAHL, PsycINFO, and Igaku-Chuo Zasshi were searched and 36 relevant articles were reviewed. The related descriptions were collected and analyzed by using content analysis. The results showed that immigrant perinatal women in Japan experienced the following problems: language barriers, a problematic relationship with a partner, illegal residency, emotional distress, physical distress, adjustment difficulties, lack of utilization of services, social isolation, lack of support, lack of information, low economic status, unsatisfactory health care, and discrimination. These results indicated that multilingual services, strengthening of social and support networks, and political action are necessary to resolve their problems.

  11. Asfotase Alfa Treatment Improves Survival for Perinatal and Infantile Hypophosphatasia

    PubMed Central

    Rockman-Greenberg, Cheryl; Ozono, Keiichi; Riese, Richard; Moseley, Scott; Melian, Agustin; Thompson, David D.; Bishop, Nicholas; Hofmann, Christine

    2016-01-01

    Context: Hypophosphatasia (HPP) is an inborn error of metabolism that, in its most severe perinatal and infantile forms, results in 50–100% mortality, typically from respiratory complications. Objectives: Our objective was to better understand the effect of treatment with asfotase alfa, a first-in-class enzyme replacement therapy, on mortality in neonates and infants with severe HPP. Design/Setting: Data from patients with the perinatal and infantile forms of HPP in two ongoing, multicenter, multinational, open-label, phase 2 interventional studies of asfotase alfa treatment were compared with data from similar patients from a retrospective natural history study. Patients: Thirty-seven treated patients (median treatment duration, 2.7 years) and 48 historical controls of similar chronological age and HPP characteristics. Interventions: Treated patients received asfotase alfa as sc injections either 1 mg/kg six times per week or 2 mg/kg thrice weekly. Main Outcome Measures: Survival, skeletal health quantified radiographically on treatment, and ventilatory status were the main outcome measures for this study. Results: Asfotase alfa was associated with improved survival in treated patients vs historical controls: 95% vs 42% at age 1 year and 84% vs 27% at age 5 years, respectively (P < .0001, Kaplan-Meier log-rank test). Whereas 5% (1/20) of the historical controls who required ventilatory assistance survived, 76% (16/21) of the ventilated and treated patients survived, among whom 75% (12/16) were weaned from ventilatory support. This better respiratory outcome accompanied radiographic improvements in skeletal mineralization and health. Conclusions: Asfotase alfa mineralizes the HPP skeleton, including the ribs, and improves respiratory function and survival in life-threatening perinatal and infantile HPP. PMID:26529632

  12. Growing Fixed With Age: Lay Theories of Malleability Are Target Age-Specific.

    PubMed

    Neel, Rebecca; Lassetter, Bethany

    2015-11-01

    Beliefs about whether people can change ("lay theories" of malleability) are known to have wide-ranging effects on social motivation, cognition, and judgment. Yet rather than holding an overarching belief that people can or cannot change, perceivers may hold independent beliefs about whether different people are malleable-that is, lay theories may be target-specific. Seven studies demonstrate that lay theories are target-specific with respect to age: Perceivers hold distinct, uncorrelated lay theories of people at different ages, and younger targets are considered to be more malleable than older targets. Both forms of target-specificity are consequential, as target age-specific lay theories predict policy support for learning-based senior services and the rehabilitation of old and young drug users. The implications of target age-specific lay theories for a number of psychological processes, the social psychology of aging, and theoretical frameworks of malleability beliefs are discussed.

  13. Age-specific survival and philopatry in three species of European ducks: a long-term study

    USGS Publications Warehouse

    Blums, P.; Mednis, A.; Bauga, I.; Nichols, J.D.; Hines, J.E.

    1996-01-01

    Capture-recapture and band recovery models were used to estimate age-specific survival probabilities for female Northern Shovelers (Anas clypeata), Common Pochards (Aythya ferina), and Tufted Ducks (Aythya.fuligula) at Engure Marsh, Latvia, in 1964-1993. We banded more than 65,100 day-old ducklings of both sexes and captured 10,211 incubating females (3,713 new bandings and 6,498 recaptures). We developed a set of 3-age capture-recapture models to estimate annual survival rates for female ducklings, yearlings (SY), and adults (ASY) using programs SURGE and SURVIV and selected parsimonious models using a method developed bv Akaike (1973). Survival rates of SY and ASY females were highest-for Tufted Ducks intermediate for Common Pochards, and lowest for Northern Shovelers. Survival rates of SY and ASY females varied in parallel for shovelers and pochards. We believe that much of the difference in survival estimates between SY and ASY birds was caused by mortality rather than permanent emigration. Estimates of day-old duckling survival, reflecting both mortality and permanent emigration, were 0.12 for shoveler, 0.06 for pochard, and 0.03 for Tufted Duck. For all species, duckling survival varied over years, but the pattern of variation was not similar to that of the other age classes. Estimates of survival using band recovery data for SY + ASY female pochards and Tufted Ducks were similar to the capture-recapturee stimates, suggestingt hat surviving females returned to the breeding marsh with probabilities approaching 1.

  14. Structural modeling of age specific fertility curves in Peninsular Malaysia: An approach of Lee Carter method

    NASA Astrophysics Data System (ADS)

    Hanafiah, Hazlenah; Jemain, Abdul Aziz

    2013-11-01

    In recent years, the study of fertility has been getting a lot of attention among research abroad following fear of deterioration of fertility led by the rapid economy development. Hence, this study examines the feasibility of developing fertility forecasts based on age structure. Lee Carter model (1992) is applied in this study as it is an established and widely used model in analysing demographic aspects. A singular value decomposition approach is incorporated with an ARIMA model to estimate age specific fertility rates in Peninsular Malaysia over the period 1958-2007. Residual plots is used to measure the goodness of fit of the model. Fertility index forecast using random walk drift is then utilised to predict the future age specific fertility. Results indicate that the proposed model provides a relatively good and reasonable data fitting. In addition, there is an apparent and continuous decline in age specific fertility curves in the next 10 years, particularly among mothers' in their early 20's and 40's. The study on the fertility is vital in order to maintain a balance between the population growth and the provision of facilities related resources.

  15. Automated tissue classification of pediatric brains from magnetic resonance images using age-specific atlases

    NASA Astrophysics Data System (ADS)

    Metzger, Andrew; Benavides, Amanda; Nopoulos, Peg; Magnotta, Vincent

    2016-03-01

    The goal of this project was to develop two age appropriate atlases (neonatal and one year old) that account for the rapid growth and maturational changes that occur during early development. Tissue maps from this age group were initially created by manually correcting the resulting tissue maps after applying an expectation maximization (EM) algorithm and an adult atlas to pediatric subjects. The EM algorithm classified each voxel into one of ten possible tissue types including several subcortical structures. This was followed by a novel level set segmentation designed to improve differentiation between distal cortical gray matter and white matter. To minimize the req uired manual corrections, the adult atlas was registered to the pediatric scans using high -dimensional, symmetric image normalization (SyN) registration. The subject images were then mapped to an age specific atlas space, again using SyN registration, and the resulting transformation applied to the manually corrected tissue maps. The individual maps were averaged in the age specific atlas space and blurred to generate the age appropriate anatomical priors. The resulting anatomical priors were then used by the EM algorithm to re-segment the initial training set as well as an independent testing set. The results from the adult and age-specific anatomical priors were compared to the manually corrected results. The age appropriate atlas provided superior results as compared to the adult atlas. The image analysis pipeline used in this work was built using the open source software package BRAINSTools.

  16. Variations of Radon Risk with Changing Mortality Rates

    NASA Astrophysics Data System (ADS)

    Chen, Jing

    2008-08-01

    This study examines the variation of radon risks with changing mortality rates. The Canadian age-specific mortality rates averaged over five year periods from 1986 to 1990 and from 1996 to 2000 were used in the risk calculations. Because of the synergistic interaction between smoking and radon, the risk of radon induced lung cancer for Canadian men decreased with the declining lung cancer mortality rates while for Canadian women the radon risks increased with the rising lung cancer mortality rates

  17. Variations of Radon Risk with Changing Mortality Rates

    SciTech Connect

    Chen Jing

    2008-08-07

    This study examines the variation of radon risks with changing mortality rates. The Canadian age-specific mortality rates averaged over five year periods from 1986 to 1990 and from 1996 to 2000 were used in the risk calculations. Because of the synergistic interaction between smoking and radon, the risk of radon induced lung cancer for Canadian men decreased with the declining lung cancer mortality rates while for Canadian women the radon risks increased with the rising lung cancer mortality rates.

  18. Guidelines for Perinatal Care. Second Edition.

    ERIC Educational Resources Information Center

    American Coll. of Obstetricians and Gynecologists, Washington, DC.

    The basic concept emphasized in this book is that a coordinated, multidisciplinary approach within a regionalized system of perinatal care is a constant factor improving the quality of pregancy outcomes. This coordinated multidisciplinary approach has had an impact on perinatal care in three important areas: (1) improved and expanded understanding…

  19. Maternal blood viscosity and perinatal outcome in steady-state homozygous sickle cell disease.

    PubMed

    Pepple, Dagogo J; Mullings, Anthony M; Reid, Harvey L

    2013-06-30

    Homozygous sickle cell disease (HbSS) is a complicating factor in pregnancy resulting in perinatal morbidity and mortality. One of the hallmarks of sickle cell disease is increased whole blood viscosity. The present study was designed to investigate the effect of the maternal blood viscosity on perinatal outcome in steady-state homozygous sickle disease in 19 women admitted to the labor ward of the University Hospital of the West Indies, Mona. Whole blood viscosity was measured with the Wells-Brookfield viscometer at 370C at low (23 sec-1) and high (230 sec-1) shear rates. Measurements were done at native hematocrit. Perinatal outcome was classified as adverse if there was one or more of the following: admission to nursery, birth weight less than 2.5 kg, 5 minute Apgar score less than 7, caesarean section for fetal distress, perinatal death or death before discharge from nursery. The whole blood viscosity value (mean ± SD) at low shear rate was 2.04 ± 0.55 mPa.s and 2.96 ± 0.80 mPa.s at high shear rate. The hematocrit was 25.13 ± 4.18%. The perinatal outcome was good in 10 (53%) subjects and adverse in 9 (47%) subjects. There was no statistically significant difference in the incidence of adverse perinatal outcome between women with low and high blood viscosities in either the low or high shear rates. Similarly, low or high hematocrit did not significantly affect the incidence of adverse perinatal outcome. This could be attributed to their similarity in the whole blood viscosity and hematocrit values.

  20. A literature review on integrated perinatal care

    PubMed Central

    Rodríguez, Charo; des Rivières-Pigeon, Catherine

    2007-01-01

    Context The perinatal period is one during which health care services are in high demand. Like other health care sub-sectors, perinatal health care delivery has undergone significant changes in recent years, such as the integrative wave that has swept through the health care industry since the early 1990s. Purpose The present study aims at reviewing scholarly work on integrated perinatal care to provide support for policy decision-making. Results Researchers interested in integrated perinatal care have, by assessing the effectiveness of individual clinical practices and intervention programs, mainly addressed issues of continuity of care and clinical and professional integration. Conclusions Improvements in perinatal health care delivery appear related not to structurally integrated health care delivery systems, but to organizing modalities that aim to support woman-centred care and cooperative clinical practice. PMID:17786177

  1. Perinatal Depression: An Update and Overview

    PubMed Central

    Stuart-Parrigon, Kaela

    2016-01-01

    Over the last 3 years there have been notable developments in screening and treatment of perinatal depression. Most importantly, the DSM-V has made only minor changes in the diagnostic criteria for perinatal depression as compared to the DSM-IV; “perinatal”, as opposed to “postpartum”, is a specifier for depression with a requirement that the depression onset occurs during pregnancy or the first 4 weeks postpartum. Advances in the treatment of perinatal depression have been made over the last 3 years, including both prevention and acute interventions. Additional support has emerged confirming the primary risk factors for perinatal depression: a personal or family history, low SES, and poor interpersonal support. There is general agreement that universal screening be conducted for all perinatal women, both by the woman’s obstetrician and the baby’s pediatrician. PMID:25034859

  2. Perinatal Safety: From Concept to Nursing Practice

    PubMed Central

    Kennedy, Holly Powell

    2010-01-01

    Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

  3. Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador.

    PubMed

    Phoa, K Y N; Chedraui, P; Pérez-López, F R; Wendte, J F; Ghiabi, S; Vrijkotte, T; Pinto, P

    2016-07-01

    Preeclampsia in Ecuador is an understudied subject since available epidemiological data are scarce. The aim of this study was to describe perinatal outcomes among singleton pregnancies complicated with preeclampsia and eclampsia in a sample of low-income Ecuadorian women. Pregnant women complicated with preeclampsia (mild and severe) and eclampsia (defined according to criteria of the ACOG) delivering at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador were surveyed with a structured questionnaire containing maternal (socio-demographic) and neonatal data. Perinatal outcomes were compared according to severity of clinical presentation. A total of 163 women with preeclampsia [mild (23.9%), severe (68.7%) and eclampsia (7.4%)] were surveyed. Perinatal mortality and stillbirth rate was similar among studied groups (mild vs. severe preeclampsia/eclampsia cases). However, severe cases displayed higher rates of adverse perinatal outcomes: lower birth Apgar scores, more preterm births, and more low birth weight and small for gestational age infants. Caesarean-section rate and the number of admissions to intensive or intermediate neonatal care were higher in severe cases. A similar trend was found when analysis excluded preterm gestations. In conclusion, in this specific low-income Ecuadorian population perinatal outcome was adverse in pregnancies complicated with severe preeclampsia/eclampsia.

  4. Maternal arrhythmia and perinatal outcomes

    PubMed Central

    Henry, Dana; Gonzalez, Juan M; Harris, Ian, S.; Sparks, Teresa; Killion, Molly; Thiet, Mari-Paule; Bianco, Katherine

    2016-01-01

    Objective To determine if arrhythmia in the setting of maternal cardiac disease (MCD) affects perinatal outcomes. Study Design This is a retrospective cohort study of pregnant women with MCD who delivered from 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared to those without. Result Among 143 women; 36 (25%) had an arrhythmia. Those with an arrhythmia were more likely to have a spontaneous vaginal delivery (64% vs. 43%, p < 0.05) and required fewer operative vaginal births (8% vs. 27%, p=0.02). Pregnancies were more likely to be complicated by IUGR (17% vs. 5%, p < 0.05) although there were no differences in the rate of small for gestational age. The risk of IUGR remained increased after controlling for confounding (aOR 6.98, 95% CI 1.59–30.79, p=0.01). Two cases of placental abruption were identified among mothers with arrhythmia while none were identified in the controls (p < 0.05) Conclusion Patients with arrhythmias were more likely to have a spontaneous vaginal delivery. Our data suggests that these pregnancies were an increased risk for IUGR. PMID:27309629

  5. Changing pattern of age-specific breast cancer incidence in the Swiss canton of Geneva.

    PubMed

    Bouchardy, Christine; Usel, Massimo; Verkooijen, Helena M; Fioretta, Gérald; Benhamou, Simone; Neyroud-Caspar, Isabelle; Schaffar, Robin; Vlastos, Georges; Wespi, Yves; Schäfer, Peter; Rapiti, Elisabetta

    2010-04-01

    Hormone replacement therapy (HRT) use declined sharply after mid-2002, when the Women's Health Initiative trial reported an association between breast cancer occurrence and HRT. Hypothesized mechanism behind this association is that HRT promotes growth of pre-existing small tumors, leading to earlier tumor detection. We evaluated the impact of the sudden decline in HRT use on age distribution of breast cancer in Geneva. We included all incident breast cancer cases recorded from 1975 to 2006 at the Geneva cancer registry. We calculated mean annual incidence rates per 100,000 for 2 year periods for three age groups and assessed temporal changes by joinpoint regression. We compared age-specific incidence curves for different periods, reflecting different prevalence rates of HRT use. After increasing constantly between 1986 and 2002 among women aged 50-69 years [annual percent change (APC): +4.4, P < 0.0001], rates declined sharply after 2003 (APC: -6.0; P = 0.0264). Age-specific breast cancer rates changed dramatically with changes in prevalence of HRT use. During low HRT prevalence, breast cancer incidence increased progressively with age, when HRT prevalence was reaching its maximum (1995-2002), higher rates were seen in 60- to 64-year-old women, with a concomitant decrease in risk among elderly. After the sudden decline in HRT use, the incidence peak diminished significantly and incidence increased again with age. Following the abrupt decline in HRT use in Geneva, breast cancer incidence rates among post-menopausal women decreased considerably with striking changes in age-specific incidence rates before, during and after the peak in HRT prevalence.

  6. A stochastic version of the brass PF ratio adjustment of age-specific fertility schedules.

    PubMed

    Baker, Jack; Alcantara, Adélamar; Ruan, Xiaomin

    2011-01-01

    Estimates of age-specific fertility rates based on survey data are known to suffer down-bias associated with incomplete reporting. Previously, William Brass (1964, 1965, 1968) proposed a series of adjustments of such data to reflect more appropriate levels of fertility through comparison with data on children-ever-born by age, a measure of cohort-specific cumulative fertility. His now widely-used Parity/Fertility or PF ratio method makes a number of strong assumptions, which have been the focus of an extended discussion in the literature on indirect estimation. However, while it is clear that the measures used in making adjusted age-specific fertility estimates with this method are captured with statistical uncertainty, little discussion of the nature of this uncertainty around PF-ratio based estimates of fertility has been entertained in the literature. Since both age-specific risk of childbearing and cumulative parity (children ever born) are measured with statistical uncertainty, an unknown credibility interval must surround every PF ratio-based estimate. Using the standard approach, this is unknown, limiting the ability to make statistical comparisons of fertility between groups or to understand stochasticity in population dynamics. This paper makes use of approaches applied to similar problems in engineering, the natural sciences, and decision analysis--often discussed under the title of uncertainty analysis or stochastic modeling--to characterize this uncertainty and to present a new method for making PF ratio-based fertility estimates with 95 percent uncertainty intervals. The implications for demographic analysis, between-group comparisons of fertility, and the field of statistical demography are explored.

  7. Uncertainty in age-specific harvest estimates and consequences for white-tailed deer management

    USGS Publications Warehouse

    Collier, B.A.; Krementz, D.G.

    2007-01-01

    Age structure proportions (proportion of harvested individuals within each age class) are commonly used as support for regulatory restrictions and input for deer population models. Such use requires critical evaluation when harvest regulations force hunters to selectively harvest specific age classes, due to impact on the underlying population age structure. We used a stochastic population simulation model to evaluate the impact of using harvest proportions to evaluate changes in population age structure under a selective harvest management program at two scales. Using harvest proportions to parameterize the age-specific harvest segment of the model for the local scale showed that predictions of post-harvest age structure did not vary dependent upon whether selective harvest criteria were in use or not. At the county scale, yearling frequency in the post-harvest population increased, but model predictions indicated that post-harvest population size of 2.5 years old males would decline below levels found before implementation of the antler restriction, reducing the number of individuals recruited into older age classes. Across the range of age-specific harvest rates modeled, our simulation predicted that underestimation of age-specific harvest rates has considerable influence on predictions of post-harvest population age structure. We found that the consequence of uncertainty in harvest rates corresponds to uncertainty in predictions of residual population structure, and this correspondence is proportional to scale. Our simulations also indicate that regardless of use of harvest proportions or harvest rates, at either the local or county scale the modeled SHC had a high probability (>0.60 and >0.75, respectively) of eliminating recruitment into >2.5 years old age classes. Although frequently used to increase population age structure, our modeling indicated that selective harvest criteria can decrease or eliminate the number of white-tailed deer recruited into older

  8. Infant Mortality

    MedlinePlus

    ... Control and Prevention. (2013). CDC health disparities and inequalities report—United States, 2013. Morbidity and Mortality Weekly ... M. (2008). The fall and rise of U.S. inequalities in premature mortality: 1960–2002. PLOS Medicine, 5 ( ...

  9. Pupillary Response as an Age-Specific Measure of Sexual Interest.

    PubMed

    Attard-Johnson, Janice; Bindemann, Markus; Ó Ciardha, Caoilte

    2016-05-01

    In the visual processing of sexual content, pupil dilation is an indicator of arousal that has been linked to observers' sexual orientation. This study investigated whether this measure can be extended to determine age-specific sexual interest. In two experiments, the pupillary responses of heterosexual adults to images of males and females of different ages were related to self-reported sexual interest, sexual appeal to the stimuli, and a child molestation proclivity scale. In both experiments, the pupils of male observers dilated to photographs of women but not men, children, or neutral stimuli. These pupillary responses corresponded with observer's self-reported sexual interests and their sexual appeal ratings of the stimuli. Female observers showed pupil dilation to photographs of men and women but not children. In women, pupillary responses also correlated poorly with sexual appeal ratings of the stimuli. These experiments provide initial evidence that eye-tracking could be used as a measure of sex-specific interest in male observers, and as an age-specific index in male and female observers.

  10. Developmentally Sensitive Markers of Personality Functioning in Adolescents: Age-Specific and Age-Neutral Expressions.

    PubMed

    Debast, Inge; Rossi, Gina; Feenstra, Dineke; Hutsebaut, Joost

    2016-05-23

    Criterion D of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) refers to a possible onset of personality disorders (PDs) in adolescence and in Section II the development/course in adolescence is described by some typical characteristics for several PDs. Yet, age-specific expressions of PDs are lacking in Section III. We urgently need a developmentally sensitive assessment instrument that differentiates developmental and contextual changes on the one hand from expressions of personality pathology on the other hand. Therefore we investigated which items of the Severity Indices for Personality Problems-118 (SIPP-118) were developmentally sensitive throughout adolescence and adulthood and which could be considered more age-specific markers requiring other content or thresholds over age groups. Applying item response theory (IRT) we detected differential item functioning (DIF) in 36% of the items in matched samples of 639 adolescents versus 639 adults. The DIF across age groups mainly reflected a different degree of symptom expressions for the same underlying level of functioning. The threshold for exhibiting symptoms given a certain degree of personality dysfunction was lower in adolescence for areas of personality functioning related to the Self and Interpersonal domains. Some items also measured a latent construct of personality functioning differently across adolescents and adults. This suggests that several facets of the SIPP-118 do not solely measure aspects of personality pathology in adolescents, but likely include more developmental issues. (PsycINFO Database Record

  11. Experimental evidence of environmental effects on age-specific reproductive success: the importance of resource quality.

    PubMed Central

    Pärt, T.

    2001-01-01

    Age-specific access to high-quality resources (e.g. territory or nest site) might be an important determinant for improved reproductive performance with increasing age. I experimentally investigated the effects of territory quality versus other age-related improvements in breeding competence (e.g. foraging skills, breeding experience and local knowledge) on age-specific reproductive success. Territory quality (i.e. territory field layer height) was manipulated in year 2 of northern wheatears (Oenanthe oenanthe) that were breeding in the same territory in two consecutive years. Changing territory quality by changing field layer height had a strong effect on within-individual change in the reproductive success of wheatears. This effect was mainly due to a corresponding change in nest predation risk. When territory quality was kept constant (i.e. no between-year change in territory field layer height), within-individual reproductive success did not change between subsequent years. Thus, age-related improvements in foraging skills, breeding experience and local familiarity had no significant effect on within-individual changes in reproductive success. Increased reproductive success with increased age in northern wheatears is therefore mainly explained by an improved access to high-quality territories with increasing age. I conclude that age-dependent access to high-quality breeding resources might be a widespread phenomenon in nature. PMID:11674875

  12. Idiopathic Polyhydramnios: Severity and Perinatal Morbidity.

    PubMed

    Wiegand, Samantha L; Beamon, Carmen J; Chescheir, Nancy C; Stamilio, David

    2016-06-01

    Objective To estimate the association between the severity of idiopathic polyhydramnios and adverse outcomes. Study Design Retrospective cohort study of deliveries at one hospital from 2000 to 2012 with an amniotic fluid index (AFI) measurement ≥24 + 0 weeks' gestation. Pregnancies complicated by diabetes, multiples, or fetal anomalies were excluded. Exposure was the degree of polyhydramnios: normal (AFI 5-24 cm), mild (≥ 24-30 cm), and moderate-severe (> 30 cm). Primary outcomes were perinatal mortality, neonatal intensive care unit (NICU) admission, and postpartum hemorrhage. Results There were 10,536 pregnancies: 10,188 with a normal AFI, 274 mild (78.74%), and 74 moderate-severe polyhydramnios (21.26%). Adverse outcomes were increased with idiopathic polyhydramnios: NICU admission (adjusted odds ratio [AOR] 3.71, 95% confidence interval [CI] 2.77-4.99), postpartum hemorrhage (AOR 15.81, 95% CI 7.82-31.96), macrosomia (AOR 3.41, 95% CI 2.61-4.47), low 5-minute Apgar score (AOR 2.60, 95% CI 1.57-4.30), and cesarean (AOR 2.16, 95% CI 1.74-2.69). There were increasing odds of macrosomia (mild: AOR 3.19, 95% CI 2.36-4.32; moderate-severe: AOR 4.44, 95% CI 2.53-7.79) and low 5-minute Apgar score (mild: AOR 2.24, 95% CI 1.23-4.08; moderate-severe: AOR 3.93, 95% CI 1.62-9.55) with increasing severity of polyhydramnios. Conclusion Idiopathic polyhydramnios is independently associated with increased risks of morbidity. There appears to be a dose-response relationship for neonatal macrosomia and low 5-minute Apgar score risks.

  13. Perinatal and Neonatal Outcomes of Triplet Gestations Based on Chorionicity

    PubMed Central

    Downing, Maureen; Sulo, Suela; Parilla, Barbara V.

    2017-01-01

    Objective To compare perinatal and neonatal outcomes of dichorionic (DC) and monochorionic (MC) with trichorionic (TC) triplet gestations. Methods A retrospective cohort study of DC + MC versus TC triplet gestations delivered at a tertiary care hospital from 2009 to 2015. The results include 42 sets of triplets (TC, n = 26; DC + MC, n = 16). Maternal demographics and pregnancy data were compared. Neonatal outcomes were assessed using composite morbidity and mortality. Results Maternal baseline characteristics including age, mode of conception, race, parity, body mass index, and previous preterm delivery were statistically comparable. Comparison of prenatal management and complications yielded no significant differences in terms of presence of shortened cervix, cerclage placement, use of tocolytics, intrauterine growth restriction, premature rupture of membranes, pregnancy-induced hypertension, or gestational diabetes. However, evaluation of composite morbidity and mortality (RDS, IVH, NEC, IUGR, and death) illustrated that all infants born from DC + MC triplet gestations suffered some morbidity or mortality compared with TC pregnancies (p < 0.01). Conclusion DC + MC triplet gestations are at an increased risk of neonatal morbidity and mortality compared with TC triplet gestations. PMID:28367358

  14. [Role of the perinatal sexologist in the interdisciplinary perinatal health care team in Canada].

    PubMed

    de Pierrepont, C; Polomeno, V

    2014-01-01

    Interdisciplinary health care teams are models of health care that are the way of the future. In this model, the sexologist has a unique and important role, particularly in perinatal health care where sexuality is a central component of health. Perinatal sexuality is a newly emerging discipline in which the perinatal sexologist has a double role to play: 1) to train other perinatal health professionals in sexuality; and 2) to educate and to intervene with future and new parenting couples by answering their multiple intimate and sexual questions and concerns during the transition to parenthood.

  15. Altered DNA methylation associated with an abnormal liver phenotype in a cattle model with a high incidence of perinatal pathologies

    PubMed Central

    Kiefer, Hélène; Jouneau, Luc; Campion, Évelyne; Rousseau-Ralliard, Delphine; Larcher, Thibaut; Martin-Magniette, Marie-Laure; Balzergue, Sandrine; Ledevin, Mireille; Prézelin, Audrey; Chavatte-Palmer, Pascale; Heyman, Yvan; Richard, Christophe; Le Bourhis, Daniel; Renard, Jean-Paul; Jammes, Hélène

    2016-01-01

    Cloning enables the generation of both clinically normal and pathological individuals from the same donor cells, and may therefore be a DNA sequence-independent driver of phenotypic variability. We took advantage of cattle clones with identical genotypes but different developmental abilities to investigate the role of epigenetic factors in perinatal mortality, a complex trait with increasing prevalence in dairy cattle. We studied livers from pathological clones dying during the perinatal period, clinically normal adult clones with the same genotypes as perinatal clones and conventional age-matched controls. The livers from deceased perinatal clones displayed histological lesions, modifications to quantitative histomorphometric and metabolic parameters such as glycogen storage and fatty acid composition, and an absence of birth-induced maturation. In a genome-wide epigenetic analysis, we identified DNA methylation patterns underlying these phenotypic alterations and targeting genes relevant to liver metabolism, including the type 2 diabetes gene TCF7L2. The adult clones were devoid of major phenotypic and epigenetic abnormalities in the liver, ruling out the effects of genotype on the phenotype observed. These results thus provide the first demonstration of a genome-wide association between DNA methylation and perinatal mortality in cattle, and highlight epigenetics as a driving force for phenotypic variability in farmed animals. PMID:27958319

  16. Fetal akinesia and multiple perinatal fractures.

    PubMed

    Chen, H; Blackburn, W R; Wertelecki, W

    1995-02-13

    Two newborn infants with fetal akinesia sequence were noted to have multiple perinatal fractures of the long bones. The radiographic manifestations are characterized by gracile ribs, thin long bones, and multiple diaphyseal fractures. Consistent histopathologic changes of bone are irregular with focal areas of extreme diaphyseal thinning, thin and long marrow spicules, and with or without callous formation at fracture sites. Pathogenic mechanisms of bone fractures in fetal akinesia sequence and the differential diagnoses of congenital/perinatal bone fractures are discussed.

  17. Genetic and perinatal effects of abused substances

    SciTech Connect

    Brande, M.C.; Zimmerman, A.M.

    1987-01-01

    This book provides an overview of the effects of several abused drugs, including opiates, cannabinoids, alcohol, nicotine, and cocaine, with special emphasis on the actions of these substances at the molecular and cellular levels. The first half deals with genetic effects, including molecular genetics, biochemical genetics, pharmacogenetics, cytogenetics, and genetic toxicity. The second half focuses on perinatal effects and covers: drug abuse during pregnancy; biochemical aspects of marihuana on male reproduction; and long-term behavioral and neuroendocrine effects of perinatal alcohol exposure.

  18. Perinatal depression: implications for child mental health

    PubMed Central

    2010-01-01

    Perinatal depression is common and primary care holds a crucial role for detecting, treating or, if necessary, providing referrals to mental health care for affected women. Family doctors should be aware of risk factors for peripartum depression, including previous history of depression, life events and interpersonal conflict. Perinatal depression has been associated with many poor outcomes, including maternal, child and family unit challenges. Infants and young children of perinatally depressed mothers are more likely to have a difficult temperament, as well as cognitive and emotional delays. The primary care setting is uniquely poised to be the screening and treatment site for perinatal depression; however, several obstacles, both at patient and systems level, have been identified that interfere with women's treatment engagement. Current published treatment guidelines favour psychotherapy above medicines as first line treatment for mild to moderate perinatal depression, while pharmacotherapy is first choice for severe depression, often in combination with psychosocial or integrative approaches. Among mothers who decide to stop taking their antidepressants despite ongoing depression during the perinatal period, the majority suffer from relapsing symptoms. If depression continues post‐partum, there is an increased risk of poor mother–infant attachment, delayed cognitive and linguistic skills in the infant, impaired emotional development and risk for behavioural problems in later life. Complex, comprehensive and multilevel algorithms are warranted to treat perinatal depression. Primary care doctors are best suited to initiate, carry out and evaluate the effectiveness of such interventions designed to prevent adverse outcomes of maternal perinatal depression on mother and child wellbeing. PMID:22477948

  19. Age-specific response of a migratory bird to an experimental alteration of its habitat.

    PubMed

    Haché, Samuel; Villard, Marc-André

    2010-07-01

    1. Recruitment, i.e. the influx of new breeding individuals into a population, is an important demographic parameter, especially in species with a short life span. Few studies have measured this parameter in solitary-breeding animal populations even though it may yield critical information on habitat suitability and functional connectivity. 2. Using a before-after, control-impact pairs (BACIP) experimental design, we measured: (i) the return rate and apparent survival rate of individually marked territorial males of a neotropical migrant bird species, the Ovenbird Seiurus aurocapilla Linnaeus and (ii) the age-specific recruitment rate. Study plots (n = 10) were paired: one was treated through single-tree selection harvesting (30-40% basal area removal) and the other acted as a control. We hypothesized that experienced males would out-compete inexperienced ones and tend to avoid settling in lower-quality, treated stands. 3. In the first year post-harvest, the mean density of territorial males was significantly lower in treated plots (-41%) than in controls and the difference remained relatively stable thereafter. This lower density mainly reflected a lower recruitment rate compared to controls (17.9 vs. 49.0% of males present), itself driven by a lower recruitment rate of experienced males (2.8 vs. 22.8%). Return rate was similar between controls and treated plots in the first year post-harvest (59 vs. 55%, respectively) but it decreased in treated plots during the second (-15.8% relative to controls) and third (-12.7%) year post-harvest. The trend was even stronger when considering only experienced males. The treatment was followed by a major expansion in mean territory size in treated plots (+49% relative to controls, 3rd year post-treatment). 4. Neither apparent survival rate nor recruitment rate varied as predicted. There was a strong year effect but no treatment effect on apparent survival rate, whereas male recruitment patterns were both year- and age-specific

  20. Adjuvant-induced Human Monocyte Secretome Profiles Reveal Adjuvant- and Age-specific Protein Signatures*

    PubMed Central

    Oh, Djin-Ye; Dowling, David J.; Ahmed, Saima; Choi, Hyungwon; Brightman, Spencer; Bergelson, Ilana; Berger, Sebastian T.; Sauld, John F.; Pettengill, Matthew; Kho, Alvin T.; Pollack, Henry J.; Steen, Hanno; Levy, Ofer

    2016-01-01

    Adjuvants boost vaccine responses, enhancing protective immunity against infections that are most common among the very young. Many adjuvants activate innate immunity, some via Toll-Like Receptors (TLRs), whose activities varies with age. Accordingly, characterization of age-specific adjuvant-induced immune responses may inform rational adjuvant design targeting vulnerable populations. In this study, we employed proteomics to characterize the adjuvant-induced changes of secretomes from human newborn and adult monocytes in response to Alum, the most commonly used adjuvant in licensed vaccines; Monophosphoryl Lipid A (MPLA), a TLR4-activating adjuvant component of a licensed Human Papilloma Virus vaccine; and R848 an imidazoquinoline TLR7/8 agonist that is a candidate adjuvant for early life vaccines. Monocytes were incubated in vitro for 24 h with vehicle, Alum, MPLA, or R848 and supernatants collected for proteomic analysis employing liquid chromatography-mass spectrometry (LC-MS) (data available via ProteomeXchange, ID PXD003534). 1894 non-redundant proteins were identified, of which ∼30 - 40% were common to all treatment conditions and ∼5% were treatment-specific. Adjuvant-stimulated secretome profiles, as identified by cluster analyses of over-represented proteins, varied with age and adjuvant type. Adjuvants, especially Alum, activated multiple innate immune pathways as assessed by functional enrichment analyses. Release of lactoferrin, pentraxin 3, and matrix metalloproteinase-9 was confirmed in newborn and adult whole blood and blood monocytes stimulated with adjuvants alone or adjuvanted licensed vaccines with distinct clinical reactogenicity profiles. MPLA-induced adult monocyte secretome profiles correlated in silico with transcriptome profiles induced in adults immunized with the MPLA-adjuvanted RTS,S malaria vaccine (Mosquirix™). Overall, adjuvants such as Alum, MPLA and R848 give rise to distinct and age-specific monocyte secretome profiles

  1. Oxytocin is an age-specific circulating hormone that is necessary for muscle maintenance and regeneration.

    PubMed

    Elabd, Christian; Cousin, Wendy; Upadhyayula, Pavan; Chen, Robert Y; Chooljian, Marc S; Li, Ju; Kung, Sunny; Jiang, Kevin P; Conboy, Irina M

    2014-06-10

    The regenerative capacity of skeletal muscle declines with age. Previous studies suggest that this process can be reversed by exposure to young circulation; however, systemic age-specific factors responsible for this phenomenon are largely unknown. Here we report that oxytocin--a hormone best known for its role in lactation, parturition and social behaviours--is required for proper muscle tissue regeneration and homeostasis, and that plasma levels of oxytocin decline with age. Inhibition of oxytocin signalling in young animals reduces muscle regeneration, whereas systemic administration of oxytocin rapidly improves muscle regeneration by enhancing aged muscle stem cell activation/proliferation through activation of the MAPK/ERK signalling pathway. We further show that the genetic lack of oxytocin does not cause a developmental defect in muscle but instead leads to premature sarcopenia. Considering that oxytocin is an FDA-approved drug, this work reveals a potential novel and safe way to combat or prevent skeletal muscle ageing.

  2. [Age-specific effects at the beginning of in-/out-/day patient welfare measures].

    PubMed

    Rücker, Stefan; Büttner, Peter; Petermann, Ulrike; Petermann, Franz

    2014-01-01

    The study presented examines age-specific differences in emotional and behaviour problems as well as resources at the beginning of in-, out- and day-patient youth welfare measures. Additionally, parenting-skills were investigated. A sample of N = 126 was divided by the median (10.1 years) thus leading to two groups: ages six to ten (version for parents) versus eleven to sixteen (self-completion). Children and adolescents were evaluated with the SDQ, parenting skills with the DEAPQ-EL-GS. Values of both groups were compared cross-sectionally with multivariate, one-factorial variance analysis. Parents of younger children achieve significantly better results for parenting-skills. Compared to the older ones, younger children show significantly greater behaviour problems. Younger children belong to the group especially affected in youth welfare measures. Therefore, measures should be specifically adapted for this group to reduce symptoms.

  3. Experimental evidence that age-specific reproductive success is independent of environmental effects

    PubMed Central

    Daunt, F.; Wanless, S.; Harris, M. P.; Monaghan, P.

    1999-01-01

    An age-specific improvement in reproductive performance has been reported in many iteroparous breeders. However, whether this is a consequence of intrinsic differences in competence amongst age classes or extrinsic differences in the environment they experience is unclear since the timing of breeding within a season generally also differs with age. To disentangle these effects, we experimentally manipulated the timing of breeding in shags, Phalacrocorax aristotelis. Old and young individuals thus reared their chicks at the same time both early and late in the breeding season. When breeding in the same environmental conditions, old pairs performed consistently better than young pairs. These data clearly demonstrate that the age-related differences in reproductive performance are not a result of environmental effects, but rather a consequence of intrinsic differences in brood rearing capacity.

  4. [The age-specific features of palm dermatoglyphics in the adults subjects].

    PubMed

    Teplov, K V; Bozhchenko, A P; Tolmachev, I A; Moiseenko, S A

    2016-01-01

    This article was designed to consider the congenital age-specific features of palm dermatoglyphics in the adults subjects (including the type of the papillary patterns, axial tri-radii, the termini of palmar main lines, the rudiments of palmar lines, the dermatoglyphic ridge count between the stable anatomical structures). The objective of the study was to look for the new diagnostic markers of the biological age. It included the identification of the palm prints obtained from 180 Caucasoid men and 120 women at the age varying from 16 to 80 years. The results of the mathematical and statistical analysis provided the basis for drawing up the list of 18 attributes of palm dermatoglyphics significantly (p<0.05) differing in the frequency of occurrence between the representatives of individual age groups. The methods are proposed allowing to use these findings for the expert evaluation of the age of unknown subjects.

  5. Age-specific inhalation radiation dose commitment factors for selected radionuclides

    SciTech Connect

    Strenge, D.L.; Peloquin, R.A.; Baker, D.A.

    1982-08-01

    Inhalation dose commitment factors are presented for selected radionuclides for exposure of individuals in four age groups: infant, child, teen and adult. Radionuclides considered are /sup 35/S, /sup 36/Cl, /sup 45/Ca, /sup 67/Ga, /sup 75/Se, /sup 85/Sr, /sup 109/Cd, /sup 113/Sn, /sup 125/I, /sup 133/Ba, /sup 170/Tm, /sup 169/Yb, /sup 182/Ta, /sup 192/Ir, /sup 198/Au, /sup 201/Tl, /sup 204/Tl, and /sup 236/Pu. The calculational method is based on the human metabolic model of ICRP as defined in Publication 2 (ICRP 1959) and as used in previous age-specific dose factor calculations by Hoenes and Soldat (1977). Dose commitment factors are presented for the following organs of reference: total body, bone, liver, kidney, thyroid, lung and lower large intestine.

  6. Oxytocin is an age-specific circulating hormone that is necessary for muscle maintenance and regeneration

    PubMed Central

    Upadhyayula, Pavan; Chen, Robert Y.; Chooljian, Marc S.; Li, Ju; Kung, Sunny; Jiang, Kevin P.; Conboy, Irina M.

    2014-01-01

    The regenerative capacity of skeletal muscle declines with age. Previous studies suggest that this process can be reversed by exposure to young circulation, but systemic age-specific factors responsible for this phenomenon are largely unknown. Here we report that oxytocin- a hormone best known for its role in lactation, parturition, and social behaviors - is required for proper muscle tissue regeneration and homeostasis, and that plasma levels of oxytocin decline with age. Inhibition of oxytocin signaling in young animals reduces muscle regeneration, whereas systemic administration of oxytocin rapidly improves muscle regeneration by enhancing aged muscle stem cell activation/proliferation throughactivation of the MAPK/ERK signalling pathway. We further show that the genetic lack of oxytocin does not cause a developmental defect in muscle, but instead leads to premature sarcopenia. Considering that oxytocin is an FDA approved drug, this work reveals a potential novel and safe way to combat or prevent skeletal muscle aging. PMID:24915299

  7. Age-specific occurrence of HPV16- and HPV18-related cervical cancer

    PubMed Central

    Quint, Wim G. V.; Hunt, William C.; Joste, Nancy E.; Alemany, Laia; Bosch, F. Xavier; Myers, Evan R.; Castle, Philip E.

    2014-01-01

    The age-specific of occurrence of cervical cancer related to human papillomavirus genotypes HPV16 and HPV18, the two targeted by current HPV vaccines, is not well described. We therefore used data from two large, tissue-based HPV genotyping studies of cervical cancer, one conducted in New Mexico (USA) (n = 744) and an international study restricted to cancers (n = 1,729) from Europe, North America, and Australia to represent those regions with widely available cervical cancer screening facilities. HPV results were categorized as HPV16 or HPV18 positive (HPV16/18) versus other HPV genotype. We observed a decreasing proportion of HPV16/18-positive cancers with increasing age in the international study (ptrend < 0.001) and New Mexico study (ptrend < 0.001). There was no heterogeneity in the relationship between age of diagnosis and the proportion of HPV16/18-positive cancers between studies (p = 0.8). Combining results from the two studies (n = 2,473), the percentages of HPV16/18-positive cases were 77.0% (95%CI: 75.1%-78.9%) for women less than 65 years old and 62.7% (95%CI: 58.4%-66.9%) for women aged 65 and older (p < 0.001). In women who are under the age of 25 and have been vaccinated before becoming sexually active, the cervical cancer incidence is expected to be approximately 3.5 per million by 2020. HPV vaccination against HPV16/18 may have a greater impact on cervical cancers in women under 65 than in women aged 65 and older. These data will inform the age-specific impact of HPV vaccination and its integration with cervical cancer screening activities. PMID:23632816

  8. Prevention of perinatal HIV transmission: the Perinatal HIV Hotline perspective.

    PubMed

    Waldura, Jess Fogler

    2011-01-01

    Among the most frequently asked questions by callers to the National Perinatal HIV Hotline are those on the use of hormonal contraception in women receiving antiretroviral therapy. Estradiol levels are reduced by ritonavir-boosted protease inhibitors (PIs), nelfinavir, and nevirapine and increased by non-ritonavir-boosted PIs (except nelfinavir), efavirenz, and etravirine. Oral contraceptives do not affect antiretroviral drug levels, and several options are available for hormonal contraception that can compensate for or avoid the effects of antiretroviral drugs on estrogen levels. Other common questions on the hotline involve interpretation and management issues that arise from indeterminate Western blot test results early and late in pregnancy and from positive rapid test results during labor. Many questions focus on appropriate selection of antiretroviral drugs in pregnancy and the need to change regimens to reduce risk of birth defects in the child. This articlesummarizes a presentation by Jess Fogler Waldura, MD, at the 13th Annual Clinical Conference for the Ryan White HIV/AIDS Program held in August 2010 in Washington, DC.

  9. Perinatal risk factors in newborns with gastrointestinal perforation

    PubMed Central

    Prgomet, Sandra; Lukšić, Boris; Pogorelić, Zenon; Jurić, Ivo; Čapkun, Vesna; Arapović, Adela; Boban, Nataša

    2017-01-01

    AIM To investigate correlation of perinatal risk factors in newborns with gastrointestinal perforation (GIP). METHODS Single-center retrospective cohort study was conducted between January 1990 and December 2012. Medical records on all newborns with GIP were reviewed (n = 35). Surgical records and histopathologic examination of all perforated intestine samples were also reviewed. RESULTS The most common cause of GIP was necrotizing enterocolitis (51.4%). The most common site of perforation was large intestine. Mortality rate was 31%. Infants with GIP more frequently had very low birth weight (< 1500 g), especially birth weight below 10th percentile according to gestational age. Ponderal index was not differing between infants with GIP and control subjects. In infants with GIP anemia was more frequently found than in control group. CONCLUSION GIP in newborns is mostly disease of infants with birth weight below 10th percentile according to gestational age. GIP occurs more often in infants with anemia. PMID:28289509

  10. Maternal and perinatal risks for women over 44--a review.

    PubMed

    Schoen, Corina; Rosen, Todd

    2009-10-20

    It has been widely documented that advanced maternal age constitutes a risk to both mother and child. The purpose of this review is to examine the risks posed to the pregnant mother over the age of 44 and determine if they are experienced in greater frequency than in their younger cohorts. A review of the recent literature demonstrates a significant increased incidence of cesarean section, pregnancy-induced hypertension, gestational diabetes, and perinatal mortality. There also appears to be different rates of maternal complications depending on mode of conception with assisted reproductive technology conferring a higher risk in this population. Further study is recommended in mode of conception and parity to examine the effects on maternal and fetal risks.

  11. Deciphering infant mortality

    NASA Astrophysics Data System (ADS)

    Berrut, Sylvie; Pouillard, Violette; Richmond, Peter; Roehner, Bertrand M.

    2016-12-01

    This paper is about infant mortality. In line with reliability theory, "infant" refers to the time interval following birth during which the mortality (or failure) rate decreases. This definition provides a systems science perspective in which birth constitutes a sudden transition falling within the field of application of the Transient Shock (TS) conjecture put forward in Richmond and Roehner (2016c). This conjecture provides predictions about the timing and shape of the death rate peak. It says that there will be a death rate spike whenever external conditions change abruptly and drastically and also predicts that after a steep rise there will be a much longer hyperbolic relaxation process. These predictions can be tested by considering living organisms for which the transient shock occurs several days after birth. Thus, for fish there are three stages: egg, yolk-sac and young adult phases. The TS conjecture predicts a mortality spike at the end of the yolk-sac phase and this timing is indeed confirmed by observation. Secondly, the hyperbolic nature of the relaxation process can be tested using very accurate Swiss statistics for postnatal death rates spanning the period from one hour immediately after birth through to age 10 years. It turns out that since the 19th century despite a significant and large reduction in infant mortality, the shape of the age-specific death rate has remained basically unchanged. Moreover the hyperbolic pattern observed for humans is also found for small primates as recorded in the archives of zoological gardens. Our overall objective is to identify a series of cases which start from simple systems and move step by step to more complex organisms. The cases discussed here we believe represent initial landmarks in this quest.

  12. Perinatal injury of the central nervous system in Lithuania from 1997 to 2014

    PubMed Central

    Vytautas, Basys; Nijolė, Drazdienė; Nijolė, Vezbergienė; Jelena, Isakova

    2016-01-01

    Background. Perinatal CNS injuries are significant for the health of neonates and for child development at a later period. The aim of this study was to evaluate the dynamics of the frequency of perinatal CNS lesions (corresponding to ICD 10 code P91) over a 20-year period, using the data collected from the Lithuanian Medical Data of Births (Registry of Births). Material and methods. In total, data of 559,164 newborns were analyzed. Results. During the period from 1997 to 2014, the frequency of term newborns with perinatal CNS injury decreased almost two times, from 20.4/1000 live births in 1997 to 15.5/1000 live births in 2014, or from 3.12% (95% CI 2.95; 3.31) to 1.46% (95% CI 1.32; 1.61). In 18 years, the rate of infant mortality from perinatal CNS injury decreased by more than four times and in 2014 it was 0.3/1000 births; it accounts for 11% of neonatal mortality (2.6/1000 live births). The largest decrease of CNS injury was seen after a caesarean birth (from 13.7% in 1999 to 1.7% in 2014) and breech delivery (from 9.7% in 1999 to 0.8% in 2014). Analysis of the dynamics of perinatal CNS injury in preterm births in selected groups did not identify a significant positive shift during the period. When evaluating the level of childbirth services in different-level maternity hospitals, CNS injury is undoubtedly diminished in 2B-level maternity hospitals (regional). Also, positive dynamics was observed in the data of 2A-level maternity hospitals, while in 3-level maternity hospitals (university hospitals), which deal with the most complicated obstetrical pathology and preterm newborns, positive dynamics was not observed. It is estimated that the frequency of hypoxic-ischemic encephalopathy was 0.63/1000 live births in Lithuania in 1993. Conclusions. The frequency of perinatal CNS injury and its positive dynamics in over 18 years shows a progressive and scientifically-based perinatal health care organization in Lithuania.

  13. Hurricane Katrina and perinatal health.

    PubMed

    Harville, Emily W; Xiong, Xu; Buekens, Pierre

    2009-12-01

    We review the literature on the effects of Hurricane Katrina on perinatal health, and providing data from our own research on pregnant and postpartum women. After Katrina, obstetric, prenatal, and neonatal care was compromised in the short term, but increases in adverse birth outcomes such as preterm birth, low birthweight, and maternal complications were mostly limited to highly exposed women. Both pregnant and postpartum women had rates of post-traumatic stress disorder similar to, or lower than, others exposed to Katrina, and rates of depression similar to other pregnant and postpartum populations. Health behaviors, such as smoking and breastfeeding, may have been somewhat negatively affected by the disaster, whereas effects on nutrition were likely associated with limited time, money, and food choices, and indicated by both weight gain and loss. We conclude that, with a few specific exceptions, postdisaster concerns and health outcomes for pregnant and postpartum women were similar to those of other people exposed to Hurricane Katrina. In such situations, disaster planners and researchers should focus on providing care and support for the normal concerns of the peripartum period, such as breastfeeding, depression, and smoking cessation. Contraception needs to be available for those who do not want to become pregnant. Although additional physical and mental health care needs to be provided for the most severely exposed women and their babies, many women are capable of surviving and thriving in postdisaster environments.

  14. Maternal nutrition and perinatal outcomes.

    PubMed

    Barger, Mary K

    2010-01-01

    Diet and patterns of eating during pregnancy can affect perinatal outcomes through direct physiologic effects or by stressing the fetus in ways that permanently affect phenotype. Supplements are not a magic nutritional remedy, and evidence of profound benefit for most supplements remains inconclusive. However, research supports calcium supplements to decrease preeclampsia. Following a low glycemic, Mediterranean-type diet appears to improve ovulatory infertility, decrease preterm birth, and decrease the risk of gestational diabetes. Although women in the United States have adequate levels of most nutrients, subpopulations are low in vitamin D, folate, and iodine. Vitamin D has increasingly been shown to be important not only for bone health, but also for glucose regulation, immune function, and good uterine contractility in labor. To ensure adequate vitamin and micronutrient intake, especially of folate before conception, all reproductive age women should take a multivitamin daily. In pregnancy, health care providers need to assess women's diets, give them weight gain recommendations based on their body mass index measurement, and advise them to eat a Mediterranean diet rich in omega-3 fatty acids (ingested as low-mercury risk fatty fish or supplements), ingest adequate calcium, and achieve adequate vitamin D levels through sun exposure or supplements. Health care providers should continue to spend time on nutrition assessment and counseling.

  15. Perinatal inflammation: a common factor in the early origins of cardiovascular disease?

    PubMed

    Nguyen, Maria U; Wallace, Megan J; Pepe, Salvatore; Menheniott, Trevelyan R; Moss, Timothy J; Burgner, David

    2015-10-01

    Cardiovascular disease continues to be the leading cause of global morbidity and mortality. Traditional risk factors account for only part of the attributable risk. The origins of atherosclerosis are in early life, a potential albeit largely unrecognized window of opportunity for early detection and treatment of subclinical cardiovascular disease. There are robust epidemiological data indicating that poor intrauterine growth and/or prematurity, and perinatal factors such as maternal hypercholesterolaemia, smoking, diabetes and obesity, are associated with adverse cardiovascular intermediate phenotypes in childhood and adulthood. Many of these early-life risk factors result in a heightened inflammatory state. Inflammation is a central mechanism in the development of atherosclerosis and cardiovascular disease, but few studies have investigated the role of overt perinatal infection and inflammation (chorioamnionitis) as a potential contributor to cardiovascular risk. Limited evidence from human and experimental models suggests an association between chorioamnionitis and cardiac and vascular dysfunction. Early life inflammatory events may be an important mechanism in the early development of cardiovascular risk and may provide insights into the associations between perinatal factors and adult cardiovascular disease. This review aims to summarise current data on the early life origins of atherosclerosis and cardiovascular disease, with particular focus on perinatal inflammation.

  16. An age-specific kinetic model of lead metabolism in humans.

    PubMed Central

    Leggett, R W

    1993-01-01

    Although considerable progress has been made in recent years in reducing human exposures to lead, the potential for high intake of this contaminant still exists in millions of homes and in many occupational settings. Moreover, there is growing evidence that levels of lead intake considered inconsequential just a few years ago can result in subtle, adverse health effects, particularly in children. Consequently, there have been increased efforts by health protection agencies to develop credible, versatile methods for relating levels of lead in environmental media to levels in blood and tissues of exposed humans of all ages. In a parallel effort motivated largely by the Chernobyl nuclear accident, the International Commission on Radiological Protection (ICRP) is assembling a set of age-specific biokinetic models for calculating radiation doses from environmentally important radionuclides, including radioisotopes of lead. This paper describes a new age-specific biokinetic model for lead originally developed for the ICRP but expanded to include additional features that are useful for consideration of lead as a chemical toxin. The model is developed within a generic, physiologically motivated framework designed to address a class of calciumlike elements. This framework provides a useful setting in which to synthesize experimental, occupational, and environmental data on lead and exploit common physiological properties of lead and the alkaline earth elements. The modular design is intended to allow researchers to modify specific parameter values or model components to address special problems in lead toxicology or to incorporate new information. Transport of lead between compartments is assumed to follow linear, first-order kinetics provided the concentration in red blood cells remains below a nonlinear threshold level, but a nonlinear relation between plasma lead and red blood cell lead is modeled for concentrations above that level. The model is shown to be consistent

  17. Perinatal Practices & Traditions Among Asian Indian Women.

    PubMed

    Goyal, Deepika

    2016-01-01

    As the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States.

  18. Age-specific incidence of neutralization antibodies of Herpes simplex virus.

    PubMed Central

    Terzin, A. L.; Masic, M. G.

    1976-01-01

    Sera of 1255 individuals from Novi Sad, varying in age from less than 1 month to 69 years, have been tested for neutralization antibodies to Herpes implex virus type 1. The eight newborns tested and 97% of the 507 adults were positive, with titres ranging from 1/4 to 1/256. The titres in newborns were significantly lower than the titres in adults. After birth the maternal antibodies declined rapidly and 94% of infants at the age of greater than 6 months and less than 2 years were negative. After the first year infants in Novi Sad start to acquire herpes-neutralizing antibodies actively, reaching a 50% incidence of positives between the 2nd and 3rd year of age. Age-specific incidence rates of herpes positives found in Novi Sad have been compared with those reported from Edinburgh, Freiburg i. Br. and Louisiana. Possible influences of several circumstances upon the incidence rate of positives detected by the neutralization test are discussed. PMID:185287

  19. Age-specific toxicity of copper to larval topsmelt Atherinops affinis

    SciTech Connect

    McNulty, H.R.; Anderson, B.S.; Hunt, J.W.; Turpen, S.L.; Singer, M.M. . Inst. of Marine Sciences)

    1994-03-01

    The age-specific sensitivity of topsmelt (Atherinops affinis) larvae to copper was assessed. A series of 7-d growth and survival experiments were conducted using cohorts of larval fish isolated into different age groups of 0, 1, 3, 5, 7, 9, 11, 15, and 20 d post-hatch. Fish aged 0, 3, and 5 d were less sensitive to copper chloride than fish [>=] 7 d old. The median lethal concentration (LC50) for copper ranged from 365 [mu]g L[sup [minus]1] in 0-d larvae, to 137 [mu]g L[sup [minus]1] in 20-d larvae. NOECs remained relatively constant for all ages: 180 [mu]g L[sup [minus]1] for 1- and 3-d-old fish, 100 [mu]g L[sup [minus]1] for all other cohorts. Regression analysis indicated a significant negative correlation between LC50 and gill surface area and cutaneous surface area. Although these correlations were expected because both morphometrics increase with age, the relationships between increasing respiratory surface area and LC50 may indicate that the increase in sensitivity with larval age is related to an increase in copper uptake, either cutaneously or branchially. GSA increased more than seven fold between hatch and 20 d, whereas CSA increased only threefold throughout the same period.

  20. 47,XXY Klinefelter syndrome: clinical characteristics and age-specific recommendations for medical management.

    PubMed

    Aksglaede, Lise; Link, Katarina; Giwercman, Aleksander; Jørgensen, Niels; Skakkebaek, Niels E; Juul, Anders

    2013-02-15

    47,XXY (Klinefelter syndrome) is the most frequent sex chromosomal disorder and affects approximately one in 660 newborn boys. The syndrome is characterized by varying degrees of cognitive, social, behavioral, and learning difficulties and in adulthood additionally primary testicular failure with small testes, hypergonadotropic hypogonadism, tall stature, and eunuchoid body proportions. The phenotype is variable ranging from "near-normal" to a significantly affected individual. In addition, newborns with Klinefelter syndrome generally present with a normal male phenotype and the only consistent clinical finding in KS is small testes, that are most often not identified until after puberty. Decreased awareness of this syndrome among health professionals and a general perception that all patients with 47,XXY exhibit the classic textbook phenotype results in a highly under-diagnosed condition with up to 75% of the patients left undetected. Typically, diagnosis is delayed with the majority of patients identified during fertility workup in adulthood, and only 10% of patients diagnosed prior to puberty. Early detection of this syndrome is recommended in order to offer treatment and intervention at the appropriate ages and stages of development for the purpose of preventing osteopenia/osteoporosis, metabolic syndrome, and other medical conditions related to hypogonadism and to the XXY as well as minimizing potential learning and psychosocial problems. The aim of this review is to present the clinical aspects of XXY and the age-specific recommendations for medical management. © 2013 Wiley Periodicals, Inc.

  1. Age-specific survival of reintroduced swift fox in Badlands National Park and surrounding lands

    USGS Publications Warehouse

    Sasmal, Indrani; Klaver, Robert W.; Jenks, Jonathan A.; Schroeder, Greg M.

    2016-01-01

    In 2003, a reintroduction program was initiated at Badlands National Park (BNP), South Dakota, USA, with swift foxes (Vulpes velox) translocated from Colorado and Wyoming, USA, as part of a restoration effort to recover declining swift fox populations throughout its historical range. Estimates of age-specific survival are necessary to evaluate the potential for population growth of reintroduced populations. We used 7 years (2003–2009) of capture–recapture data of 243 pups, 29 yearlings, and 69 adult swift foxes at BNP and the surrounding area to construct Cormack–Jolly–Seber model estimates of apparent survival within a capture–mark–recapture framework using Program MARK. The best model for estimating recapture probabilities included no differences among age classes, greater recapture probabilities during early years of the monitoring effort than later years, and variation among spring, winter, and summer. Our top ranked survival model indicated pup survival differed from that of yearlings and adults and varied by month and year. The apparent annual survival probability of pups (0.47, SE = 0.10) in our study area was greater than the apparent annual survival probability of yearlings and adults (0.27, SE = 0.08). Our results indicate low survival probabilities for a reintroduced population of swift foxes in the BNP and surrounding areas. Management of reintroduced populations and future reintroductions of swift foxes should consider the effects of relative low annual survival on population demography.

  2. Handling Age Specification in the SNOMED CT to ICD-10-CM Cross-map

    PubMed Central

    Xu, Junchuan; Fung, Kin Wah

    2012-01-01

    A SNOMED CT-encoded problem list will be required to satisfy the Certification Criteria for Stage 2 “Meaningful Use” of the EHR incentive program. ICD-10-CM will be replacing ICD-9-CM as the reimbursement code set in the near future. Having a cross-map from SNOMED CT to ICD-10-CM will promote the use of SNOMED CT as the primary problem list terminology, while easing the transition to ICD-10-CM. This rule-based map will support semi-automatic generation of ICD-10-CM codes from SNOMED CT-encoded data. Among the different types of rules, the age rule is used to handle age-specific code assignment in ICD-10-CM. To supplement the manual process of creation of age rules, a special QA process was implemented to flag maps that were potentially missing age rules. The QA flagged 342 concepts for review (out of 7,277), of which 172 concepts (50.3%) were true positives. Without the special QA, many of the age rules would have been missed. PMID:23304377

  3. Development of age-specific Japanese head phantoms for dose evaluation in paediatric head CT examinations.

    PubMed

    Yamauchi-Kawaura, C; Fujii, K; Akahane, K; Yamauchi, M; Narai, K; Aoyama, T; Katsu, T; Obara, S; Imai, K; Ikeda, M

    2015-02-01

    In this study, the authors developed age-specific physical head phantoms simulating the physique of Japanese children for dose evaluation in paediatric head computed tomography (CT) examinations. Anatomical structures at 99 places in 0-, 0.5-, 1- and 3-y-old Japanese patients were measured using DICOM viewer software from CT images, and the head phantom of each age was designed. For trial manufacture, a 3-y-old head phantom consisting of acrylic resin and gypsum was produced by machine processing. Radiation doses for the head phantom were measured with radiophotoluminescence glass dosemeters and Si-pin photodiode dosemeters. To investigate whether the phantom shape was suitable for dose evaluation, organ doses in the same scan protocol were compared between the 3-y-old head and commercially available anthropomorphic phantoms having approximately the same head size. The doses of organs in both phantoms were equivalent. The authors' designed paediatric head phantom will be useful for dose evaluation in paediatric head CT examinations.

  4. Age-specific survival and reproductive probabilities: evidence for senescence in male fallow deer (Dama dama).

    PubMed Central

    McElligott, Alan G; Altwegg, Res; Hayden, Thomas J

    2002-01-01

    Survival and reproduction are key features in the evolution of life-history strategies. In this study, we use capture-mark-resighting and multi-state models to examine survival senescence and reproductive senescence in six successive cohorts of fallow bucks that were studied for 16 years. We found that the overall age-specific survival probabilities of males were highly variable and the best-fitting model revealed that fallow bucks have four life-history stages: yearling, pre-reproductive, prime-age and senescent. Pre-reproductive males (2 and 3 years old) had the highest survival. Survival declined sharply after the age of 9 years, indicating that senescence had begun. When we considered reproducing and non-reproducing males separately, there was no evidence of senescence in the former, and steadily decreasing survival after the onset of social maturity in the latter. Reproduction probability also declined in older males, and thus we provide very strong evidence of senescence. Reproducers had a greater chance of reproducing again in the following year than non-reproducers. Furthermore, there were differences in the survival probabilities, with reproducers consistently surviving better than non-reproducers. In our study population, reproducers allocate more to the effort to reproduce than non-reproducers. Therefore our results indicate the generally higher phenotypic quality of reproducing males. These results, along with earlier studies on the same population, could indicate positive relationships between fitness correlates. PMID:12061956

  5. Age-Specific Lipid and Fatty Acid Profiles of Atlantic Salmon Juveniles in the Varzuga River

    PubMed Central

    Murzina, Svetlana A.; Nefedova, Zinaida A.; Pekkoeva, Svetlana N.; Veselov, Alexey E.; Efremov, Denis A.; Nemova, Nina N.

    2016-01-01

    The age-specific lipid and fatty acid profiles of juvenile Atlantic salmon at different ages (0+, 1+, and 2+ years) after hatching from nests located in the mainstream of a large Arctic River, the Varzuga River, and resettling to the favorable Sobachji shoal in autumn before overwinter are herein presented. The contemporary methods of the lipid analysis were used: thin layer chromatography and gas chromatography. The results show that the stability of the regulation of important functions in developing organisms is maintained through structural alterations in lipids. These alterations can be considered as a sequence of the modifications and changes in the ratios of certain lipid classes and fatty acids constituents. In general, changes in the lipids and fatty acids (FAs) maintained the physiological limits and controls through the adaptive systems of the organism. The mechanisms of juvenile fish biochemical adaptation to the environmental conditions in the studied biotope include the modification of the energy metabolism and anabolism, and here belongs to the energy characteristics of metabolic processes. PMID:27376274

  6. Gender- and Age-Specific REE and REE/FFM Distributions in Healthy Chinese Adults

    PubMed Central

    Cheng, Yu; Yang, Xue; Na, Li-Xin; Li, Ying; Sun, Chang-Hao

    2016-01-01

    Basic data on the resting energy expenditure (REE) of healthy populations are currently rare, especially for developing countries. The aims of the present study were to describe gender- and age-specific REE distributions and to evaluate the relationships among glycolipid metabolism, eating behaviors, and REE in healthy Chinese adults. This cross-sectional survey included 540 subjects (343 women and 197 men, 20–79 years old). REE was measured by indirect calorimetry and expressed as kcal/day/kg total body weight. The data were presented as the means and percentiles for REE and the REE to fat-free mass (FFM) ratio; differences were described by gender and age. Partial correlation analysis was used to analyze the correlations between REE, tertiles of REE/FFM, and glycolipid metabolism and eating behaviors. In this study, we confirmed a decline in REE with age in women (p = 0.000) and men (p = 0.000), and we found that men have a higher REE (p = 0.000) and lower REE/FFM (p = 0.021) than women. Furthermore, we observed no associations among glycolipid metabolism, eating behaviors, and REE in healthy Chinese adults. In conclusion, the results presented here may be useful to clinicians and nutritionists for comparing healthy and ill subjects and identifying changes in REE that are related to aging, malnutrition, and chronic diseases. PMID:27598192

  7. Age-Specific Lipid and Fatty Acid Profiles of Atlantic Salmon Juveniles in the Varzuga River.

    PubMed

    Murzina, Svetlana A; Nefedova, Zinaida A; Pekkoeva, Svetlana N; Veselov, Alexey E; Efremov, Denis A; Nemova, Nina N

    2016-06-30

    The age-specific lipid and fatty acid profiles of juvenile Atlantic salmon at different ages (0+, 1+, and 2+ years) after hatching from nests located in the mainstream of a large Arctic River, the Varzuga River, and resettling to the favorable Sobachji shoal in autumn before overwinter are herein presented. The contemporary methods of the lipid analysis were used: thin layer chromatography and gas chromatography. The results show that the stability of the regulation of important functions in developing organisms is maintained through structural alterations in lipids. These alterations can be considered as a sequence of the modifications and changes in the ratios of certain lipid classes and fatty acids constituents. In general, changes in the lipids and fatty acids (FAs) maintained the physiological limits and controls through the adaptive systems of the organism. The mechanisms of juvenile fish biochemical adaptation to the environmental conditions in the studied biotope include the modification of the energy metabolism and anabolism, and here belongs to the energy characteristics of metabolic processes.

  8. Age-specific variation in immune response in Drosophila melanogaster has a genetic basis.

    PubMed

    Felix, Tashauna M; Hughes, Kimberly A; Stone, Eric A; Drnevich, Jenny M; Leips, Jeff

    2012-07-01

    Immunosenescence, the age-related decline in immune system function, is a general hallmark of aging. While much is known about the cellular and physiological changes that accompany immunosenescence, we know little about the genetic influences on this phenomenon. In this study we combined age-specific measurements of bacterial clearance ability following infection with whole-genome measurements of the transcriptional response to infection and wounding to identify genes that contribute to the natural variation in immunosenescence, using Drosophila melanogaster as a model system. Twenty inbred lines derived from nature were measured for their ability to clear an Escherichia coli infection at 1 and 4 weeks of age. We used microarrays to simultaneously determine genome-wide expression profiles in infected and wounded flies at each age for 12 of these lines. Lines exhibited significant genetically based variation in bacterial clearance at both ages; however, the genetic basis of this variation changed dramatically with age. Variation in gene expression was significantly correlated with bacterial clearance ability only in the older age group. At 4 weeks of age variation in the expression of 247 genes following infection was associated with genetic variation in bacterial clearance. Functional annotation analyses implicate genes involved in energy metabolism including those in the insulin signaling/TOR pathway as having significant associations with bacterial clearance in older individuals. Given the evolutionary conservation of the genes involved in energy metabolism, our results could have important implications for understanding immunosenescence in other organisms, including humans.

  9. Substance use in the perinatal period

    PubMed Central

    Forray, Ariadna; Foster, Dawn

    2015-01-01

    Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common, and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health and current treatments. PMID:26386836

  10. Prevention of perinatal group B streptococcal infections: a review with an Indian perspective.

    PubMed

    Narava, S; Rajaram, G; Ramadevi, A; Prakash, G V; Mackenzie, S

    2014-01-01

    Group B Streptococcus (GBS) is an important cause of maternal and neonatal morbidity and mortality in many parts of the world. Asymptomatic colonisation of the vagina and rectum with Group B streptococci is common in pregnancy. Maternal colonisation of GBS can vary depending on ethnicity and geographical distribution. Vertical transmission of this organism from mother to foetus may lead to neonatal GBS disease. Intra-partum use of antibiotics in these women has led to a decrease in the rate of early onset but not late onset GBS disease. Identification of women with GBS is the key factor in the prevention of perinatal GBS disease. There are different screening strategies available to identify women at risk of perinatal GBS disease. Clinicians continue to face the challenge of choosing between preventive strategies to reduce the impact of perinatal GBS disease. Controversy exists regarding the ideal preventive strategy. In India, the mortality and morbidity associated with the GBS disease remains largely a under-recognised problem. This comprehensive review summarises the salient features of GBS disease and discusses the epidemiology, risk factors, screening strategies, intra-partum antibiotic prophylaxis with an Indian perspective and how it compares with the Western nations.

  11. Does maternal behaviour influence the risk of perinatal death in Jamaica?

    PubMed

    Greenwood, R; McCaw-Binns, A

    1994-04-01

    Features of behaviour of mothers of singleton perinatal deaths collected over the 12-month period from 1 September 1986 to 31 August 1987 were compared with 9919 mothers of singleton infants born in September and October 1986 and surviving the first week of life, as part of the Jamaican Perinatal Mortality Survey. For perinatal deaths as a whole, and in the presence of maternal age and social and environmental features, logistic regression analyses showed that the following were independently related with higher risk of mortality: (1) deliberately trying to get pregnant; (2) ever having used Depo Provera; (3) not drinking alcohol in pregnancy; and (4) smoking cigarettes in pregnancy. There were no associations with coital frequency, ever using the contraceptive pill or smoking ganja (cannabis). Deaths were classified using the Wigglesworth scheme, and separate analyses carried out for the three major groups--antepartum fetal deaths, deaths from immaturity and deaths from intrapartum asphyxia. Antepartum fetal deaths were at increased risk if (1) mothers were deliberately trying to get pregnant or (2) they had ever used Depo Provera. Deaths from immaturity were not associated with any health behaviour variables. Deaths from intrapartum asphyxia were more likely if (1) the mother was deliberately trying to get pregnant or (2) she had never used an intrauterine contraceptive device.

  12. Mortality rates among Arab Americans in Michigan.

    PubMed

    Dallo, Florence J; Schwartz, Kendra; Ruterbusch, Julie J; Booza, Jason; Williams, David R

    2012-04-01

    The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.

  13. Perinatal Care for Women Who Are Addicted: Implications for Empowerment.

    ERIC Educational Resources Information Center

    Carter, Carolyn S.

    2002-01-01

    This article explores societal responses to perinatal drug abuse, including stigmatic attitudes and behaviors of health care workers. Empowering strategies are suggested by which social workers and clients can potentially redefine perinatal drug abuse as a health problem rather than a legal issue and improve the environment in which perinatal care…

  14. Genetics and genomics: impact on perinatal nursing.

    PubMed

    Lewis, Judith A

    2011-01-01

    In 1953, Watson and Crick first described the structure of the DNA molecule, an event that led to a new understanding of the nature of heredity. Just 50 years later, a conference was held in Bethesda, Maryland to announce the completion of the sequencing of the human genome. The era of genomic healthcare has begun, and it has profound implications for nursing education, nursing practice, and nursing research. This article will highlight some important areas in perinatal and neonatal nursing that have been affected by genetics and genomics, as well as some emerging areas of research that will be relevant to perinatal and neonatal nursing.

  15. Age-specific absolute and relative organ weight distributions for Fischer 344 rats.

    PubMed

    Marino, Dale J

    2012-01-01

    The Fischer 344 (F344) rat has been the standard rat strain used in toxicology studies conducted by the National Cancer Institute (NCI) and the National Toxicology Program (NTP). However, the numerous reports published to date on growth, survival, and tumor incidence have not included an overall compilation of organ weight data. Notably, dose-related organ weight effects are endpoints used by regulatory agencies to develop toxicity reference values (TRVs) for use in human health risk assessments. In addition, physiologically-based pharmacokinetic (PBPK) models, which utilize relative organ weights, are increasingly being used to develop TRVs. Because a compilation of organ weights for F344 rats could prove beneficial for TRV development and PBPK modeling, all available absolute and relative organ weight data for untreated control F344 rats were collected from NCI/NTP feed, drinking-water, and inhalation studies in order to develop age-specific distributions. Results showed that organ weights were collected more frequently at 2-wk (59 studies), 3-mo (148 studies), and 15-mo (38 studies) intervals than at other intervals and more frequently from feeding and inhalation than from drinking-water studies. Liver, right kidney, lung, heart, thymus, and brain weights were most frequently collected. From the collected data, the mean and standard deviation for absolute and relative organ weights were calculated. Findings showed age-related increases in absolute weights and decreases in relative weights for brain, liver, right kidney, lung, heart, thyroid, and right testis. The results suggest a general variability trend in absolute organ weights of brain < right testis < heart < right kidney < liver < lung < thymus < thyroid.

  16. Spatially adapted augmentation of age-specific atlas-based segmentation using patch-based priors

    NASA Astrophysics Data System (ADS)

    Liu, Mengyuan; Seshamani, Sharmishtaa; Harrylock, Lisa; Kitsch, Averi; Miller, Steven; Chau, Van; Poskitt, Kenneth; Rousseau, Francois; Studholme, Colin

    2014-03-01

    One of the most common approaches to MRI brain tissue segmentation is to employ an atlas prior to initialize an Expectation- Maximization (EM) image labeling scheme using a statistical model of MRI intensities. This prior is commonly derived from a set of manually segmented training data from the population of interest. However, in cases where subject anatomy varies significantly from the prior anatomical average model (for example in the case where extreme developmental abnormalities or brain injuries occur), the prior tissue map does not provide adequate information about the observed MRI intensities to ensure the EM algorithm converges to an anatomically accurate labeling of the MRI. In this paper, we present a novel approach for automatic segmentation of such cases. This approach augments the atlas-based EM segmentation by exploring methods to build a hybrid tissue segmentation scheme that seeks to learn where an atlas prior fails (due to inadequate representation of anatomical variation in the statistical atlas) and utilize an alternative prior derived from a patch driven search of the atlas data. We describe a framework for incorporating this patch-based augmentation of EM (PBAEM) into a 4D age-specific atlas-based segmentation of developing brain anatomy. The proposed approach was evaluated on a set of MRI brain scans of premature neonates with ages ranging from 27.29 to 46.43 gestational weeks (GWs). Results indicated superior performance compared to the conventional atlas-based segmentation method, providing improved segmentation accuracy for gray matter, white matter, ventricles and sulcal CSF regions.

  17. Hepatitis A virus age-specific sero-prevalence and risk factors among Jordanian children.

    PubMed

    Hayajneh, Wail A; Balbeesi, Adel; Faouri, Samir

    2015-04-01

    Hepatitis A Virus (HAV) has been a significant cause of infections among the children and adolescents of Jordan. Availability of safe vaccines made it necessary to identify the ill-defined temporal immunity trends for HAV and possible age-specific prevalence transitions. This community-based cross sectional study was conducted during the period July-August 2008 on 3,066 recruited subjects from the 12 governorates of Jordan, with pre-defined criteria. Several households were chosen at random within each selected block to enroll the subjects. They were interviewed and data were collected. Their sera were tested for total antibodies against HAV. A multivariate model was then performed to identify the possible risk factors. The HAV sero-prevalence rates among the age categories-second year, 2-4 years, 5-9 years, 10-14 years, 15-19 years, and those above 20 years were 26%, 32%, 44%, 63%, 78%, and 94%, respectively. The model revealed the association of several risk factors for higher HAV sero-prevalence rates: (i) older age groups; (ii) lower maternal education levels; (iii) residing in certain governorates; (iv) using public net drinking water; and (v) avoiding use of public net sewage system. This study provided strong evidence for continuous transition of HAV epidemiology towards intermediate endemicity in Jordan, with more susceptible adolescents and adults. Following the World Health Organization (WHO) recommendations for countries with intermediate endemicity, large-scale hepatitis A vaccination is recommended for children in Jordan. This is strengthened by the availability of effective and safe HAV vaccines, improving the socio-economic status of the Jordanians, and increasing life expectancy among Jordanians.

  18. Age-Specific Epigenetic Drift in Late-Onset Alzheimer's Disease

    PubMed Central

    Wang, Sun-Chong; Oelze, Beatrice; Schumacher, Axel

    2008-01-01

    Despite an enormous research effort, most cases of late-onset Alzheimer's disease (LOAD) still remain unexplained and the current biomedical science is still a long way from the ultimate goal of revealing clear risk factors that can help in the diagnosis, prevention and treatment of the disease. Current theories about the development of LOAD hinge on the premise that Alzheimer's arises mainly from heritable causes. Yet, the complex, non-Mendelian disease etiology suggests that an epigenetic component could be involved. Using MALDI-TOF mass spectrometry in post-mortem brain samples and lymphocytes, we have performed an analysis of DNA methylation across 12 potential Alzheimer's susceptibility loci. In the LOAD brain samples we identified a notably age-specific epigenetic drift, supporting a potential role of epigenetic effects in the development of the disease. Additionally, we found that some genes that participate in amyloid-β processing (PSEN1, APOE) and methylation homeostasis (MTHFR, DNMT1) show a significant interindividual epigenetic variability, which may contribute to LOAD predisposition. The APOE gene was found to be of bimodal structure, with a hypomethylated CpG-poor promoter and a fully methylated 3′-CpG-island, that contains the sequences for the ε4-haplotype, which is the only undisputed genetic risk factor for LOAD. Aberrant epigenetic control in this CpG-island may contribute to LOAD pathology. We propose that epigenetic drift is likely to be a substantial mechanism predisposing individuals to LOAD and contributing to the course of disease. PMID:18628954

  19. Age-Specific Frequencies and Characteristics of Ovarian Cysts in Children and Adolescents

    PubMed Central

    Emeksiz, Hamdi Cihan; Derinöz, Okşan; Akkoyun, Esra Betül; Güçlü Pınarlı, Faruk; Bideci, Aysun

    2017-01-01

    Objective: The aim of the present study was to document ovarian cyst frequency and characteristics as well as distribution of these parameters with respect to age in children and adolescents. Methods: We retrospectively analyzed the medical records of 1009 girls between the ages of 5-18 years who presented to our pediatric emergency department (PED) with pelvic pain and therefore underwent pelvic ultrasound examination between June 2011 and May 2014. Results: In total, 132 of 1009 girls (13.1%) were identified as having ovarian cysts ≥1 cm in diameter. The frequency of ovarian cysts was found to be 1.8% (6/337) in children aged 5-9 years and 18.8% (126/672) in those aged 10-18 years. All the cysts detected in children aged 5-9 years were small (<3 cm) and simple with age-specific frequencies ranging between 1.5-2.7%. With the onset of adolescence, ovarian cyst frequency started to increase with age and ranged between 3.8-31.3% throughout adolescence. Age of peak ovarian cyst frequency was 15 years with a rate of 31.3%. Large ovarian cysts (>5 cm) were identified in 19 adolescents (15.1%) with most occurring during middle adolescence. Of the 19 adolescents, five were found to have cyst-related significant ovarian pathologies including cystadenoma (n=3) and ovarian torsion (n=2). Conclusion: In children aged 5-9 years, ovarian cysts were infrequent and small (<3 cm). Peak ovarian cyst frequency was detected at the age of 15 years. All patients diagnosed with cyst-related significant ovarian pathologies were adolescents having a cyst >5 cm in diameter with a complex appearance in most. PMID:28044991

  20. Perinatal health care in a conflict-affected setting: evaluation of health-care services and newborn outcomes at a regional medical centre in Iraq.

    PubMed

    Ahamadani, F A B; Louis, H; Ugwi, P; Hines, R; Pomerleau, M; Ahn, R; Burke, T F; Nelson, B D

    2015-02-02

    A field-based assessment was conducted to assess maternal and newborn health-care services, perinatal and newborn outcomes and associated risk factors at Bint Al-Huda Maternal and Newborn Teaching Hospital, a large referral hospital in southern Iraq. The multi-method approach used interviews, discussions, observation and review of perinatal and newborn outcome data. There is limited assessment of maternal vital signs, labour pattern, fetal response, and complications during pregnancy and labour. Perinatal and neonatal mortality rates are 27.4/1000 births and 30.9/1000 live births respectively. Associated neonatal mortality factors were gestational age < 37 weeks, male sex, birth weight < 2.5 kg, maternal age > 35 years, rural maternal residence and vaginal delivery. Improving birth outcomes in southern Iraq requires evidence-based clinical guidelines, additional supplies and equipment, quality improvement initiatives and in-service training.

  1. Gestational diabetes. Incidence, maternal characteristics, and perinatal outcome.

    PubMed

    Sepe, S J; Connell, F A; Geiss, L S; Teutsch, S M

    1985-06-01

    Accurate estimates of the incidence of abnormal glucose tolerance during pregnancy are virtually nonexistent. Screening select populations of women with risk factors for the condition and the nonrandom, non-population-based nature of most studies have given rise to wide variances in reported incidence. We analyzed data from the states of Mississippi and Washington and from the National Natality and Fetal Mortality Surveys conducted in 1980 in an attempt to provide more accurate population-based estimates of the incidence of gestational diabetes mellitus (GDM). In the national surveys GDM was noted (screening and diagnostic criteria were unavailable) as a complication in 0.38% of all sampled pregnancies; overt (type I and type II) diabetes was noted in 0.78%. Mean maternal age for the GDM group was 28.4 yr; 85% were white (81% controls) and 15% non-white (19% controls). Prepregnancy weights were higher in the GDM group by an average of 20 lb. However, mean weight gain was less in this group than in controls (23 versus 29 lb). Perinatal mortality was noted in approximately 2.8% (1.3% in controls) of the offspring in GDM-complicated pregnancies and congenital malformations in 6.4% (7.9% in controls). Methodologic problems were encountered and included lack of screening and diagnostic criteria, underreporting, and underrecording.

  2. The feasibility of age-specific travel restrictions during influenza pandemics

    PubMed Central

    2011-01-01

    Background Epidemiological studies have shown that imposing travel restrictions to prevent or delay an influenza pandemic may not be feasible. To delay an epidemic substantially, an extremely high proportion of trips (~99%) would have to be restricted in a homogeneously mixing population. Influenza is, however, strongly influenced by age-dependent transmission dynamics, and the effectiveness of age-specific travel restrictions, such as the selective restriction of travel by children, has yet to be examined. Methods A simple stochastic model was developed to describe the importation of infectious cases into a population and to model local chains of transmission seeded by imported cases. The probability of a local epidemic, and the time period until a major epidemic takes off, were used as outcome measures, and travel restriction policies in which children or adults were preferentially restricted were compared to age-blind restriction policies using an age-dependent next generation matrix parameterized for influenza H1N1-2009. Results Restricting children from travelling would yield greater reductions to the short-term risk of the epidemic being established locally than other policy options considered, and potentially could delay an epidemic for a few weeks. However, given a scenario with a total of 500 imported cases over a period of a few months, a substantial reduction in the probability of an epidemic in this time period is possible only if the transmission potential were low and assortativity (i.e. the proportion of contacts within-group) were unrealistically high. In all other scenarios considered, age-structured travel restrictions would not prevent an epidemic and would not delay the epidemic for longer than a few weeks. Conclusions Selectively restricting children from traveling overseas during a pandemic may potentially delay its arrival for a few weeks, depending on the characteristics of the pandemic strain, but could have less of an impact on the economy

  3. DRINKING WATER ARSENIC AND PERINATAL OUTCOMES

    EPA Science Inventory

    Drinking Water Arsenic and Perinatal Outcomes
    DT Lobdell, Z Ning, RK Kwok, JL Mumford, ZY Liu, P Mendola

    Many studies have documented an association between drinking water arsenic (DWA) and cancer, vascular diseases, and dermatological outcomes, but few have investigate...

  4. Experiences with perinatal loss from the health professionals' perspective.

    PubMed

    Pastor Montero, Sonia María; Romero Sánchez, José Manuel; Hueso Montoro, César; Lillo Crespo, Manuel; Vacas Jaén, Ana Gema; Rodríguez Tirado, María Belén

    2011-01-01

    The purpose of this paper is to know the experience of health professionals in situations of perinatal death and grief and to describe their action strategies in the management of perinatal loss. A qualitative study with a phenomenological approach was carried out through interviews conducted with 19 professionals. Three thematic categories were identified: Healthcare practice, feelings aroused by perinatal loss and meaning and beliefs about perinatal loss and grief. The results revealed that the lack of knowledge and skills to deal with perinatal loss are identified as the main reason behind unsuitable attitudes that are usually adopted in these situations. This generates anxiety, helplessness and frustration that compromise professional competency. The conclusion reached is that the promotion of training programs to acquire knowledge, skills and abilities in management of perinatal bereavement and the development of a clinical practice guideline for perinatal loss are necessary.

  5. Perinatal characteristics and risk of polio among Swedish twins.

    PubMed

    Perng, Wei; Cnattingius, Sven; Iliadou, Anastasia; Villamor, Eduardo

    2012-05-01

    Prenatal exposure to adverse environmental conditions is related to increased adult mortality in regions where infections are highly prevalent, yet there is little evidence of the impact of perinatal conditions on the risk of severe infections throughout life. Using prospectively collected data from 21 604 like-sexed Swedish twins of known zygosity born in 1926-1958, we examined the risk of polio in relation to perinatal characteristics using cohort and nested co-twin case-control analyses. Polio incidence was determined through an interview in 1998, and linkage with the Swedish national inpatient and death registries. There were 133 cases of polio. In the cohort analysis, birth length, birthweight and head circumference were positively associated with polio risk. After adjustment for sex, birth year, gestational age at birth and within-twin pair correlations, twins of shortest length (<44 cm) had a 67% ([95% CI: 6%, 88%]; P=0.04) lower risk of polio compared with the reference group (47-49 cm). After additional adjustment for birth length, every 100-g increase in birthweight was related to a 34% increased risk of polio ([95% CI: -1%, 82%]; P=0.06), and every 10-mm increase in head circumference was related to a 17% greater risk of polio ([95% CI: 5%, 31%]; P=0.004). In co-twin control analyses among 226 disease-discordant twins, birth length, birthweight and head circumference were 0.3 cm (P=0.19), 84 g (P=0.07) and 3 mm (P=0.08) higher in cases than controls, respectively. Similar associations were observed among monozygotic (n=84) and dizygotic (n=142) twins. These findings suggest that early intrauterine growth restriction may be inversely related to the incidence of polio.

  6. Social deprivation and adverse perinatal outcomes among Western and non-Western pregnant women in a Dutch urban population.

    PubMed

    Poeran, Jashvant; Maas, Arno F G; Birnie, Erwin; Denktas, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2013-04-01

    Social deprivation is considered a key factor in adverse perinatal outcomes. Rotterdam, the second largest city in The Netherlands, has large inequalities in perinatal health and a high number of deprived neighbourhoods. Social deprivation is measured here through a composite variable: 'Social Index' (SI). We studied the impact of the SI (2008-2009; 5 categories) in terms of perinatal mortality, congenital anomalies, preterm birth, small for gestational age (SGA) and low 5-minute Apgar score as registered in The Netherlands Perinatal Registry (Rotterdam 2000-2007, n = 56,443 singleton pregnancies). We applied ethnic dichotomisation as Western (European/North-American/Australian) vs. Non-Western (all others) ethnicity was expected to interact with the impact of SI. Tests for trend and multilevel regression analysis were applied. Gradually decreasing prevalence of adverse perinatal outcomes was observed in Western women from the lowest SI category (low social quality) to the highest SI category (high social quality). In Western women the low-high SI gradient for prevalence of spontaneous preterm birth (per 1000) changed from 57.2 to 34.1, for iatrogenic preterm birth from 35.2 to 19.0, for SGA from 119.6 to 59.4, for low Apgar score from 10.9 to 8.2, and for perinatal mortality from 14.9 to 7.6. These trends were statistically confirmed by Chi2-tests for trend (p < 0.001). For non-Western women such trends were absent. These strong effects for Western women were confirmed by significant odds ratios for almost all adverse perinatal outcomes estimated from multilevel regression analysis. We conclude social deprivation to play a different role among Western vs. non-Western women. Our results suggest that improvements in social quality may improve perinatal outcomes in Western women, but alternative approaches may be necessary for non-Western groups. Suggested explanations for non-Western 'migrant' groups include the presence of 'protective' effects through knowledge

  7. Maternal morbidity and perinatal outcomes among women in rural versus urban areas

    PubMed Central

    Lisonkova, Sarka; Haslam, Matthew D.; Dahlgren, Leanne; Chen, Innie; Synnes, Anne R.; Lim, Kenneth I.

    2016-01-01

    Background: Most studies examining geographic barriers to maternity care in industrialized countries have focused solely on fetal and neonatal outcomes. We examined the association between rural residence and severe maternal morbidity, in addition to perinatal mortality and morbidity. Methods: We conducted a retrospective population-based cohort study of all women who gave birth in British Columbia, Canada, between Jan. 1, 2005, and Dec. 31, 2010. We compared maternal mortality and severe morbidity (e.g., eclampsia) and adverse perinatal outcomes (e.g., perinatal death) between women residing in areas with moderate to no metropolitan influence (rural) and those living in metropolitan areas or areas with a strong metropolitan influence (urban). We used logistic regression analysis to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: We found a significant association between death or severe maternal morbidity and rural residence (adjusted OR 1.15, 95% CI 1.03–1.28). In particular, women in rural areas had significantly higher rates of eclampsia (adjusted OR 2.70, 95% CI 1.79–4.08), obstetric embolism (adjusted OR 2.16, 95% CI 1.14–4.07) and uterine rupture or dehiscence (adjusted OR 1.96, 95% CI 1.42–2.72) than women in urban areas. Perinatal mortality did not differ significantly between the study groups. Infants in rural areas were more likely than those in urban areas to have a severe neonatal morbidity (adjusted OR 1.14, 95% CI 1.02–1.29), to be born preterm (adjusted OR 1.06, 95% CI 1.01–1.11), to have an Apgar score of less than 7 at 5 minutes (adjusted OR 1.24, 95% CI 1.13–1.31) and to be large for gestational age (adjusted OR 1.14, 95% CI 1.10–1.19). They were less likely to be small for gestational age (adjusted OR 0.90, 95% CI 0.85–0.95) and to be admitted to an neonatal intensive care unit (NICU) (adjusted OR 0.36, 95% CI 0.33–0.38) compared with infants in urban areas. Interpretation: Compared with women

  8. Mortality of atomic bomb survivors predicted from laboratory animals

    NASA Technical Reports Server (NTRS)

    Carnes, Bruce A.; Grahn, Douglas; Hoel, David

    2003-01-01

    Exposure, pathology and mortality data for mice, dogs and humans were examined to determine whether accurate interspecies predictions of radiation-induced mortality could be achieved. The analyses revealed that (1) days of life lost per unit dose can be estimated for a species even without information on radiation effects in that species, and (2) accurate predictions of age-specific radiation-induced mortality in beagles and the atomic bomb survivors can be obtained from a dose-response model for comparably exposed mice. These findings illustrate the value of comparative mortality analyses and the relevance of animal data to the study of human health effects.

  9. Prediction of mortality rates in the presence of missing values

    NASA Astrophysics Data System (ADS)

    Tan, Chon Sern; Pooi, Ah Hin

    2015-12-01

    A time series model based on multivariate power-normal distribution has been applied in the past literature on the United States (US) mortality data from the years 1933 to 2000 to forecast the future age-specific mortality rates of the years 2001 to 2010. In this paper, we show that the method based on multivariate power-normal distribution can still be used for an incomplete US mortality dataset that contains some missing values. The prediction intervals based on this incomplete training data are found to still have good ability of covering the observed future mortality rates although the interval lengths may become wider for long-range prediction.

  10. A Method to Teach Age-Specific Demography with Field Grown Rapid Cycling "Brassica rapa" (Wisconsin Fast Plants)

    ERIC Educational Resources Information Center

    Kelly, Martin G.; Terrana, Sebastian

    2004-01-01

    In this paper, we demonstrate that rapid cycling "Brassica rapa" (Wisconsin Fast Plants) can be used in inquiry-based, student ecological fieldwork. We are the first to describe age-specific survival for field-grown Fast Plants and identify life history traits associated with individual survival. This experiment can be adapted by educators as a…

  11. [Multiple pregnancies. Neonatal morbidity and mortality].

    PubMed

    Lenclen, R; Chassevent, J; Blanc, P; Hoenn, E; Olivier-Martin, M; Paupe, A; Philippe, H J

    1991-10-01

    The increase in the number of multiple pregnancies and the high incidence of prematurity in this type of pregnancy justifies a pediatric evaluation. A retrospective study (1985-1989) compared the perinatal and neonatal characteristics of children resulting from 14 multifetal (at least 3 fetuses) pregnancies, with a gestational age of less than 34 weeks, with 27 children resulting from monofetal pregnancies of the same duration. Neonatal morbidity and mortality appeared to be similar in both groups. Thus at this very early time of onset of labour (mean gestational age of 30 weeks), fetal multiplicity expressed itself neither by any particular neonatal pathology nor by malnutrition.

  12. Perinatal outcomes among foreign-born and US-born Chinese Americans, 1995-2000.

    PubMed

    Li, Qing; Keith, Louis G; Kirby, Russell S

    2010-06-01

    This paper examines nativity differences in adverse perinatal outcomes of Chinese-American mothers. Singleton live births to US-resident Chinese women (150,620 foreign-born, 15,040 US-born) and a random sample of 150,620 non-Hispanic White mothers were selected from 1995 to 2000 national linked birth/infant death certificate files. Associations between maternal nativity status and adverse perinatal outcomes were assessed using multivariable logistic regressions. Compared to US-born Chinese mothers, foreign-born Chinese mothers were less likely to be unmarried, teen mothers, have a non-Hispanic White or other race partner, be rural residents, and more likely to be less educated, or utilize prenatal care inadequately. Controlling for these factors, foreign-born Chinese-American mothers had significantly lower risks for low birth weight, preterm birth, and small-for-gestational age, whereas risks for infant mortality, neonatal mortality, and post-neonatal mortality did not differ significantly from those of infants of US-born Chinese mothers. Chinese Americans exhibited clear nativity differentials for adverse birth outcomes.

  13. Geographical and Temporal Variations in Female Breast Cancer Mortality in the Municipalities of Andalusia (Southern Spain)

    PubMed Central

    Ocaña-Riola, Ricardo; Montaño-Remacha, Carmen; Mayoral-Cortés, José María

    2016-01-01

    The last published figures have shown geographical variations in mortality with respect to female breast cancer in European countries. However, national health policies need a dynamic image of the geographical variations within the country. The aim of this paper was to describe the spatial distribution of age-specific mortality rates from female breast cancer in the municipalities of Andalusia (southern Spain) and to analyze its evolution over time from 1981 to 2012. An ecological study was devised. Two spatio-temporal hierarchical Bayesian models were estimated. One of these was used to estimate the age-specific mortality rate for each municipality, together with its time trends, and the other was used to estimate the age-specific rate ratio compared with Spain as a whole. The results showed that 98% of the municipalities exhibited a decreasing or a flat mortality trend for all the age groups. In 2012, the geographical variability of the age-specific mortality rates was small, especially for population groups below 65. In addition, more than 96.6% of the municipalities showed an age-specific mortality rate similar to the corresponding rate for Spain, and there were no identified significant clusters. This information will contribute towards a reflection on the past, present and future of breast cancer outcomes in Andalusia. PMID:27879690

  14. Geographical and Temporal Variations in Female Breast Cancer Mortality in the Municipalities of Andalusia (Southern Spain).

    PubMed

    Ocaña-Riola, Ricardo; Montaño-Remacha, Carmen; Mayoral-Cortés, José María

    2016-11-22

    The last published figures have shown geographical variations in mortality with respect to female breast cancer in European countries. However, national health policies need a dynamic image of the geographical variations within the country. The aim of this paper was to describe the spatial distribution of age-specific mortality rates from female breast cancer in the municipalities of Andalusia (southern Spain) and to analyze its evolution over time from 1981 to 2012. An ecological study was devised. Two spatio-temporal hierarchical Bayesian models were estimated. One of these was used to estimate the age-specific mortality rate for each municipality, together with its time trends, and the other was used to estimate the age-specific rate ratio compared with Spain as a whole. The results showed that 98% of the municipalities exhibited a decreasing or a flat mortality trend for all the age groups. In 2012, the geographical variability of the age-specific mortality rates was small, especially for population groups below 65. In addition, more than 96.6% of the municipalities showed an age-specific mortality rate similar to the corresponding rate for Spain, and there were no identified significant clusters. This information will contribute towards a reflection on the past, present and future of breast cancer outcomes in Andalusia.

  15. Perinatal outcome in sickle cell anemia: a prospective study from India.

    PubMed

    Daigavane, Mayoor M; Jena, Rabindra K; Kar, Tushar J

    2013-01-01

    Sickle cell anemia, the homozygous genotype of sickle cell disease is one of the most common heritable diseases in the world. The Arab-Asian haplotype present in India is one of the least severe of all haplotypes. Many sickle cell anemia patients are now leading a symptom-free productive life due to hydroxyurea (HU) and better supportive care. Although pregnancy in sickle cell anemia patients is considered a high-risk category, it perinatal outcome is least studied, particularly among carriers of the Arab-Asian haplotype. Thus, the present prospective, randomized study was performed to assess the perinatal outcome in sickle cell anemia. Neonatal outcome such as low birth weight, perinatal mortality rate, special care newborn unit (SCNU) admission, intrauterine growth retardation (IUGR) and pre term births were significantly higher in sickle cell anemia mothers. Maternal outcome such as severe anemia, preeclampsia, vasoocclusive crisis (VOC), pulmonary complications, jaundice and blood transfusion requirements were significantly higher in sickle cell anemia mothers, which were successfully managed. Cesarian section rate was not significantly different from normal controls. Successful pregnancies were achieved in 84.44% of cases. However, we strongly recommend that pregnancies in these patients should be managed in an institutional setup.

  16. Autonomy and advocacy in perinatal nursing practice.

    PubMed

    Simmonds, Anne H

    2008-05-01

    Advocacy has been positioned as an ideal within the practice of nursing, with national guidelines and professional standards obliging nurses to respect patients' autonomous choices and to act as their advocates. However, the meaning of advocacy and autonomy is not well defined or understood, leading to uncertainty regarding what is required, expected and feasible for nurses in clinical practice. In this article, a feminist ethics perspective is used to examine how moral responsibilities are enacted in the perinatal nurse-patient relationship and to explore the interaction between the various threads that influence, and are in turn affected by, this relationship. This perspective allows for consideration of contextual and relational factors that impact on the way perinatal nursing care is given and received, and provides a framework for exploring the ways in which patient autonomy, advocacy and choice are experienced by childbearing women and their nurses during labour and birth.

  17. Nicotine Dependence Measures for Perinatal Women.

    PubMed

    Yang, Irene; Hall, Lynne A

    2016-03-02

    This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.

  18. Age-specific survival estimates of King Eiders derived from satellite telemetry

    USGS Publications Warehouse

    Oppel, Steffen; Powell, Abby N.

    2010-01-01

    Age- and sex-specific survival and dispersal are important components in the dynamics and genetic structure of bird populations. For many avian taxa survival rates at the adult and juvenile life stages differ, but in long-lived species juveniles' survival is logistically challenging to study. We present the first estimates of hatch-year annual survival rates for a sea duck, the King Eider (Somateria spectabilis), estimated from satellite telemetry. From 2006 to 2008 we equipped pre-fiedging King Eiders with satellite transmitters on breeding grounds in Alaska and estimated annual survival rates during their first 2 years of life with known-fate models. We compared those estimates to survival rates of adults marked in the same area from 2002 to 2008. Hatch-year survival varied by season during the first year of life, and model-averaged annual survival rate was 0.67 (95% CI: 0.48–0.80). We did not record any mortality during the second year and were therefore unable to estimate second-year survival rate. Adults' survival rate was constant through the year (0.94, 95% CI: 0.86–0.97). No birds appeared to breed during their second summer. While 88% of females with an active transmitter (n = 9) returned to their natal area at the age of 2 years, none of the 2-year old males (n = 3) did. This pattern indicates that females' natal philopatry is high and suggests that males' higher rates of dispersal may account for sex-specific differences in apparent survival rates of juvenile sea ducks when estimated with mark—recapture methods.

  19. Perinatal Risk Factors for Mild Motor Disability

    ERIC Educational Resources Information Center

    Hands, Beth; Kendall, Garth; Larkin, Dawne; Parker, Helen

    2009-01-01

    The aetiology of mild motor disability (MMD) is a complex issue and as yet is poorly understood. The aim of this study was to identify the prevalence of perinatal risk factors in a cohort of 10-year-old boys and girls with (n = 362) and without (n = 1193) MMD. Among the males with MMD there was a higher prevalence of postpartum haemorrhage,…

  20. Blood Biomarkers for Evaluation of Perinatal Encephalopathy

    PubMed Central

    Graham, Ernest M.; Burd, Irina; Everett, Allen D.; Northington, Frances J.

    2016-01-01

    Recent research in identification of brain injury after trauma shows many possible blood biomarkers that may help identify the fetus and neonate with encephalopathy. Traumatic brain injury shares many common features with perinatal hypoxic-ischemic encephalopathy. Trauma has a hypoxic component, and one of the 1st physiologic consequences of moderate-severe traumatic brain injury is apnea. Trauma and hypoxia-ischemia initiate an excitotoxic cascade and free radical injury followed by the inflammatory cascade, producing injury in neurons, glial cells and white matter. Increased excitatory amino acids, lipid peroxidation products, and alteration in microRNAs and inflammatory markers are common to both traumatic brain injury and perinatal encephalopathy. The blood-brain barrier is disrupted in both leading to egress of substances normally only found in the central nervous system. Brain exosomes may represent ideal biomarker containers, as RNA and protein transported within the vesicles are protected from enzymatic degradation. Evaluation of fetal or neonatal brain derived exosomes that cross the blood-brain barrier and circulate peripherally has been referred to as the “liquid brain biopsy.” A multiplex of serum biomarkers could improve upon the current imprecise methods of identifying fetal and neonatal brain injury such as fetal heart rate abnormalities, meconium, cord gases at delivery, and Apgar scores. Quantitative biomarker measurements of perinatal brain injury and recovery could lead to operative delivery only in the presence of significant fetal risk, triage to appropriate therapy after birth and measure the effectiveness of treatment. PMID:27468268

  1. Incarceration, maternal hardship, and perinatal health behaviors.

    PubMed

    Dumont, Dora M; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela; Clarke, Jennifer G

    2014-11-01

    Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Women reporting incarceration of themselves or their partners in the year before birth of a child had .86 the odds (95 % CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the US simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development.

  2. Neoplasms in young dogs after perinatal irradiation

    SciTech Connect

    Benjamin, S.A.; Lee, A.C.; Angleton, G.M.; Saunders, W.J.; Miller, G.K.; Williams, J.S.; Brewster, R.D.; Long, R.I.

    1986-08-01

    For a study of the life-time effects of irradiation during development, 1,680 beagles were given single, whole-body exposures to /sup 60/Co gamma-radiation at one of three prenatal (preimplantation, embryonic, and fetal) or at one of three postnatal (neonatal, juvenile, and young adult) ages. Mean doses were 0, 0.16, or 0.83 Gy. For comparison with data on childhood cancer after prenatal irradiation, examination was made of tumors occurring in young dogs in this life-span experiment. Up to 4 years of age, 18 dogs had neoplasms diagnosed, 2 of these being in controls. Four dogs that were irradiated in the perinatal (late fetal or neonatal) period died of cancers prior to 2 years of age. This risk was of significant increase compared to the risks for other experimental groups and for the canine population in general. Overall, 71% (5 of 7) of all cancers and 56% (10 of 18) of all benign and malignant neoplasms seen in the first 4 years of life occurred in 29% (480 of 1680) of the dogs irradiated in the perinatal period. These data suggest an increased risk for neoplasia after perinatal irradiation in dogs.

  3. Untreated perinatal paternal depression: Effects on offspring.

    PubMed

    Gentile, Salvatore; Fusco, Maria Luigia

    2017-03-02

    Transition to parenthood represents an important life event which increases vulnerability to psychological disorders. Aim of this article is to analyze all studies which investigated the effects of untreated perinatal paternal depression in offspring. We searched pertinent, peer-reviewed articles published in English (January 1980 to April 2016) on MEDLINE, PsycINFO, and Science.gov. Twenty-three studies met the inclusion criteria. Most of the reviewed studies suffer from methodological limitations, including the small sample, the lack of a structured psychiatric diagnosis, and inclusion bias. Despite such limitations, paternal depression seems to be associated with an increased risk of developmental and behavioural problems and even psychiatric disorders in offspring. In particular, in infants and toddlers such problems vary from increased crying to hyperactivity and conduct problems to psychological and developmental impairment, and poor social outcomes. School-age children of depressed fathers have a doubled risk for suffering from specific psychiatric disorders. Hence, facilitating access to vigorous and evidence based treatments is a public health opportunity for improving the quality of life of depressed parents and their children. Evidences emerging from this review actually suggest that the traditional gender-focused approach to perinatal mood disorders should be completed by a family-centred approach, in order to improve the effectiveness of perinatal mental health programs.

  4. A concept analysis of optimality in perinatal health.

    PubMed

    Kennedy, Holly Powell

    2006-01-01

    This analysis was conducted to describe the concept of optimality and its appropriateness for perinatal health care. The concept was identified in 24 scientific disciplines. Across all disciplines, the universal definition of optimality is the robust, efficient, and cost-effective achievement of best possible outcomes within a rule-governed framework. Optimality, specifically defined for perinatal health care, is the maximal perinatal outcome with minimal intervention placed against the context of the woman's social, medical, and obstetric history.

  5. Test for age-specificity in survival of the common tern

    USGS Publications Warehouse

    Nisbet, I.C.T.; Cam, E.

    2002-01-01

    study meant that a decline in survival probability within individuals (actuarial senescence) could have been masked by heterogeneity in survival probability among individuals (mortality selection). This emphasizes the need for the development of modelling tools permitting separation of these two phenomena, valid under field conditions in which the recapture probabilities are less than one.

  6. Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand

    PubMed Central

    Munir, Kerim; Kanabkaew, Cheeraya; Le Coeur, Sophie

    2017-01-01

    Background Existing studies have suggested decreased adherence and rebound in mortality in perinatally HIV-infected adolescents receiving antiretroviral therapy (ART) as compared to adults and young children. Methods We used both quantitative and qualitative approaches to identify factors influencing adherence among perinatally infected adolescents in Thailand. We analyzed data from 568 pairs of perinatally infected adolescents (aged 12–19) and their primary caregivers in the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional survey conducted in 2010–2012. We also conducted 12 in-depth interviews in 2014 with infected adolescents or their primary caregivers to elicit experiences of living with long-term ART. Results From the quantitative analysis, a total of 275 (48.4%) adolescents had evidence of suboptimal adherence based on this composite outcome: adolescents self-reported missing doses in the past 7 days, caregiver rating of overall adherence as suboptimal, or latest HIV-RNA viral load ≥1000 copies/ml. In multivariate logistic regression analysis, younger age, having grandparents or extended family members as the primary caregiver, caregiver-assessed poor intellectual ability, having a boy/girlfriend, frequent online chatting, self-reported unhappiness and easiness in asking doctors questions were significantly associated with suboptimal adherence. From the in-depth interviews, tensed relationships with caregivers, forgetfulness due to busy schedules, and fear of disclosing HIV status to others, especially boy/girlfriends, were important contributors to suboptimal adherence. Social and emotional support and counseling from peer group was consistently reported as a strong adherence-promoting factor. Conclusion Our findings highlight unique barriers of ART adherence among the perinatally infected adolescents. Future interventions should be targeted at helping adolescents to improve interpersonal relationships and build adaptive skills in

  7. A regionalized perinatal continuing education programme: successful adaptation to a foreign health care system and language.

    PubMed

    Kattwinkel, J; Nowacek, G; Cook, L J; Pietrzyk, J; Borkowski, V; Karasinska-Urbanik, O; Molicki, J; Godlewska, Z; Rozanski, B

    1997-05-01

    Much of the decline in perinatal mortality over the past two decades in the United States has been attributed to regionalization of perinatal care. Outreach education from regional medical centres to community hospitals is an essential component of regionalization. The Perinatal Continuing Education Program (PCEP) has been successfully used for outreach education in more than 30 states since 1979. This project tested the efficacy of implementing the PCEP strategy in Poland. PCEP was adapted to Polish conditions, translated, and implemented in four phases. The scheme allowed gradual transfer of ownership to Polish leaders and use of the existing regional structure to disseminate information from regional centres to community hospitals. Evaluation included measures of programme use (participation and completion rates) and acceptance (participant evaluation forms), cognitive knowledge (pre- vs. post-tests), and patient care (chart reviews). Of 2093 doctors, nurses and midwives who began, 1615 (77%) completed the programme, with higher completion by regional centre than community hospital staff. All participant groups responded favourably to the materials and expressed moderate confidence in their mastery of the information and skills. Test scores improved significantly for all phases and for all disciplines, with baseline and final scores consistent with degrees of previous professional education. Large baseline and inter-hospital variations in chart review data restricted analysis of care practices. A comprehensive perinatal education programme can be successfully transferred to a foreign health care system. We believe the following to be particularly important: multidisciplinary instructors and students; a self-instructional format; content aimed at practice rather than theory; and an organized implementation strategy co-ordinated by local personnel.

  8. Malignant Perinatal Variant of Long-QT Syndrome Caused by a Profoundly Dysfunctional Cardiac Sodium Channel

    PubMed Central

    Wang, Dao W.; Crotti, Lia; Shimizu, Wataru; Pedrazzini, Matteo; Cantu', Francesco; De Filippo, Paolo; Kishiki, Kanako; Miyazaki, Aya; Ikeda, Tomoaki; Schwartz, Peter J.; George, Alfred L.

    2009-01-01

    Background Inherited cardiac arrhythmia susceptibility contributes to sudden death during infancy and may contribute to perinatal and neonatal mortality, but the molecular basis of this risk and the relationship to genetic disorders presenting later in life is unclear. We studied the functional and pharmacological properties of a novel de novo cardiac sodium channel gene (SCN5A) mutation associated with an extremely severe perinatal presentation of long-QT syndrome in unrelated probands of different ethnicity. Methods and Results Two subjects exhibiting severe fetal and perinatal ventricular arrhythmias were screened for SCN5A mutations and the functional properties of a novel missense mutation (G1631D) were determined by whole-cell patch clamp recording. In vitro electrophysiological studies revealed a profound defect in sodium channel function characterized by ~10-fold slowing of inactivation, increased persistent current, slowing of recovery from inactivation, depolarized voltage dependence of activation and inactivation. Single channel recordings demonstrated increased frequency of late openings, prolonged mean open time and increased latency to first opening for the mutant. Subjects carrying this mutation responded clinically to the combination of mexiletine with propranolol and survived. Pharmacologically, the mutant exhibited 2-fold greater tonic and use-dependent mexiletine block than wildtype channels. The mutant also exhibited enhanced tonic (2.4-fold) and use-dependent block (~5-fold) by propranolol, and we observed additive effects of the two drugs on the mutant. Conclusions Our study demonstrates the molecular basis for a malignant perinatal presentation of long-QT syndrome, illustrates novel functional and pharmacological properties of SCN5A-G1631D which caused the disorder, and reveals therapeutic benefits of propranolol block of mutant sodium channels in this setting. PMID:19808432

  9. Acknowledged Dependence and the Virtues of Perinatal Hospice

    PubMed Central

    Cobb, Aaron D.

    2016-01-01

    Prenatal screening can lead to the detection and diagnosis of significantly life-limiting conditions affecting the unborn child. Recognizing the difficulties facing parents who decide to continue the pregnancy, some have proposed perinatal hospice as a new modality of care. Although the medical literature has begun to devote significant attention to these practices, systematic philosophical reflection on perinatal hospice has been relatively limited. Drawing on Alasdair MacIntyre’s account of the virtues of acknowledged dependence, I contend that perinatal hospice manifests and facilitates virtues essential to living well with human dependency and vulnerability. For this reason, perinatal hospice deserves broad support within society. PMID:26661051

  10. Dual role of astrocytes in perinatal asphyxia injury and neuroprotection.

    PubMed

    Romero, J; Muñiz, J; Logica Tornatore, T; Holubiec, M; González, J; Barreto, G E; Guelman, L; Lillig, C H; Blanco, E; Capani, F

    2014-04-17

    Perinatal asphyxia represents an important cause of severe neurological deficits including delayed mental and motor development, epilepsy, major cognitive deficits and blindness. However, at the moment, most of the therapeutic strategies were not well targeted toward the processes that induced the brain injury during perinatal asphyxia. Traditionally, experimental research focused on neurons, whereas astrocytes have been more related with the damage mechanisms of perinatal asphyxia. In this work, we propose to review possible protective as well as deleterious roles of astrocytes in the asphyctic brain with the aim to stimulate further research in this area of perinatal asphyxia still not well studied.

  11. Acknowledged Dependence and the Virtues of Perinatal Hospice.

    PubMed

    Cobb, Aaron D

    2016-02-01

    Prenatal screening can lead to the detection and diagnosis of significantly life-limiting conditions affecting the unborn child. Recognizing the difficulties facing parents who decide to continue the pregnancy, some have proposed perinatal hospice as a new modality of care. Although the medical literature has begun to devote significant attention to these practices, systematic philosophical reflection on perinatal hospice has been relatively limited. Drawing on Alasdair MacIntyre's account of the virtues of acknowledged dependence, I contend that perinatal hospice manifests and facilitates virtues essential to living well with human dependency and vulnerability. For this reason, perinatal hospice deserves broad support within society.

  12. New uses of legacy systems: examples in perinatal care.

    PubMed Central

    Margolis, A.; Vázquez, R.; Mendoza, G.; Zignago, A.; López, A.; Lucián, H.

    1999-01-01

    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dynamically answer questions and make managerial decisions, and eventually link these data with other sources. Future steps regarding clinical information systems are outlined. Images Figure 1 Figure 2 PMID:10566481

  13. Peptic ulcers: mortality and hospitalization.

    PubMed

    Riley, R

    1991-01-01

    This study analyzes data on peptic ulcer disease based on deaths for 1951-1988 and hospital separations for 1969-1988. The source of the data are mortality and morbidity statistics provided to Statistics Canada by the provinces. The age-standardized mortality rates (ASMR) for peptic ulcer disease decreased from 1951 to 1988 by 69.4% for men (8.5 to 2.6 per 100,000 population), and 31.8% for women (2.2 to 1.5). Separation rates from hospitals during 1969-1988 for peptic ulcer disease also decreased by 59.8% for men (242.7 to 97.6 per 100,000 population) and 35.6% for women (103.2 to 66.5). Age-specific rates for both mortality and hospital separations increased with age. Epidemiological studies indicate that the incidence of peptic ulcer disease is declining in the general population. The downward trends in mortality and hospitalization rates for peptic ulcer disease reflect this change in incidence, but additional factors probably contribute as well to this decline. Male rates for both mortality and hospital separations were much higher than female rates at the beginning of the study period; but toward the end, the gap between the sexes narrowed considerably, mainly because the male rates declined substantially while the female rates decline moderately. The slower decline in the rates for women may be related to such factors as the increasing labour force participation among women and the slower decline in the population of female smokers.

  14. Decomposing variation in male reproductive success: age-specific variances and covariances through extra-pair and within-pair reproduction.

    PubMed

    Lebigre, Christophe; Arcese, Peter; Reid, Jane M

    2013-07-01

    Age-specific variances and covariances in reproductive success shape the total variance in lifetime reproductive success (LRS), age-specific opportunities for selection, and population demographic variance and effective size. Age-specific (co)variances in reproductive success achieved through different reproductive routes must therefore be quantified to predict population, phenotypic and evolutionary dynamics in age-structured populations. While numerous studies have quantified age-specific variation in mean reproductive success, age-specific variances and covariances in reproductive success, and the contributions of different reproductive routes to these (co)variances, have not been comprehensively quantified in natural populations. We applied 'additive' and 'independent' methods of variance decomposition to complete data describing apparent (social) and realised (genetic) age-specific reproductive success across 11 cohorts of socially monogamous but genetically polygynandrous song sparrows (Melospiza melodia). We thereby quantified age-specific (co)variances in male within-pair and extra-pair reproductive success (WPRS and EPRS) and the contributions of these (co)variances to the total variances in age-specific reproductive success and LRS. 'Additive' decomposition showed that within-age and among-age (co)variances in WPRS across males aged 2-4 years contributed most to the total variance in LRS. Age-specific (co)variances in EPRS contributed relatively little. However, extra-pair reproduction altered age-specific variances in reproductive success relative to the social mating system, and hence altered the relative contributions of age-specific reproductive success to the total variance in LRS. 'Independent' decomposition showed that the (co)variances in age-specific WPRS, EPRS and total reproductive success, and the resulting opportunities for selection, varied substantially across males that survived to each age. Furthermore, extra-pair reproduction increased

  15. Perinatal program evaluations: methods, impacts, and future goals.

    PubMed

    Thomas, Suzanne D; Hudgins, Jodi L; Sutherland, Donald E; Ange, Brittany L; Mobley, Sandra C

    2015-07-01

    The objective of this methodology note is to examine perinatal program evaluation methods as they relate to the life course health development model (LCHD) and risk reduction for poor birth outcomes. We searched PubMed, CDC, ERIC, and a list from the Association of Maternal and Child Health Programs (AMCHP) to identify sources. We included reports from theory, methodology, program reports, and instruments, as well as reviews of Healthy Start Programs and home visiting. Because our review focused upon evaluation methods we did not include reports that described the Healthy Start Program. The LCHD model demonstrates the non-linear relationships among epigenetic factors and environmental interactions, intentionality or worldview within a values framework, health practices, and observed outcomes in a lifelong developmental health trajectory. The maternal epigenetic and social environment during fetal development sets the stage for the infant's lifelong developmental arc. The LCHD model provides a framework to study challenging maternal child health problems. Research that tracks the long term maternal-infant health developmental trajectory is facilitated by multiple, linked public record systems. Two instruments, the life skills progression instrument and the prenatal risk overview are theoretically consistent with the LCHD and can be adapted for local or population-based use. A figure is included to demonstrate a method of reducing interaction among variables by sample definition. Both in-place local programs and tests of best practices in community-based research are needed to reduce unacceptably high infant mortality. Studies that follow published reporting standards strengthen evidence.

  16. Application of glycated hemoglobin in the perinatal period

    PubMed Central

    Yu, Haiyan; Qi, Xiaorong; Wang, Xiaodong

    2014-01-01

    Glycated hemoglobin (HbA1c) is a special fragment formed by the binding of glucose to the C chain or D chain of hemoglobin A and as a result of non-enzymatic catalysis of mature hemoglobin and glucose, which is an indicator used to evaluate the blood glucose control in diabetes mellitus (DM) patients. Recent researches indicated that HbA1c could be applied in gestational diabetes mellitus (GDM) and pregnancy combined DM, and increasing of HbA1c was close associated with adverse outcomes of women with pregnancy combined DM and GDM. HbA1c was reported to have a significant importance in monitoring congenital malformation, abortion, perinatal mortality, preeclampsia, postpartum abnormal glucose metabolism, vascular complications and so on, which could be a test item during the second trimester. Sensitivity of HbA1c in diagnoses of DM is lower than oral glucose tolerance test (OGTT), thus OGTT is still the golden standard of GDM. Emphasis should be put on standardization of detection and threshold of HbA1c and establishment of HbA1c normal ranges of different trimesters, when HbA1c is used to diagnose pregnancy combined DM and GDM, and evaluate effects of treatments. PMID:25663962

  17. Maternal education and child mortality in Zimbabwe.

    PubMed

    Grépin, Karen A; Bharadwaj, Prashant

    2015-12-01

    In 1980, Zimbabwe rapidly expanded access to secondary schools, providing a natural experiment to estimate the impact of increased maternal secondary education on child mortality. Exploiting age specific exposure to these reforms, we find that children born to mothers most likely to have benefited from the policies were about 21% less likely to die than children born to slightly older mothers. We also find that increased education leads to delayed age at marriage, sexual debut, and first birth and that increased education leads to better economic opportunities for women. We find little evidence supporting other channels through which increased education might affect child mortality. Expanding access to secondary schools may greatly accelerate declines in child mortality in the developing world today.

  18. Mortal assets

    SciTech Connect

    Howe, Geoffrey R.; Zablotska, Lydia B.; Fix, John J.; Egel, John N.; Buchanan, Jeffrey A.

    2005-11-01

    Workers employed in 15 utilities that generate nuclear power in the United States have been followed for up to 18 years between 1979 and 1997. Their cumulative dose from whole-body ionizing radiation has been determined from the dose records maintained by the facilities themselves and the REIRS and REMS systems maintained by the Nuclear Regulatory Commission and the Department of Energy, respectively. Mortality in the cohort from a number of causes has been analyzed with respect to individual radiation doses. The cohort displays a very substantial healthy worker effect, i.e. considerably lower cancer and noncancer mortality than the general population. Based on 26 and 368 deaths, respectively, positive though statistically nonsignificant associations were seen for mortality from leukemia (excluding chronic lymphocytic leukemia) and all solid cancers combined, with excess relative risks per sievert of 5.67 (95% confidence interval (CI) -2.56, 30.4) and 0.596 (95% CI -2.01, 4.64), respectively. These estimates are very similar to those from the atomic bomb survivors study, though the wide confidence intervals are also consistent with lower or higher risk estimates. A strong positive and statistically significant association between radiation dose and deaths from arteriosclerotic heart disease including coronary heart disease was also observed in the cohort, with an ERR of 8.78 (95% CI 2.10, 20.0). Whle associations with heart disease have been reported in some other occupational studies, the magnitude of the present association is not consistent with them and therefore needs cautious interpretation and merits further attention. At present, the relatively small number of deaths and the young age of the cohort (mean age at end of follow-up is 45 years) limit the power of the study, but further follow-up is 45 years) limit the power of the study, but further follow-up and the inclusion of the present data in an ongoing IARC combined analysis of nuclear workers from 15

  19. [Adverse perinatal and infant outcomes among children born to mothers with major mental disorders in a psychiatric hospital in Rio de Janeiro, Brazil].

    PubMed

    Pereira, Priscila Krauss; Vieira, Cláudia Lima; Santos, Jacqueline Fernandes de Cintra; Lima, Lúcia Abelha; Legay, Letícia Fortes; Lovisi, Giovanni Marcos

    2014-08-01

    Adverse perinatal and infant outcomes are the leading causes of infant morbidity and mortality in developing countries like Brazil. Among the risk factors are maternal mental disorders. A retrospective longitudinal study was conducted based on passive follow-up using probabilistic record linkage to estimate the prevalence of adverse perinatal and infant outcomes in children of women admitted to a public psychiatric hospital in Rio de Janeiro, Brazil, and who gave birth from 1999 to 2009. Prevalence rates were: low birth weight (27.6%), prematurity (17.4%), malformations (2.5%), stillbirths (4.8%), and neonatal deaths (3.7%). Associated factors were deficient prenatal care, schizophrenia, and low income. The results corroborate the high prevalence of adverse perinatal and infant outcomes in mothers with major mental disorders, and that screening of psychiatric symptoms and specialized care by mental health professionals are essential throughout prenatal and postpartum care.

  20. Perinatal Generalized Anxiety Disorder: Assessment and Treatment.

    PubMed

    Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-09-01

    Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

  1. Incarceration, Maternal Hardship, and Perinatal Health Behaviors

    PubMed Central

    Dumont, Dora M.; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela A.; Clarke, Jennifer G.

    2014-01-01

    Background Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. Methods We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Results Women reporting incarceration of themselves or their partners in the year before birth of a child had 0.86 the odds (95% CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Conclusions Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the U.S. simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development. PMID:24615355

  2. Perinatal Generalized Anxiety Disorder: Assessment and Treatment

    PubMed Central

    Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-01-01

    Abstract Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%–10.5% during pregnancy and 4.4%–10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother–infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum. PMID:26125602

  3. Asperger Syndrome: Familial and Pre- and Perinatal Factors

    ERIC Educational Resources Information Center

    Gillberg, Christopher; Cederlund, Mats

    2005-01-01

    Objective: Study familial and pre- and perinatal factors in Asperger Syndrome (AS). Methods: Hundred boys with AS had their records reviewed. "Pathogenetic subgroups" were defined according to presence of medical syndromes/chromosomal abnormalities, indices of familiarity, and pre- and perinatal risk factors predisposing to brain damage. Results:…

  4. Biomagnetism in perinatal medicine. Our experience in Greece.

    PubMed

    Kotini, A; Anastasiadis, A N; Koutlaki, N; Tamiolakis, D; Anninos, P; Anastasiadis, P

    2007-01-01

    This is a report on our experience in the application of biomagnetism in perinatal medicine. We provide a brief description of our research work in fetal magnetoencephalography and fetal magnetocardiography in normal, preeclamptic and IUGR pregnancies, together with hemodynamics of the umbilical cord and uterine arteries, providing a new approach to biomagnetism as a non invasive imaging modality in the investigation of perinatal complications.

  5. Marital Status as a Predictor of Perinatal Outcome in Finland.

    ERIC Educational Resources Information Center

    Manderbacka, Kristiina; And Others

    1992-01-01

    Examined association between mother's marital status and perinatal outcome among single births in Finland in 1987 (n=56,595 infants). Found that perinatal deaths, low birthweight, and preterm infants were more common among single mothers than among married mothers. Results for cohabiting mothers were more similar to those of married than to those…

  6. Barriers to and Facilitators of Perinatal Depression Screening.

    PubMed

    Harris, Allyssa L

    Depression is a significant health issue for women of reproductive age. A number of professional organizations have issued guidance regarding perinatal depression screening. However, some health care providers are reluctant to screen women. This column takes a second look at two recent research studies in which investigators examined the barriers to and facilitators of perinatal depression screening.

  7. Community Conversations with Parents to Improve Perinatal Care

    ERIC Educational Resources Information Center

    Martin, Joanne

    2007-01-01

    The state of Indiana took a unique approach to developing a statewide plan to improve perinatal health outcomes by engaging parents in a series of focus groups, called Community Conversations in Perinatal Care (CCPC), to hear directly from consumers about their health care experiences and needs. Recognizing that disparities exist among different…

  8. Cortical Reorganization of Language Functioning Following Perinatal Left MCA Stroke

    ERIC Educational Resources Information Center

    Tillema, Jan-Mendelt; Byars, Anna W.; Jacola, Lisa M.; Schapiro, Mark B.; Schmithorst, Vince J.; Szaflarski, Jerzy P.; Holland, Scott K.

    2008-01-01

    Objective: Functional MRI was used to determine differences in patterns of cortical activation between children who suffered perinatal left middle cerebral artery (MCA) stroke and healthy children performing a silent verb generation task. Methods: Ten children with prior perinatal left MCA stroke (age 6-16 years) and ten healthy age matched…

  9. Modifying CBT for Perinatal Depression: What Do Women Want?

    ERIC Educational Resources Information Center

    O'Mahen, Heather; Fedock, Gina; Henshaw, Erin; Himle, Joseph A.; Forman, Jane; Flynn, Heather A.

    2012-01-01

    The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling…

  10. Maternal and perinatal outcomes of eclampsia with and without HELLP syndrome in a teaching hospital in western Turkey.

    PubMed

    Asıcıoglu, O; Güngördük, K; Yildirim, G; Aslan, H; Günay, T

    2014-05-01

    In this study, we compared the perinatal and maternal outcomes of women with eclampsia with and without HELLP syndrome. A total of 219 pregnancies complicated by eclampsia with and without HELLP syndrome managed between January 2002 and December 2011, were reviewed. The incidence of eclampsia was 1.7/1,000 deliveries. Among 219 patients with eclampsia, 141 (64.4%) did not develop HELLP syndrome and 78 (35.6%) did develop HELLP syndrome. Maternal age and the rates of nulliparity were similar in both groups. Interval time from eclamptic seizure to delivery was significantly longer in the without-HELLP syndrome group (0.92 ± 0.29 weeks vs 0.16 ± 0.12 weeks, p = 0.028). Furthermore, overall perinatal mortality (particularly after gestational week 32) was significantly higher in the with-HELLP syndrome group (20.5% vs 9.9%, p = 0.029). In conclusion, patients with HELLP syndrome had significantly higher perinatal mortality than those with eclampsia without HELLP syndrome and no regular prenatal care.

  11. Poly-LacNAc as an Age-Specific Ligand for Rotavirus P[11] in Neonates and Infants

    PubMed Central

    Liu, Yang; Huang, Pengwei; Jiang, Baoming; Tan, Ming; Morrow, Ardythe L.; Jiang, Xi

    2013-01-01

    Rotavirus (RV) P[11] is an unique genotype that infects neonates. The mechanism of such age-specific host restriction remains unknown. In this study, we explored host mucosal glycans as a potential age-specific factor for attachment of P[11] RVs. Using in vitro binding assays, we demonstrated that VP8* of a P[11] RV (N155) could bind saliva of infants (60.3%, N = 151) but not of adults (0%, N = 48), with a significantly negative correlation between binding of VP8* and ages of infants (P<0.01). Recognition to the infant saliva did not correlate with the ABO, secretor and Lewis histo-blood group antigens (HBGAs) but with the binding of the lectin Lycopersicon esculentum (LEA) that is known to recognize the oligomers of N-acetyllactosamine (LacNAc), a precursor of human HBGAs. Direct evidence of LacNAc involvement in P[11] binding was obtained from specific binding of VP8* with homopolymers of LacNAc in variable lengths through a glycan array analysis of 611 glycans. These results were confirmed by strong binding of VP8* to the Lec2 cell line that expresses LacNAc oligomers but not to the Lec8 cell line lacking the LacNAc. In addition, N155 VP8* and authentic P[11] RVs (human 116E and bovine B223) hemagglutinated human red blood cells that are known to express poly-LacNAc. The potential role of poly-LacNAc in host attachment and infection of RVs has been obtained by abrogation of 116E replication by the PAA-conjugated poly-LacNAc, human milk, and LEA positive infant saliva. Overall, our results suggested that the poly-LacNAc could serve as an age-specific receptor for P[11] RVs and well explained the epidemiology that P[11] RVs mainly infect neonates and young children. PMID:24244290

  12. Preventing Workplace Injuries Among Perinatal Nurses.

    PubMed

    Harolds, Laura; Hurst, Helen

    2016-01-01

    Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized.

  13. Perinatal transmission of human papilomavirus DNA.

    PubMed

    Rombaldi, Renato L; Serafini, Eduardo P; Mandelli, Jovana; Zimmermann, Edineia; Losquiavo, Kamille P

    2009-06-21

    The purpose was to study the perinatal transmission of human papillomavirus DNA (HPV-DNA) in 63 mother-newborn pairs, besides looking at the epidemiological factors involved in the viral DNA transmission. The following sampling methods were used: (1) in the pregnant woman, when was recruited, in cervix and clinical lesions of the vagina, vulva and perineal region; (2) in the newborn, (a) buccal, axillary and inguinal regions; (b) nasopharyngeal aspirate, and (c) cord blood; (3) in the children, buccal was repeated in the 4th week and 6th and 12th month of life. HPV-DNA was identified using two methodologies: multiplex PCR (PGMY09 and MY11 primers) and nested-PCR (genotypes 6/11, 16, 18, 31, 33, 42, 52 and 58). Perinatal transmission was considered when concordance was found in type-specific HPV between mother/newborn or mother/child. HPV-DNA genital was detected in 49 pregnant women submitted to delivery. Eleven newborns (22.4%, n = 11/49) were HPV-DNA positive. In 8 cases (16.3%, n = 8/49) there was type specific HPV concordance between mother/newborn samples. At the end of the first month of life three children (6.1%, n = 3/49) became HPV-DNA positive, while two remained positive from birth. In 3 cases (100%, n = 3/3) there was type specific HPV concordance between mother/newborn samples. In the 6th month, a child (2%, n = 1/49) had become HPV-DNA positive between the 1st and 6th month of life, and there was type specific HPV concordance of mother/newborn samples. All the HPV-DNA positive children (22.4%, n = 11/49) at birth and at the end first month of life (6.1%, n = 3/49) became HPV-DNA negative at the age of 6 months. The HPV-DNA positive child (2%, n = 1/49) from 1st to the 6th month of life became HPV-DNA negative between the 6th and 12th month of life and one child had anogenital warts. In the twelfth month all (100%, n = 49/49) the children studied were HPV-DNA negative. A positive and significant correlation was observed between perinatal transmission

  14. Presumed Perinatal Stroke: Risk Factors, Clinical and Radiological Findings.

    PubMed

    Ilves, Pilvi; Laugesaar, Rael; Loorits, Dagmar; Kolk, Anneli; Tomberg, Tiiu; Lõo, Silva; Talvik, Inga; Kahre, Tiina; Talvik, Tiina

    2016-04-01

    It is unknown why some infants with perinatal stroke present clinical symptoms late during infancy and will be identified as infants with presumed perinatal stroke. The risk factors and clinical and radiological data of 42 infants with presumed perinatal stroke (69% with periventricular venous infarction and 31% with arterial ischemic stroke) from the Estonian Pediatric Stroke Database were reviewed. Children with presumed perinatal stroke were born at term in 95% of the cases and had had no risk factors during pregnancy in 43% of the cases. Children with periventricular venous infarction were born significantly more often (82%) vaginally (P = .0213) compared to children with arterial stroke (42%); nor did they require resuscitation (P = .0212) or had any neurological symptoms after birth (P = .0249). Periventricular venous infarction is the most common type of lesion among infants with the presumed perinatal stroke. Data suggest that the disease is of prenatal origin.

  15. Perinatal depression: a review of US legislation and law.

    PubMed

    Rhodes, Ann M; Segre, Lisa S

    2013-08-01

    Accumulating research documenting the prevalence and negative effects of perinatal depression, together with highly publicized tragic critical incidents of suicide and filicide by mothers with postpartum psychosis, have fueled a continuum of legislation. Specialists in perinatal mental health should recognize how their work influences legislative initiatives and penal codes, and take this into consideration when developing perinatal services and research. Yet, without legal expertise, the status of legislative initiatives can be confusing. To address this shortfall, we assembled an interdisciplinary team of academics specializing in law, as well as perinatal mental health, to summarize these issues. This review presents the relevant federal and state legislation and summarizes the criminal codes that governed the court decisions on cases in which a mother committed filicide because of postpartum psychosis. Moreover, the review aims to help researchers and providers who specialize in perinatal depression understand their role in this legal landscape.

  16. The experience of depression, anxiety, and mania among perinatal women.

    PubMed

    Kim, J Jo; Silver, Richard K; Elue, Rita; Adams, Marci G; La Porte, Laura M; Cai, Li; Kim, Jong Bae; Gibbons, Robert D

    2016-10-01

    We assessed differential item functioning (DIF) based on computerized adaptive testing (CAT) to examine how perinatal mood disorders differ from adult psychiatric disorders. The CAT-Mental Health (CAT-MH) was administered to 1614 adult psychiatric outpatients and 419 perinatal women with IRB approval. We examined individual item-level differences using logistic regression and overall score differences by scoring the perinatal data using the original bifactor model calibration based on the psychiatric sample data and a new bifactor model calibration based on the perinatal data and computing their correlation. To examine convergent validity, we computed correlations of the CAT-MH with contemporaneously administered Edinburgh Postnatal Depression Scales (EPDS). The rate of major depression in the perinatal sample was 13 %. Rates of anxiety, mania, and suicide risk were 5, 6, and 0.4 %, respectively. One of 66 depression items, one of 69 anxiety items, and 15 of 53 mania items exhibited DIF (i.e., failure to discriminate between high and low levels of the disorder) in the perinatal sample based on the psychiatric sample calibration. Removal of these items resulted in correlations of the original and perinatal calibrations of r = 0.983 for depression, r = 0.986 for anxiety, and r = 0.932 for mania. The 91.3 % of cases were concordantly categorized as either "at-risk" or "low-risk" between the EPDS and the perinatal calibration of the CAT-MH. There was little evidence of DIF for depression and anxiety symptoms in perinatal women. This was not true for mania. Now calibrated for perinatal women, the CAT-MH can be evaluated for longitudinal symptom monitoring.

  17. “Nothing Special, Everything Is Maamuli”: Socio-Cultural and Family Practices Influencing the Perinatal Period in Urban India

    PubMed Central

    Raman, Shanti; Srinivasan, Krishnamachari; Kurpad, Anura; Razee, Husna; Ritchie, Jan

    2014-01-01

    Background Globally, India contributes the largest share in sheer numbers to the burden of maternal and infant under-nutrition, morbidity and mortality. A major gap in our knowledge is how socio-cultural practices and beliefs influence the perinatal period and thus perinatal outcomes, particularly in the rapidly growing urban setting. Methods and Findings Using data from a qualitative study in urban south India, including in-depth interviews with 36 women who had recently been through childbirth as well as observations of family life and clinic encounters, we explored the territory of familial, cultural and traditional practices and beliefs influencing women and their families through pregnancy, childbirth and infancy. We found that while there were some similarities in cultural practices to those described before in studies from low resource village settings, there are changing practices and ideas. Fertility concerns dominate women’s experience of married life; notions of gender preference and ideal family size are changing rapidly in response to the urban context; however inter-generational family pressures are still considerable. While a rich repertoire of cultural practices persists throughout the perinatal continuum, their existence is normalised and even underplayed. In terms of diet and nutrition, traditional messages including notions of ‘hot’ and ‘cold’ foods, are stronger than health messages; however breastfeeding is the cultural norm and the practice of delayed breastfeeding appears to be disappearing in this urban setting. Marriage, pregnancy and childbirth are so much part of the norm for women, that there is little expectation of individual choice in any of these major life events. Conclusions A greater understanding is needed of the dynamic factors shaping the perinatal period in urban India, including an acknowledgment of the health promoting as well as potentially harmful cultural practices and the critical role of the family. This will

  18. Mortality in Vietnam, 1979-1989.

    PubMed

    Merli, M G

    1998-08-01

    Little is known about past and present mortality in Vietnam, as the first official data on mortality have only recently become available from censuses taken in 1979 and 1989. Using these data, I estimate Vietnamese mortality during the intercensal period using two techniques that rely on age-specific growth rates from two successive age distributions. Intercensal emigration and differential completeness of census enumeration associated with massive outflows of refugees in the wake of the Vietnam War, population-redistribution policies, and a highly mobile population represent important sources of bias for the estimation of intercensal mortality. I incorporate several strategies to minimize bias from these sources and to select the method that is least sensitive to errors associated with them. Life expectancy at birth estimated for the 1979-1989 intercensal period is 61.4 years for males and 63.2 for females. These results suggest a trend of declining mortality between the 1970s and the 1980s and add solid empirical evidence to the debate over whether mortality in Vietnam has been deteriorating or improving.

  19. Liver cancer mortality rate model in Thailand

    NASA Astrophysics Data System (ADS)

    Sriwattanapongse, Wattanavadee; Prasitwattanaseree, Sukon

    2013-09-01

    Liver Cancer has been a leading cause of death in Thailand. The purpose of this study was to model and forecast liver cancer mortality rate in Thailand using death certificate reports. A retrospective analysis of the liver cancer mortality rate was conducted. Numbering of 123,280 liver cancer causes of death cases were obtained from the national vital registration database for the 10-year period from 2000 to 2009, provided by the Ministry of Interior and coded as cause-of-death using ICD-10 by the Ministry of Public Health. Multivariate regression model was used for modeling and forecasting age-specific liver cancer mortality rates in Thailand. Liver cancer mortality increased with increasing age for each sex and was also higher in the North East provinces. The trends of liver cancer mortality remained stable in most age groups with increases during ten-year period (2000 to 2009) in the Northern and Southern. Liver cancer mortality was higher in males and increase with increasing age. There is need of liver cancer control measures to remain on a sustained and long-term basis for the high liver cancer burden rate of Thailand.

  20. Perinatal Outcome of Second Twin with Respect to Mode of Delivery: An Observational Study

    PubMed Central

    Nadkarni, Trupti K

    2016-01-01

    Introduction With the advent of assisted reproductive techniques, multi-fetal pregnancies are on the rise. While caesarean section is the defined mode of delivery for triplets and higher order pregnancies, the picture for twin delivery is not so clear. While a trial for vaginal delivery is attempted, the second twin is considered vulnerable to complications. Whether this translates into worsened perinatal outcomes is not well defined. Aim To study the perinatal outcome and to identify the various factors influencing the perinatal outcome of second twin with respect to mode of delivery. Materials and Methods Data was collected from hospital birth records regarding the mode of delivery of viable twins (period of gestation >28 weeks) and outcome of second twin with respect to APGAR scores, NICU stay, neonatal morbidity and mortality, over a period of 12 months. Results Of the 93 pairs of twins delivered, in 21(22.6%) pregnancies both twins were delivered vaginally, in 70(75.2%) pregnancies both were delivered by caesarean section and in 2 (1.8%) pregnancies 1st twin was delivered by vaginal route and 2nd by caesarean. In the vaginal delivery group, 85.7% times both twins were in vertex position. In the caesarean group, vertex/non-vertex (38.57%) was the most common presentation followed by non-vertex /non-vertex (25.71%) and vertex/vertex (24.28%). Comparing the perinatal outcome of second twin in both groups, the odds for APGAR score ≤7 was 3.385 times (OR-3.384, 95% CI 1.2099- 9.4684, p=0.02) in the vaginal group compared to the caesarean group. There was no association (OR-1.054, 95% CI 0.3344- 3.3268, p=0.9) between neonatal morbidity of second twin compared to mode of delivery. All 3 perinatal deaths were in the vaginal group (all between 28-32 weeks of gestation). Conclusion There is an increased preference for caesarean delivery in twin pregnancies except in cases where both the twins are in vertex position and not associated with any other maternal or fetal

  1. Effects of perinatal, late foetal, and early embryonic insults on the cardiovascular phenotype in experimental animal models and humans.

    PubMed

    Meister, Theo Arthur; Rexhaj, Emrush; Rimoldi, Stefano Flavio; Scherrer, Urs; Sartori, Claudio

    2016-11-01

    Cardiovascular diseases are the main cause of mortality and morbidity in Western countries, but the underlying mechanisms are still poorly understood. Genetic polymorphisms, once thought to represent a major determinant of cardiovascular risk, individually and collectively, only explain a tiny fraction of phenotypic variation and disease risk in humans. It is now clear that non-genetic factors, i.e., factors that modify gene activity without changing the DNA sequence and that are sensitive to the environment can cause important alterations of the cardiovascular phenotype in experimental animal models and humans. Here, we will review recent studies demonstrating that distinct pathological events during the perinatal (transient perinatal hypoxemia), late foetal (preeclampsia), and early embryonic (assisted reproductive technologies) periods induce profound alterations of the cardiovascular phenotype in humans and experimental animals. Moreover, we will provide evidence that epigenetic modifications are contributing importantly to this problem and are conferring the potential for its transmission to subsequent generations.

  2. Using auditory pre-information to solve the cocktail-party problem: electrophysiological evidence for age-specific differences.

    PubMed

    Getzmann, Stephan; Lewald, Jörg; Falkenstein, Michael

    2014-01-01

    Speech understanding in complex and dynamic listening environments requires (a) auditory scene analysis, namely auditory object formation and segregation, and (b) allocation of the attentional focus to the talker of interest. There is evidence that pre-information is actively used to facilitate these two aspects of the so-called "cocktail-party" problem. Here, a simulated multi-talker scenario was combined with electroencephalography to study scene analysis and allocation of attention in young and middle-aged adults. Sequences of short words (combinations of brief company names and stock-price values) from four talkers at different locations were simultaneously presented, and the detection of target names and the discrimination between critical target values were assessed. Immediately prior to speech sequences, auditory pre-information was provided via cues that either prepared auditory scene analysis or attentional focusing, or non-specific pre-information was given. While performance was generally better in younger than older participants, both age groups benefited from auditory pre-information. The analysis of the cue-related event-related potentials revealed age-specific differences in the use of pre-cues: Younger adults showed a pronounced N2 component, suggesting early inhibition of concurrent speech stimuli; older adults exhibited a stronger late P3 component, suggesting increased resource allocation to process the pre-information. In sum, the results argue for an age-specific utilization of auditory pre-information to improve listening in complex dynamic auditory environments.

  3. Using auditory pre-information to solve the cocktail-party problem: electrophysiological evidence for age-specific differences

    PubMed Central

    Getzmann, Stephan; Lewald, Jörg; Falkenstein, Michael

    2014-01-01

    Speech understanding in complex and dynamic listening environments requires (a) auditory scene analysis, namely auditory object formation and segregation, and (b) allocation of the attentional focus to the talker of interest. There is evidence that pre-information is actively used to facilitate these two aspects of the so-called “cocktail-party” problem. Here, a simulated multi-talker scenario was combined with electroencephalography to study scene analysis and allocation of attention in young and middle-aged adults. Sequences of short words (combinations of brief company names and stock-price values) from four talkers at different locations were simultaneously presented, and the detection of target names and the discrimination between critical target values were assessed. Immediately prior to speech sequences, auditory pre-information was provided via cues that either prepared auditory scene analysis or attentional focusing, or non-specific pre-information was given. While performance was generally better in younger than older participants, both age groups benefited from auditory pre-information. The analysis of the cue-related event-related potentials revealed age-specific differences in the use of pre-cues: Younger adults showed a pronounced N2 component, suggesting early inhibition of concurrent speech stimuli; older adults exhibited a stronger late P3 component, suggesting increased resource allocation to process the pre-information. In sum, the results argue for an age-specific utilization of auditory pre-information to improve listening in complex dynamic auditory environments. PMID:25540608

  4. Neonatal mortality: an analysis of the recent improvement in the United States.

    PubMed Central

    Lee, K S; Paneth, N; Gartner, L M; Pearlman, M A; Gruss, L

    1980-01-01

    To test the hypothesis that the recent substantial decline in the United States neonatal mortality rate (20.0/1000 in 1950 to 11.6/1000 in 1975) is associated with improvements in perinatal medical care, we examined this change in relation to the two primary components which determine neonatal mortality: birthweight distribution and birthweight-specific mortality. No improvement in the weight distribution of U.S. live births has occurred during this 25-year period, indicating that the change in neonatal mortality is attributable to improved survival for one or more birthweight groups. Decline in the mortality rate in the first 15 years was slow; three-fourths of the decline in the entire 25-year period occurred since 1965. With the exception of perinatal medical care, factors known to affect survival at a given birthweight have not changed in prevalence in the 25-year period. It is a plausible hypothesis that improved perinatal medical care is a major factor in declining neonatal mortality in the U.S. PMID:7350819

  5. Vitamin B-12 and Perinatal Health.

    PubMed

    Finkelstein, Julia L; Layden, Alexander J; Stover, Patrick J

    2015-09-01

    Vitamin B-12 deficiency (<148 pmol/L) is associated with adverse maternal and neonatal outcomes, including developmental anomalies, spontaneous abortions, preeclampsia, and low birth weight (<2500 g). The importance of adequate vitamin B-12 status periconceptionally and during pregnancy cannot be overemphasized, given its fundamental role in neural myelination, brain development, and growth. Infants born to vitamin B-12-deficient women may be at increased risk of neural tube closure defects, and maternal vitamin B-12 insufficiency (<200 pmol/L) can impair infant growth, psychomotor function, and brain development, which may be irreversible. However, the underlying causal mechanisms are unknown. This review was conducted to examine the evidence that links maternal vitamin B-12 status and perinatal outcomes. Despite the high prevalence of vitamin B-12 deficiency and associated risk of pregnancy complications, few prospective studies and, to our knowledge, only 1 randomized trial have examined the effects of vitamin B-12 supplementation during pregnancy. The role of vitamin B-12 in the etiology of adverse perinatal outcomes needs to be elucidated to inform public health interventions.

  6. [Perinatal innate immune activation and neuropsychological development].

    PubMed

    Nagai, Taku

    2013-08-01

    Development of animal models is a crucial issue in biological psychiatry for the search of novel drug targets as well as the screening of candidate compounds. Epidemiologic studies suggest that environmental insults, such as prenatal infection and perinatal complication, are involved in the development of schizophrenia. Recently, we have developed a novel mouse model of viral infection during the perinatal stage by injecting polyriboinosinic-polyribocytidilic acid (polyI:C) into neonatal mice. Neonatal treatment of mice with polyI:C, an inducer of innate immune responses via toll-like receptor 3, caused a significant increase in interferon-induced transmembrane protein 3 (IFITM3) levels in the astrocytes of the hippocampus, which resulted in long-lasting brain dysfunction, including cognitive and emotional impairments as well as a deficit in depolarization-evoked glutamate release in the hippocampus in adulthood. Neonatal polyI:C-induced neuronal impairments have not been observed in IFITM3-KO mice. These findings suggest that the induction of IFITM3 expression in astrocytes by the activation of the innate immune system during the early stages of neurodevelopment has non-cell autonomous effects that affect subsequent neurodevelopment, leading to neuropathological impairments and brain dysfunction, by impairing endocytosis in astrocytes.

  7. Disasters and Perinatal Health: A Systematic Review

    PubMed Central

    Harville, EW; Xiong, X; Buekens, P

    2012-01-01

    Background The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health. Methods A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birthweight, congenital anomalies), mental health, and child development. 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria. Results Studies addressing the World Trade Center disaster of September 11th and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, though there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. The mother's mental health after a disaster may more strongly influence on child development than any direct effect of disaster-related prenatal stress. Conclusions There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly-exposed women. Future research should focus on under-studied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health. PMID:21375788

  8. Perinatal cardiac arrest. Quality of the survivors.

    PubMed Central

    Steiner, H; Neligan, G

    1975-01-01

    Steiner, H., and Neligan, G. (1975). Archives of Disease in Childhood, 50, 696. Perinatal cardiac arrest: quality of the survivors. Twenty-two consecutive survivors of perinatal cardiac arrest have been followed to a mean age of 4 1/4 years, using methods of neurological and developmental assessment appropriate to their ages. 4 showed evidence of gross, diffuse brain-damage (2 of these died before the age of 3 years). These were the only 4 survivors of the first month of life who took more than 30 minutes to establish regular, active respiration after their heartbeat had been restored. The arrest in these cases had occurred during or within 15 minutes of delivery, and followed antepartum haemorrhage, breech delivery, or prolapsed cord. The remaining 18 were free of any evidence of brain damage. In the majority of these the arrest had occurred during shoulder dystocia or exchange transfusion, or was unexplained; the heartbeat had been restored within 5 minutes in most cases, and regular, active respiration had been established within 30 minutes thereafter in all cases. PMID:1190819

  9. Endocrine consequences of perinatal methadone exposure.

    PubMed

    Kuhn, C; Bero, L; Ignar, D; Lurie, S; Field, E

    1987-01-01

    In summary, we have shown that marked acute responses as well as persistent changes in hypothalamopituitary responsivity to opiate challenge result from perinatal opioid addiction. We have also shown that different endocrine systems and opioid receptor subtypes develop at different rates, and that the responses of these systems depend upon the relative timing of the treatment regimen and the functional development of the particular opioid system involved. It should be emphasized that these studies have investigated only a single developmental window. The additional critical question of how opioid neuron function is affected by treatment during the period of active neuronal differentiation has not yet been answered. However, these studies do demonstrate the utility of this neuroendocrine model in assessing opioid function following chronic treatment regimens. By using neuroendocrine function as an end point, multiple systems can be studied simultaneously in the same animal. This has a particular advantage in studying the effects of chronic drug exposure on the developing nervous system, because hormone secretion is an easily quantifiable and early maturing functional index which can be used to identify vulnerable (and resistant) systems. Endogenous opioid systems appear to be particularly important in neuroendocrine regulation during the early phase of development, when other neural controls have not yet matured. Our preliminary results suggest that specific opioid systems that mature early may be especially important in the specific neuroendocrine effects of perinatal opiate addiction.

  10. Perinatal testicular torsion and medicolegal considerations.

    PubMed

    Massoni, F; Troili, G M; Pelosi, M; Ricci, S

    2014-06-01

    Perinatal testicular torsion (PTT) is a very complex condition because of rarity of presentation and diagnostic and therapeutic difficulties. In presence of perinatal testicular torsion, the involvement of contralateral testis can be present also in absence of other indications which suggest the bilateral involvement; therefore, occurrences supported by literature do not exclude the use of surgery to avoid the risk of omitted or delayed diagnosis. The data on possible recovery of these testicles are not satisfactory, and treatment consists of an observational approach ("wait-and-see") or an interventional approach. The hypothesis of randomized clinical trials seems impracticable because of rarity of disease. The authors present a case of PTT, analyzing injuries due to clinical and surgical management of these patients, according to medicolegal profile. The delayed diagnosis and the choice of an incorrect therapeutic approach can compromise the position of healthcare professionals, defective in terms of skill, prudence and diligence. Endocrine insufficiency is an unfortunate event. The analysis of literature seems to support, because of high risk, a surgical approach aimed not only at resolution of unilateral pathology or prevention of a relapse, but also at prevention of contralateral testicular torsion.

  11. New insights into perinatal testicular torsion

    PubMed Central

    Van Kerrebroeck, Philip

    2009-01-01

    Perinatal testicular torsion is a relatively rare event that remains unrecognized in many patients or is suspected and treated accordingly only after an avoidable loss of time. The authors report their own experience with several patients, some of them quite atypical but instructive. Missed bilateral torsion is an issue, as are partial torsion, possible antenatal signs, and late presentation. These data are discussed together with the existing literature and may help shed new light on the natural course of testicular torsion and its treatment. The most important conclusion is that a much higher index of suspicion based on clinical findings is needed for timely detection of perinatal torsion. It is the authors’ opinion that immediate surgery is mandatory not only in suspected bilateral torsions but also in cases of possible unilateral torsions. There is no place for a more fatalistic “wait-and-see” approach. Whenever possible, even necrotic testes should not be removed during surgery because some endocrine function may be retained. PMID:19856186

  12. Vitamin B-12 and Perinatal Health123

    PubMed Central

    Finkelstein, Julia L; Layden, Alexander J; Stover, Patrick J

    2015-01-01

    Vitamin B-12 deficiency (<148 pmol/L) is associated with adverse maternal and neonatal outcomes, including developmental anomalies, spontaneous abortions, preeclampsia, and low birth weight (<2500 g). The importance of adequate vitamin B-12 status periconceptionally and during pregnancy cannot be overemphasized, given its fundamental role in neural myelination, brain development, and growth. Infants born to vitamin B-12-deficient women may be at increased risk of neural tube closure defects, and maternal vitamin B-12 insufficiency (<200 pmol/L) can impair infant growth, psychomotor function, and brain development, which may be irreversible. However, the underlying causal mechanisms are unknown. This review was conducted to examine the evidence that links maternal vitamin B-12 status and perinatal outcomes. Despite the high prevalence of vitamin B-12 deficiency and associated risk of pregnancy complications, few prospective studies and, to our knowledge, only 1 randomized trial have examined the effects of vitamin B-12 supplementation during pregnancy. The role of vitamin B-12 in the etiology of adverse perinatal outcomes needs to be elucidated to inform public health interventions. PMID:26374177

  13. Trends in perinatal deaths from 2010 to 2013 in the Guatemalan Western Highlands

    PubMed Central

    2015-01-01

    Background While progress has been made in reducing neonatal mortality in Guatemala, stillbirth and maternal mortality rates remain high, especially among the indigenous populations, which have among the highest adverse pregnancy-related mortality rates in Guatemala. Methods We conducted a prospective study in the Western Highlands of Guatemala from 2010 through 2013, enrolling women during pregnancy with follow-up through 42-days postpartum. All pregnant women were identified and enrolled by study staff in the clusters in the Chimaltenango region for which we had 4 years of data. Enrolment usually occurred during the antenatal period; women were also visited following delivery and 42-days postpartum to collect outcomes. Measures of antenatal and delivery care were also obtained. Results Approximately four thousand women were enrolled annually (3,869 in 2010 to 4,570 in 2013). The stillbirth rate decreased significantly, from 22.0 per 1000 births (95% CI 16.6, 29.0) in 2010 to 16.7 (95% CI 13.5, 20.6) in 2013 (p-value 0.0223). The perinatal mortality rate decreased from 43.9 per 1,000 births (95% CI 36.0, 53.6) to 31.6 (95% CI 27.2, 36.7) (p-value 0.0003). The 28-day neonatal mortality rate decreased from 28.9 per 1000 live births (95% CI 25.2, 33.2) to 21.7 (95% CI 17.5, 26.9), p-value 0.0004. The maternal mortality rate was 134 per 100,000 in 2010 vs. 113 per 100,000 in 2013. Over the same period, hospital birth rates increased from 30.0 to 50.3%. Conclusions In a relatively short time period, significant improvements in neonatal, fetal and perinatal mortality were noted in an area of Guatemala with a history of poor pregnancy outcomes. These changes were temporally related to major increases in hospital-based delivery with skilled birth attendants, as well as improvements in the quality of delivery care, neonatal care, and prenatal care. PMID:26062407

  14. Mortality from lung cancer and chronic obstructive pulmonary disease in New Mexico, 1958-82.

    PubMed

    Samet, J M; Wiggins, C L; Key, C R; Becker, T M

    1988-09-01

    We examined mortality from lung cancer and from chronic obstructive pulmonary disease in Hispanic White, Other White, and Native American residents of New Mexico during the period 1958-82. Age-specific mortality was calculated by combining death certificate data with population estimates based on the 1960, 1970, and 1980 censuses that were adjusted for inconsistencies in the designation of race and ethnicity. In Other Whites, age-adjusted mortality rates from lung cancer and from chronic obstructive pulmonary disease increased progressively in males and females. Mortality rates for both diseases also increased in Hispanics during the study period, but the most recent rates for Hispanics were well below those for Other Whites. Age-specific mortality rates for lung cancer declined for more recently born Hispanic women at older ages. In Native Americans, rates for both diseases were low throughout the study period and did not show consistent temporal trends.

  15. Age-Specific Anti-Hepatitis A Virus Seroepidemiology in Italian Travelers: Indications for Anti-Hepatitis A Vaccination.

    PubMed

    Castelli; Carosi; Tebaldi; Pizzocolo; Pisani; Rossitto; Boffelli; Crevatin; Pettoello; Fausti; Messino; Brunelli; Costa; Ronca

    1996-12-01

    Background: Hepatitis A virus (HAV) circulation in the environment is decreasing in most industrialized Western countries. This decrease has lead to low seroprevalence rates in adults. As a consequence, many nonimmune unprotected travelers from areas of low prevalence are considered at risk of acquiring HAV infection when traveling to high HAV endemic areas in developing countries. The recent HAV inactivated vaccine has proved safe and effective, and its use in different geographic areas should be guided by local age-specific HAV seroprevalence rates. The aim of this paper is to describe the age-specific sero-epidemiology of HAV infection in travelers from a highly industrialized region in Northern Italy (Lombardy). Methods: Seven hundred and forty-four consecutive travelers aged from 20 to 59 years, subdivided in 10-year age groups, gave blood samples in the collaborative Health Centers in the Lombardy region and sera were tested for HAV IgG antibodies. A questionnaire was given to travelers that investigated alimentary habits and a history of previous travel. Results: Anti-HAV seroprevalence was 18.0%, 58.0%, 75.8%, and 89.5% in the 20-29, 30-39, 40-49, and 50-59 age groups, respectively. Age was the single most important determinant of anti-HAV seroprevalence. The influence of previous travels, eating shellfish, or ingestion of self-cultivated vegetables was ruled out by multivariate analysis. Conclusions: In the Lombardy region (Northern Italy), age specific anti-HAV seroprevalence rates are much higher than those reported in other Western European countries. The cost-benefit analysis suggested that travelers born after 1960 do not need serologic screening before vaccination. Whenever possible, however, HAV serologic screening is advisable for travelers born before 1960. However, the severity of the disease in older subjects, and the proved safety of HAV vaccination in immune subjects, may advise d'emblée HAV vaccination without prior screening, when serologic

  16. The changing face of death: recent trends in Australian mortality.

    PubMed

    Ireland, A W; Lawson, J S

    1980-06-14

    The principal causes of death for persons aged between 55 and 64 years are identified from Australian mortality data for 1966 and 1977. Four conditions--ischaemic heart disease, cerebrovascular disease, bronchial carcinoma, and chronic airways disease--account for 62% of deaths in this age group, with 36% of deaths being attributed to ischaemic heart disease. Changes in age-specific mortality rates during the period from 1966 to 1977 are described for each of these four conditions. There have been substantial reductions in mortality from vascular disease in both sexes, and this trend has accelerated since 1974. A recent fall in mortality from bronchial carcinoma and chronic airways disease is indicated for males, while death rates from these disorders continue to increase rapidly for females. The introduction of beta-blockade in the treatment of vascular disease, and changes in the pattern of cigarette smoking are discussed in relation to these mortality trends.

  17. [Perinatal Information System. Incorporation latency and impact on perinatal clinical registry].

    PubMed

    Simini, F; Fernández, A; Sosa, C; Díaz Rossello, J L

    2001-10-01

    The Perinatal Information System (SIP) is a clinical record, local management and quality assurance software standard in Latin America and the Caribbean. The time to implement SIP in a Maternity Hospital is evaluated as well as the effect of statistics on perinatal health indicators in subsequent years. In the sample of 20 Maternity Hospitals (5 Countries, 40% Private and 60% Public) 85% had a reliable information system by the third year of use of SIP. 15% of hospitals still had problems at that time that were already clear during the second year, a time corrective measures can still be taken. The evaluation of the impact of yearly reports shows that 58% of recommendations were fulfilled, specially those regarding the complete filling-in of clinical records (62%) and to a lesser extent variables that reflect clinical practices and organization of services (52%). The conclusion is that Maternity Hospitals in Latin America and the Caribbean have the capacity to adopt a complex tool of computerized clinical records for quality assurance of perinatal care and monitoring of health indicators.

  18. Age-Specific Dynamics of Corpus Callosum Development in Children and its Peculiarities in Infantile Cerebral Palsy.

    PubMed

    Krasnoshchekova, E I; Zykin, P A; Tkachenko, L A; Aleksandrov, T A; Sereda, V M; Yalfimov, A N

    2016-10-01

    The age dynamics of corpus callosum development was studied on magnetic resonance images of the brain in children aged 2-11 years without neurological abnormalities and with infantile cerebral palsy. The areas of the total corpus callosum and its segments are compared in the midsagittal images. Analysis is carried out with the use of an original formula: proportion of areas of the anterior (genu, CC2; and anterior part, CC3) and posterior (isthmus, CC6 and splenium, CC7) segments: kCC=(CC2+CC3)×CC6/CC7. The results characterize age-specific dynamics of the corpus callosum development and can be used for differentiation, with high confidence, of the brain of children without neurological abnormalities from the brain patients with infantile cerebral palsy.

  19. Age-Specific Incidence Rates for Norovirus in the Community and Presenting to Primary Healthcare Facilities in the United Kingdom

    PubMed Central

    O'Brien, Sarah J.; Donaldson, Anna L.; Iturriza-Gomara, Miren; Tam, Clarence C.

    2016-01-01

    In a prospective, population-based cohort study and a study of primary-healthcare consultations, we had a rare opportunity to estimate age-specific rates of norovirus-associated infectious intestinal disease in the United Kingdom. Rates in children aged <5 years were significantly higher than those for other age groups in the community (142.6 cases per 1000 person-years [95% confidence interval {CI}, 99.8–203.9] vs 37.6 [95% CI, 31.5–44.7]) and those for individuals presenting to primary healthcare (14.4 cases per 1000 person-years [95% CI, 8.5–24.5] vs 1.4 [95% CI, .9–2.0]). Robust incidence estimates are crucial for vaccination policy makers. This study emphasises the impact of norovirus-associated infectious intestinal disease, especially in children aged <5 years. PMID:26744427

  20. Race/ethnicity-, gender- and age-specific differences in micronutrient intakes of US adults with and without diabetes.

    PubMed

    Vaccaro, Joan A; Huffman, Fatma G

    2013-03-01

    Race/ethnicity-, gender- and age-specific differences in dietary micronutrient intakes of US adults ≥  21 years were assessed from National Health and Nutrition Examination Survey, 2007-2008. The participants included Black non-Hispanics, Mexican-American and White non-Hispanics who signed an informed consent form for the interview and who completed the in-person 24-h recall. Micronutrient intakes were based on the Institute of Medicines' classifications of recommended dietary allowances specific for age and gender. Likelihood of many micronutrient insufficiencies was associated with being female, over 65 years, having diabetes and minority status. Younger and female adults had a greater likelihood of iron insufficiency than male and older adults. These findings demonstrate the importance of considering the intersection of age, gender and race in setting policies for micronutrient deficiency screening, particularly in young female adults and minorities.

  1. Perinatal outcomes after maternal 2009/H1N1 infection: national cohort study

    PubMed Central

    Pierce, Matthias; Kurinczuk, Jennifer J; Spark, Patsy; Brocklehurst, Peter

    2011-01-01

    Objectives To follow up a UK national cohort of women admitted to hospital with confirmed 2009/H1N1 influenza in pregnancy in order to obtain a complete picture of pregnancy outcomes and estimate the risks of adverse fetal and infant outcomes. Design National cohort study. Setting 221 hospitals with obstetrician led maternity units in the UK. Participants 256 women admitted to hospital with confirmed 2009/H1N1 in pregnancy during the second wave of pandemic infection between September 2009 and January 2010; 1220 pregnant women for comparison. Main outcome measures Rates of stillbirth, perinatal mortality, and neonatal mortality; odds ratios for infected versus comparison women. Results Perinatal mortality was higher in infants born to infected women (10 deaths among 256 infants; rate 39 (95% confidence interval 19 to 71) per 1000 total births) than in infants of uninfected women (9 deaths among 1233 infants; rate 7 (3 to 13) per 1000 total births) (P<0.001). This was principally explained by an increase in the rate of stillbirth (27 per 1000 total births v 6 per 1000 total births; P=0.001). Infants of infected women were also more likely to be born prematurely than were infants of comparison women (adjusted odds ratio 4.0, 95% confidence interval 2.7 to 5.9). Infected women who delivered preterm were more likely to be infected in their third trimester (P=0.046), to have been admitted to an intensive care unit (P<0.001), and to have a secondary pneumonia (P=0.001) than were those who delivered at term. Conclusions This study suggests an increase in the risk of poor outcomes of pregnancy in women infected with 2009/H1N1, which reinforces the message from studies of maternal risk alone. The health of pregnant women is an important public health priority in future waves of this and other influenza pandemics. PMID:21672992

  2. Gender and age-specific seroprevalence of human papillomavirus 16 and 18 in general population in Tehran, Iran.

    PubMed

    Aghakhani, Arezoo; Mamishi, Setareh; Sabeti, Shahram; Bidari-Zerehpoosh, Farahnaz; Banifazl, Mohammad; Bavand, Anahita; Ramezani, Amitis

    2017-04-01

    The assessment of the gender and age-specific seroprevalence of human papillomavirus (HPV) is essential for planning of HPV vaccine implementation into the preventive programs. In this study, we aimed to determine the age-specific seroprevalence of HPV-16 and 18 in both males and females in Tehran, Iran. Three hundred and seventy-eight women (10-35 years) and 162 men (10-25 years) from Tehran, Iran, were enrolled. Anti-HPV IgG antibodies against HPV-16 and HPV-18 were detected by ELISA using papillomavirus type 16 and 18 L1-capsids as antigen. HPV-16 antibody was detected in 15.6 and 13.6% of women and men, respectively. Antibody against HPV-18 was found positive in 12.7 and 8% of women and men, respectively. The highest seroprevalence of HPV-16 and 18 were seen in women aged 26-30 years (22.2 and 19.4%, respectively), and the lowest HPV-16 and 18 seropositivity rates were seen in males and females aged 10-15 years (9.3 and 1.9%, respectively). In our cohort of study, in males, both anti-HPV-16 and 18 increased after age 15 years, peaking in men aged 21-25 years. In women, both HPV-16 and 18 seropositivity increased after 15 years, declined at 21-25 years, peaked in women aged 26-30 years and again decreased after 30 years. Our data showed increasing exposure rate to high-risk HPV vaccine types in our studied population over 15 years of age. In order to prevent the HPV-related cancers, implementation of HPV vaccine into the national immunization program in Iran and vaccination of females and males less than 15 years of age are suggested.

  3. Maternal and perinatal outcomes amongst haemoglobinopathy carriers: a systematic review.

    PubMed

    Jans, S M P J; de Jonge, A; Lagro-Janssen, A L M

    2010-11-01

    With the introduction of screening programmes for haemoglobinopathies (HbP), more women will be aware of their HbP status. The genetic risk for women who are carriers of HbP is well known. However, midwives and obstetricians need to know whether there are other risks involved in the pregnancies of women who are carriers of HbP. The objective of this study was to investigate the hypothesis that being a carrier of HbP has no consequences for the health of pregnant women and the outcome of their pregnancies. A systematic search was carried out until August 2008 in the Cochrane Library, Medline, EMBASE and CINAHL databases. All references were inspected to identify further studies. The authors of key publications were contacted for any unpublished research. Selection of studies was made on the basis of the following criteria: Cohort and case-control studies, pregnant women with a singleton pregnancy, exposure: HbAS or thalassaemia minor and the following outcomes: urinary tract infection (UTI), anaemia, (pre-)eclampsia, gestational diabetes, premature labour, low birth weight, intrauterine growth retardation, miscarriage, neonatal death, low Apgar score, neural tube defects. Quality assessment and data extraction were carried out by two researchers. A total of 780 subjects were identified of which nine were included in the study. A protective effect of sickle cell trait was found for premature birth, low Apgar score and perinatal mortality rate. No significant effect was found for low birth weight, growth retardation, UTI or high blood pressure. The risk of anaemia and bacteriuria was increased. In conclusion, the risks amongst pregnant HbP carriers are low. Midwives and obstetricians need to be aware of the risk of anaemia and UTI.

  4. Maternal health literacy progression among rural perinatal women.

    PubMed

    Mobley, Sandra C; Thomas, Suzanne Dixson; Sutherland, Donald E; Hudgins, Jodi; Ange, Brittany L; Johnson, Maribeth H

    2014-10-01

    This research examined changes in maternal health literacy progression among 106 low income, high risk, rural perinatal African American and White women who received home visits by Registered Nurse Case Managers through the Enterprise Community Healthy Start Program. Maternal health literacy progression would enable women to better address intermediate factors in their lives that impacted birth outcomes, and ultimately infant mortality (Lu and Halfon in Mater Child Health J 7(1):13-30, 2003; Sharma et al. in J Natl Med Assoc 86(11):857-860, 1994). The Life Skills Progression Instrument (LSP) (Wollesen and Peifer, in Life skills progression. An outcome and intervention planning instrument for use with families at risk. Paul H. Brookes Publishing Co., Baltimore, 2006) measured changes in behaviors that represented intermediate factors in birth outcomes. Maternal Health Care Literacy (LSP/M-HCL) was a woman's use of information, critical thinking and health care services; Maternal Self Care Literacy (LSP/M-SCL) was a woman's management of personal and child health at home (Smith and Moore in Health literacy and depression in the context of home visitation. Mater Child Health J, 2011). Adequacy was set at a score of (≥4). Among 106 women in the study initial scores were inadequate (<4) on LSP/M-HCL (83 %), and on LSP/M-SCL (30 %). Significant positive changes were noted in maternal health literacy progression from the initial prenatal assessment to the first (p < .01) postpartum assessment and to the final (p < .01) postpartum assessment using McNemar's test of gain scores. Numeric comparison of first and last gain scores indicated women's scores progressed (LSP/M-HCL; p < .0001) and (LSP/M-SCL; p < .0001). Elevated depression scores were most frequent among women with <4 LSP/M-HCL and/or <4 LSP/M-SCL. Visit notes indicated lack or loss of relationship with the father of the baby and intimate partner discord contributed to higher depression scores.

  5. The autonomic nervous system and perinatal metabolism.

    PubMed

    Milner, R D; De Gasparo, M

    1981-01-01

    The development of the autonomic nervous system in relation to perinatal metabolism is reviewed with particular attention given to the adipocyte, hepatocyte and the A and B cells of the islets of Langerhans. Adrenergic receptors develop in the B cell independently of normal innervation and by the time of birth, in most species studied, the pancreas, liver and adipose tissue respond appropriately to autonomic signals. Birth is associated with a huge surge in circulating catecholamines which is probably responsible for the early postnatal rise in free fatty acids and glucagon concentrations in plasma. beta-Blocking drugs such as propranolol have an adverse effect on fetal growth and neonatal metabolism, being responsible for hypoglycemia and for impairing the thermogenic response to cold exposure. beta-Mimetic drugs are commonly used to prevent premature labour and may help the fetus in other ways, for example, by improving the placental blood supply and the delivery of nutrients by increasing maternal fat and carbohydrate mobilization.

  6. Cytomegalovirus myelitis in perinatally acquired HIV.

    PubMed Central

    Güngör, T; Funk, M; Linde, R; Jacobi, G; Horn, M; Kreuz, W

    1993-01-01

    A 7 year old child perinatally infected with HIV who died from progressive muscular paralysis and central nervous respiratory failure is described. Cytomegalovirus (CMV) prophylaxis with a special intravenous CMV hyper-immunoglobulin had been successfully conducted for more than four years. Macroscopic and microscopic immunohistochemical examination of the spinal cord revealed a diffuse CMV infiltration of the entire myelon. CMV infected cells were identified as astrocytes, oligodendrocytes, neurons, macrophages, ependymal, endothelial, and Schwann cells. Other organs had no signs of CMV infection. Central nervous spinal CMV infection was most probably due to insufficient penetration of the blood-brain barrier by the CMV hyper-immunoglobulin. In suspicious cases early spinal magnetic resonance imaging (1.5 tesla) combined with an examination of urine and cerebrospinal fluid for CMV is recommended. Images Figure 1 Figure 2 Figure 3 PMID:8385439

  7. Neonatal thyroid function: influence of perinatal factors.

    PubMed Central

    Franklin, R C; Carpenter, L M; O'Grady, C M

    1985-01-01

    Indices of thyroid function were measured in 229 healthy term neonates at birth and at 5, 10, and 15 days of age. Results were analysed to assess whether maternal diabetes mellitus, toxaemia of pregnancy, intrapartum fetal distress, duration of labour, method of delivery, asphyxia at birth, race, sex, birthweight, birth length, head circumference, or method of feeding influenced any index. Thyroxine, the free thyroxine index, and free thyroxine concentrations at birth correlated with birthweight. Method of delivery influenced mean thyroxine and free thyroxine index values at birth and at age 5 days. Mean values of triiodothyronine, reverse triiodothyronine, thyroxine binding globulin, and thyroid stimulating hormone were not affected by any of the perinatal factors studied. Birthweight and perhaps method of delivery should be taken into account when interpreting neonatal thyroxine parameters but determination of thyroid stimulating hormone as a screen for congenital hypothyroidism in healthy term neonates circumvents these considerations. PMID:3977386

  8. Broader skills for working with perinatal depression.

    PubMed

    Marks, Lucy; McConnell, Jennifer; Baker, Martyn

    2005-08-01

    Health visitors' involvement in work with maternal depression has developed considerably over the last 10 years, with a focus upon problems in the postnatal period. In a paper last month we reported on research highlighting dilemmas that can arise for health visitors connected with a lack of an agreed conceptual framework. Conflicting roles they find themselves using when working with distressed mothers, and within a pressured organisational work setting, make it hard to give sufficient priority to such work. By focussing too narrowly on postnatal depression, other important perinatal psychological difficulties may be left unattended. We argue the need to create workplace time to address these issues by describing the provision of a training and supervision package to facilitate this. We give some informal indications of its success and some indicators of the broadening development of its membership and its content

  9. How midwives can help with perinatal depression.

    PubMed

    Morton, Joanne

    2014-03-01

    In 2011 a national children's charity led a campaign that identified why help with postnatal depression (PND) needed to improve; however PND remains a huge problem. Numerous cases are still coming to light where a mother has not sought help or has not been given adequate support, with disastrous consequences. Why is this still happening and what can health professionals do? Former practising midwife and specialist PND counsellor at a charity supporting women and families suffering from PND, Joanne Morton discusses why increasing awareness, education and understanding of perinatal illness are vital to limit the devastating effects of antenatal depression (AND) and PND and how standards of care must improve to help mothers in need.

  10. Maternal and perinatal health research priorities beyond 2015: an international survey and prioritization exercise

    PubMed Central

    2014-01-01

    Background Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required. Methods We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international stakeholders constituting a large reference group, and consolidated into a final list of research questions by a technical working group. Questions on this list were then scored by the reference working group according to five independent and equally weighted criteria. Normalized research priority scores (NRPS) were calculated, and research priority questions were ranked accordingly. Results A list of 190 priority research questions for improving maternal and perinatal health was scored by 140 stakeholders. Most priority research questions (89%) were concerned with the evaluation of implementation and delivery of existing interventions, with research subthemes frequently concerned with training and/or awareness interventions (11%), and access to interventions and/or services (14%). Twenty-one questions (11%) involved the discovery of new interventions or technologies. Conclusions Key research priorities in maternal and perinatal health were identified. The resulting ranked list of research questions provides a valuable resource for health research investors, researchers and other stakeholders. We are hopeful that this exercise will inform the post-2015 Development Agenda and assist donors, research-policy decision makers and researchers to invest in research that will ultimately make the most

  11. Estimating cause-specific mortality from community- and facility-based data sources in the United Republic of Tanzania: options and implications for mortality burden estimates.

    PubMed Central

    Whiting, David R.; Setel, Philip W.; Chandramohan, Daniel; Wolfson, Lara J.; Hemed, Yusuf; Lopez, Alan D.

    2006-01-01

    OBJECTIVE: To compare mortality burden estimates based on direct measurement of levels and causes in communities with indirect estimates based on combining health facility cause-specific mortality structures with community measurement of mortality levels. METHODS: Data from sentinel vital registration (SVR) with verbal autopsy (VA) were used to determine the cause-specific mortality burden at the community level in two areas of the United Republic of Tanzania. Proportional cause-specific mortality structures from health facilities were applied to counts of deaths obtained by SVR to produce modelled estimates. The burden was expressed in years of life lost. FINDINGS: A total of 2884 deaths were recorded from health facilities and 2167 recorded from SVR/VAs. In the perinatal and neonatal age group cause-specific mortality rates were dominated by perinatal conditions and stillbirths in both the community and the facility data. The modelled estimates for chronic causes were very similar to those from SVR/VA. Acute febrile illnesses were coded more specifically in the facility data than in the VA. Injuries were more prevalent in the SVR/VA data than in that from the facilities. CONCLUSION: In this setting, improved International classification of diseases and health related problems, tenth revision (ICD-10) coding practices and applying facility-based cause structures to counts of deaths from communities, derived from SVR, appears to produce reasonable estimates of the cause-specific mortality burden in those aged 5 years and older determined directly from VA. For the perinatal and neonatal age group, VA appears to be required. Use of this approach in a nationally representative sample of facilities may produce reliable national estimates of the cause-specific mortality burden for leading causes of death in adults. PMID:17242829

  12. Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa

    PubMed Central

    Marston, Milly; Becquet, Renaud; Zaba, Basia; Moulton, Lawrence H; Gray, Glenda; Coovadia, Hoosen; Essex, Max; Ekouevi, Didier K; Jackson, Debra; Coutsoudis, Anna; Kilewo, Charles; Leroy, Valériane; Wiktor, Stefan; Nduati, Ruth; Msellati, Philippe; Dabis, François; Newell, Marie-Louise; Ghys, Peter D

    2011-01-01

    Background Previously, HIV epidemic models have used a double Weibull curve to represent high initial and late mortality of HIV-infected children, without distinguishing timing of infection (peri- or post-natally). With more data on timing of infection, which may be associated with disease progression, a separate representation of children infected early and late was proposed. Methods Paediatric survival post-HIV infection without anti-retroviral treatment was calculated using pooled data from 12 studies with known timing of HIV infection. Children were grouped into perinatally or post-natally infected. Net mortality was calculated using cause-deleted life tables to give survival as if HIV was the only competing cause of death. To extend the curve beyond the available data, children surviving beyond 2.5 years post infection were assumed to have the same survival as young adults. Double Weibull curves were fitted to both extended survival curves to represent survival of children infected perinatally or through breastfeeding. Results Those children infected perinatally had a much higher risk of dying than those infected through breastfeeding, even allowing for background mortality. The final-fitted double Weibull curves gave 75% survival at 5 months after infection for perinatally infected, and 1.1 years for post-natally infected children. An estimated 25% of the early infected children would still be alive at 10.6 years compared with 16.9 years for those infected through breastfeeding. Conclusions The increase in available data has enabled separation of child mortality patterns by timing of infection allowing improvement and more flexibility in modelling of paediatric HIV infection and survival. PMID:21247884

  13. Optimizing the treatment of mood disorders in the perinatal period.

    PubMed

    Meltzer-Brody, Samantha; Jones, Ian

    2015-06-01

    The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response.

  14. Perinatal care for women who are addicted: implications for empowerment.

    PubMed

    Carter, Carolyn S

    2002-08-01

    This article explores societal responses to perinatal drug abuse, including stigmatic attitudes and behaviors of health care workers that are directed toward women who abuse drugs during pregnancy. Health care providers' stigmatic responses can deter women from receiving perinatal care and place women and their unborn children at risk. Because poor women and women of color face a greater probability of being prosecuted or losing custody of their children for using drugs while they are pregnant, the article emphasizes societal responses to these client populations. Empowering strategies are suggested by which social workers and clients can potentially redefine perinatal drug abuse as a health problem rather than a legal issue and improve the environment in which perinatal care is provided.

  15. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors with... SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Monitoring Devices § 884.2740 Perinatal monitoring system and accessories. (a) Identification. A...

  16. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors with... SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Monitoring Devices § 884.2740 Perinatal monitoring system and accessories. (a) Identification. A...

  17. Optimizing the treatment of mood disorders in the perinatal period

    PubMed Central

    Meltzer-Brody, Samantha; Jones, Ian

    2015-01-01

    The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response. PMID:26246794

  18. Obstetrics and perinatal medicine in Iceland 1881-1971, with a detailed report on deliveries in Iceland 1972-1974.

    PubMed

    Snaedal, G; Biering, G; Sigvaldason, H

    1975-01-01

    Chapter I describes the adoption of a new certificate of the outcome of pregnancy in Iceland and Iceland's participation in a feasibility study of the registration of pregnancies and their outcome in cooperation with WHO. New maternity and infant forms adopted in 1972 are described and their effect on antenatal control and the coordination of the registration of deliveries and their outcome explained. Chapter II offers a survey of population growth in Iceland since 1881. Data concerning birth-rate and death-rate from 1881-1971 are given, together with data on perinatal mortality. The perinatal mortality rate is shown year by year from 1951 to 1971 and maternal death from 1881-1970. There follows a description of the development of birth institutions in Iceland and the chapter is concluded by data on maternal age since the turn of the century. Chapter III shows processing of data for the years 1972-1974. Tables and diagrams demonstrate the distribution of deliveries in Iceland, the distribution of first births according to mothers age, the marital status of Icelandic mothers, the relation between marital status and the number of deliveries, years of mothers education, parity in Iceland, gestational length, the relation between the number of antenatal visits and perinatal mortality. Tables further demonstrate registered complications of pregnancy and delivery. The sex, weight and bodylength of newborns are discussed. Also tabulations of registered infant diagnoses. At the conclusion of the report, the advantages and disadvantages brought to light by the data processing and expected improvements and future processing are discussed.

  19. Perinatal-lethal Gaucher disease presenting as hydrops fetalis

    PubMed Central

    BenHamida, Emira; Ayadi, Imene; Ouertani, Ines; Chammem, Maroua; Bezzine, Ahlem; BenTmime, Riadh; Attia, Leila; Mrad, Ridha; Marrakchi, Zahra

    2015-01-01

    Perinatal-lethal Gaucher disease is very rare and is considered a variant of type 2 Gaucher disease that occurs in the neonatal period. The most distinct features of perinatal-lethal Gaucher disease are non-immune hydrops fetalis. Less common signs of the disease are hepatosplenomegaly, ichthyosis and arthrogryposis. We report a case of Gaucher's disease (type 2) diagnosed in a newborn who presented with Hydrops Fetalis. PMID:26327947

  20. Mother-Infant Antidepressant Levels, Maternal Depression and Perinatal Events

    PubMed Central

    Sit, Dorothy; Perel, James M.; Wisniewski, Stephen R.; Helsel, Joseph C.; Luther, James F.; Wisner, Katherine L.

    2011-01-01

    Objectives The authors explored the relationship of cord-maternal antidepressant concentration ratios and maternal depression with perinatal events and preterm birth. Method The investigators examined 21 mother-infant pairs with antidepressant exposure during pregnancy. The antidepressants included serotonergic reuptake inhibitors (SRI) and nortriptyline (noradrenergic inhibitor and mild SRI). The mothers were evaluated with the Structured Clinical Interview for DSM-IV. Depression ratings were repeated at 20, 30 and 36 weeks pregnancy. At delivery, investigators assessed cord and maternal antidepressant concentrations, neonatal outcomes on the Peripartum Events Scale (PES) and gestational weeks at birth. Results Mean cord-to-maternal concentration ratios were 0.52±0.35 (0.08–1.64) - parent drug and 0.54±0.17 (0.28–0.79) - metabolite. Nine of 21 mothers (43%) had a major depressive episode. From examining the maximum depression ratings, the mean SIGH-ADS score was 16.0±7.6. One-third (7/21) of infants had at least one perinatal event (PES≥1). The frequency of deliveries complicated by perinatal event(s) was similar in depressed and non-depressed mothers. There was no significant association between perinatal events and cord-to-maternal antidepressant concentration ratios or maternal depression levels. Exposure to short half-life antidepressants compared to fluoxetine resulted in more perinatal events (7/16 =44% vs 0/5=0%; p=0.06). Fourteen percent (3/21) of infants were preterm. Preterm birth was not associated with cord-to-maternal metabolite concentration ratios, depression levels or exposure to fluoxetine. Conclusion Antidepressant-exposed infants experienced a limited number of transient perinatal events. No association between cord-maternal concentration ratios or maternal depression and perinatal events could be identified. Contrary to other reports, we detected no increased risk for perinatal events with fluoxetine therapy compared to the short half

  1. A clinically relevant model of perinatal global ischemic brain damage in rats.

    PubMed

    Yang, Ting; Zhuang, Lei; Terrando, Niccolò; Wu, Xinmin; Jonhson, Mark R; Maze, Mervyn; Ma, Daqing

    2011-04-06

    We have designed a clinically relevant model of perinatal asphyxia providing intrapartum hypoxia in rats. On gestation day 22 SD rats were anesthetized and the uterine horns were exteriorized and placed in a water bath at 37°C for up to 20min. After this, pups were delivered from the uterus and manually stimulated to initiate breathing in an incubator at 37°C for 1 h in air. Brains were harvested and stained with cresyl violet, caspase-3, and TUNEL to detect morphological and apoptotic changes on postnatal days (PND) 1, 3, and 7. Separate cohorts were maintained until PND 50 and tested for learning and memory using Morris water maze (WM). Survival rate was decreased with longer hypoxic time, and 100% mortality was noted when hypoxia time was beyond 18min. Apoptosis was increased with the duration of hypoxia with neuronal loss and cell shrinkage in the CA1 of hippocampus. The time taken for the juveniles to locate the hidden platform during WM was increased in animals subjected to hypoxia. These data demonstrate that perinatal ischemic injury leads to neuronal death in the hippocampus and long-lasting cognitive dysfunction. This model mimics hypoxic ischemic encephalopathy in humans and may be appropriate for investigating therapeutic interventions.

  2. [Introduction of British guidelines in perinatal mental healthcare--towards enhancing the function of perinatal mental healthcare in Japan].

    PubMed

    Suzuki, Toshihito

    2014-01-01

    Professionals in many different occupations, from psychiatrists, obstetricians, and pediatricians to nurses, midwives, pharmacists, clinical psychologists, public health nurses, and psychiatric social workers, are involved in perinatal mental healthcare. In order to enhance the function of such healthcare, it is necessary both to provide specialized training in each occupation and form a system and to smoothly conduct medical collaboration between different occupations. A deficiency in the medical function of perinatal mental healthcare greatly influences the mother and child's health, mental hygiene, and social life later in life. Therefore, a demand is seen for specialized staff and system formation capable of the following: 1) responding with appropriate perinatal management of female patients taking psychotropic drugs; 2) providing support and pregnancy consultation to female patients who wish to have children; and 3) properly handling postpartum mental disorder management, possibility of breastfeeding, and various issues that arise in mother-child relationships during upbringing. In the UK, the clinical guideline (NICE Clinical Guideline 45) for perinatal mental healthcare, which was created by the National Institute for Clinical Excellence (NICE), provides important guidelines on how to handle perinatal mental health. Aside from the NICE guideline, the Maudsley Prescribing Guidelines in Psychiatry indicates basic guidelines on prescribing perinatal drug therapy. In Japan, however, the current situation of perinatal mental healthcare is such that it has yet to be systemically developed. In this paper, we introduce the basic content in these British guidelines that should be noted. In addition, we consider the current status and future disposition of Japan's perinatal mental healthcare, with consideration for the differences in healthcare circumstances between Japan and the UK.

  3. Age-specific absolute and relative organ weight distributions for B6C3F1 mice.

    PubMed

    Marino, Dale J

    2012-01-01

    The B6C3F1 mouse is the standard mouse strain used in toxicology studies conducted by the National Cancer Institute (NCI) and the National Toxicology Program (NTP). While numerous reports have been published on growth, survival, and tumor incidence, no overall compilation of organ weight data is available. Importantly, organ weight change is an endpoint used by regulatory agencies to develop toxicity reference values (TRVs) for use in human health risk assessments. Furthermore, physiologically based pharmacokinetic (PBPK) models, which utilize relative organ weights, are increasingly being used to develop TRVs. Therefore, all available absolute and relative organ weight data for untreated control B6C3F1 mice were collected from NCI/NTP studies in order to develop age-specific distributions. Results show that organ weights were collected more frequently in NCI/NTP studies at 2-wk (60 studies), 3-mo (147 studies), and 15-mo (40 studies) intervals than at other intervals, and more frequently from feeding and inhalation than drinking water studies. Liver, right kidney, lung, heart, thymus, and brain weights were most frequently collected. From the collected data, the mean and standard deviation for absolute and relative organ weights were calculated. Results show age-related increases in absolute liver, right kidney, lung, and heart weights and relatively stable brain and right testis weights. The results suggest a general variability trend in absolute organ weights of brain < right testis < right kidney < heart < liver < lung < spleen < thymus. This report describes the results of this effort.

  4. Age-specific vibrissae growth rates: a tool for determining the timing of ecologically important events in Steller sea lions

    USGS Publications Warehouse

    Rea, L.D.; Christ, A.M.; Hayden, A.B.; Stegall, V.K.; Farley, S.D.; Stricker, Craig A.; Mellish, J.E.; Maniscalco, John M.; Waite, J.N.; Burkanov, V.N.; Pitcher, K.W.

    2015-01-01

    Steller sea lions (SSL; Eumetopias jubatus) grow their vibrissae continually, providing a multiyear record suitable for ecological and physiological studies based on stable isotopes. An accurate age-specific vibrissae growth rate is essential for registering a chronology along the length of the record, and for interpreting the timing of ecologically important events. We utilized four methods to estimate the growth rate of vibrissae in fetal, rookery pup, young-of-the-year (YOY), yearling, subadult, and adult SSL. The majority of vibrissae were collected from SSL live-captured in Alaska and Russia between 2000 and 2013 (n = 1,115), however, vibrissae were also collected from six adult SSL found dead on haul-outs and rookeries during field excursions to increase the sample size of this underrepresented age group. Growth rates of vibrissae were generally slower in adult (0.44 ± 0.15 cm/mo) and subadult (0.61 ± 0.10 cm/mo) SSL than in YOY (0.87 ± 0.28 cm/mo) and fetal (0.73 ± 0.05 cm/mo) animals, but there was high individual variability in these growth rates within each age group. Some variability in vibrissae growth rates was attributed to the somatic growth rate of YOY sea lions between capture events (P = 0.014, r2 = 0.206, n = 29).

  5. Estimating Age-Specific Immunity and Force of Infection of Varicella Zoster Virus in Norway Using Mixture Models

    PubMed Central

    Rimseliene, Grazina; Flem, Elmira; Freiesleben de Blasio, Birgitte; Scalia Tomba, Gianpaolo; Manfredi, Piero

    2016-01-01

    This study applies mixture modelling to examine age-specific immunity to varicella zoster virus (VZV) infection in Norway based on the first large-scale serological study in the general population. We estimated the seropositive proportions at different ages and calculated the underlying force of infection by using a sample of 2103 residual sera obtained from patients seeking primary and hospital care. A rapid increase in the VZV-associated immunity is observed in the first years of life with 63% of children being immune by age 5. The increase in the immunity levels slows down thereafter, with a large proportion of adults still susceptible by age 20 (around 14.5%), thus at risk of serious sequelae of varicella infection. The corresponding force of infection peaks during the preschool period, subsequently declines to a minimum between ages 10 and 20 years, and afterwards moderately increases to reach a plateau lasting throughout the childbearing period. In comparison with the traditional cut-off approach, mixture modelling used the whole data without producing any inconclusive cases, led to an unbiased classification of individuals between susceptible and immune, and provided a smoother immune profile by age. These findings represent an important step towards any decision about the introduction of varicella vaccination in Norway, as they are a primary input for mathematical transmission models aimed at evaluating potential vaccination scenarios. PMID:27689800

  6. Age-specific reproduction in female sea otters (Enhydra lutris) from south-central Alaska: analysis of reproductive tracts

    USGS Publications Warehouse

    Bodkin, James L.; Mulcahy, Daniel M.; Lensink, Calvin J.

    1993-01-01

    We estimated age at sexual maturity and age-specific reproductive rates by examining carcasses and reproductive tracts from 177 female sea otters (Enhydra lutris). Carcasses were recovered from south-central Alaska, Primarily from western Prince William Sound, as a result of the T/V Exxon Valdez oil spill in 1989. We found 65% of our sample to be sexually mature. Sexual maturity was first attained at age 2. The proportion of sexually mature animals increased from 30% at age 2 to 100% at age 5. Annual reproductive rates increased from 22% at age 2 to 78% at age 5 and remained relatively stable (75-88%) through to age 15. the sex ratio (female:male) of 49 fetal sea otters was 18:37 and differed significantly from parity. Females younger than 8 tended to produce more female fetuses, while older mothers did not. Our estimates of the reproductive characteristics of female sea otters obtained by examination of reproductive tracts were similiar to those reported in the literature based on in situ observations of marked individuals.

  7. Haploinsufficiency in the PPAR{alpha} and LDL receptor genes leads to gender- and age-specific obesity and hyperinsulinemia

    SciTech Connect

    Sugiyama, Eiko . E-mail: eikoyoko@nagano-kentan.ac.jp; Tanaka, Naoki; Nakajima, Tamie; Kamijo, Yuji; Yokoyama, Shin; Li Yufeng; Gonzalez, Frank J.; Aoyama, Toshifumi

    2006-11-17

    When preparing peroxisome proliferator-activated receptor (PPAR){alpha}:low-density lipoprotein receptor (LDLR) (-/-) double knockout mice, we unexpectedly found a unique gender- and age-specific obesity in the F1 generation, PPAR{alpha} (+/-):LDLR (+/-), even in mice fed standard chow. Body weights of the male heterozygous mice increased up to about 60 g at 75 weeks of age, then decreased by about 30 g at 100 weeks of age. More than 95% of the heterozygous mice between 35- and 75-week-olds were overweight. Of interest, the obese heterozygous mice also exhibited hyperinsulinemia correlating with moderate insulin resistance. Hepatic gene expression of LDLR was lower than expected in the heterozygous mice, particularly at 50 and 75 weeks of age. In contrast, the hepatic expression of PPAR{alpha} was higher than expected in obese heterozygous mice, but decreased in non-obese older heterozygous mice. Modulated expression of these genes may be partially associated with the onset of the hyperinsulinemia.

  8. Population-based study on infant mortality.

    PubMed

    Lima, Jaqueline Costa; Mingarelli, Alexandre Marchezoni; Segri, Neuber José; Zavala, Arturo Alejandro Zavala; Takano, Olga Akiko

    2017-03-01

    Although Brazil has reduced social, economic and health indicators disparities in the last decade, intra- and inter-regional differences in child mortality rates (CMR) persist in regions such as the state capital of Mato Grosso. This population-based study aimed to investigate factors associated with child mortality in five cohorts of live births (LB) of mothers living in Cuiabá (MT), Brazil, 2006-2010, through probabilistic linkage in 47,018 LB. We used hierarchical logistic regression analysis. Of the 617 child deaths, 48% occurred in the early neonatal period. CMR ranged from 14.6 to 12.0 deaths per thousand LB. The following remained independently associated with death: mothers without companion (OR = 1.32); low number of prenatal consultations (OR = 1.65); low birthweight (OR = 4.83); prematurity (OR = 3.05); Apgar ≤ 7 at the first minute (OR = 3.19); Apgar ≤ 7 at the fifth minute (OR = 4.95); congenital malformations (OR = 14.91) and male gender (OR = 1.26). CMR has declined in Cuiabá, however, there is need to guide public healthcare policies in the prenatal and perinatal period to reduce early neonatal mortality and further studies to identify the causes of preventable deaths.

  9. [Maternal and perinatal risk factors for neonatal morbidity: a narrative literature review].

    PubMed

    Hernández Núñez, Jónathan; Valdés Yong, Magel; Suñol Vázquez, Yoanca de la Caridad; López Quintana, Marelene de la Caridad

    2015-07-14

    Newborn diseases increase neonatal mortality rates, so a literature review was conducted to establish the risk factors related to maternal and peripartum morbidity affecting the newborn. We searched the following electronic databases: Cumed, EBSCO, LILACS, IBECS and PubMed/MEDLINE. We used specific terms and Boolean operators in Spanish, Portuguese and English. We included longitudinal and cross-sectional descriptive studies, as well as case-control and cohort studies, systematic reviews and meta-analysis, spanning from 2010 to 2015 that responded the topic of interest. The included studies show that multiple maternal and perinatal conditions are risk factors for significant increase of neonatal morbidity, which are described in this narrative review.

  10. Age-specific discrimination of blood plasma samples of healthy and ovarian cancer prone mice using laser-induced breakdown spectroscopy

    NASA Astrophysics Data System (ADS)

    Melikechi, Noureddine; Markushin, Yuri; Connolly, Denise C.; Lasue, Jeremie; Ewusi-Annan, Ebo; Makrogiannis, Sokratis

    2016-09-01

    Epithelial ovarian cancer (EOC) mortality rates are strongly correlated with the stage at which it is diagnosed. Detection of EOC prior to its dissemination from the site of origin is known to significantly improve the patient outcome. However, there are currently no effective methods for early detection of the most common and lethal subtype of EOC. We sought to determine whether laser-induced breakdown spectroscopy (LIBS) and classification techniques such as linear discriminant analysis (LDA) and random forest (RF) could classify and differentiate blood plasma specimens from transgenic mice with ovarian carcinoma and wild type control mice. Herein we report results using this approach to distinguish blood plasma samples obtained from serially bled (at 8, 12, and 16 weeks) tumor-bearing TgMISIIR-TAg transgenic and wild type cancer-free littermate control mice. We have calculated the age-specific accuracy of classification using 18,000 laser-induced breakdown spectra of the blood plasma samples from tumor-bearing mice and wild type controls. When the analysis is performed in the spectral range 250 nm to 680 nm using LDA, these are 76.7 (± 2.6)%, 71.2 (± 1.3)%, and 73.1 (± 1.4)%, for the 8, 12 and 16 weeks. When the RF classifier is used, we obtain values of 78.5 (± 2.3)%, 76.9 (± 2.1)% and 75.4 (± 2.0)% in the spectral range of 250 nm to 680 nm, and 81.0 (± 1.8)%, 80.4 (± 2.1)% and 79.6 (± 3.5)% in 220 nm to 850 nm. In addition, we report, the positive and negative predictive values of the classification of the two classes of blood plasma samples. The approach used in this study is rapid, requires only 5 μL of blood plasma, and is based on the use of unsupervised and widely accepted multivariate analysis algorithms. These findings suggest that LIBS and multivariate analysis may be a novel approach for detecting EOC.

  11. Estimating the net effect of HIV on child mortality in African populations affected by generalized HIV epidemics.

    PubMed

    Marston, Milly; Zaba, Basia; Salomon, Joshua A; Brahmbhatt, Heena; Bagenda, Danstan

    2005-02-01

    For a given prevalence, HIV has a relatively higher impact on child mortality when mortality from other causes is low. To project the effect of the epidemic on child mortality, it is necessary to estimate a realistic schedule of "net" age-specific mortality rates that would operate if HIV were the only cause of child death observable. We assume that this net pattern would be independent of mortality from other causes. We used African studies that measured the survival of HIV-infected children (direct data) or survival of children of HIV-infected mothers (indirect data). We developed a mathematic procedure to estimate the mortality of infected children from indirect data sources and obtained net HIV mortality patterns for each study population. The net age-specific HIV mortality pattern for infected children can be described by a double Weibull curve fitted to empiric data; this gives a functional representation of age-specific mortality rates that decline after infancy and rise in the preteens. The fitted curve that we would expect if HIV were the only effective cause of death shows 67% net survival at 1 year and 39% at 5 years. The curve also predicts 13% net survival at 10 years using constraints based on survival of infected adults.

  12. Projecting the impact of AIDS on mortality.

    PubMed

    Stover, J; Way, P

    1998-01-01

    The authors describe the projected impact of AIDS on mortality, explain the reasons for the differences in mortality projections by major international organizations, and offer an approach to estimating the impact of AIDS upon life expectancy. Although AIDS has already significantly increased mortality in many countries, the impact of AIDS upon mortality is expected to grow substantially over the next 10 years and into future decades. By 2005, the population of the most severely affected countries in Africa will be 13-59 million less than it would have been without AIDS, and life expectancy may decline by as much as 27% in those countries. Uncertainty about current and future trends in HIV prevalence among adults has led to differences in the projections of future AIDS-related mortality. For example, while the UN projects that AIDS will reduce the population growth of the most severely affected countries in Africa by 13 million by 2005 and 30 million by 2025, the US Census Bureau projects the reduction to be 59 million by 2005 and 120 million by 2025. These differences are largely due to the use of different methodologies for projecting future levels of adult HIV prevalence. There are also differing estimates of current levels of HIV prevalence and differing assumptions about the length of the incubation period and the perinatal transmission rate. As data and projection methodologies improve, the differences in projections may be reduced for sub-Saharan Africa, while the growing epidemic in some of the largest countries of Asia may increase uncertainty about future global impacts.

  13. Tobacco control policies and perinatal and child health: a systematic review and meta-analysis protocol

    PubMed Central

    Been, Jasper V; Mackenbach, Johan P; Millett, Christopher; Basu, Sanjay; Sheikh, Aziz

    2015-01-01

    Introduction Children experience considerable morbidity and mortality due to tobacco smoke exposure. Tobacco control policies may benefit child health by reducing this exposure. We aim to comprehensively assess the effects of the range of tobacco control policies advocated by the WHO on perinatal and child health. Methods and analysis We will systematically search 19 electronic literature databases (from inception) for published studies, and the WHO International Clinical Trials Registry Platform for unpublished studies. Additional work will be identified via handsearching references and citations, and through consulting an international panel of experts. No language restrictions will apply. Following Cochrane Effective Practice and Organisation of Care (EPOC) guidelines, randomised and clinical controlled trials, controlled before-and-after studies, and interrupted time series designs, are eligible. Studies of interest will assess the impact of any of the WHO-advocated tobacco control policies contained in the MPOWER acronym (except ‘Monitoring tobacco use’) on at least one outcome of interest among children aged 0–12 years. The primary outcomes are: perinatal mortality, preterm birth, asthma exacerbations requiring hospital attendance and respiratory infections requiring hospital attendance. Data will be extracted using customised forms and authors will be contacted to obtain missing information. Risk of bias will be assessed using EPOC criteria. Findings will be reported in narrative and tabular form. Between-study heterogeneity will be assessed clinically and statistically using I2. If appropriate and possible, random-effects meta-analysis will be conducted for each unique combination of intervention and outcome. Subgroup analyses will be performed to assess the influence of the comprehensiveness of each policy, and to explore the impact of each policy according to socioeconomic status. Ethics and dissemination No ethical assessment is necessary as we

  14. Evidence for healing interventions with perinatal bereavement.

    PubMed

    Capitulo, Kathleen Leask

    2005-01-01

    The purpose of this article is to explore the concept of perinatal grief and evidence-based healing interventions for it. The loss of a pregnancy or death of an infant causes profound grief, yet society has long minimized or ignored this grief, which is among the most painful of bereavement experiences. Throughout the last century, research on grief and the special needs of bereaved parents has changed the context of professional intervention from protective to supportive. The central focus of bereavement interventions is to assist families in healing by helping them make meaning of their losses. The use of symbols, spirituality, and rituals has been shown to help bring meaning. Research has shown that memories are key to healing, and that gender, age, and relationships bring different grief expressions and experiences. While children's understanding of loss and grief differs with developmental age, they should also be given the opportunity to participate in grief rituals and practices. Professionals who care for bereaved parents have a unique opportunity to offer support by validating their grief, facilitating rituals, providing mementos, and letting the bereaved tell their stories. While no intervention can bring back their beloved children, appropriate intervention can promote healing.

  15. Perinatal epidemiological risk factors for preeclampsia.

    PubMed

    Bobić, Mirna Vuković; Habek, Dubravko; Habek, Jasna Čerkez

    2015-03-01

    In the present study, the impact of the potential perinatal epidemiological factors on preeclampsia development was assessed. This clinical study included 55 pregnant women with preeclampsia and control group of 50 healthy pregnant women. Positive family history of cardiovascular disease, diabetes mellitus or thromboembolic disease was recorded in 50% of women with preeclampsia versus 28% of control group women. Positive personal history of this disease was recorded in 15% of women with preeclampsia, whereas all control group women had negative personal history of preeclampsia. Dietary habits, i.e. the intake of meat and meat products, fruit and vegetables, coffee and alcohol drinks were similar in the two groups, without statistically significant differences. The women with preeclampsia and control women reported comparable habits; there was no difference in the consumption of meat, fruit, vegetables, coffee and alcohol, smoking, use of folate and oral hormonal contraception before pregnancy, or in physical activity as the potential risk factors for preeclampsia in current pregnancy. However, personal and family history of vascular disease proved to be significant risk factors for the occurrence of preeclampsia, emphasizing the need of lifestyle and dietary modifications with healthy dietary habits, while avoiding adverse habits in pregnancy.

  16. Visual function and perinatal focal cerebral infarction.

    PubMed Central

    Mercuri, E; Atkinson, J; Braddick, O; Anker, S; Nokes, L; Cowan, F; Rutherford, M; Pennock, J; Dubowitz, L

    1996-01-01

    AIMS: To evaluate the visual function of infants with perinatal cerebral infarction in whom the site and size of the lesion has been determined using magnetic resonance imaging (MRI). METHODS: Twelve infants with cerebral infarction on MRI were studied with a battery of tests specifically designed to evaluate visual function in infancy. This included tests: for visual attention (fixation shifts); of cerebral asymmetry (optokinetic nystagmus, visual fields); for assessment of acuity (forced choice preferential looking); and neurophysiological measures of vision (phase reversal and orientation reversal visual evoked potential). RESULTS: A considerable incidence of abnormalities on at least one of the tests for visual function used was observed. The presence or severity of visual abnormalities could not always be predicted by the site and extent of the lesion seen on imaging. CONCLUSIONS: Early focal lesions affecting the visual pathway can, to some extent, be compensated for by the immature developing brain. These data suggest that all the infants presenting with focal lesions need to be investigated with a detailed assessment of various aspects of vision. Images PMID:8949687

  17. Behavioral effects of perinatal opioid exposure.

    PubMed

    Fodor, Anna; Tímár, Júlia; Zelena, Dóra

    2014-05-28

    Opioids are among the world's oldest known drugs used mostly for pain relief, but recreational use is also widespread. A particularly important problem is opioid exposure in females, as their offspring can also be affected. Adverse intrauterine and postnatal environments can affect offspring development and may lead to various disabilities later in life. It is clear that repetitive painful experiences, such as randomly occurring invasive procedures during neonatal intensive care, can permanently alter neuronal and synaptic organization and therefore later behavior. At the same time, analgesic drugs can also be harmful, inducing neuronal apoptosis or withdrawal symptoms in the neonate and behavioral alterations in adulthood. Hence, risk-benefit ratios should be taken into consideration when pain relief is required during pregnancy or in neonates. Recreational use of opioids can also alter many aspects of life. Intrauterine opioid exposure has many toxic effects, inducing poor pregnancy outcomes due to underdevelopment, but it is believed that later negative consequences are more related to environmental factors such as a chaotic lifestyle and inadequate prenatal care. One of the crucial components is maternal care, which changes profoundly in addicted mothers. In substance-dependent mothers, pre- and postnatal care has special importance, and controlled treatment with a synthetic opioid (e.g., methadone) could be beneficial. We aimed to summarize and compare human and rodent data, as it is important to close the gap between scientific knowledge and societal policies. Special emphasis is given to gender differences in the sensitivity of offspring to perinatal opioid exposure.

  18. Conquering racial disparities in perinatal outcomes.

    PubMed

    Willis, Earnestine; McManus, Patricia; Magallanes, Norma; Johnson, Sheri; Majnik, Amber

    2014-12-01

    Infant mortality rate (IMR) is a reference indicator for societal health status. Trend analysis of IMR highlights 2 challenges to overcome in the United States: (1) US IMR is higher than most industrialized countries and (2) there are persistent racial/ethnic disparities in birth outcomes, especially for blacks. Racial/ethnic infant mortality disparities result from the complex interplay of adverse social, economic, and environmental exposures. In this article, racial/ethnic disparities are discussed, highlighting trends, the role of epigenetics in understanding mechanisms, key domains of community action planning, and programs and policies addressing the racial gaps in adverse birth outcomes.

  19. Age-specific nomograms for follicle stimulating hormone and anti-Mullerian hormone: A pilot study in Ile-Ife, Nigeria

    PubMed Central

    Okunola, Omoladun Temitope; Ajenifuja, Olusegun Kayode; Loto, Morebise Olabisi; Salawu, Afolabi; Omitinde, Oluseyi Stephen; Akande, Joel; Oke, Elizabeth

    2016-01-01

    Background: Assessment of ovarian reserve is one of the steps in the management of infertile couples. Follicle Stimulating hormone (FSH) and anti-Müllerian hormone (AMH) are commonly used ovarian reserve markers in Africa. However, there is paucity of age-specific reference values for FSH and AMH among the African population. Objective: This study aimed at conducting a pilot study for generation of age-specific nomograms for FSH and AMH among fertile women in Ile-Ife, Nigeria. Materials and Methods: A pilot cross-sectional study that involved 65 fertile women within the age range of 18-45 yr were prospectively and consecutively recruited from November 2014 to January 2015. Peripheral blood samples were taken for basal serum FSH and random serum AMH. The samples were processed using enzyme linked immunosorbent (ELISA) assays. Results: Age-specific FSH nomogram showed a gradual increase which became steeper at age 35 yr with an average yearly increase of 0.2 IU/L in basal serum FSH, while age-specific AMH nomogram showed a peak at 25 yr and then; an average yearly decrease of 0.11 ng/ml in random serum AMH from 25 yr. Conclusion: The age-specific nomograms generated by this pilot study suggest that AMH may be an earlier marker of reduced ovarian reserve; which if validated by future multicenter population based studies may facilitate counseling of women on their reproductive potentials. PMID:28066837

  20. Urinary Uric Acid/Creatinine Ratio - A Marker For Perinatal Asphyxia

    PubMed Central

    Patel, Kinjal Prahaladbhai; Makadia, Mayur Goradhanbhai; Patel, Vishwal Indravardan; Nilayangode, Haridas Neelakandan

    2017-01-01

    Background Perinatal hypoxia is one of the leading causes of perinatal mortality in developing countries. Both apgar score and arterial blood pH predict the neonatal mortality in asphyxia. Apgar score alone does not predict neurologic outcome and as it is influenced by various factors. This study was conducted to evaluate the utility and sensitivity of urinary uric acid to creatinine ratio (UA/Cr ratio) in asphyxia diagnosis, compared to invasive Arterial Blood Gas (ABG) analysis. Aim To assess the urinary uric acid/creatinine ratio as an additional marker for perinatal asphyxia compared with ABG analysis in apgar score monitoring. Materials and Methods The present case control study was conducted at a teaching hospital in Central Gujarat. Data of 40 healthy newborns and 40 asphyxiated newborns were collected. In absence of regional estimates, a sample of size 39 was required to attain a power of 80% at 5% alpha (type I error) considering a moderate effect size of 0.65. (UA/Cr) ratio was measured from the spot urine sample collected during 24-72 hours of birth. Statistical analysis was performed by Independent t-test, Pearson’s correlation coefficient (r) and Receiver Operating Characteristic (ROC) plots. Results The mean (UA/Cr ratio) (2.75±0.18 vs 1.78±0.23) is significantly higher in asphyxiated group than in the control group (p<0.0001). Urinary UA/Cr ratio had negative correlation with blood pH (r= -0.27, p=0.18), which was not significant (p>0.05). Urinary UA/Cr ratio with criterion of >2.3 had 100% sensitivity, 100% specificity with AUC of 1 (p<0.0001) had a better predictive value. Conclusions Apgar score is usually reduced in neonates with congenital anomalies and premature neonates. Hence, it is preferable that the clinical diagnosis of asphyxia by apgar scores be supported by other investigations so that early decision can be taken about the level of care the baby needs. pH, lactates and base deficits change with establishment of respiration

  1. Consultation needs in perinatal HIV care: experience of the National Perinatal HIV Consultation Service.

    PubMed

    Fogler, Jessica A; Weber, Shannon; Goldschmidt, Ronald H; Mahoney, Megan R; Cohan, Deborah

    2007-09-01

    This study evaluates the consultation needs of clinicians who provide perinatal human immunodeficiency virus (HIV) care in the United States. The Perinatal Hotline (1-888-448-8765) is a telephone consultation service for providers who treat HIV-infected pregnant women and their infants. Hotline calls were analyzed for demographics about callers and their patients and information about consultation topics. There were 430 calls to the hotline from January 1, 2005, through June 30, 2006. Most calls (59.5%) were related to pregnant patients; 5.1% of the calls pertained to women currently in labor. The most common topic was HIV care in pregnancy (49.1%), particularly antiretroviral drug use (42.1%). HIV testing was discussed in 21.9%, and intrapartum treatment was discussed in 24.0%. Callers most often requested help choosing antiretroviral drug regimens; many of the discussions were about drug toxicities and viral resistance. Although the hotline received few calls about women in labor, the need for these consultations is expected to increase with the expanding use of rapid HIV testing. Access to 24-hour consultation can help ensure that state-of-the-art care is provided.

  2. Mortality table construction

    NASA Astrophysics Data System (ADS)

    Sutawanir

    2015-12-01

    Mortality tables play important role in actuarial studies such as life annuities, premium determination, premium reserve, valuation pension plan, pension funding. Some known mortality tables are CSO mortality table, Indonesian Mortality Table, Bowers mortality table, Japan Mortality table. For actuary applications some tables are constructed with different environment such as single decrement, double decrement, and multiple decrement. There exist two approaches in mortality table construction : mathematics approach and statistical approach. Distribution model and estimation theory are the statistical concepts that are used in mortality table construction. This article aims to discuss the statistical approach in mortality table construction. The distributional assumptions are uniform death distribution (UDD) and constant force (exponential). Moment estimation and maximum likelihood are used to estimate the mortality parameter. Moment estimation methods are easier to manipulate compared to maximum likelihood estimation (mle). However, the complete mortality data are not used in moment estimation method. Maximum likelihood exploited all available information in mortality estimation. Some mle equations are complicated and solved using numerical methods. The article focus on single decrement estimation using moment and maximum likelihood estimation. Some extension to double decrement will introduced. Simple dataset will be used to illustrated the mortality estimation, and mortality table.

  3. Sex mortality differentials and selective survival in large medfly cohorts: implications for human sex mortality differentials.

    PubMed

    Carey, J R; Liedo, P

    1995-10-01

    Experimental studies on male-female mortality differences in nonhuman species are important because they provide insights into both the nature of age-specific gender differences and the concept of selective survival--whether one subgroup in a population (e.g., males) is consistently more frail than another subgroup (e.g., females). We found that it was not possible to classify either sex as more robust or longer lived since relative longevity was conditional on age (young or old), cage conditions (solitary confinement or grouped cages), and treatment (starvation, irradiation, or density). Implications of these findings are discussed including selective survival, demographic selection, a framework for male-female mortality differentials, and an evolutionary perspective on gender differences in longevity.

  4. Provider communication on perinatal depression: a population-based study.

    PubMed

    Farr, Sherry L; Ko, Jean Y; Burley, Kim; Gupta, Seema

    2016-02-01

    Women's lack of knowledge on symptoms of perinatal depression and treatment resources is a barrier to receiving care. We sought to estimate the prevalence and predictors of discussing depression with a prenatal care provider. We used the 2011 population-based data from 24 sites participating in the Pregnancy Risk Assessment Monitoring System (n = 32,827 women with recent live births) to examine associations between maternal characteristics and report that a prenatal care provider discussed with her what to do if feeling depressed during or after pregnancy. Overall, 71.9 % of women reported discussing perinatal depression with their prenatal care provider (range 60.7 % in New York City to 85.6 % in Maine). Women were more likely to report a discussion on perinatal depression with their provider if they they were 18-29 years of age than over 35 years of age compared to older (adjusted prevalence ratio [aPR] 18 to 19 y = 1.08, 20 to 24 y = 1.10, 25 to 29 y = 1.09), unmarried (aPR = 1.07) compared to married, had <12 years of education (aPR = 1.05) compared to > 12 years, and had no previous live births (aPR = 1.03) compared to ≥ 1 live births. Research is needed on effective ways to educate women about perinatal depression and whether increased knowledge on perinatal depression results in higher rates of treatment and shorter duration of symptoms.

  5. HLA-G and mother-child perinatal HIV transmission.

    PubMed

    Luo, Ma; Czarnecki, Chris; Ramdahin, Suzie; Embree, Joanne; Plummer, Francis A

    2013-04-01

    Transplacental passage is a well-known phenomenon in HIV infection and immune responses at the maternal-fetal interface play a critical role in perinatal mother-to-child HIV transmission (MCHT). The high expression of HLA-G at the maternal-fetal interface and its role in mediating immune tolerance suggest that it could play an important role in MCHT. We investigated the role of HLA-G polymorphism in perinatal HIV transmission in 348 ART naïve mother-child pairs enrolled in a mother-child HIV transmission cohort, established in Nairobi, Kenya in 1986. Among the 348 children born to 266 HIV+ mothers, 258 were uninfected and 90 became infected perinatally. HLA-G exons 2 and 3 of 266 mothers and 251 children were sequenced and genotyped. Among 14 HLA-G alleles identified, only 4 alleles have a phenotype frequency above 10%. Correlation analysis showed that HLA-G(∗)01:03+ mothers were less likely to perinatally transmit HIV-1 to their children (p=0.038, Odds ratio:0.472, 95%CI:0.229-0.973). Mother-child HLA-G concordance was not associated with the increased perinatal HIV transmission. There was no significant difference in the general health between the transmitting mothers and the mothers who did not transmit HIV to their children.

  6. The Parental Experience of Pregnancy after Perinatal Loss

    PubMed Central

    Hill, Pamela D.; DeBackere, Katrina; Kavanaugh, Karen L.

    2010-01-01

    Objective To review the research literature on the parental experience of pregnancy, primarily maternal, subsequent to perinatal loss. Data Sources Computerized searches on CINAHL and PubMed databases. Study Selection Articles from indexed journals relevant to the objective were reviewed from January 1997 to December 2007. Only research-based studies in English were included. Data Extraction The review was performed using the methodology of Whittemore and Knafl (2005). Data were extracted and organized under headings: author/year/setting; purpose; sample; design/instruments; results; and nursing implications for parents during a pregnancy following a perinatal loss. Data Synthesis Depression and anxiety are frequently seen in pregnant women subsequent to a perinatal loss. The parental experience is filled with intense and conflicting emotions as parents balance being hopeful while worrying about another potential loss. Conclusions It is important for health care providers to evaluate the woman's obstetric history, acknowledge and validate previous perinatal loss, and discuss with her what would be helpful during the prenatal period with respect to the previous perinatal loss. PMID:18811772

  7. Midwifery care: a perinatal mental health case scenario.

    PubMed

    Marnes, Joanne; Hall, Pauline

    2013-12-01

    The establishment of the National Perinatal Depression Initiative (NPDI, 2008-2013) has brought a focus across Australia for the need to identify women at risk of perinatal mental health disorders, suggesting that routine screening by relevant health professionals may aid earlier detection, better care and improved outcomes. Midwives are frequently the primary point of contact in the perinatal period and thus ideally placed to identify, interpret and manage complex situations, including screening for perinatal mental health disorders. This paper offers strategies that could be implemented into daily midwifery practice in order to achieve the goals consistent with the National Perinatal Depression Initiative. A case study (Jen) and discussion, guided by recommendations from the Australian Nursing and Midwifery Competency standards and beyondblue Clinical Practice Guidelines, are used to demonstrate how midwifery care can be provided. In accordance with her legal obligations, the midwife should act within her scope of practice to undertake a series of psychosocial and medical assessments in order to best determine how midwifery care and support can be of benefit to Jen, her infant and her family. Suggestions described include administration of validated screening questionnaires, clinical interview, physical assessment, discussion with partner, awareness of the mother-infant interactions and questioning around baby's sleep and feeding. Based on evaluation of the information gained from a bio-psycho-social assessment, suggestions are made as to the midwifery care options that could be applied.

  8. Perinatal Morbidity and Mortality in the U.S. Department of Defense, 2001-2005

    DTIC Science & Technology

    2009-05-01

    decrease in the VBAC rate (28.58% to 16.70%), and decrease in the operative vaginal delivery rate (9.92% to 7.91 %). The decrease in operative vaginal...Repeat Cesarean rate 36.48% 33.33% 36.06% 36.69% 37.61% 38.28% VBACs : 6251 1449 1494 1281 1087 940 VBAC rate 22.39% Yo 22.43% 18.65% 16.70% Total

  9. Challenge of Fetal Mortality

    MedlinePlus

    ... Mortality Series 21. Data on Natality, Marriage, and Divorce Series 22. Data from the National Natality and ... Compilations of Data on Natality, Mortality, Marriage, and Divorce Vital Statistics Rapid Release Quarterly Provisional Estimates Dashboard ...

  10. Shared responsibility for electronic records: governance in perinatal data entry.

    PubMed

    Craswell, Alison; Moxham, Lorna; Broadbent, Marc

    2014-01-01

    This paper presents research undertaken as part of a larger research project to examine the factors that influence midwives when entering perinatal data. A grounded theory methodology was used to undertake qualitative interviews with 15 participants from 12 different hospitals across Queensland, Australia using three different systems for perinatal data collection. The findings surrounding accountability are presented revealing that a shift in governance relating to responsibility and accountability is not occurring in midwifery units across Queensland. Without assignation of responsibility for entries and accountability for mistakes or omissions, perinatal data records can be left incomplete or inaccurate. Increasing use of electronic health records and creation of digital hospitals indicates these issues are highly relevant in planning for these services.

  11. Complementary and Alternative Medicine Therapies for Perinatal Depression

    PubMed Central

    Deligiannidis, Kristina M.; Freeman, Marlene P.

    2014-01-01

    Complementary and Alternative Medicine (CAM) therapies are increasingly sought out by patients with psychiatric disorders. This article provides a review of the evidence for several commonly utilized CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine (SAMe), St. John’s Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or the postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence based use of CAM treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of CAM in the treatment of perinatal depression. PMID:24041861

  12. Perinatal Programming of Asthma: The Role of Gut Microbiota

    PubMed Central

    Azad, Meghan B.; Kozyrskyj, Anita L.

    2012-01-01

    Perinatal programming, a dominant theory for the origins of cardiovascular disease, proposes that environmental stimuli influence developmental pathways during critical periods of prenatal and postnatal development, inducing permanent changes in metabolism. In this paper, we present evidence for the perinatal programming of asthma via the intestinal microbiome. While epigenetic mechanisms continue to provide new explanations for the programming hypothesis of asthma development, it is increasingly apparent that the intestinal microbiota plays an independent and potentially interactive role. Commensal gut bacteria are essential to immune system development, and exposures disrupting the infant gut microbiota have been linked to asthma. This paper summarizes the recent findings that implicate caesarean delivery, breastfeeding, perinatal stress, probiotics, and antibiotics as modifiers of infant gut microbiota in the development of asthma. PMID:22110540

  13. Characterization of Smoc-1 uncovers two transcript variants showing differential tissue and age specific expression in Bubalus bubalis

    PubMed Central

    Srivastava, Jyoti; Premi, Sanjay; Kumar, Sudhir; Parwez, Iqbal; Ali, Sher

    2007-01-01

    Background Secreted modular calcium binding protein-1 (Smoc-1) belongs to the BM-40 family which has been implicated with tissue remodeling, angiogenesis and bone mineralization. Besides its anticipated role in embryogenesis, Smoc-1 has been characterized only in a few mammalian species. We made use of the consensus sequence (5' CACCTCTCCACCTGCC 3') of 33.15 repeat loci to explore the buffalo transcriptome and uncovered the Smoc-1 transcript tagged with this repeat. The main objective of this study was to gain an insight into its structural and functional organization, and expressional status of Smoc-1 in water buffalo, Bubalus bubalis. Results We cloned and characterized the buffalo Smoc-1, including its copy number status, in-vitro protein expression, tissue & age specific transcription/translation, chromosomal mapping and localization to the basement membrane zone. Buffalo Smoc-1 was found to encode a secreted matricellular glycoprotein containing two EF-hand calcium binding motifs homologous to that of BM-40/SPARC family. In buffalo, this single copy gene consisted of 12 exons and was mapped onto the acrocentric chromosome 11. Though this gene was found to be evolutionarily conserved, the buffalo Smoc-1 showed conspicuous nucleotide/amino acid changes altering its secondary structure compared to that in other mammals. In silico analysis of the Smoc-1 proposed its glycoprotein nature with a calcium dependent conformation. Further, we unveiled two transcript variants of this gene, varying in their 3'UTR lengths but both coding for identical protein(s). Smoc-1 evinced highest expression of both the variants in liver and modest to negligible in other tissues. The relative expression of variant-02 was markedly higher compared to that of variant-01 in all the tissues examined. Moreover, expression of Smoc-1, though modest during the early ages, was conspicuously enhanced after 1 year and remained consistently higher during the entire life span of buffalo with gradual

  14. Thrombophilia risk is not increased in children after perinatal stroke.

    PubMed

    Curtis, Colleen; Mineyko, Aleksandra; Massicotte, Patricia; Leaker, Michael; Jiang, Xiu Yan; Floer, Amalia; Kirton, Adam

    2017-03-03

    Perinatal stroke causes cerebral palsy and lifelong disability. Specific diseases are definable but mechanisms are poorly understood. Evidence suggests possible associations between arterial perinatal stroke and prothrombotic disorders but population-based, controlled, disease-specific studies are limited. Understanding thrombophilia in perinatal stroke informs pathogenesis models and clinical management. We conducted a population-based, prospective, case-control study to determine the association of specific perinatal stroke diseases with known thrombophilias. Children with idiopathic, MRI-classified neonatal arterial ischemic stroke (NAIS), arterial presumed perinatal ischemic stroke (APPIS), or fetal periventricular venous infarction (PVI) were recruited. Standardized thrombophilia evaluations were performed after 12 months of age on stroke cases and controls including quantified protein C and S, antithrombin, factors VIII/IX/XI, fibrinogen, lipoprotein(a), homocysteine, lupus anticoagulant, anticardiolipin antibodies and genotyping of factor V Leiden (FVL), factor II G20210A (FII), and MTHFR C677T. A total of 212 children were studied: 46 NAIS, 34 APPIS, 55 PVI, and 77 controls (53% male, median 4.8 years). Of 14 parameters, no differences were observed in 12 including all common thrombophilias. Mean prothrombin time was shorter in arterial strokes (p<0.001). Rates of antiphospholipid antibodies were low, comparable to controls, and resolved on repeat testing. FVL and FII rates were comparable to population norms. Total number of possible abnormalities did not differ between cases and controls. Our prospective, population-based, controlled, disease-specific study suggests minimal association between perinatal stroke and thrombophilia. This does not exclude the possibility of disordered coagulation at the time of stroke but suggests testing in childhood is not indicated.

  15. Eating Disorders and Trauma History in Women with Perinatal Depression

    PubMed Central

    Zerwas, Stephanie; Leserman, Jane; Holle, Ann Von; Regis, Taylor; Bulik, Cynthia

    2011-01-01

    Abstract Objective Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression. Methods A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n=99) or postpartum (n=59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory. Results In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p=0.02; PHQ-severity 14.5, SD 7.4, p=0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD=6.1; PHQ 9.0, SD=6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, p<0.05), and those with BN were more likely report physical (50.0%, p<0.05) and sexual (66.7%, p<0.05) trauma histories. Conclusions ED histories were present in over one third of admissions to a perinatal psychiatry clinic. Women with BN reported more severe depression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression. PMID:21671774

  16. Race and Mortality.

    ERIC Educational Resources Information Center

    Scanlan, James P.

    2000-01-01

    Discusses increasing racial and socioeconomic disparities in mortality despite general declines in mortality, examining disparities in infant mortality and explaining that whenever two groups differ in their susceptibility to some condition, the less prevalent the condition, the greater will be the disparity in rates of experiencing the condition.…

  17. Perinatal information systems for quality improvement: visions for today.

    PubMed

    Slagle, T A

    1999-01-01

    Today clinical information is used for a multitude of purposes beyond patient care documentation including quality review and improvement processes, allocation of resources, budgetary and long-term planning, productivity measurement, and justification to payers for services provided. Providers in perinatal medicine are faced with the challenge of finding methods to meet these information needs. Case examples of the different approaches to collecting and using obstetric and neonatal information are described. The role of computer-based patient records is outlined and solutions available to perinatal medicine are reviewed.

  18. Association of Cardiometabolic Multimorbidity With Mortality

    PubMed Central

    2015-01-01

    IMPORTANCE The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960–2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006–2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAIN OUTCOMES AND MEASURES All-cause mortality and estimated reductions in life expectancy. RESULTS In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95%CI, 1.8–2.0) in participants with a history of diabetes, 2.1 (95%CI, 2.0–2.2) in those with stroke, 2.0 (95%CI, 1.9–2.2) in those with MI, 3.7 (95%CI, 3.3–4.1) in those with both diabetes and MI, 3.8 (95%CI, 3.5–4.2) in those with both diabetes and stroke, 3.5 (95%CI, 3.1–4.0) in those with both stroke and

  19. Accidents in Canada: mortality and hospitalization.

    PubMed

    Riley, R; Paddon, P

    1989-01-01

    For Canadians under 45, accidents are the leading cause of both death and hospitalization. For the Canadian population as a whole, accidents rank fourth as a cause of death, after cardiovascular disease (CVD), cancer and respiratory disease. This article analyzes accident mortality and hospitalization in Canada using age-specific rates, age-standardized mortality rates (ASMR), and potential years of life lost (PYLL). The six major causes of accidental death for men are motor vehicle traffic accidents (MVTA), falls, drowning, fires, suffocation and poisoning. For women, the order is slightly different: MVTA, falls, fires, suffocation, poisoning and drowning. From 1971 to 1986, age-standardized mortality rates (ASMR) for accidents decreased by 44% for men and 39% for women. The largest decrease occurred in the under 15 age group. Accidents accounted for 11.5% of total hospital days in 1985, and 8% of hospital discharges. Because young people have the highest rates of accidental death, potential years of life lost (PYLL) are almost as high for accidents as for cardiovascular disease, although CVD deaths outnumbered accidental deaths by almost five to one in 1985.

  20. Mortality as a function of obesity and diabetes mellitus.

    PubMed

    Pettitt, D J; Lisse, J R; Knowler, W C; Bennett, P H

    1982-03-01

    Mortality according to body mass index (weight/height2) was studied in 2197 Pima Indians aged 15-74 years, as part of the longitudinal study of diabetes begun in 1965 in the Gila River Indian Community of Arizona. The Pima Indians are a population with a high prevalence of obesity, and they have the highest known incidence of type II (non-insulin dependent) diabetes mellitus. Among males, mortality was greatest in those with a body mass index of at least 40 kg/m2, but obesity had little effect on mortality at body mass indices below 40 kg/m2. Age-specific death rates in women were not consistently related to obesity, although mortality in subjects with diabetes was higher than in those without. In men, diabetes had little effect on mortality. In this study, as in several other mortality studies, the lowest mortality rates were experienced by people with body weights well above those recommended as "desirable" by the Society of Actuaries in 1959. Thus, the applicability of the "desirable" weight standards in common use is questioned.

  1. Social class differences in child mortality, Sweden 1981-1986.

    PubMed Central

    Ostberg, V

    1992-01-01

    STUDY OBJECTIVE--The aim was to analyse social class differences in mortality among Swedish children, 1-19 years old, during the period 1981-86. In order to study the development of these differences, mortality differences during the study period were compared with those 20 years earlier, ie, 1961-66. DESIGN--The study used data from two census linked death registries (CDR80 and CDR60). These were constructed by linkages between the 1980 and 1960 population censuses, respectively, and the corresponding national cause of death registries. Age specific and age standardised death rates, for total and cause specific mortality, were calculated for each social class and for the genders separately. To compare the death rates of social classes, relative risks with approximately 95% confidence limits were calculated. STUDY POPULATION--The study included children younger than 16 years at the time of the censuses and all deaths in the age range 1-19 years. The children were followed up for a period of six years after the censuses with respect to mortality. MAIN RESULTS--During the period 1981-86, children in families of both manual workers and self employed persons had a significantly higher mortality than children in families of non-manual workers. CONCLUSIONS--Although there has been a marked decrease in child mortality during the last decades the study shows that social class differences in child mortality still exist and show little tendency to disappear. PMID:1479315

  2. Working together for women's empowerment: Strategies for interdisciplinary collaboration in perinatal care.

    PubMed

    Kwee, Janelle L; McBride, Hillary L

    2015-06-02

    Women's experiences of pregnancy, birth, and postpartum adjustment are often characterized by feelings of disempowerment, trauma, and emotional pain. Psychosocial perinatal care has not kept up with medical advances in perinatal care. Access to psychosocial care appears to be inadequate because of the following: (a) perinatal health care providers are insufficiently prepared to address emotional aspects of maternal care and (b) traditional, compartmentalized psychological services benefit only a subsection of perinatal women, often in an untimely manner. Practical and innovative psychosocial services, integrated into routine perinatal care, can provide widespread access to psychosocial resources for mothers and supports providers in delivering optimal care.

  3. Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

    PubMed Central

    Pourali, Leila; Ayati, Sedigheh; Jelodar, Shahrzad; Zarifian, Ahmadreza; Sheikh Andalibi, Mohammad Sobhan

    2016-01-01

    Introduction: Regarding to the recent advances in assisted reproductive techniques (ART), twin and multiple pregnancies have increased during past years. Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96) and ART group (n=31). Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR), postpartum hemorrhage), neonatal outcomes (weight, first and fifth minute Apgar score, Neonatal Intensive Care Unit (NICU) admission, mortality, respiratory distress, and icterus) were recorded using a questionnaire. Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD) were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1st and 5th min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus). Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART. PMID:27326416

  4. [Infant Mortality in Argentina: reducibility criteria, 3rd review].

    PubMed

    Finkelstein, Juliana Zoe; Duhau, Mariana; Abeyá Gilardon, Enrique; Ferrario, Claudia; Speranza, Ana; Asciutto, Carolina; Marconi, Élida; Guevel, Carlos; Fernández, María de las Mercedes; Martínez, María Laura; Santoro, Adrián; Loiacono, Karina; Lomuto, Celia

    2015-08-01

    The infant mortality rate is an indicator of quality of life, development, and quality and accessibility of health care. Improvements in science, technology and better access to health care have contributed to a major decrease in the infant mortality rate in Argentina. Since the 1980s, infant deaths have been classified based on the opportunities for reducibility yielded by scientific knowledge and available technologies, in order to obtain a basis for the monitoring and implementation of health policies. The last review of this classification was in 2011. In 2012, a total of 5,541 neonatal deaths (less than 28 days of life) were registered and, under this new classification, over 61% were reducible mainly by the improvement of perinatal health care and adequate and timely treatment of the at-risk newborn. In 2012, a total of 2,686 post-neonatal deaths (from 28 days of life to a year) were registered and, under this new classification, over 66.8% were reducible by improving prevention strategies and providing adequate and timely treatment. This new analysis demonstrates the need to improve the opportunity, accessibility and quality of perinatal care starting at pregnancy, guaranteeing quality care at delivery and reinforcing prevention and timely treatment of common diseases in childhood over the first year of life.

  5. Comparisons of infant mortality using a percentile-based method of standardization for birthweight or gestational age.

    PubMed

    Hertz-Picciotto, I; Din-Dzietham, R

    1998-01-01

    Comparisons of infant, perinatal, or neonatal mortality across populations with different birthweight or gestational age distributions are problematic. Summary measures with adjustment for birthweight or gestational age frequently are invalid or lack interpretability. We propose a percentile-based method of standardization for comparing infant, perinatal, or neonatal mortality across populations that have different distributions of birthweight and/or gestational age. The underlying concept is a simple one: comparable health for two population groups will be expressed as equal rates of disease or mortality at equal quantiles in the two distributions of birthweight or gestational age. We describe this method mathematically and present an example comparing mortality rates for African-American vs European-American infants in North Carolina. When gestational age is transformed to its rank, the well-known crossover in mortality rates, in which preterm African-American infants die at lower rates but term infants at higher rates, disappears: African-Americans show higher mortality rates at any percentile of gestational age. With homogeneous mortality rate ratios, a summary statistic becomes meaningful. We also demonstrate adjustment for percentile-transformed gestational age or birthweight in multiple logistic regression models. Percentile standardization is easily implemented, has advantages over other methods of internal standardization such as that of Wilcox and Russell, and communicates an intuitive public health-based concept of equality of mortality across populations.

  6. Perinatal Pitocin as an Early ADHD Biomarker: Neurodevelopmental Risk?

    ERIC Educational Resources Information Center

    Kurth, Lisa; Haussmann, Robert

    2011-01-01

    Objective: To investigate a potential relationship between coincidental increases in perinatal Pitocin usage and subsequent childhood ADHD onset in an attempt to isolate a specific risk factor as an early biomarker of this neurodevelopmental disorder. Method: Maternal labor/delivery and corresponding childbirth records of 172 regionally diverse,…

  7. Relative Risk of Perinatal Complications in Common Childhood Disorders

    ERIC Educational Resources Information Center

    Dean, Raymond S.; Davis, Andrew S.

    2007-01-01

    Perinatal complications have been associated with a myriad of later-developing behavioral, neurological, and psychological disorders. These have included school-related disorders such as attention-deficit/hyperactivity disorder, autism, mood and anxiety disorders, and learning disabilities. This article reviews the research that considers the…

  8. Perinatal transmission of dengue: a report of 7 cases.

    PubMed

    Ribeiro, Christiane Fernandes; Lopes, Vânia Glória Silami; Brasil, Patrícia; Coelho, Janice; Muniz, Adriana Gouveia; Nogueira, Rita Maria Ribeiro

    2013-11-01

    Perinatal transmission of dengue virus was confirmed by the evidence of virus in fetal tissue, newborn serum, and placenta of pregnant women. Abortion, several different clinical findings, and placental inflammatory findings were documented. No association was seen between severity of maternal dengue and disease of the newborn.

  9. An Endangered Generation: Impact of Perinatal Drug Use.

    ERIC Educational Resources Information Center

    Jones, Melanie M.

    This article reviews some of the literature on educational approaches for drug-exposed children. Common effects of prenatal and perinatal drug use on the female user, the developing fetus, and the neonate are reviewed. It is noted that female drug users have an increased incidence of medical complications during pregnancy; that the specific…

  10. Prenatal and Perinatal Risk Factors for Autism in China

    ERIC Educational Resources Information Center

    Zhang, Xin; Lv, Cong-Chao; Tian, Jiang; Miao, Ru-Juan; Xi, Wei; Hertz-Picciotto, Irva; Qi, Lihong

    2010-01-01

    We conducted a case-control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted…

  11. Perinatal Staff Nurse Medical Device Use and Education.

    ERIC Educational Resources Information Center

    McConnell, Edwina A.

    1998-01-01

    Survey responses from 48 perinatal nurses found that most learned about medical devices by reading manuals; 75% had received inservice training; and 95% learned from other staff. Inadequate knowledge was related to fear of causing patient harm. Initial learning method influenced what was learned, and hands-on experience was considered efficacious.…

  12. Prenatal and Perinatal Factors Associated with Intellectual Disability

    ERIC Educational Resources Information Center

    Bilder, Deborah A.; Pinborough-Zimmerman, Judith; Bakian, Amanda V.; Miller, Judith S.; Dorius, Josette T.; Nangle, Barry; McMahon, William M.

    2013-01-01

    Prenatal and perinatal risk factors associated with intellectual disability (ID) were studied in 8-year-old Utah children from a 1994 birth cohort (N = 26,108) using broad ascertainment methods and birth records following the most current recording guidelines. Risk factor analyses were performed inclusive and exclusive of children with a known or…

  13. PREGNANCY AND PERINATAL HEALTH, BAMEN, INNER MONGOLIA, CHINA

    EPA Science Inventory

    For developing countries, especially in remote rural areas, measures of maternal and perinatal health may be difficult to obtain because it is not systematically collected and/or electronic data is not available. We assisted the public health officials of Bayingnormen (BaMen), In...

  14. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Perinatal monitoring system and accessories. 884.2740 Section 884.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors...

  15. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Perinatal monitoring system and accessories. 884.2740 Section 884.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors...

  16. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Perinatal monitoring system and accessories. 884.2740 Section 884.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors...

  17. Perinatal Mental Health: Supporting New Families through Vulnerability and Change.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2002-01-01

    "Zero to Three is a single focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Noting that because the perinatal periodfrom the later stages of pregnancy through the first 6 months of the infants lifeis a period of…

  18. Assessing the knowledge of perinatal mental illness among student midwives.

    PubMed

    Phillips, Louise

    2015-11-01

    The experience of perinatal mental illness (mental illness occurring around the time of pregnancy) currently affect 1 in 10 women and can have adverse effects on the mother and her child (Massie and Szajnberg, 2002; O'Connor et al., 2002). The care and effective management of women experiencing perinatal mental illness is therefore an important issue for health care staff, managers, psychiatrists, commissioners and campaigners. Midwives play a significant part in caring for women throughout their pregnancies, during labour and up to the first month after birth. Midwives are in a unique position to assess a woman's well-being and to offer appropriate support. However, previous research has revealed that midwives often have poor understanding and knowledge of perinatal mental health issues and require improved training (Ross-Davie et al, 2006; McCann and Clark, 2010). This research project aims to systematically assess student midwives awareness of perinatal mental illness. The findings of this study will inform curriculum development for graduate and post-graduate midwifery students therefore improving the care and support women with mental illness receive from antenatal services. The findings from this study will also be used for the formation of an educational web-based programme for student and qualified midwives.

  19. Genetic polymorphisms for vascular endothelial growth factor in perinatal complications.

    PubMed

    Bányász, Ilona; Bokodi, Géza; Vásárhelyi, Barna; Treszl, András; Derzbach, László; Szabó, András; Tulassay, Tivadar; Vannay, Adám

    2006-12-01

    Low birth weight (LBW) infants have increased susceptibility to perinatal complications. An immature and impaired vascular system may possibly participate in these complications. There is evidence that supports the notion that vascular endothelial growth factor (VEGF), which is an essential regulator of embryonic angiogenesis, plays a central role in the pathogenesis of perinatal complications. We aimed to test whether functional genetic polymorphisms of VEGF are associated with the risk of preterm birth or perinatal morbidity. We enrolled 128 LBW infants (< or = 1500 grams). VEGF T-460C, VEGF C-2578A and VEGF G+405C polymorphisms were determined by real-time PCR or PCR-RFLP, respectively. Their genotypes were compared with VEGF genotypes of 200 healthy, term neonates. The prevalence of the VEGF+405 C allele was higher in LBW infants than in healthy, term neonates (OR [95% CI]: 1.29 [1.01-1.65]). Carrier state for the VEGF -2578A allele was an independent risk factor for enterocolitis necrotisans (NEC) (adjusted OR [95% CI]: 2.77 [1.00-7.65]). The carrier state for the VEGF -2578AA genotype was associated with a decreased risk of acute renal failure (ARF) (adjusted OR [95% CI]: 0.2 [0.05-0.78]). These results suggest that VEGF G+405C polymorphism might be associated with a higher risk of preterm birth and that VEGF C-2578A polymorphism may participate in the development of perinatal complications such as NEC and ARF.

  20. Impaired Lung Mitochondrial Respiration Following Perinatal Nicotine Exposure in Rats.

    PubMed

    Cannon, Daniel T; Liu, Jie; Sakurai, Reiko; Rossiter, Harry B; Rehan, Virender K

    2016-04-01

    Perinatal smoke/nicotine exposure predisposes to chronic lung disease and morbidity. Mitochondrial abnormalities may contribute as the PPARγ pathway is involved in structural and functional airway deficits after perinatal nicotine exposure. We hypothesized perinatal nicotine exposure results in lung mitochondrial dysfunction that can be rescued by rosiglitazone (RGZ; PPARγ receptor agonist). Sprague-Dawley dams received placebo (CON), nicotine (NIC, 1 mg kg(-1)), or NIC + RGZ (3 mg kg(-1)) daily from embryonic day 6 to postnatal day 21. Parenchymal lung (~10 mg) was taken from adult male offspring for mitochondrial assessment in situ. ADP-stimulated O2 consumption was less in NIC and NIC + RGZ compared to CON (F[2,14] = 17.8; 4.5 ± 0.8 and 4.1 ± 1.4 vs. 8.8 ± 2.5 pmol s mg(-1); p < 0.05). The respiratory control ratio for ADP, an index of mitochondrial coupling, was reduced in NIC and remediated in NIC + RGZ (F[2,14] = 3.8; p < 0.05). Reduced mitochondrial oxidative capacity and abnormal coupling were evident after perinatal nicotine exposure. RGZ improved mitochondrial function through tighter coupling of oxidative phosphorylation.

  1. Perinatal Substance Abuse: What's Best for the Children?

    ERIC Educational Resources Information Center

    Poulsen, Marie Kanne

    This report, which is based on the work of the Perinatal Substance Exposure Think Tanks, establishes priorities for statewide services in California to young children who are prenatally exposed to alcohol and drugs. Although the report focuses on the developmental needs of children, it also examines efforts to provide prevention and treatment…

  2. The historical development of suicide mortality in Russia, 1870-2007.

    PubMed

    Jukkala, Tanya; Mäkinen, Ilkka Henrik; Stickley, Andrew

    2015-01-01

    Russia has one of the highest suicide mortality rates in the world. This study investigates the development of Russian suicide mortality over a longer time period in order to provide a context within which the contemporary high level might be better understood. Annual sex- and age-specific suicide-mortality data for Russia for the period 1870-2007 were studied, where available. Russian suicide mortality increased 11-fold over the period. Trends in male and female suicide developed similarly, although male suicide rates were consistently much higher. From the 1990s suicide has increased in a relative sense among the young (15-34), while the high suicide mortality among middle-aged males has reduced. Changes in Russian suicide mortality over the study period may be attributable to modernization processes.

  3. Could Perinatal Asphyxia Induce a Synaptopathy? New Highlights from an Experimental Model

    PubMed Central

    Herrera, María Inés; Udovin, Lucas Daniel; Kusnier, Carlos; Kölliker-Frers, Rodolfo; de Souza, Wanderley

    2017-01-01

    Birth asphyxia also termed perinatal asphyxia is an obstetric complication that strongly affects brain structure and function. Central nervous system is highly susceptible to oxidative damage caused by perinatal asphyxia while activation and maturity of the proper pathways are relevant to avoiding abnormal neural development. Perinatal asphyxia is associated with high morbimortality in term and preterm neonates. Although several studies have demonstrated a variety of biochemical and molecular pathways involved in perinatal asphyxia physiopathology, little is known about the synaptic alterations induced by perinatal asphyxia. Nearly 25% of the newborns who survive perinatal asphyxia develop neurological disorders such as cerebral palsy and certain neurodevelopmental and learning disabilities where synaptic connectivity disturbances may be involved. Accordingly, here we review and discuss the association of possible synaptic dysfunction with perinatal asphyxia on the basis of updated evidence from an experimental model. PMID:28326198

  4. Could Perinatal Asphyxia Induce a Synaptopathy? New Highlights from an Experimental Model.

    PubMed

    Herrera, María Inés; Otero-Losada, Matilde; Udovin, Lucas Daniel; Kusnier, Carlos; Kölliker-Frers, Rodolfo; de Souza, Wanderley; Capani, Francisco

    2017-01-01

    Birth asphyxia also termed perinatal asphyxia is an obstetric complication that strongly affects brain structure and function. Central nervous system is highly susceptible to oxidative damage caused by perinatal asphyxia while activation and maturity of the proper pathways are relevant to avoiding abnormal neural development. Perinatal asphyxia is associated with high morbimortality in term and preterm neonates. Although several studies have demonstrated a variety of biochemical and molecular pathways involved in perinatal asphyxia physiopathology, little is known about the synaptic alterations induced by perinatal asphyxia. Nearly 25% of the newborns who survive perinatal asphyxia develop neurological disorders such as cerebral palsy and certain neurodevelopmental and learning disabilities where synaptic connectivity disturbances may be involved. Accordingly, here we review and discuss the association of possible synaptic dysfunction with perinatal asphyxia on the basis of updated evidence from an experimental model.

  5. Cancer mortality in Brazil

    PubMed Central

    Barbosa, Isabelle R.; de Souza, Dyego L.B.; Bernal, María M.; Costa, Íris do C.C.

    2015-01-01

    Abstract Cancer is currently in the spotlight due to their heavy responsibility as main cause of death in both developed and developing countries. Analysis of the epidemiological situation is required as a support tool for the planning of public health measures for the most vulnerable groups. We analyzed cancer mortality trends in Brazil and geographic regions in the period 1996 to 2010 and calculate mortality predictions for the period 2011 to 2030. This is an epidemiological, demographic-based study that utilized information from the Mortality Information System on all deaths due to cancer in Brazil. Mortality trends were analyzed by the Joinpoint regression, and Nordpred was utilized for the calculation of predictions. Stability was verified for the female (annual percentage change [APC] = 0.4%) and male (APC = 0.5%) sexes. The North and Northeast regions present significant increasing trends for mortality in both sexes. Until 2030, female mortality trends will not present considerable variations, but there will be a decrease in mortality trends for the male sex. There will be increases in mortality rates until 2030 for the North and Northeast regions, whereas reductions will be verified for the remaining geographic regions. This variation will be explained by the demographic structure of regions until 2030. There are pronounced regional and sex differences in cancer mortality in Brazil, and these discrepancies will continue to increase until the year 2030, when the Northeast region will present the highest cancer mortality rates in Brazil. PMID:25906105

  6. Psychosocial impact of perinatal loss among Muslim women

    PubMed Central

    2012-01-01

    Background Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. Methods A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Results Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Conclusion Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed. PMID:22708998

  7. US and territory telemedicine policies: identifying gaps in perinatal care

    PubMed Central

    Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

    2016-01-01

    BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

  8. CLOCK DRAWING IN CHILDREN WITH PERI-NATAL STROKE

    PubMed Central

    Yousefian, Omid; Ballantyne, Angela O.; Doo, Alex; Trauner, Doris A.

    2015-01-01

    BACKGROUND Children with peri-natal stroke may show evidence of contralateral spatial neglect. The goal of this study was to determine whether a clock drawing task commonly used in adults to identify neglect would be effective in detecting neglect in children with peri-natal stroke. METHODS Thirty-eight individuals (age range 6–21 years) with left hemisphere (LH) or right hemisphere (RH) peri-natal onset unilateral lesions and one hundred seventy-nine age-matched controls were given the free-drawn Clock Drawing Task (CDT) in a cross-sectional design. An adapted scoring system that evaluated right- and left-sided errors separately was developed as part of the investigation. RESULTS Children with LH lesions made a greater number of errors on both the right and left sides of the clock drawings in all age subgroups (6–8 years, 9–14 years, and 15–21 years) compared to controls. Children with RH lesions showed greater left and right errors in the younger groups compared to controls, with significantly poorer performance on the left at 6–8 years, suggestive of contralateral neglect. However, by ages 15–21 years, the RH lesion subjects no longer differed from controls. CONCLUSIONS Clock drawing can identify spatial neglect in children with early hemispheric damage. However, brain development is a dynamic process, and as children age, spatial neglect may no longer be evident. These findings demonstrate the limitations of predicting long-term outcome after peri-natal stroke from early neuro-cognitive data. Children with peri-natal stroke may require different neural pathways to accomplish specific skills or to overcome deficits, but ultimately they may have “typical” outcomes. PMID:26002051

  9. Perinatal Depression Algorithm: A Home Visitor Step-by-Step Guide for Advanced Management of Perinatal Depressive Symptoms

    ERIC Educational Resources Information Center

    Laszewski, Audrey; Wichman, Christina L.; Doering, Jennifer J.; Maletta, Kristyn; Hammel, Jennifer

    2016-01-01

    Early childhood professionals do many things to support young families. This is true now more than ever, as researchers continue to discover the long-term benefits of early, healthy, nurturing relationships. This article provides an overview of the development of an advanced practice perinatal depression algorithm created as a step-by-step guide…

  10. On forecasting mortality.

    PubMed

    Olshansky, S J

    1988-01-01

    Official forecasts of mortality made by the U.S. Office of the Actuary throughout this century have consistently underestimated observed mortality declines. This is due, in part, to their reliance on the static extrapolation of past trends, an atheoretical statistical method that pays scant attention to the behavioral, medical, and social factors contributing to mortality change. A "multiple cause-delay model" more realistically portrays the effects on mortality of the presence of more favorable risk factors at the population level. Such revised assumptions produce large increases in forecasts of the size of the elderly population, and have a dramatic impact on related estimates of population morbidity, disability, and health care costs.

  11. A biological approach to the interspecies prediction of radiation-induced mortality risk

    SciTech Connect

    Carnes, B.A.; Grahn, D.; Olshansky, S.J.

    1997-08-01

    Evolutionary explanations for why sexually reproducing organisms grow old suggest that the forces of natural selection affect the ages when diseases occur that are subject to a genetic influence (referred to here as intrinsic diseases). When extended to the population level for a species, this logic leads to the general prediction that age-specific death rates from intrinsic causes should begin to rise as the force of selection wanes once the characteristic age of sexual maturity is attained. Results consistent with these predictions have been found for laboratory mice, beagles, and humans where, after adjusting for differences in life span, it was demonstrated that these species share a common age pattern of mortality for intrinsic causes of death. In quantitative models used to predict radiation-induced mortality, risks are often expressed as multiples of those observed in a control population. A control population, however, is an aging population. As such, mortality risks related to exposure must be interpreted relative to the age-specific risk of death associated with aging. Given the previous success in making interspecies predictions of age-related mortality, the purpose of this study was to determine whether radiation-induced mortality observed in one species could also be predicted quantitatively from a model used to describe the mortality consequences of exposure to radiation in a different species. Mortality data for B6CF{sub 1} mice and beagles exposed to {sup 60}Co {gamma}-rays for the duration of life were used for analysis.

  12. Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality

    PubMed Central

    Roth, Gregory A.; Forouzanfar, Mohammad H.; Moran, Andrew E.; Barber, Ryan; Nguyen, Grant; Feigin, Valery L.; Naghavi, Mohsen; Mensah, George A.; Murray, Christopher J.L.

    2015-01-01

    BACKGROUND Global deaths from cardiovascular disease are increasing as a result of population growth, the aging of populations, and epidemiologic changes in disease. Disentangling the effects of these three drivers on trends in mortality is important for planning the future of the health care system and benchmarking progress toward the reduction of cardiovascular disease. METHODS We used mortality data from the Global Burden of Disease Study 2013, which includes data on 188 countries grouped into 21 world regions. We developed three counterfactual scenarios to represent the principal drivers of change in cardiovascular deaths (population growth alone, population growth and aging, and epidemiologic changes in disease) from 1990 to 2013. Secular trends and correlations with changes in national income were examined. RESULTS Global deaths from cardiovascular disease increased by 41% between 1990 and 2013 despite a 39% decrease in age-specific death rates; this increase was driven by a 55% increase in mortality due to the aging of populations and a 25% increase due to population growth. The relative contributions of these drivers varied by region; only in Central Europe and Western Europe did the annual number of deaths from cardiovascular disease actually decline. Change in gross domestic product per capita was correlated with change in age-specific death rates only among upper-middle income countries, and this correlation was weak; there was no significant correlation elsewhere. CONCLUSIONS The aging and growth of the population resulted in an increase in global cardiovascular deaths between 1990 and 2013, despite a decrease in age-specific death rates in most regions. Only Central and Western Europe had gains in cardiovascular health that were sufficient to offset these demographic forces. (Funded by the Bill and Melinda Gates Foundation and others.) PMID:25830423

  13. Impact of HAART and CNS-penetrating antiretroviral regimens on HIV encephalopathy among perinatally infected children and adolescents

    PubMed Central

    Patel, Kunjal; Ming, Xue; Williams, Paige L.; Robertson, Kevin R.; Oleske, James M.; Seage, George R.

    2010-01-01

    Objectives Prior to antiretroviral treatment, HIV-infected children frequently developed encephalopathy, resulting in debilitating morbidity and mortality. This is the first large study to evaluate the impact of HAART and central nervous system (CNS)-penetrating antiretroviral regimens on the incidence of HIV encephalopathy and survival after diagnosis of HIV encephalopathy among perinatally infected children. Design A total of 2398 perinatally HIV-infected children with at least one neurological examination were followed in a US-based prospective cohort study conducted from 1993 to 2007. Methods Trends in incidence rates over calendar time were described and Cox regression models were used to estimate the effects of time-varying HAART and CNS-penetrating antiretroviral regimens on HIV encephalopathy and on survival after diagnosis of HIV encephalopathy. Results During a median of 6.4 years of follow-up, 77 incident cases of HIV encephalopathy occurred [incidence rate 5.1 cases per 1000 person-years, 95% confidence interval (CI) 4.0–6.3]. A 10-fold decline in incidence was observed beginning in 1996, followed by a stable incidence rate after 2002. HAART regimens were associated with a 50% decrease (95% CI 14–71%) in the incidence of HIV encephalopathy compared with non-HAART regimens. High CNS-penetrating regimens were associated with a substantial survival benefit (74% reduction in the risk of death, 95% CI 39–89%) after HIV encephalopathy diagnosis compared with low CNS-penetrating regimens. Conclusion A dramatic decrease in the incidence of HIV encephalopathy occurred after the introduction of HAART. The use of HAART was highly effective in reducing the incidence of HIV encephalopathy among perinatally infected children and adolescents. Effective CNS-penetrating antiretroviral regimens are important in affecting survival after diagnosis of HIV encephalopathy. PMID:19644348

  14. Development and test of sets of 3D printed age-specific thyroid phantoms for 131I measurements.

    PubMed

    Beaumont, Tiffany Mélanie; Caldeira Ideias, Pedro; Rimlinger, Maeva; Broggio, David; Franck, Didier

    2017-03-07

    In the case of a nuclear reactor accident the release contains a high proportion of iodine-131 that can be inhaled or ingested by members of the public. Iodine-131 is naturally retained in the thyroid and increases the thyroid cancer risk. Since the radiation induced thyroid cancer risk is greater for children than for adults, the thyroid dose to children should be assessed as accurately as possible. For that purpose direct measurements should be carried out with age-specific calibration factors but, currently, there is no age-specific thyroid phantoms allowing a robust measurement protocol. A set of age-specific thyroid phantoms for 5, 10, 15 years old children and for the adult has been designed and 3D printed. A realistic thyroid shape has been selected and material properties taken into account to simulate the attenuation of biological tissues. The thyroid volumes follow ICRP recommendations and the phantoms also include the trachea and a spine model. Several versions, with or without spine, with our without trachea, with or without age-specific neck have been manufactured, in order to study the influence of these elements on calibration factors. The calibration factor obtained with the adult phantom and a reference phantom are in reasonable agreement. In vivo calibration experiments with germanium detectors have shown that the difference in counting efficiency, the inverse of the calibration factor, between the 5-years and adult phantoms is 25% for measurement at contact. It is also experimentally evidenced that the inverse of the calibration factor varies linearly with the thyroid volume. The influence of scattering elements like the neck or spine is not evidenced by experimental measurements.

  15. Using clinically acquired MRI to construct age-specific ADC atlases: Quantifying spatiotemporal ADC changes from birth to 6-year old.

    PubMed

    Ou, Yangming; Zöllei, Lilla; Retzepi, Kallirroi; Castro, Victor; Bates, Sara V; Pieper, Steve; Andriole, Katherine P; Murphy, Shawn N; Gollub, Randy L; Grant, Patricia Ellen

    2017-03-31

    Diffusion imaging is critical for detecting acute brain injury. However, normal apparent diffusion coefficient (ADC) maps change rapidly in early childhood, making abnormality detection difficult. In this article, we explored clinical PACS and electronic healthcare records (EHR) to create age-specific ADC atlases for clinical radiology reference. Using the EHR and three rounds of multiexpert reviews, we found ADC maps from 201 children 0-6 years of age scanned between 2006 and 2013 who had brain MRIs with no reported abnormalities and normal clinical evaluations 2+ years later. These images were grouped in 10 age bins, densely sampling the first 1 year of life (5 bins, including neonates and 4 quarters) and representing the 1-6 year age range (an age bin per year). Unbiased group-wise registration was used to construct ADC atlases for 10 age bins. We used the atlases to quantify (a) cross-sectional normative ADC variations; (b) spatiotemporal heterogeneous ADC changes; and (c) spatiotemporal heterogeneous volumetric changes. The quantified age-specific whole-brain and region-wise ADC values were compared to those from age-matched individual subjects in our study and in multiple existing independent studies. The significance of this study is that we have shown that clinically acquired images can be used to construct normative age-specific atlases. These first of their kind age-specific normative ADC atlases quantitatively characterize changes of myelination-related water diffusion in the first 6 years of life. The quantified voxel-wise spatiotemporal ADC variations provide standard references to assist radiologists toward more objective interpretation of abnormalities in clinical images. Our atlases are available at https://www.nitrc.org/projects/mgh_adcatlases. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc.

  16. Major depressive disorder in the perinatal period: using data linkage to inform perinatal mental health policy.

    PubMed

    Xu, Fenglian; Austin, Marie-Paule; Reilly, Nicole; Hilder, Lisa; Sullivan, Elizabeth A

    2012-10-01

    This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period.

  17. Maternal Age-Specific Rates for Trisomy 21 and Common Autosomal Trisomies in Fetuses from a Single Diagnostic Center in Thailand

    PubMed Central

    Jaruthamsophon, Kanoot; Sriplung, Hutcha; Charalsawadi, Chariyawan

    2016-01-01

    To provide maternal age-specific rates for trisomy 21 (T21) and common autosomal trisomies (including trisomies 21, 18 and 13) in fetuses. We retrospectively reviewed prenatal cytogenetic results obtained between 1990 and 2009 in Songklanagarind Hospital, a university teaching hospital, in southern Thailand. Maternal age-specific rates of T21 and common autosomal trisomies were established using different regression models, from which only the fittest models were used for the study. A total of 17,819 records were included in the statistical analysis. The fittest models for predicting rates of T21 and common autosomal trisomies were regression models with 2 parameters (Age and Age2). The rate of T21 ranged between 2.67 per 1,000 fetuses at the age of 34 and 71.06 per 1,000 at the age of 48. The rate of common autosomal trisomies ranged between 4.54 per 1,000 and 99.65 per 1,000 at the same ages. This report provides the first maternal age-specific rates for T21 and common autosomal trisomies fetuses in a Southeast Asian population and the largest case number of fetuses have ever been reported in Asians. PMID:27812158

  18. Lifespan and Aggregate Size Variables in Specifications of Mortality or Survivorship

    PubMed Central

    Epelbaum, Michael

    2014-01-01

    A specification of mortality or survivorship provides respective explicit details about mortality's or survivorship's relationships with one or more other variables (e.g., age, sex, etc.). Previous studies have discovered and analyzed diverse specifications of mortality or survivorship; these discoveries and analyses suggest that additional specifications of mortality or survivorship have yet to be discovered and analyzed. In consistency with previous research, multivariable limited powered polynomials regression analyses of mortality and survivorship of selected humans (Swedes, 1760–2008) and selected insects (caged medflies) show age-specific, historical-time-specific, environmental-context-specific, and sex-specific mortality and survivorship. These analyses also present discoveries of hitherto unknown lifespan-specific, contemporary-aggregate-size-specific, and lifespan-aggregate-size-specific mortality and survivorship. The results of this investigation and results of previous research help identify variables for inclusion in regression models of mortality or survivorship. Moreover, these results and results of previous research strengthen the suggestion that additional specifications of mortality or survivorship have yet to be discovered and analyzed, and they also suggest that specifications of mortality and survivorship indicate corresponding specifications of frailty and vitality. Furthermore, the present analyses reveal the usefulness of a multivariable limited powered polynomials regression model-building approach. This article shows that much has yet to be learned about specifications of mortality or survivorship of diverse kinds of individuals in diverse times and places. PMID:24454719

  19. Variations in Multiple Birth Rates and Impact on Perinatal Outcomes in Europe

    PubMed Central

    Heino, Anna; Gissler, Mika; Hindori-Mohangoo, Ashna D.; Blondel, Béatrice; Klungsøyr, Kari; Verdenik, Ivan; Mierzejewska, Ewa; Velebil, Petr; Sól Ólafsdóttir, Helga; Macfarlane, Alison; Zeitlin, Jennifer

    2016-01-01

    Objective Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with random-effects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. Results In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1–9.8) of preterm birth (<37 weeks GA), an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0–12.4) of very preterm birth (<32 weeks GA). Pooled RR were 2.4 (95% Cl 1.5–3.6) for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1–8.0) for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8–20.2) versus 9.8% (95% Cl 9.6–11.0) for neonatal death and 29.6% (96% CI 28.5–30.6) versus 17.5% (95% CI 15.7–18.3) for very preterm births, respectively). Conclusions Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health. PMID:26930069

  20. Identifying Maternal Constraints on Fetal Growth and Subsequent Perinatal Outcomes Using a Multiple Embryo Implantation Model

    PubMed Central

    Cozzubbo, Tyler; Cheung, Stephanie; Rosenwaks, Zev; Neri, Queenie V.

    2016-01-01

    Introduction Although the majority of singleton births after in vitro fertilization (IVF) are uncomplicated, studies have suggested that IVF pregnancies may be independently associated with low birth weight (LBW), preterm birth (PTB), and perinatal mortality. These outcomes complicate multiple gestations as expected, but have also been reported in singletons. A multiple embryo implantation model allows for assessment of the early in utero environment, and therefore, assessment of any maternal constraints on developing fetuses. We question whether adverse perinatal outcomes associated with assisted reproductive techniques (ART) occur as a result of maternal physiologic adaptations. Patients and Methods This is a retrospective, single center study of ART cycles, specifically intracytoplasmic sperm injection (ICSI) cycles during a 16-year period. For each positive pregnancy test 9–11 days after embryo transfer, an ultrasonogram was performed at 7 weeks of gestation to record the number of implanted fetal poles with cardiac activity. Controlled ovarian stimulation (COS), hCG trigger, oocyte retrieval and sperm injection were performed as per our standard protocols. First trimester implantation sites that resulted in live births were defined as “true” to distinguish them from those that spontaneously reduced called “virtual.” Birth outcomes analyzed included birth weight and gestational age at delivery. Results A total of 17,415 cycles were analyzed. The average maternal age was 36.9 (±5.0) years. An overall fertilization rate of 73.4% generated approximately 48,708 good quality cleavage-stage embryos. In most patients (92.8%), an average of 3 embryos were transferred. The clinical pregnancy rate was 39.2% (n = 6,281). The overall occurrence of multiple gestations was 38.2% (n = 2,608) consisting of 2,038 twin, 511 triplet, and 59 quadruplet pregnancies. Of these multiple gestations, 18.6% of twin, 54.2% of triplet and 76.3% of quadruplet gestations

  1. Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates

    PubMed Central

    Orsolini, Laura; Valchera, Alessandro; Vecchiotti, Roberta; Tomasetti, Carmine; Iasevoli, Felice; Fornaro, Michele; De Berardis, Domenico; Perna, Giampaolo; Pompili, Maurizio; Bellantuono, Cesario

    2016-01-01

    Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide has been considered a relatively rare event during the perinatal period. However, in some mental disorders (i.e., postpartum depression, bipolar disorder, postpartum psychosis, etc.) have been reported a higher risk of suicidal ideation, suicide attempt, or suicide. Therefore, a complete screening of mothers’ mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors, and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk factors, and an overview about the main clinical correlates associated with the suicidal behavior during the pregnancy and postpartum period. Practical recommendations have been provided as well. PMID:27570512

  2. Perinatal Depression and Patterns of Attachment: A Critical Risk Factor?

    PubMed Central

    Meuti, Valentina; Aceti, Franca; Giacchetti, Nicoletta; Carluccio, Giuseppe Mattia; Zaccagni, Michela; Marini, Isabella; Giancola, Orazio; Ciolli, Paola; Biondi, Massimo

    2015-01-01

    Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Experience in Close Relationship (ECR). A clinical group of subjects with perinatal depression (PND, 89 subjects) was selected and compared with a control group (C), regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of “Fearful-Avoidant” attachment style in PND group (29.2% versus 1.1%, p < 0.001); additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety). Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention. PMID:26798510

  3. A systematic review of perinatal depression interventions for adolescent mothers.

    PubMed

    Lieberman, Kate; Le, Huynh-Nhu; Perry, Deborah F

    2014-12-01

    Poor, adolescent, racial/ethnic minority women are at great risk for developing perinatal depression. However, little research has been conducted evaluating interventions for this population. We conducted a systematic review of preventive and treatment interventions for perinatal depression tested with adolescents, with a focus on low income, minority populations. Nine research-based articles (including one that reported on two studies) were reviewed systematically, and quality ratings were assigned based on a validated measure assessing randomization, double-blinding, and reporting of participant withdrawals. Two treatment studies were identified, both of which were successful in reducing depression. Eight prevention studies were located, of which four were more efficacious than control conditions in preventing depression. Studies sampled mostly minority, low socioeconomic status adolescents. No consistent characteristics across efficacious interventions could be identified. This review underscores the need for researchers to further investigate and build an evidence base.

  4. Perinatal and Early Childhood Environmental Factors Influencing Allergic Asthma Immunopathogenesis

    PubMed Central

    Gaffin, Jonathan M.; Kanchongkittiphon, Watcharoot; Phipatanakul, Wanda

    2014-01-01

    Background The prevalence of asthma has increased dramatically over the past several decades. While hereditary factors are highly important, the rapid rise outstrips the pace of genomic variation. Great emphasis has been placed on potential modifiable early life exposures leading to childhood asthma. Methods We reviewed the recent medical literature for important studies discussing the role of the perinatal and early childhood exposures and the inception of childhood asthma. Results and Discussion Early life exposure to allergens (House dust mite (HDM), furred pets, cockroach, rodent and mold)air pollution (nitrogen dioxide (NO2), ozone (O3), volatile organic compounds (VOCs), and particulate matter (PM)) and viral respiratory tract infections (Respiratory syncytial virus (RSV) and human rhinovirus (hRV)) have been implicated in the development of asthma in high risk children. Conversely, exposure to microbial diversity in the perinatal period may diminish the development of atopy and asthma symptoms. PMID:24952205

  5. Building Perinatal Case Manager Capacity Using Quality Improvement.

    PubMed

    Fitzgerald, Elaine

    2015-01-01

    Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.

  6. Perinatal Education and Support Program: Baystate’s New Beginnings

    PubMed Central

    Congden, Kimberly A.

    2016-01-01

    ABSTRACT Parent education traditionally focuses on childbirth, whereas the perinatal period gets little attention despite parents’ reports of feeling unprepared. Lack of education surrounding newborn behavior leads to decreased maternal confidence and ineffective responsiveness to infant cues for feeding, crying, and sleep. This can cause overfeeding, lowered breastfeeding success, and contributes to parental stress which can impact maternal–infant bonding. Lack of postpartum maternal support adds to fatigue and stress which contributes to poor maternal well-being. This article describes an innovative perinatal program, Baystate’s New Beginnings, modeled after the education from the 2011 California Baby Behavior Campaign and The Secrets of Baby Behavior that combines newborn behavior education and maternal support in the first 3 months postpartum to improve maternal role transition. PMID:27445447

  7. Prenatal and Perinatal Risk Factors for Autism in China

    PubMed Central

    Zhang, Xin; Lv, Cong-Chao; Tian, Jiang; Miao, Ru-Juan; Xi, Wei; Hertz-Picciotto, Irva

    2010-01-01

    We conducted a case–control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted analyses identified seven prenatal and seven perinatal risk factors significantly associated with autism. In the adjusted analysis, nine risk factors showed significant association with autism: maternal second-hand smoke exposure, maternal chronic or acute medical conditions unrelated to pregnancy, maternal unhappy emotional state, gestational complications, edema, abnormal gestational age (<35 or >42 weeks), nuchal cord, gravidity >1, and advanced paternal age at delivery (>30 year-old). PMID:20358271

  8. Adverse Trends in Ischemic Heart Disease Mortality among Young New Yorkers, Particularly Young Black Women

    PubMed Central

    Smilowitz, Nathaniel R.; Maduro, Gil A.; Lobach, Iryna V.; Chen, Yu; Reynolds, Harmony R.

    2016-01-01

    Background Ischemic heart disease (IHD) mortality has been on the decline in the United States for decades. However, declines in IHD mortality have been slower in certain groups, including young women and black individuals. Hypothesis Trends in IHD vary by age, sex, and race in New York City (NYC). Young female minorities are a vulnerable group that may warrant renewed efforts to reduce IHD. Methods IHD mortality trends were assessed in NYC 1980–2008. NYC Vital Statistics data were obtained for analysis. Age-specific IHD mortality rates and confidence bounds were estimated. Trends in IHD mortality were compared by age and race/ethnicity using linear regression of log-transformed mortality rates. Rates and trends in IHD mortality rates were compared between subgroups defined by age, sex and race/ethnicity. Results The decline in IHD mortality rates slowed in 1999 among individuals aged 35–54 years but not ≥55. IHD mortality rates were higher among young men than women age 35–54, but annual declines in IHD mortality were slower for women. Black women age 35–54 had higher IHD mortality rates and slower declines in IHD mortality than women of other race/ethnicity groups. IHD mortality trends were similar in black and white men age 35–54. Conclusions The decline in IHD mortality rates has slowed in recent years among younger, but not older, individuals in NYC. There was an association between sex and race/ethnicity on IHD mortality rates and trends. Young black women may benefit from targeted medical and public health interventions to reduce IHD mortality. PMID:26882207

  9. Short and long term prognosis in perinatal asphyxia: An update

    PubMed Central

    Ahearne, Caroline E; Boylan, Geraldine B; Murray, Deirdre M

    2016-01-01

    Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy (NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy (HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and long-term outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing

  10. Perinatal Loss: The Effect on Attachment in Subsequent Pregnancies

    DTIC Science & Technology

    1989-01-01

    attachment, during subsequent pregnancies, between mothers who had experienced a previous perinatal loss and those who had not. A Likert Scale was used to...immediate postpartum period which effect attachment to the fetus and later to the infant? Are there key concerns/issues particular to these mothers...the main point behind encouraging bonding immedately during the postpartum period regardless of whether or not the baby lives. With resolution mothers

  11. Maternal Factors Influencing Perinatal Transmission of HIV Infection

    DTIC Science & Technology

    1990-01-01

    tested for 28. HIV. If yes, specify sex, age and result * PAST HEALTH HISTORY 1 - yes 2 - no 3 - not applicable 29. Heart Disease 29. 30. Lung...been reported to the Centers for Disease Control and it is now estimated that between 945,000 and 1.4 million persons in the United States are infected...HIV disease progression during pregnancy is uncommon. Perinatal transmission represents the primary route of HIV infection for children. Over 80% of all

  12. Nitrotyrosine in brain tissue of neonates after perinatal asphyxia

    PubMed Central

    Groenendaal, F; Lammers, H; Smit, D; Nikkels, P G J

    2006-01-01

    Hypothesis Nitrotyrosine, a reaction product of peroxynitrite and proteins, could be demonstrated in the postmortem examination of brain tissue of full‐term neonates who had severe perinatal asphyxia. Methods The brain tissue of 22 full‐term neonates who died after severe perinatal asphyxia was examined, including cerebral cortex, basal ganglia, thalamus, hippocampus, brain stem, olives and cerebellum. Median age at death was 52 h. Routine histopathological examination and additional immunohistological staining were carried out with anti‐cysteine protease protein 32 antibodies to detect activated caspase 3, anti‐nitrotyrosine antibodies to detect nitrotyrosine and anti‐CD68 antibodies to detect activated microglia and macrophages, which might be associated with the production of nitric oxide. Staining was scored as none, weak (1–25% positive cells), moderate (26–75% positive cells) or severe (>75% positive cells). Results 14 patients showed global injury, 4 showed injury of the basal ganglia and thalamus, and 4 showed predominantly parasagittal brain injury. One neonate without perinatal asphyxia served as a control. Nitrotyrosine staining of neurones was shown in all neonates with asphyxia, mostly in the thalamus (70%) and inferior olives (68%). Total nitrotyrosine staining tended to be less in the base of the pons and inferior olives of neonates with parasagittal brain injury. Activated caspase 3 was found mostly in the thalamus (60%) and hippocampus (53%). Positive CD68 staining was mainly present in the thalamus (70% positive). Conclusion Nitrotyrosine was found in brain tissue of full‐term neonates, suggesting that nitric oxide toxicity might have a role in hypoxic–ischaemic brain injury at term. This may be relevant for neuroprotective strategies in full‐term neonates with perinatal asphyxia. PMID:16835259

  13. Sustainability of improvements in perinatal teamwork and safety climate.

    PubMed

    Budin, Wendy C; Gennaro, Susan; OʼConnor, Caitlin; Contratti, Flavia

    2014-01-01

    The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.

  14. Piloting the perinatal obsessive-compulsive scale (POCS): development and validation.

    PubMed

    Lord, Catherine; Rieder, Amber; Hall, Geoffrey B C; Soares, Claudio N; Steiner, Meir

    2011-12-01

    Onset/worsening of obsessive-compulsive disorder (OCD) during the perinatal period are frequently seen clinically. No specific tool assessing the unique content, context, severity, and onset of perinatal OCD exists. A self-report scale of perinatal obsessions and compulsions, the Perinatal Obsessive-Compulsive Scale (POCS), was developed and validated. A total of 162 women (67 pregnant, 95 postpartum) participated in this pilot study. They completed the POCS as well as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The POCS has good construct validity, reflected by representative items, high internal consistency, good concurrent validity and discriminative capacity. The most common obsessions were fear of having an unhealthy baby at birth, contamination, the baby being taken away, and infant death. Behavioral compulsions such as repeating rituals, asking for reassurance, checking, and cleaning mirrored these obsessions. The POCS helps clinicians detect perinatal OCD while giving perinatal women an opportunity to openly discuss socially sensitive issues.

  15. Perinatal data collection: current practice in the Australian nursing and midwifery healthcare context.

    PubMed

    Craswell, Alison; Moxham, Lorna; Broadbent, Marc

    2013-01-01

    The collection of perinatal data within Queensland, Australia, has traditionally been achieved via a paper form completed by midwives after each birth. Recently, with an increase in the use of e-health systems in healthcare, perinatal data collection has migrated to an online system. It is suggested that this move from paper to an ehealth platform has resulted in improvement to error rates, completion levels, timeliness of data transfer from healthcare institutions to the perinatal data collection and subsequent publication of data items. Worldwide, perinatal data are collected utilising a variety of methods, but essentially data are used for similar purposes: to monitor outcome patterns within obstetrics and midwifery. This paper discusses current practice in relation to perinatal data collection worldwide and within Australia, with a specific focus on Queensland, highlights relevant issues for midwives, and points to the need for further research into the efficient use of an e-health platform for perinatal data collection.

  16. Antiretroviral prophylaxis of perinatal HIV-1 transmission and the potential impact of antiretroviral resistance.

    PubMed

    Nolan, Monica; Fowler, Mary Glenn; Mofenson, Lynne M

    2002-06-01

    Since 1994, trials of zidovudine, zidovudine and lamivudine, and nevirapine have demonstrated that these antiretroviral drugs can substantially reduce the risk of perinatal HIV-1 transmission. With reductions in drug price, identification of simple, effective antiretroviral regimens to prevent perinatal HIV-1 transmission, and an increasing international commitment to support health care infrastructure, antiretrovirals for both perinatal HIV-1 prevention and HIV-1 treatment will likely become more widely available to HIV-1-infected persons in resource-limited countries. In the United States, widespread antiretroviral usage has been associated with increased antiretroviral drug resistance. This raises concern that drug resistance may reduce the effectiveness of perinatal antiretroviral prophylaxis as well as therapeutic intervention strategies. The purpose of this article is to review what is known about resistance and risk of perinatal HIV transmission, assess the interaction between antiretroviral resistance and the prevention of perinatal HIV-1 transmission, and discuss implications for current global prevention and treatment strategies.

  17. Low income, unemployment, and suicide mortality rates for middle-age persons in Japan.

    PubMed

    Yamasaki, Akiko; Sakai, Ryoji; Shirakawa, Taro

    2005-04-01

    The relationships between age-specific suicide mortality rates and social life factors for all 47 Japanese prefectures in 1980, 1985, and 1990 were assessed by multiple regression analysis after factor analysis on 20 social life indicators. During this period, Japan experienced a secondary oil crisis in 1980-1983 and a bubble economy in 1986-1990. It was concluded that (1) low income was the major determinant which positively affected suicide mortality rate in middle-aged men during a previous 20-yr. period (1970-1990), (2) urbanization was negatively associated with male suicide mortality rates in most of the age classes in the 1980s, (3) unemployment was one of the major determinants of increased suicide mortality rate in middle-age men in the 1980s, and (4) unemployment was the major factor which was inversely associated with suicide mortality rate for elderly women from 1980 to 1990 in Japan.

  18. Understanding racial and ethnic disparities in U.S. infant mortality rates.

    PubMed

    MacDorman, Marian F; Mathews, T J

    2011-09-01

    In the United States, different racial and ethnic groups have very different infant mortality patterns. When assessing the relative contribution of the percentage of preterm births and gestational age-specific infant mortality rates to racial and ethnic infant mortality differences, we found that for non-Hispanic black women, 78 percent of their elevated infant mortality rate compared with non-Hispanic white women was due to their higher percentage of preterm births, while 22 percent was due to higher gestational age-specific infant mortality rates (primarily at 34 weeks of gestation or more). For Puerto Rican women, their elevated infant mortality rate compared with non-Hispanic white women was entirely due to their higher percentage of preterm births. However, AIAN women had a very different infant mortality pattern: 76 percent of their higher infant mortality rate compared with non-Hispanic white women was due to their higher gestational age-specific infant mortality rates (primarily at 34 weeks or more), and only 24 percent was due to their higher percentage of preterm births.These findings are consistent with the cause-of-death analysis, which found that for bothnon-Hispanic black and Puerto Rican women, most of their higher infant mortality rate compared with non-Hispanic white women was due to preterm-related causes. In contrast, for AIAN women, the infant mortality rate from SIDS was 2.4 times, and the rate from unintentional injuries was 2.3 times, the non-Hispanic white rate. Infant mortality rates for non-Hispanic black women would be reduced by 71 percent, those for AIAN women by 64 percent, and those for Puerto Rican women by 67 percent if rates from preterm-related causes, congenital malformations, SIDS, and unintentional injuries could be reduced to non-Hispanic white levels.The different infant mortality patterns for non-Hispanic black, Puerto Rican, and AIAN women suggest different prevention strategies (6,7). In addition, because the percentage of

  19. Experimental models of perinatal hypoxic-ischemic brain damage.

    PubMed

    Vannucci, R C

    1993-01-01

    Animal research has provided important information on the pathogenesis of and neuropathologic responses to perinatal cerebral hypoxia-ischemia. In experimental animals, structural brain damage from hypoxia-ischemia has been produced in immature rats, rabbits, guinea pigs, sheep and monkeys (18, 20, 24, 25, 38). Of the several available animal models, the fetal and newborn rhesus monkey and immature rat have been studied most extensively because of their similarities to humans in respect to the physiology of reproduction and their neuroanatomy at or shortly following birth. Given the frequency of occurrence of human perinatal hypoxic-ischemic brain damage and the multiple, often severe neurologic handicaps which ensue in infants and children, it is not surprising that the above described animal models have been developed. These models have provided the basis for investigations to clarify not only physiologic and biochemical mechanisms of tissue injury but also the efficacy of specific management strategies. Hopefully, such animal research will continue to provide important information regarding how best to prevent or minimize the devastating consequences of perinatal cerebral hypoxia-ischemia.

  20. Infertility and Perinatal Loss: When the Bough Breaks.

    PubMed

    Bhat, Amritha; Byatt, Nancy

    2016-03-01

    Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and post-traumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy.

  1. Aquaporin7 expression during perinatal development of mouse brain.

    PubMed

    Shin, Incheol; Kim, Hyun J; Lee, Jae E; Gye, Myung C

    2006-12-01

    Emerging evidence suggests that brain aquaporins (AQPs) play important roles in the dynamic regulation of brain water homeostasis and the production of cerebrospinal fluid (CSF) under normal, as well as pathological, conditions. To date, the spatiotemporal expression patterns of AQP1, 4, and 9 have been elucidated in brain tissues. However, the expression of AQP7, an aquaglyceroporin associated with brain development, has not been shown. In the present study, we examined expression of AQP7 during perinatal and adult brain development in the mouse. Throughout brain development, the immunoreactivity of AQP7 was largely found in the choroid plexus (CP). AQP7 immunoreactivity in ependyma (Ep), pia, and blood vessels (BV) was increased during perinatal to postnatal development. Cells in the different layers of cerebral cortex became a little positive for AQP7 immunoreactivity during postnatal development. Optimized semi-quantitative RT-PCR and Western blot analysis revealed that AQP7 mRNA and protein levels increased during perinatal development of brain. To our knowledge, this is the first report on the pattern of AQP7 expression in brain tissues. These results suggest that AQP7 is an important structural element in the choroid plexus and is possibly involved in the production of CSF during brain development in mice.

  2. Gestational Weight Gain in Japanese Women With Favorable Perinatal Outcomes

    PubMed Central

    Suzuki, Shunji

    2017-01-01

    Background We examined the optimal gestational weight gain (GWG) in the healthy Japanese women with favorable perinatal outcomes of singleton pregnancy. Methods We calculated the average GWG in the women whose height was 150 - 164 cm with favorable perinatal outcomes set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index categories according to the Institute of Medicine guideline. Results The average GWG in the normal-weight women with the favorable perinatal outcomes was 11.4 ± 3.7 kg. It was not significantly different from that in the underweight and overweight women (12.0 ± 3.4 and 10.0 ± 4.8 kg) by Student’s t-test. The average GWG in the obese women was significantly lower than that in the other three groups (3.2 ± 2.2 kg, P < 0.01). Conclusion Based on the current results, the optimal GWG for the Japanese women without obesity was found to be 10 - 12 kg. PMID:27924177

  3. Timing of cardiomyocyte growth, maturation, and attrition in perinatal sheep

    PubMed Central

    Jonker, Sonnet S.; Louey, Samantha; Giraud, George D.; Thornburg, Kent L.; Faber, J. Job

    2015-01-01

    Studies in altricial rodents attribute dramatic changes in perinatal cardiomyocyte growth, maturation, and attrition to stimuli associated with birth. Our purpose was to determine whether birth is a critical trigger controlling perinatal cardiomyocyte growth, maturation and attrition in a precocial large mammal, sheep (Ovis aries). Hearts from 0–61 d postnatal lambs were dissected or enzymatically dissociated. Cardiomyocytes were measured by micromorphometry, cell cycle activity assessed by immunohistochemistry, and nuclear number counted after DNA staining. Integration of this new data with published fetal data from our laboratory demonstrate that a newly appreciated >30% decrease in myocyte number occurred in the last 10 d of gestation (P < 0.0005) concomitant with an increase in cleaved poly (ADP-ribose) polymerase 1 (P < 0.05), indicative of apoptosis. Bisegmental linear regressions show that most changes in myocyte growth kinetics occur before birth (median = 15.2 d; P < 0.05). Right ventricular but not left ventricular cell number increases in the neonate, by 68% between birth and 60 d postnatal (P = 0.028). We conclude that in sheep few developmental changes in cardiomyocytes result from birth, excepting the different postnatal degrees of free wall hypertrophy between the ventricles. Furthermore, myocyte number is reduced in both ventricles immediately before term, but proliferation increases myocyte number in the neonatal right ventricle.—Jonker, S. S., Louey, S., Giraud, G. D., Thornburg, K. L., Faber, J. J. Timing of cardiomyocyte growth, maturation, and attrition in perinatal sheep. PMID:26139099

  4. The role of inflammation in perinatal brain injury

    PubMed Central

    Hagberg, Henrik; Mallard, Carina; Ferriero, Donna M.; Vannucci, Susan J.; Levison, Steven W.; Vexler, Zinaida S.; Gressens, Pierre

    2015-01-01

    Inflammation is increasingly recognized as being a critical contributor to both normal development and injury outcome in the immature brain. The focus of this Review is to highlight important differences in innate and adaptive immunity in immature versus adult brain, which support the notion that the consequences of inflammation will be entirely different depending on context and stage of CNS development. Perinatal brain injury can result from neonatal encephalopathy and perinatal arterial ischaemic stroke, usually at term, but also in preterm infants. Inflammation occurs before, during and after brain injury at term, and modulates vulnerability to and development of brain injury. Preterm birth, on the other hand, is often a result of exposure to inflammation at a very early developmental phase, which affects the brain not only during fetal life, but also over a protracted period of postnatal life in a neonatal intensive care setting, influencing critical phases of myelination and cortical plasticity. Neuroinflammation during the perinatal period can increase the risk of neurological and neuropsychiatric disease throughout childhood and adulthood, and is, therefore, of concern to the broader group of physicians who care for these individuals. PMID:25686754

  5. Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome

    PubMed Central

    2012-01-01

    Background Giant placental chorioangiomas have been associated with a number of severe fetal complications and high perinatal mortality. Case presentation We report a case of giant chorioangioma with fetal hydrops, additionally complicated by severe anemia, mild cardiomegaly with hyperdinamic heart circulation and maternal mirror syndrome. Intrauterine blood transfusion and amniodrainage was performed at 29 weeks. Worsening of the fetal and maternal condition prompted us to proceed with delivery at 29 + 5 weeks. The newborn died 3 hours later due to pulmonary hypoplasia and hemodynamic failure. Maternal course was favourable, mirror syndrome resolved in the second day and the patient was discharged four days following delivery. Conclusions In the case described here, fetal condition got worse despite of the anemia correction and amniodrainage. Our outcome raises the issue whether additional intrauterine clinical intervention, as intersticial laser, should have been performed to stop further deterioration of the fetal condition when progressive severe hydrops develops. PMID:22840187

  6. Breastfeeding and the risk for diarrhea morbidity and mortality

    PubMed Central

    2011-01-01

    Background Lack of exclusive breastfeeding among infants 0-5 months of age and no breastfeeding among children 6-23 months of age are associated with increased diarrhea morbidity and mortality in developing countries. We estimate the protective effects conferred by varying levels of breastfeeding exposure against diarrhea incidence, diarrhea prevalence, diarrhea mortality, all-cause mortality, and hospitalization for diarrhea illness. Methods We systematically reviewed all literature published from 1980 to 2009 assessing levels of suboptimal breastfeeding as a risk factor for selected diarrhea morbidity and mortality outcomes. We conducted random effects meta-analyses to generate pooled relative risks by outcome and age category. Results We found a large body of evidence for the protective effects of breastfeeding against diarrhea incidence, prevalence, hospitalizations, diarrhea mortality, and all-cause mortality. The results of random effects meta-analyses of eighteen included studies indicated varying degrees of protection across levels of breastfeeding exposure with the greatest protection conferred by exclusive breastfeeding among infants 0-5 months of age and by any breastfeeding among infants and young children 6-23 months of age. Specifically, not breastfeeding resulted in an excess risk of diarrhea mortality in comparison to exclusive breastfeeding among infants 0-5 months of age (RR: 10.52) and to any breastfeeding among children aged 6-23 months (RR: 2.18). Conclusions Our findings support the current WHO recommendation for exclusive breastfeeding during the first 6 months of life as a key child survival intervention. Our findings also highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and mortality throughout the first 2 years of life. PMID:21501432

  7. Mortality among professional drivers.

    PubMed

    Rafnsson, V; Gunnarsdóttir, H

    1991-10-01

    The mortality of truck drivers and taxi drivers was studied in Reykjavík. The national mortality rate was used for comparison, and the follow-up lasted until 1 December 1988. The 868 truck drivers (28,788.0 person-years) had an excess of lung cancer deaths [24 observed, 11.2 expected, standardized mortality ratio (SMR) 2.14], but fewer deaths than expected from respiratory diseases (15 observed versus 30.1 expected). The SMR from lung cancer did not steadily increase as the duration of employment increased, nor did it change with the length of follow-up. The SMR values did not deviate substantially from unity for the taxi drivers. Since the high mortality from lung cancer among the truck drivers did not seem to be due to their smoking habits, it might have been caused by one or more occupational factors, especially in light of this group's exposure to engine exhaust gases.

  8. Preventing infant and child morbidity and mortality due to maternal depression.

    PubMed

    Surkan, Pamela J; Patel, Shivani A; Rahman, Atif

    2016-10-01

    This review provides an overview of perinatal depression and its impacts on the health of mothers, their newborns, and young children in low- and middle-income countries (LMICs). We define and describe the urgency and scope of the problem of perinatal depression for mothers, while highlighting some specific issues such as suicidal ideation and decreased likelihood to seek health care. Pathways through which stress may link maternal depression to childhood growth and development (e.g., the hypo-pituitary axis) are discussed, followed by a summary of the adverse effects of depression on birth outcomes, parenting practices, and child growth and development. Although preliminary studies on the association between maternal depressive symptoms and maternal and child mortality exist, more research on these topics is needed. We describe the available interventions and suggest strategies to reduce maternal depressive symptoms in LMICs, including integration of services with existing primary health-care systems.

  9. Globalization and perinatal medicine--how do we respond?

    PubMed

    Kurjak, Asim; Di Renzo, Gian Carlo; Stanojevic, Milan

    2010-04-01

    Globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care. In this review, we will discuss some of the global problems facing modern perinatologists. Close to 1.5 billion people in the world, live in extreme poverty, a situation which is particularly stark in the developing world, where 80% of them live. Poor people have little or no access to qualified health services and education, and do not participate in the decisions critical to their day-to-day lives. Poverty cannot be defined solely in terms of lack of income. A person, a family, even a nation is not deemed poor only because of low economic resources. Little or no access to health services, lack of access to safe water and adequate nutrition, illiteracy or low educational level, and a distorted perception of rights and needs are also essential components of poverty. Expression of poverty in perinatal health care in developing countries are high maternal death and morbidity rates, huge perinatal and childhood losses, and high birth rates. There are good reasons to define it as a global tragedy in our time. Although the mankind has come quite far because the development of civilization and more advances in the health care were made during the past 100 years than in all previous human history, some inhabitants of our planet are not able to experience it. According to some data, every 3 s a newborn dies, and every minute a pregnant woman dies in the globalized world. All together over 10 million deaths every year, which indicates that health security is not strong enough. It is

  10. Lung cancer mortality among U. S. uranium miners: a reappraisal

    SciTech Connect

    Whittemore, A.S.; McMillan, A.

    1983-09-01

    This report examines lung cancer mortality among a cohort of white underground uranium miners in the Colorado plateau and is based on mortality follow-up through December 31, 1977. The analytic methods represent a miner's annual age-specific lung cancer mortality rate as the (unspecified) rate among nonsmoking men born at the same time and with no mining history, multiplied by the relative risk factor R. This factor depends on the miner's total exposures to radon daughters (in working level months (WLM) and to cigarettes (in packs), accumulated from start of exposure until 10 years before his current age. Among those examined, the relative risk function giving the highest likelihood of the data was R . (1 + 0.31 X 10(-/sup 2/) WLM)(1 + 0.51 X 10(-/sup 3/) packs). This multiplicative function specifies that ratios of mortality rates for miners versus nonminers with similar age and smoking characteristics do not depend on smoking status. By contrast, differences between miners' and nonminers' mortality rates are substantially higher for smokers than for nonsmokers. The data rejected (P . .01) several additive functions for R that specify relative risk as a sum of components due to radiation and to cigarette smoking. Cumulative exposures to both radiation and cigarettes gave better fits to the data than did average annual exposure rates. Age at start of underground mining had no effect on risk, after controlling for age at lung cancer death, year of birth, and cumulative radiation and smoking exposures.

  11. Weather-Related Mortality

    PubMed Central

    Anderson, Brooke G.; Bell, Michelle L.

    2012-01-01

    Background Many studies have linked weather to mortality; however, role of such critical factors as regional variation, susceptible populations, and acclimatization remain unresolved. Methods We applied time-series models to 107 US communities allowing a nonlinear relationship between temperature and mortality by using a 14-year dataset. Second-stage analysis was used to relate cold, heat, and heat wave effect estimates to community-specific variables. We considered exposure timeframe, susceptibility, age, cause of death, and confounding from pollutants. Heat waves were modeled with varying intensity and duration. Results Heat-related mortality was most associated with a shorter lag (average of same day and previous day), with an overall increase of 3.0% (95% posterior interval: 2.4%–3.6%) in mortality risk comparing the 99th and 90th percentile temperatures for the community. Cold-related mortality was most associated with a longer lag (average of current day up to 25 days previous), with a 4.2% (3.2%–5.3%) increase in risk comparing the first and 10th percentile temperatures for the community. Mortality risk increased with the intensity or duration of heat waves. Spatial heterogeneity in effects indicates that weather–mortality relationships from 1 community may not be applicable in another. Larger spatial heterogeneity for absolute temperature estimates (comparing risk at specific temperatures) than for relative temperature estimates (comparing risk at community-specific temperature percentiles) provides evidence for acclimatization. We identified susceptibility based on age, socioeconomic conditions, urbanicity, and central air conditioning. Conclusions Acclimatization, individual susceptibility, and community characteristics all affect heat-related effects on mortality. PMID:19194300

  12. Aging differently: diet- and sex-dependent late-life mortality patterns in Drosophila melanogaster.

    PubMed

    Zajitschek, Felix; Jin, Tuo; Colchero, Fernando; Maklakov, Alexei A

    2014-06-01

    Diet effects on age-dependent mortality patterns are well documented in a large number of animal species, but studies that look at the effects of nutrient availability on late-life mortality plateaus are lacking. Here, we focus on the effect of dietary protein content (low, intermediate, and high) on mortality trajectories in late life in the fruit fly Drosophila melanogaster. According to the two theories that are mainly implicated in explaining the deceleration of mortality rate in late life (the heterogeneity/frailty theory and the Hamiltonian theory), we predict, in general, the occurrence of late-life mortality deceleration under most circumstances, independent of sex and dietary regime. However, the heterogeneity theory of late life is more flexible in allowing no mortality deceleration to occur under certain circumstances compared with the Hamiltonian theory. We applied a novel statistical approach based on Bayesian inference of age-specific mortality rates and found a deceleration of late-life mortality rates on all diets in males but only on the intermediate (standard) diet in females. The difference in mortality rate deceleration between males and females on extreme diets suggests that the existence of mortality plateaus in late life is sex and diet dependent and, therefore, not a universal characteristic of large enough cohorts.

  13. Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013

    PubMed Central

    Wong, JY; Wu, P; Liao, Q; Lau, EH; Wu, JT; Fielding, R; Leung, GM

    2013-01-01

    Between 31 March and 21 April 2013, 102 laboratory-confirmed influenza A(H7N9) infections have been reported in six provinces of China. Using survey data on age-specific rates of exposure to live poultry in China, we estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages. Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date. PMID:23725807

  14. Bridging between professionals in perinatal care: towards shared care in the Netherlands.

    PubMed

    Posthumus, A G; Schölmerich, V L N; Waelput, A J M; Vos, A A; De Jong-Potjer, L C; Bakker, R; Bonsel, G J; Groenewegen, P; Steegers, E A P; Denktaş, S

    2013-12-01

    Relatively high perinatal mortality rates in the Netherlands have required a critical assessment of the national obstetric system. Policy evaluations emphasized the need for organizational improvement, in particular closer collaboration between community midwives and obstetric caregivers in hospitals. The leveled care system that is currently in place, in which professionals in midwifery and obstetrics work autonomously, does not fully meet the needs of pregnant women, especially women with an accumulation of non-medical risk factors. This article provides an overview of the advantages of greater interdisciplinary collaboration and the current policy developments in obstetric care in the Netherlands. In line with these developments we present a model for shared care embedded in local 'obstetric collaborations'. These collaborations are formed by obstetric caregivers of a single hospital and all surrounding community midwives. Through a broad literature search, practical elements from shared care approaches in other fields of medicine that would suit the Dutch obstetric system were selected. These elements, focusing on continuity of care, patient centeredness and interprofessional teamwork form a comprehensive model for a shared care approach. By means of this overview paper and the presented model, we add direction to the current policy debate on the development of obstetrics in the Netherlands. This model will be used as a starting point for the pilot-implementation of a shared care approach in the 'obstetric collaborations', using feedback from the field to further improve it.

  15. [Maternal and perinatal surgical complications in low platelet count for HELLP syndrome in severe preeclampsia-eclampsia in intensive care].

    PubMed

    Basavilvazo Rodríguez, Antonia; Pacheco Pérez, Claudia; Lemus Rocha, Roberto; Martínez Pérez, José Ma; Martínez Martínez, Armando; Hernández-Valencia, Marcelino

    2003-08-01

    The preeclampsia is the first cause of maternal morbility, with increase in the obstetric complications when it is associated to HELLP syndrome, for the low platelets that even involves to the neonate. This study was carried out in the patients accepted in the intensive Adults Cares Unit in the period of one year, surgical complications and the perinatal results were determined in women with low platelet count for HELLP syndrome in preeclampsia-eclampsia. Three groups were formed according to the platelets account and then were analyzed using chi square to determine association among these groups of patients, as well as mean and standard deviation (M +/- DE) to describe results. Forty patients were studied with low platelets by HELLP syndrome in preeclampsia-eclampsia, where the distribution for the group with platelets < 50,000 were 12 patients (30%), in the group among 51,000-100,000 of 18 cases (45%), and of 101,000-150,000 were of 10 cases (25%). The mean of gestas was of 2.3 +/- 1.2, more frequent delivery was for cesarean section in 39 cases (97.5%) and a single case for vaginal via (2.5%), a maternal death was presented (8.3%). The surgical reintervention was observed with more frequency in the group of < 50,000 platelets, the most frequent cause in these reinterventions was the hipovolemic shock. Also in this group the perinatal mortality was presented in 3 cases (25%) and the asphyxia at the birth with Apgar < 6 was presented in 5 cases (41.7%). A bigger morbility was observed inversely proportional to the account platelets, being the renal failure the cause most frequent of this morbility in the three groups. The low platelets account contribute in a direct way in the obstetric complications, since there are more surgical reinterventions, with bled in the transsurgical and increase in the days of intrahospitalary stay. Also with smaller account platelet, there are bigger prematural index, asphyxia and perinatal mortality in the newborn of mothers with

  16. Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France

    PubMed Central

    Blondel, Béatrice; Drewniak, Nicolas; Zeitlin, Jennifer

    2014-01-01

    Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001–08 by distance from mother’s municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5–45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome. PMID:24390464

  17. Legal abortion mortality.

    PubMed

    Kestelman, P

    1978-04-01

    Statistics on legal abortion in Britain between 1968-1974 are presented. There was a mortality rate of 10+ or -2 per 100,000 abortions: 27+ or -11 in 1968-1969, 12+ or -4 in 1970-1972, and 6+ or -3 in 1973-1974. Legal abortion mortality increased from 4+ or -3 when performed at gestation under 9 weeks to 5+ or -2 at 9-12 weeks, 13+ or -7 at 13-16 weeks, and 62+ or -33 at 17 weeks and over. The ratio was 11+ or -6 for women under 20 years of age, increasing to 5+ or -3 at age 20-29, 10+ or -6 at age 30-39, and 23+ or -19 at age 40 and over. The parity had little influence on abortion mortality, but the technique used had a great influence. Hysterotomy, hypertonic saline, and abortifacient paste were the most dangerous, in increasing order, with mortality rates of 39+ or -30, 106+ or -75, and 152+ or -89, respectively. The rates for aspiration and curretage were 4+ or -2 and 4+ or -3, respectively. There was a higher mortality risk with abortion with sterilization. The main causes of legal abortion mortality were infection, pulmonary embolism, and complications of general anesthesia. The high incidence of mortality associated with legal abortion in Britain is partially caused by: 1) high incidence of concurrent sterilization, 2) former use of dangerous techniques, 3) significant incidence of second trimester abortion, 4) routine use of general anesthesia, and 5) previous ill health of some of the women.

  18. The forms and fitness cost of senescence: age-specific recapture, survival, reproduction, and reproductive value in a wild bird population.

    PubMed

    Bouwhuis, Sandra; Choquet, Rémi; Sheldon, Ben C; Verhulst, Simon

    2012-01-01

    Longitudinal studies of senescence accumulate rapidly from natural populations. However, it is largely unknown whether different fitness components senesce in parallel, how reproductive and survival senescence contribute to declines in reproductive value, and how large the fitness cost of senescence is (the difference between the observed reproductive value and the hypothetical reproductive value, if senescence would not occur). We analyzed age-specific survival in great tits Parus major and combined our results with analyses of reproductive senescence to address these issues. Recapture probability of breeding females declined with age, suggesting age-specific increases in skipped or failed breeding and highlighting an important bias that studies of senescence in wild populations should incorporate. Survival probability also declined with age and in parallel with recruit production. Reproductive value decreased 87% between age 1 and age 9 but at a fitness cost of only 4%; the proportion of the contribution of reproductive senescence versus survival senescence to this cost was 0.7. For 11 other species, we estimated fitness costs of senescence of 6%-63% (average: birds, 9%; mammals, 42%), with relative contributions of reproductive senescence of 0.0-0.7 (average: birds, 0.4; mammals, 0.3). We suggest that understanding when and why reproductive and survival senescence differ will help in the identification of proximate mechanisms underlying variation in rates of senescence and its evolution.

  19. Cholesterol trials and mortality.

    PubMed

    Warren, John B; Dimmitt, Simon B; Stampfer, Hans G

    2016-07-01

    An overview of clinical trials can reveal a class effect on mortality that is not apparent from individual trials. Most large trials of lipid pharmacotherapy are not powered to detect differences in mortality and instead assess efficacy with composite cardiovascular endpoints. We illustrate the importance of all-cause mortality data by comparing survival in three different sets of the larger controlled lipid trials that underpin meta-analyses. These trials are for fibrates and statins. Fibrate treatment in five of the six main trials was associated with a decrease in survival, one fibrate trial showed a non-significant reduction in mortality that can be explained by a different target population. In secondary prevention, statin treatment increased survival in all five of the main trials, absolute mean increase ranged from 0.43% to 3.33%, the median change was 1.75%, which occurred in the largest trial. In primary prevention, statin treatment increased survival in six of the seven main trials, absolute mean change in survival ranged from -0.09% to 0.89%, median 0.49%. Composite safety endpoints are rare in these trials. The failure to address composite safety endpoints in most lipid trials precludes a balanced summary of risk-benefit when a composite has been used for efficacy. Class effects on survival provide informative summaries of the risk-benefit of lipid pharmacotherapy. We consider that the presentation of key mortality/survival data adds to existing meta-analyses to aid personal treatment decisions.

  20. The decrease in socioeconomic differences in mortality from 1920 to 2000 in the United States and England.

    PubMed

    Rothstein, William G

    2012-10-01

    This study found that the effect of socioeconomic status (SES) on mortality decreased steadily during the twentieth century. It examined trends in age-specific adult mortality rates for employed men and infants in a number of social classes based on occupation in England and Wales and for black, white, and immigrant nationality groups of men, women, and infants in the United States. Both countries experienced continuing decreases in mortality rates and narrowing of SES differences in mortality rates from 1920 to the end of the century. Most of the decrease and narrowing in England and Wales occurred before the establishment of the National Health Service and the unprecedented improvements in clinical and preventive medicine after midcentury. Current cancer mortality rates in both countries show no consistent relationship with SES. The very low mortality rates of some low SES immigrant nationality groups in the United States throughout the century demonstrate that other social factors can have a greater effect on health than SES.

  1. Neonatal mortality in Utah.

    PubMed

    Woolley, F R; Schuman, K L; Lyon, J L

    1982-09-01

    A cohort study of neonatal mortality (N = 106) in white singleton births (N = 14,486) in Utah for January-June 1975 was conducted. Using membership and activity in the Church of Jesus Christ of Latter-day Saints (LDS or Mormon) as a proxy for parental health practices, i.e., tobacco and alcohol abstinence, differential neonatal mortality rates were calculated. The influence of potential confounding factors was evaluated. Low activity LDS members were found to have an excess risk of neonatal death five times greater than high activity LDS, with an upper bound of a two-sided 95% confidence interval of 7.9. The data consistently indicate a lower neonatal mortality rate for active LDS members. Non-LDS were found to have a lower rate than either medium or low activity LDS.

  2. The mortality of companies

    PubMed Central

    Daepp, Madeleine I. G.; Hamilton, Marcus J.; West, Geoffrey B.; Bettencourt, Luís M. A.

    2015-01-01

    The firm is a fundamental economic unit of contemporary human societies. Studies on the general quantitative and statistical character of firms have produced mixed results regarding their lifespans and mortality. We examine a comprehensive database of more than 25 000 publicly traded North American companies, from 1950 to 2009, to derive the statistics of firm lifespans. Based on detailed survival analysis, we show that the mortality of publicly traded companies manifests an approximately constant hazard rate over long periods of observation. This regularity indicates that mortality rates are independent of a company's age. We show that the typical half-life of a publicly traded company is about a decade, regardless of business sector. Our results shed new light on the dynamics of births and deaths of publicly traded companies and identify some of the necessary ingredients of a general theory of firms. PMID:25833247

  3. Mortality scoring in ITU.

    PubMed

    Niewiński, Grzegorz; Kański, Andrzej

    2012-01-01

    Chronic shortage of ITU beds makes decisions on admission difficult and responsible. The use of computer-based mortality scoring should help in decision-making and for this purpose, a number of different scoring systems have been created; in principle, they should be easy to use, adaptable to all populations of patients and suitable for predicting the risk of mortality during both ITU and hospital stay. Most of existing scales and scoring systems were included in this review. They are frequently used in ITUs and become a necessary tool to describe ITU populations and to explain differences in mortality. As there are several pitfalls related to the interpretation of the numbers supplied by the systems, they should be used with the knowledge on the severity scoring science. Moreover, the cost and significant workload limit the use of scoring systems; in many cases an extra person has to be employed for collection and analysis of data only.

  4. Autoantibodies, mortality and ageing.

    PubMed

    Richaud-Patin, Y; Villa, A R

    1995-01-01

    Immunological failure may be the cause of predisposition to certain infections, neoplasms, and vascular diseases in adulthood. Mortality risks through life may reflect an undetermined number of causes. This study describes the prevalence of positivity of autoantibodies through life, along with general and specific mortality causes in three countries with different socioeconomic development (Guatemala, Mexico and the United States). Prevalence of autoantibodies by age was obtained from previous reports. In spite of having involved different ethnic groups, the observed trends in prevalence of autoantibodies, as well as mortality through life, showed a similar behavior. Thus, both the increase in autoantibody production and death risk as age rises, may share physiopathological phenomena related to the ageing process.

  5. Perinatal Outcomes in Pregnant Women Users of Illegal Drugs.

    PubMed

    Oliveira, Tenilson Amaral; Bersusa, Ana Aparecida Sanches; Santos, Tatiana Fiorelli Dos; Aquino, Márcia Maria Auxiliadora de; Mariani Neto, Corintio

    2016-04-01

    Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p < 0.001). Low birth weight (2,620 g versus 3,333 g on average, p < 0.001) and maternal syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs.

  6. Context Modulates Outcome of Perinatal Glucocorticoid Action in the Brain

    PubMed Central

    de Kloet, E. Ronald; Claessens, Sanne E. F.; Kentrop, Jiska

    2014-01-01

    Prematurely born infants may be at risk, because of inadequate maturation of tissues. If there are signs of preterm birth, it has become common practice therefore to treat either antenatally the mother or postnatally the infant with glucocorticoids to accelerate tissue development, particularly of the lung. However, this life-saving early glucocorticoid treatment was found to increase the risk of adverse outcome in later life. In one animal study, the authors reported a 25% shorter lifespan of rats treated as newborns with the synthetic glucocorticoid dexamethasone, but so far this finding has not been replicated. After a brief clinical introduction, we discuss studies in rodents designed to examine how perinatal glucocorticoid action affects the developing brain. It appears that the perinatal action of the glucocorticoid depends on the context and the timing as well as the type of administered steroid. The type of steroid is important because the endogenous glucocorticoids cortisol and corticosterone bind to two distinct receptor populations, i.e., mineralocorticoid and glucocorticoid receptors (GR), while synthetic glucocorticoids predominantly bind to the GR. In addition, if given antenatally hydrocortisone is inactivated in the placenta by 11β-HSD type 2, and dexamethasone is not. With respect to timing, the outcome of glucocorticoid effects is different in early vs. late phases of brain development. The context refers to the environmental input that can affect the susceptibility to glucocorticoid action in the newborn rodent brain; early handling of pups and maternal care obliterate effects of post-natal dexamethasone treatment. Context also refers to coping with environmental conditions in later life, for which the individual may have been programed epigenetically by early-life experience. This knowledge of determinants affecting the outcome of perinatal glucocorticoid exposure may have clinical implications for the treatment of prematurely born infants

  7. Perinatal exposure to polychlorinated biphenyls alters social behaviors in rats

    PubMed Central

    Jolous-Jamshidi, Banafsheh; Cromwell, Howard C.; McFarland, Ashley M.; Meserve, Lee A.

    2014-01-01

    Perinatal exposure to polychlorinated biphenyls (PCBs) leads to significant alterations of neural and hormonal systems. These alterations have been shown to impair motor and sensory development. Less is known about the influence of PCB exposure on developing emotional and motivational systems involved in social interactions and social learning. The present study examined the impact of perinatal PCB exposure (mixture of congeners 47 and 77) on social recognition in juvenile animals, conspecific-directed investigation in adults and on neural and hormonal systems involved in social functions. We used a standard habituation–dishabituation paradigm to evaluate juvenile recognition and a social port paradigm to monitor adult social investigation. Areal measures of the periventricular nucleus (PVN) of the hypothalamus were obtained to provide correlations with related hormone and brain systems. PCB exposed rats were significantly impaired in social recognition as indicated by persistent conspecific-directed exploration by juvenile animals regardless of social experience. As adults, PCB exposure led to a dampening of the isolation-induced enhancement of social investigation. There was not a concomitant alteration of social investigation in pair-housed PCB exposed animals at this stage of development. Interestingly, PVN area was significantly decreased in juvenile animals exposed to PCB during the perinatal period. Shifts in hypothalamic regulation of hormones involved in social behavior and stress could be involved in the behavioral changes observed. Overall, the results suggest that PCB exposure impairs context or experience-dependent modulation of social approach and investigation. These types of social-context deficits are similar to behavioral deficits observed in social disorders such as autism and other pervasive developmental disorders. PMID:20813172

  8. Maternal Stress and Emotional Status during the Perinatal Period and Childhood Adjustment

    ERIC Educational Resources Information Center

    Anhalt, Karla; Telzrow, Cathy F.; Brown, Courtney L.

    2007-01-01

    An emerging literature suggests that maternal distress during the prenatal and perinatal period may adversely affect offspring development. The association between maternal stress and emotional status in the perinatal period (defined as 1 month after birth) and adjustment of first-grade children was examined in 948 mother-child dyads from the…

  9. PREGNANCY AND PERINATAL HEALTH, INNER MONGOLIA, CHINA, DECEMBER 1996-DECEMBER 1999

    EPA Science Inventory

    Pregnancy and Perinatal Health, Inner Mongolia, China, December 1996- December 1999
    Subtitle: Pregnancy and Perinatal Health, Inner Mongolia, China
    Authors: Z. Liu1, D.T. Lobdell2, L. He1, M. Yang1, R. Kwok2, J. Mumford2
    Affiliations:
    1 Ba Men Anti-Epidemic Station, ...

  10. Marketing and Quality of Life: A Model for Improving Perinatal Health Status

    ERIC Educational Resources Information Center

    Dever, G. E. Alan; Smith, Leah T.; Stamps, Bunnie V.

    2005-01-01

    Introduction: A marketing/business model using non-traditional Quality of Life measures was developed to assess perinatal health status on a micro-geographic level. This perinatal health status needs assessment study for Georgia South Central Region was conducted for the years 1994-1999. The model may be applied to any geographic unit in the…

  11. Perinatal Factors, Parenting Behavior, and Reactive Aggression: Does Cortisol Reactivity Mediate This Developmental Risk Process?

    ERIC Educational Resources Information Center

    Ryan, Stacy R.; Schechter, Julia C.; Brennan, Patricia A.

    2012-01-01

    Little is known about the mechanisms of action that link perinatal risk and the development of aggressive behavior. The aim of this study was to examine whether perinatal risk and parenting interacted to specifically predict reactive aggression, as opposed to general aggressive behavior, and to examine cortisol reactivity as a mediator of this…

  12. Evaluation of Clinical Diagnosis of Fetal Distress and Perinatal Outcome in a Low Resource Nigerian Setting

    PubMed Central

    Ibekwe, Perpetus Chudi; Onu, Fidelis Agwu; Onwe, Ogah Emeka; Ezeonu, Thecla Chinonyelum; Omeje, Innocent

    2016-01-01

    Introduction Fetal distress has been shown to contribute to the increasing caesarean section rate. There has been controversy on the usefulness of clinical diagnosis of fetal distress using only the intermittent counting of the fetal heart rate and/or passage of meconium-stained liquor. Aim To evaluate the clinical diagnosis of fetal distress and the perinatal outcome. Materials and Methods This was a retrospective study in which the case records of the patients, who were diagnosed of fetal distress at Federal Teaching Hospital, Abakaliki, Nigeria, from January 1, 2008 to December 31, 2014, were collated. The statistical analysis was done using the Statistical Package for Social Sciences version 17 software (SPSS Inc., Chicago IL, USA). Results Out of the 15,640 deliveries carried out within the study period, 3,761 (24.05%) deliveries were through caesarean section. A total of 326 (8.9%) of the 3,761 caesarean sections were due to fetal distress within the study period. More so, a total of 227 (70.9%) babies were born with ≥ 7 Apgar score at the 1st minute of delivery. The perinatal mortality rate was 31.25 per 1000 deliveries. Though birth asphyxia was recorded more on babies of mothers that had fresh meconium-stained liquor and whose decision-intervention interval was more than 30 minutes when compared with those without any of the two conditions, there was no statistical significant difference between them. Conclusion The clinical diagnosis of fetal distress is accurate in 29.1% of the cases. However, it has led to an unnecessary caesarean section in the remaining 70.9% of the parturients. In order to reduce this high trend of unnecessary caesarean sections due to clinical diagnosis of fetal distress in this environment, antepartum fetal assessment with non-stress test or biophysical profile and intrapartum use of continuous electronic fetal monitoring should be used to confirm or refute the fetal distress before any surgical intervention. Fetal blood sampling

  13. Income inequality and mortality in metropolitan areas of the United States.

    PubMed Central

    Lynch, J W; Kaplan, G A; Pamuk, E R; Cohen, R D; Heck, K E; Balfour, J L; Yen, I H

    1998-01-01

    OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority. Images FIGURE 1 PMID:9663157

  14. Injury mortality in New Mexico's American Indians, Hispanics, and non-Hispanic whites, 1958 to 1982.

    PubMed Central

    Sewell, C M; Becker, T M; Wiggins, C L; Key, C R; Hull, H F; Samet, J M

    1989-01-01

    New Mexico has extraordinarily high injury mortality rates. To better characterize the injury problem in New Mexico, we calculated proportionate injury mortality and age-adjusted and age-specific injury mortality rates for the state's 3 major ethnic groups--American Indians, Hispanics, and non-Hispanic whites. According to death certificate data collected from 1958 to 1982 and US population census figures, age-adjusted mortality rates for total external causes varied widely between the sexes and among the ethnic groups. Males in each ethnic group consistently had higher average annual age-adjusted external mortality rates than females. Injury mortality rates for American Indians of both sexes were 2 to 3 times higher than those for the other New Mexico ethnic groups. Motor vehicle crashes were the leading cause of death from injury for all 3 groups. Homicide accounted for twice the proportion of injury death in Hispanic compared with non-Hispanic white males (12.5% and 6.1%, respectively), while the proportion of males dying of suicide was highest in non-Hispanic whites. Deaths from excessive cold and exposure were leading causes of injury mortality for American Indians, but these causes were not among the leading causes of injury mortality for Hispanics or non-Hispanic whites. We conclude that the minority populations in New Mexico are at high risk for injury-related death and that the major causes of injury mortality vary substantially in the state's predominant ethnic populations. Images PMID:2750163

  15. [Maternal mortality and impact of dengue in Southeast Brazil: an ecological study, 2001-2005].

    PubMed

    Mota, Anne Karin Madureira da; Miranda Filho, Adalberto Luiz; Saraceni, Valéria; Koifman, Sergio

    2012-06-01

    The aim of this study was to explore the distribution of reproductive outcomes following dengue virus infection during pregnancy (2001-2005). An ecological epidemiological study was conducted in all counties with more than 80,000 inhabitants in Southeast Brazil. The study explored the correlation between dengue incidence rates in women 15-39 years of age and selected mortality indicators (maternal, fetal, perinatal, neonatal, early neonatal, and infant) in these counties, and Spearman correlation coefficients were calculated. A positive correlation was observed between median dengue incidence in women 15-39 years of age and median maternal mortality (r = 0.88; 95%CI: 0.51; 1.00), with a determination coefficient R² = 0.78. The correlation between dengue incidence in childbearing-age women and reproductive outcomes in Southeast Brazil suggests that dengue infection during pregnancy can negatively impact its outcome and increase maternal mortality.

  16. Perinatal and Delivery Management of Infants with Congenital Heart Disease.

    PubMed

    Sanapo, Laura; Moon-Grady, Anita J; Donofrio, Mary T

    2016-03-01

    Advances in fetal echocardiography have improved prenatal diagnosis of congenital heart disease (CHD) and allowed better delivery and perinatal management. Some newborns with CHD require urgent intervention after delivery. In these cases, delivery close to a pediatric cardiac center may be considered, and the presence of a specialized cardiac team in the delivery room or urgent transport of the infant should be planned in advance. Delivery planning, monitoring in labor, rapid intervention at birth if needed, and avoidance of iatrogenic preterm delivery have the potential to improve outcomes for infants with prenatally diagnosed CHD.

  17. Clinics in diagnostic imaging (112). Perinatal lethal hypophosphatasia (PLH).

    PubMed

    Kritsaneepaiboon, S; Jaruratanasirikul, S; Dissaneevate, S

    2006-11-01

    A two-hour-old female infant presented with respiratory distress and short limbs. Neonatal radiographs showed micromelic dwarfism and generalised demineralisation, especially at the ribs, long bones of both forearms and both fibulae. The spine showed a flattened shape. All long bones showed metaphyseal irregularities and flaring. Normal serum calcium and elevated serum phosphorus were found, while serum alkaline phosphatase was markedly reduced. A diagnosis of perinatal lethal hypophosphatasia was made. The aetiology, clinical manifestations, radiographical findings, laboratory assays, prenatal diagnosis and treatment of hypophosphatasia are discussed.

  18. Perinatal lethal type II osteogenesis imperfecta: a case report.

    PubMed

    Ayadi, Imene Dahmane; Hamida, Emira Ben; Rebeh, Rania Ben; Chaouachi, Sihem; Marrakchi, Zahra

    2015-01-01

    We report a new case of osteogenesis imperfecta (OI) type II which is a perinatal lethal form. First trimester ultrasound didn't identified abnormalities. Second trimester ultrasound showed incurved limbs, narrow chest, with hypomineralization and multiple fractures of ribs and long bones. Parents refused pregnancy termination; they felt that the diagnosis was late. At birth, the newborn presented immediate respiratory distress. Postnatal examination and bone radiography confirmed the diagnosis of OI type IIA. Death occurred on day 25 of life related to respiratory failure.

  19. An Emerging Best Practice Model for Perinatal Depression Care

    PubMed Central

    Sit, Dorothy K. Y.; Flint, Cheryl; Svidergol, Donald; White, Joanne; Wimer, Michelle; Bish, Bettina; Wisner, Katherine L.

    2009-01-01

    Perinatal depression is a significant health problem, especially among inner-city women. The authors explored the feasibility of an innovative model that integrated depression screening and treatment within an agency for maternal-child health. The team conducted depression screening with the Edinburgh Postnatal Depression Scale; they confirmed the primary diagnosis with the PRIME-MD instrument for 29 women with positive screens. Most participants had moderate or severe major depressive disorder. Women contended with multiple treatment barriers. Colocated depression care was highly acceptable and enabled evidence-based care delivery for at-risk mothers. PMID:19880455

  20. [Perinatal HIV transmission prophylaxis in the Liege region].

    PubMed

    Jacquet, Y; Hoyoux, C; Dresse, M F

    1998-08-01

    In Liège, since February 1994, Protocole ACTG 076 has been followed for prevention of perinatal transmission of VIH. The pregnant women are treated by AZT during pregnancy and delivery. The newborn is also treated during 6 weeks. Following this treatment strategy, vertical transmission rate of VIH has dropped from 25.6% to 8.7%. The PCR is particulary promising for the early detection of infection in newborn, but definitive conclusion about infective status of the newborn can't be done during the first week of life. The potential role of intrapartum transmission is now under evaluation in the hope to establish the safest mode of delivery.

  1. Perinatal Light Imprinting of Circadian Clocks and Systems (PLICCS): The PLICCS and Cancer Hypothesis

    PubMed Central

    Lewis, Philip; Erren, Thomas C.

    2017-01-01

    Circadian disruption is associated with sleep, mood, and metabolic disorders, and—according to the International Agency for Research on Cancer—even with cancer. Mechanistically, the source of disease may be circadian system instability which likely arises during development. In animal experiments, both low perinatal light:dark ratios and chronic perinatal photoperiod phase shifting yield enduring, detrimental effects on neuroendocrine physiology via circadian system instability. Certainly, accumulating disturbances to neuroendocrine physiology and detrimental downstream effects could predispose to internal cancers. Epidemiologically, either season of birth or latitude of birth, both of which co-determine perinatal photoperiod-zeitgeber strengths, have been utilized independently as proxies for other environmental co-etiologies of cancer. Both have been independently associated with cancer; however, the evidence is inconclusive. We hypothesize that time of birth and location of birth, together determining perinatal photoperiod, contribute to cancer development through Perinatal Light Imprinting of Circadian Clocks and Systems. PMID:28373965

  2. The business of preventing African-American infant mortality.

    PubMed Central

    Gates-Williams, J; Jackson, M N; Jenkins-Monroe, V; Williams, L R

    1992-01-01

    African-American women are twice as likely as women from other ethnic groups to have babies with low birth weights and to experience the loss of infant death. The problem is so endemic in black communities in Alameda County, California, that numerous programs have been developed over the past decade to reduce maternal risk factors and eliminate barriers to prenatal care. Despite these efforts, African-American ethnicity continues to be a major risk factor for infant mortality for reasons that are poorly understood. We take a critical look at 3 types of studies characteristic of infant mortality research: epidemiologic, studies that advocate prenatal care, and ethnomedical (cultural). We argue that the assumptions informing this research restrict the thinking about infant mortality and the political issues involved in how prevention programs are developed and structured. The persistent focus on maternal behavioral characteristics limits more in-depth analysis of the micropolitics of perinatal bureaucracies established in response to this ongoing crisis. PMID:1413783

  3. Aging in the natural world: comparative data reveal similar mortality patterns across primates.

    PubMed

    Bronikowski, Anne M; Altmann, Jeanne; Brockman, Diane K; Cords, Marina; Fedigan, Linda M; Pusey, Anne; Stoinski, Tara; Morris, William F; Strier, Karen B; Alberts, Susan C

    2011-03-11

    Human senescence patterns-late onset of mortality increase, slow mortality acceleration, and exceptional longevity-are often described as unique in the animal world. Using an individual-based data set from longitudinal studies of wild populations of seven primate species, we show that contrary to assumptions of human uniqueness, human senescence falls within the primate continuum of aging; the tendency for males to have shorter life spans and higher age-specific mortality than females throughout much of adulthood is a common feature in many, but not all, primates; and the aging profiles of primate species do not reflect phylogenetic position. These findings suggest that mortality patterns in primates are shaped by local selective forces rather than phylogenetic history.

  4. Slowing of Mortality Rates at Older Ages in Large Medfly Cohorts

    NASA Astrophysics Data System (ADS)

    Carey, James R.; Liedo, Pablo; Orozco, Dina; Vaupel, James W.

    1992-10-01

    It is generally assumed for most species that mortality rates increase monotonically at advanced ages. Mortality rates were found to level off and decrease at older ages in a population of 1.2 million medflies maintained in cages of 7,200 and in a group of approximately 48,000 adults maintained in solitary confinement. Thus, life expectancy in older individuals increased rather than decreased with age. These results cast doubt on several central concepts in gerontology and the biology of aging: (i) that senescence can be characterized by an increase in age-specific mortality, (ii) that the basic pattern of mortality in nearly all species follows the same unitary pattern at older ages, and (iii) that species have absolute life-span limits.

  5. Slowing of mortality rates at older ages in large medfly cohorts.

    PubMed

    Carey, J R; Liedo, P; Orozco, D; Vaupel, J W

    1992-10-16

    It is generally assumed for most species that mortality rates increase monotonically at advanced ages. Mortality rates were found to level off and decrease at older ages in a population of 1.2 million medflies maintained in cages of 7,200 and in a group of approximately 48,000 adults maintained in solitary confinement. Thus, life expectancy in older individuals increased rather than decreased with age. These results cast doubt on several central concepts in gerontology and the biology of aging: (i) that senescence can be characterized by an increase in age-specific mortality, (ii) that the basic pattern of mortality in nearly all species follows the same unitary pattern at older ages, and (iii) that species have absolute life-span limits.

  6. Aging in the Natural World: Comparative Data Reveal Similar Mortality Patterns Across Primates

    PubMed Central

    Bronikowski, Anne M.; Altmann, Jeanne; Brockman, Diane K.; Cords, Marina; Fedigan, Linda M.; Pusey, Anne; Stoinski, Tara; Morris, William F.; Strier, Karen B.; Alberts, Susan C.

    2012-01-01

    Human senescence patterns—late onset of mortality increase, slow mortality acceleration, and exceptional longevity—are often described as unique in the animal world. Using an individual-based data set from longitudinal studies of wild populations of seven primate species, we show that contrary to assumptions of human uniqueness, human senescence falls within the primate continuum of aging; the tendency for males to have shorter life spans and higher age-specific mortality than females throughout much of adulthood is a common feature in many, but not all, primates; and the aging profiles of primate species do not reflect phylogenetic position. These findings suggest that mortality patterns in primates are shaped by local selective forces rather than phylogenetic history. PMID:21393544

  7. Mortality Trajectories at Extreme Old Ages: A Comparative Study of Different Data Sources on U.S. Old-Age Mortality.

    PubMed

    Gavrilova, Natalia S; Gavrilov, Leonid A

    The growing number of individuals living beyond age 80 underscores the need for accurate measurement of mortality at advanced ages. Our earlier published study challenged the common view that the exponential growth of mortality with age (Gompertz law) is followed by a period of deceleration, with slower rates of mortality increase (Gavrilov and Gavrilova 2011). This refutation of mortality deceleration was made using records from the U.S. Social Security Administration's Death Master File (DMF). Taking into account the significance of this finding for actuarial theory and practice, we tested these earlier observations using additional independent datasets and alternative statistical approaches. In particular, the following data sources for U.S. mortality at advanced ages were analyzed: (1) data from the Human Mortality Database (HMD) on age-specific death rates for 1890-99 U.S. birth cohorts, (2) recent extinct birth cohorts of U.S. men and women based on DMF data, and (3) mortality data for railroad retirees. In the case of HMD data, the analyses were conducted for 1890-99 birth cohorts in the age range 80-106. Mortality was fitted by the Gompertz and logistic (Kannisto) models using weighted nonlinear regression and Akaike information criterion as the goodness-of-fit measure. All analyses were conducted separately for men and women. It was found that for all studied HMD birth cohorts, the Gompertz model demonstrated better fit of mortality data than the Kannisto model in the studied age interval. Similar results were obtained for U.S. men and women born in 1890-99 and railroad retirees born in 1895-99 using the full DMF file (obtained from the National Technical Information Service, or NTIS). It was also found that mortality estimates obtained from the DMF records are close to estimates obtained using the HMD cohort data. An alternative approach for studying mortality patterns at advanced ages is based on calculating the age-specific rate of mortality change

  8. Mortality Trajectories at Extreme Old Ages: A Comparative Study of Different Data Sources on U.S. Old-Age Mortality

    PubMed Central

    Gavrilova, Natalia S.; Gavrilov, Leonid A.

    2014-01-01

    The growing number of individuals living beyond age 80 underscores the need for accurate measurement of mortality at advanced ages. Our earlier published study challenged the common view that the exponential growth of mortality with age (Gompertz law) is followed by a period of deceleration, with slower rates of mortality increase (Gavrilov and Gavrilova 2011). This refutation of mortality deceleration was made using records from the U.S. Social Security Administration’s Death Master File (DMF). Taking into account the significance of this finding for actuarial theory and practice, we tested these earlier observations using additional independent datasets and alternative statistical approaches. In particular, the following data sources for U.S. mortality at advanced ages were analyzed: (1) data from the Human Mortality Database (HMD) on age-specific death rates for 1890–99 U.S. birth cohorts, (2) recent extinct birth cohorts of U.S. men and women based on DMF data, and (3) mortality data for railroad retirees. In the case of HMD data, the analyses were conducted for 1890–99 birth cohorts in the age range 80–106. Mortality was fitted by the Gompertz and logistic (Kannisto) models using weighted nonlinear regression and Akaike information criterion as the goodness-of-fit measure. All analyses were conducted separately for men and women. It was found that for all studied HMD birth cohorts, the Gompertz model demonstrated better fit of mortality data than the Kannisto model in the studied age interval. Similar results were obtained for U.S. men and women born in 1890–99 and railroad retirees born in 1895–99 using the full DMF file (obtained from the National Technical Information Service, or NTIS). It was also found that mortality estimates obtained from the DMF records are close to estimates obtained using the HMD cohort data. An alternative approach for studying mortality patterns at advanced ages is based on calculating the age-specific rate of mortality

  9. Projection of mesothelioma mortality in Britain using Bayesian methods

    PubMed Central

    Tan, E; Warren, N; Darnton, A J; Hodgson, J T

    2010-01-01

    Background: Mesothelioma mortality has increased more than ten-fold over the past 40 years in Great Britain, with >1700 male deaths recorded in the British mesothelioma register in 2006. Annual mesothelioma deaths now account for >1% of all cancer deaths. A Poisson regression model based on a previous work by Hodgson et al has been fitted, which has allowed informed statistical inferences about model parameters and predictions of future mesothelioma mortality to be made. Methods: In the Poisson regression model, the mesothelioma risk of an individual depends on the average collective asbestos dose for the individual in a given year and an age-specific exposure potential. The model has been fitted to the data within a Bayesian framework using the Metropolis–Hastings algorithm, a Markov Chain Monte Carlo technique, providing credible intervals for model parameters as well as prediction intervals for the number of future cases of mortality. Results: Males were most likely to have been exposed to asbestos between the ages of 30 and 49 years, with the peak year of asbestos exposure estimated to be 1963. The estimated number of background cases was 1.08 cases per million population. Conclusion: Mortality among males is predicted to peak at approximately 2040 deaths in the year 2016, with a rapid decline thereafter. Approximately 91 000 deaths are predicted to occur from 1968 to 2050 with around 61 000 of these occurring from 2007 onwards. PMID:20628377

  10. [Mortality in metropolitan regions].

    PubMed

    Simoes Ccds

    1980-01-01

    Data from the 1970 census and a 1974-1975 survey carried out in Brazil by the Fundacao Instituto Brasileiro de Geografia e Estatistica are used to examine recent mortality trends in urban areas. Specifically, life expectancy in nine metropolitan areas is analyzed in relation to income, diet, and sanitary facilities in the home.

  11. Adolescents, Egocentrism, and Mortality

    ERIC Educational Resources Information Center

    Hanna, Jennie L.

    2017-01-01

    Adolescents are often described as egocentric, but a major source of this external behavior is the internal fear of adolescents have about feeling invisible, being different, and even their own mortality. Facing this fear through a curricular focus on death can help to combat this behavior. This can be accomplished through novel studies of books…

  12. Mortality among Swedish Journalists.

    ERIC Educational Resources Information Center

    Furhoff, Anna-Karin; Furhoff, Lars

    1987-01-01

    Charts the various environmental factors that might influence the mortality rate of Swedish journalists. Concludes that, although there may be a slightly higher death rate among Swedish journalists in the 50-59 age group, the death rate for journalists is the same as for the population in general. (MM)

  13. Mortality of white South African gold miners.

    PubMed Central

    Reid, P J; Sluis-Cremer, G K

    1996-01-01

    OBJECTIVES--This two part study aimed to determine whether there was an excess mortality generally or for some diseases among middle aged white South African gold miners on the Witwatersrand and whether the underground dust exposure of these miners contributed to the development of lung cancer, chronic obstructive pulmonary disease (COPD), or ischaemic heart disease (IHD). METHODS--A cohort of 4925 white miners in South Africa, born between 1 January 1916 and 31 December 1930 who were alive and working in the vicinity of Johannesburg on 1 January 1970, then aged between 39 and 54, was followed up for 20 years by which time 2032 had died. Most were gold miners (about 87% had worked 85% or more of their shifts in gold mines). Standardised mortality ratios (SMRs) were calculated as percentages of the number of deaths observed in the cohort for a condition as stated on the death certificate divided by the number expected on the basis of concurrent mortality in the reference population (the total age specific white male population of South Africa). A case-control analysis was performed for three diseases (lung cancer, COPD, and IHD), the results of which are presented for those miners in the cohort who had spent at least 85% of their service on gold mines and had worked at least 15% of their shifts underground. RESULTS--The SMR for all causes of death was 129.6%, raised because of excess mortality due to the following causes: lung cancer (SMR = 139.8%), IHD (124.1%), COPD (189%) and cirrhosis of the liver (155.3%). Smoking was confirmed to be the main risk factor for lung cancer and COPD although cumulative dust exposure was found to increase the risk of COPD in conjunction with smoking. No significant risk of lung cancer resulted from exposure to dust. High blood pressure and smoking were found to increase the risk of IHD, but no association between IHD and the quetelet index (weight/height2) was found. CONCLUSIONS--The most significant and unexpected finding was the

  14. Home-based neonatal care by community health workers for preventing mortality in neonates in low- and middle-income countries: a systematic review

    PubMed Central

    Gogia, S; Sachdev, H P S

    2016-01-01

    The objective of this review is to assess the effect of home-based neonatal care provided by community health workers (CHWs) for preventing neonatal, infant and perinatal mortality in resource-limited settings with poor access to health facility-based care. The authors conducted a systematic review, including meta-analysis and meta-regression of controlled trials. The data sources included electronic databases, with a hand search of reviews, abstracts and proceedings of conferences to search for randomized, or cluster randomized, controlled trials evaluating the effect of home-based neonatal care provided by CHWs for preventing neonatal, infant and perinatal mortality. Among the included trials, all from South Asian countries, information on neonatal, infant and perinatal mortality was available in five, one and three trials, respectively. The intervention package comprised three components, namely, home visits during pregnancy (four trials), home-based preventive and/or curative neonatal care (all trials) and community mobilization efforts (four trials). Intervention was associated with a reduced risk of mortality during the neonatal (random effects model relative risk (RR) 0.75; 95% confidence intervals (CIs) 0.61 to 0.92, P=0.005; I2=82.2%, P<0.001 for heterogeneity; high-quality evidence) and perinatal periods (random effects model RR 0.78; 95% CI 0.64 to 0.94, P=0.009; I2=79.6%, P=0.007 for heterogeneity; high-quality evidence). In one trial, a significant decline in infant mortality (RR 0.85; 95% CI 0.77 to 0.94) was documented. Subgroup and meta-regression analyses suggested a greater effect with a higher baseline neonatal mortality rate. The authors concluded that home-based neonatal care is associated with a reduction in neonatal and perinatal mortality in South Asian settings with high neonatal-mortality rates and poor access to health facility-based care. Adoption of a policy of home-based neonatal care provided by CHWs is justified in such settings

  15. Effects of Maternal Age and Age-Specific Preterm Birth Rates on Overall Preterm Birth Rates - United States, 2007 and 2014.

    PubMed

    Ferré, Cynthia; Callaghan, William; Olson, Christine; Sharma, Andrea; Barfield, Wanda

    2016-11-04

    Reductions in births to teens and preterm birth rates are two recent public health successes in the United States (1,2). From 2007 to 2014, the birth rate for females aged 15-19 years declined 42%, from 41.5 to 24.2 per 1,000 females. The preterm birth rate decreased 8.4%, from 10.41% to 9.54% of live births (1). Rates of preterm births vary by maternal age, being higher among the youngest and oldest mothers. It is unknown how changes in the maternal age distribution in the United States have affected preterm birth rates. CDC used birth data to assess the relative contributions of changes in the maternal age distribution and in age-specific preterm birth rates to the overall decrease in preterm birth rates. The preterm birth rate declined in all age groups. The effects of age distribution changes on the preterm birth rate decrease were different in younger and older mothers. The decrease in the proportion of births to mothers aged ≤19 and 20-24 years and reductions in age-specific preterm rates in all age groups contributed to the overall decline in the preterm birth rate. The increase in births to mothers aged ≥30 years had no effect on the overall preterm birth rate decrease. The decline in preterm births from 2007 to 2014 is related, in part, to teen pregnancy prevention and the changing maternal age distribution. Effective public health strategies for further reducing preterm birth rates need to be tailored to different age groups.

  16. Age-specific and age-standardised incidence rates for intraoral squamous cell carcinoma in blacks on the Witwatersrand, South Africa.

    PubMed

    Altini, M; Kola, A H

    1985-12-01

    All new cases of intraoral squamous cell carcinoma which occurred in Blacks resident on the Witwatersrand during the 10-yr period 1971-80 were traced by examining the records of all the hospital pathology departments in this area. The population at risk at the mid-point of the study (1975) was calculated from the National Population Censuses of 1970 and 1980, and consisted of 1125960 men and 880269 women. Age-specific incidence rates and age-standardised incidence rates were calculated for each intraoral site for men and women. In the latter calculation a standard World population was used. All rates are expressed as average number of cases per 100000 population per annum. The age-specific incidence rates and age-standardised incidence rates (in brackets) for men and women respectively are: tongue, 1.43 and 0.26 (2.69 and 0.41); gingiva and alveolar ridge, 0.04 and 0.01 (0.07 and 0.01); floor of mouth, 0.87 and 0.22 (1.64 and 0.38); buccal mucosa, 0.05 and 0.04 (0.13 and 0.05); hard and soft palate, 0.34 and 0.05 (0.63 and 0.08). There appears to have been an increase in the incidence of intraoral cancer in Black South Africans since the first survey in 1953-55, which can probably be ascribed to the urbanization process. In Europe, North America and in other population groups in South Africa, the palate is least frequently affected. In contrast, in Black South Africans lesions of the palate are much more common, being less frequent only than tongue and floor of mouth lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Premating isolation is determined by larval rearing substrates in cactophilic Drosophila mojavensis. X. Age-specific dynamics of adult epicuticular hydrocarbon expression in response to different host plants.

    PubMed

    Etges, William J; de Oliveira, Cassia C

    2014-06-01

    Analysis of sexual selection and sexual isolation in Drosophila mojavensis and its relatives has revealed a pervasive role of rearing substrates on adult courtship behavior when flies were reared on fermenting cactus in preadult stages. Here, we assessed expression of contact pheromones comprised of epicuticular hydrocarbons (CHCs) from eclosion to 28 days of age in adults from two populations reared on fermenting tissues of two host cacti over the entire life cycle. Flies were never exposed to laboratory food and showed significant reductions in average CHC amounts consistent with CHCs of wild-caught flies. Overall, total hydrocarbon amounts increased from eclosion to 14-18 days, well past age at sexual maturity, and then declined in older flies. Most flies did not survive past 4 weeks. Baja California and mainland populations showed significantly different age-specific CHC profiles where Baja adults showed far less age-specific changes in CHC expression. Adults from populations reared on the host cactus typically used in nature expressed more CHCs than on the alternate host. MANCOVA with age as the covariate for the first six CHC principal components showed extensive differences in CHC composition due to age, population, cactus, sex, and age × population, age × sex, and age × cactus interactions. Thus, understanding variation in CHC composition as adult D. mojavensis age requires information about population and host plant differences, with potential influences on patterns of mate choice, sexual selection, and sexual isolation, and ultimately how these pheromones are expressed in natural populations. Studies of drosophilid aging in the wild are badly needed.

  18. Premating isolation is determined by larval rearing substrates in cactophilic Drosophila mojavensis. X. Age-specific dynamics of adult epicuticular hydrocarbon expression in response to different host plants

    PubMed Central

    Etges, William J; de Oliveira, Cassia C

    2014-01-01

    Analysis of sexual selection and sexual isolation in Drosophila mojavensis and its relatives has revealed a pervasive role of rearing substrates on adult courtship behavior when flies were reared on fermenting cactus in preadult stages. Here, we assessed expression of contact pheromones comprised of epicuticular hydrocarbons (CHCs) from eclosion to 28 days of age in adults from two populations reared on fermenting tissues of two host cacti over the entire life cycle. Flies were never exposed to laboratory food and showed significant reductions in average CHC amounts consistent with CHCs of wild-caught flies. Overall, total hydrocarbon amounts increased from eclosion to 14–18 days, well past age at sexual maturity, and then declined in older flies. Most flies did not survive past 4 weeks. Baja California and mainland populations showed significantly different age-specific CHC profiles where Baja adults showed far less age-specific changes in CHC expression. Adults from populations reared on the host cactus typically used in nature expressed more CHCs than on the alternate host. MANCOVA with age as the covariate for the first six CHC principal components showed extensive differences in CHC composition due to age, population, cactus, sex, and age × population, age × sex, and age × cactus interactions. Thus, understanding variation in CHC composition as adult D. mojavensis age requires information about population and host plant differences, with potential influences on patterns of mate choice, sexual selection, and sexual isolation, and ultimately how these pheromones are expressed in natural populations. Studies of drosophilid aging in the wild are badly needed. PMID:25360246

  19. Perinatal lamb model of respiratory syncytial virus (RSV) infection.

    PubMed

    Derscheid, Rachel J; Ackermann, Mark R

    2012-10-23

    Respiratory syncytial virus (RSV) is the most frequent cause of bronchiolitis in infants and children worldwide. Many animal models are used to study RSV, but most studies investigate disease in adult animals which does not address the unique physiology and immunology that makes infants more susceptible. The perinatal (preterm and term) lamb is a useful model of infant RSV disease as lambs have similar pulmonary structure including airway branching, Clara and type II cells, submucosal glands and Duox/lactoperoxidase (LPO) oxidative system, and prenatal alveologenesis. Lambs can be born preterm (90% gestation) and survive for experimentation although both preterm and term lambs are susceptible to ovine, bovine and human strains of RSV and develop clinical symptoms including fever, tachypnea, and malaise as well as mild to moderate gross and histologic lesions including bronchiolitis with epithelial injury, neutrophil infiltration and syncytial cell formation. RSV disease in preterm lambs is more severe than in term lambs; disease is progressively less in adults and age-dependent susceptibility is a feature similar to humans. Innate and adaptive immune responses by perinatal lambs closely parallel those of infants. The model is used to test therapeutic regimens, risk factors such as maternal ethanol consumption, and formalin inactivated RSV vaccines.

  20. Gestational, perinatal and family findings of patients with Patau syndrome

    PubMed Central

    Rosa, Rafael Fabiano M.; Sarmento, Melina Vaz; Polli, Janaina Borges; Groff, Daniela de Paoli; Petry, Patrícia; de Mattos, Vinícius Freitas; Rosa, Rosana Cardoso M.; Trevisan, Patrícia; Zen, Paulo Ricardo G.

    2013-01-01

    OBJECTIVE: To describe gestational, perinatal and family findings of patients with Patau syndrome (PS). METHODS: The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, being significant p<0.05. RESULTS: The sample was composed of 27 patients, 63% were male, with a median age of nine days at the first evaluation. Full trisomy of chromosome 13 was the main cytogenetic finding (74%). Only six patients were submitted to obstetric ultrasound and none had prenatal diagnosis of PS. The patients' demographic characteristics, compared to born alive infants in the same Brazilian state showed a higher frequency of: mothers with 35 years old or more (37.5%); multiparous mothers (92.6%); vaginal delivery (77%); preterm birth (34.6%); birth weight <2500g (33.3%), and Apgar scores <7 in the 1st (75%) and in the 5th minute (42.9%). About half of them (53%) died during the first month of life. CONCLUSIONS: The understanding of the PS patients' gestational, perinatal and family findings has important implications, especially on the decision about the actions to be taken in relation to the management of these patients. PMID:24473950

  1. Perinatal Lamb Model of Respiratory Syncytial Virus (RSV) Infection

    PubMed Central

    Derscheid, Rachel J.; Ackermann, Mark R.

    2012-01-01

    Respiratory syncytial virus (RSV) is the most frequent cause of bronchiolitis in infants and children worldwide. Many animal models are used to study RSV, but most studies investigate disease in adult animals which does not address the unique physiology and immunology that makes infants more susceptible. The perinatal (preterm and term) lamb is a useful model of infant RSV disease as lambs have similar pulmonary structure including airway branching, Clara and type II cells, submucosal glands and Duox/lactoperoxidase (LPO) oxidative system, and prenatal alveologenesis. Lambs can be born preterm (90% gestation) and survive for experimentation although both preterm and term lambs are susceptible to ovine, bovine and human strains of RSV and develop clinical symptoms including fever, tachypnea, and malaise as well as mild to moderate gross and histologic lesions including bronchiolitis with epithelial injury, neutrophil infiltration and syncytial cell formation. RSV disease in preterm lambs is more severe than in term lambs; disease is progressively less in adults and age-dependent susceptibility is a feature similar to humans. Innate and adaptive immune responses by perinatal lambs closely parallel those of infants. The model is used to test therapeutic regimens, risk factors such as maternal ethanol consumption, and formalin inactivated RSV vaccines. PMID:23202468

  2. Perinatal exercise improves glucose homeostasis in adult offspring

    PubMed Central

    Carter, Lindsay G.; Lewis, Kaitlyn N.; Wilkerson, Donald C.; Tobia, Christine M.; Ngo Tenlep, Sara Y.; Shridas, Preetha; Garcia-Cazarin, Mary L.; Wolff, Gretchen; Andrade, Francisco H.; Charnigo, Richard J.; Esser, Karyn A.; Egan, Josephine M.; de Cabo, Rafael

    2012-01-01

    Emerging research has shown that subtle factors during pregnancy and gestation can influence long-term health in offspring. In an attempt to be proactive, we set out to explore whether a nonpharmacological intervention, perinatal exercise, might improve offspring health. Female mice were separated into sedentary or exercise cohorts, with the exercise cohort having voluntary access to a running wheel prior to mating and during pregnancy and nursing. Offspring were weaned, and analyses were performed on the mature offspring that did not have access to running wheels during any portion of their lives. Perinatal exercise caused improved glucose disposal following an oral glucose challenge in both female and male adult offspring (P < 0.05 for both). Blood glucose concentrations were reduced to lower values in response to an intraperitoneal insulin tolerance test for both female and male adult offspring of parents with access to running wheels (P < 0.05 and P < 0.01, respectively). Male offspring from exercised dams showed increased percent lean mass and decreased fat mass percent compared with male offspring from sedentary dams (P < 0.01 for both), but these parameters were unchanged in female offspring. These data suggest that short-term maternal voluntary exercise prior to and during healthy pregnancy and nursing can enhance long-term glucose homeostasis in offspring. PMID:22932781

  3. Perinatal radiation-induced renal damage in the beagle

    SciTech Connect

    Jaenke, R.S.; Angleton, G.M. )

    1990-04-01

    The developing perinatal kidney is particularly sensitive to radiation. The pathogenesis of the radiation-induced lesion is related to the destruction of outer cortical developing nephrons and direct radiation injury with secondary hemodynamic alterations in remnant nephrons. In this study, which is part of a life span investigation of the effects of whole-body gamma radiation during prenatal and early postnatal life, dogs were given 0, 0.16, 0.83, or 1.25 Gy irradiation at either 55 days postcoitus or 2 days postpartum and were examined morphometrically and histopathologically at 70 days of age. Although irradiated dogs showed no reduction in the total number of nephrons per kidney, there was a significant increase in the total number and relative percentage of immature, dysplastic glomeruli. In addition, deeper cortical glomeruli of irradiated kidneys exhibited mesangial sclerosis similar to that associated with progressive renal failure in our previous studies. These findings are in accord with those reported at doses of 2.24 to 3.57 Gy and demonstrate that the perinatal kidney is affected by radiation doses much lower than previously demonstrated.

  4. Perinatal exercise improves glucose homeostasis in adult offspring.

    PubMed

    Carter, Lindsay G; Lewis, Kaitlyn N; Wilkerson, Donald C; Tobia, Christine M; Ngo Tenlep, Sara Y; Shridas, Preetha; Garcia-Cazarin, Mary L; Wolff, Gretchen; Andrade, Francisco H; Charnigo, Richard J; Esser, Karyn A; Egan, Josephine M; de Cabo, Rafael; Pearson, Kevin J

    2012-10-15

    Emerging research has shown that subtle factors during pregnancy and gestation can influence long-term health in offspring. In an attempt to be proactive, we set out to explore whether a nonpharmacological intervention, perinatal exercise, might improve offspring health. Female mice were separated into sedentary or exercise cohorts, with the exercise cohort having voluntary access to a running wheel prior to mating and during pregnancy and nursing. Offspring were weaned, and analyses were performed on the mature offspring that did not have access to running wheels during any portion of their lives. Perinatal exercise caused improved glucose disposal following an oral glucose challenge in both female and male adult offspring (P < 0.05 for both). Blood glucose concentrations were reduced to lower values in response to an intraperitoneal insulin tolerance test for both female and male adult offspring of parents with access to running wheels (P < 0.05 and P < 0.01, respectively). Male offspring from exercised dams showed increased percent lean mass and decreased fat mass percent compared with male offspring from sedentary dams (P < 0.01 for both), but these parameters were unchanged in female offspring. These data suggest that short-term maternal voluntary exercise prior to and during healthy pregnancy and nursing can enhance long-term glucose homeostasis in offspring.

  5. Contrasting patterns of larval mortality in two sympatric riverine fish species: a test of the critical period hypothesis.

    PubMed

    McCasker, Nicole; Humphries, Paul; Meredith, Shaun; Klomp, Nicholas

    2014-01-01

    Understanding the causal mechanisms that determine recruitment success is critical to the effective conservation of wild fish populations. Although recruitment strength is likely determined during early life when mortality is greatest, few studies have documented age-specific mortality rates for fish during this period. We investigated age-specific mortality of individual cohorts of two species of riverine fish from yolksac larvae to juveniles, assaying for the presence of a "critical period": A time when mortality is unusually high. Early life stages of carp gudgeons (Hypseleotris spp.) and unspecked hardyhead (Craterocephalus stercusmuscarum fulvus)-two fishes that differ in fecundity, egg size and overlap between endogenous and exogenous feeding-were collected every second day for four months. We fitted survivorship curves to 22 carp gudgeon and 15 unspecked hardyhead four-day cohorts and tested several mortality functions. Mortality rates declined with age for carp gudgeon, with mean instantaneous mortality rates (-Z) ranging from 1.40-0.03. In contrast, mortality rates for unspecked hardyhead were constant across the larval period, with a mean -Z of 0.15. There was strong evidence of a critical period for carp gudgeon larvae from hatch until 6 days old, and no evidence of a critical period for unspecked hardyhead. Total larval mortality for carp gudgeon and unspecked hardyhead up to 24 days of age was estimated to be 97.8 and 94.3%, respectively. We hypothesise that life history strategy may play an important role in shaping overall mortality and the pattern of mortality during early life in these two fishes.

  6. Contrasting Patterns of Larval Mortality in Two Sympatric Riverine Fish Species: A Test of the Critical Period Hypothesis

    PubMed Central

    McCasker, Nicole; Humphries, Paul; Meredith, Shaun; Klomp, Nicholas

    2014-01-01

    Understanding the causal mechanisms that determine recruitment success is critical to the effective conservation of wild fish populations. Although recruitment strength is likely determined during early life when mortality is greatest, few studies have documented age-specific mortality rates for fish during this period. We investigated age-specific mortality of individual cohorts of two species of riverine fish from yolksac larvae to juveniles, assaying for the presence of a “critical period”: A time when mortality is unusually high. Early life stages of carp gudgeons (Hypseleotris spp.) and unspecked hardyhead (Craterocephalus stercusmuscarum fulvus)—two fishes that differ in fecundity, egg size and overlap between endogenous and exogenous feeding—were collected every second day for four months. We fitted survivorship curves to 22 carp gudgeon and 15 unspecked hardyhead four-day cohorts and tested several mortality functions. Mortality rates declined with age for carp gudgeon, with mean instantaneous mortality rates (-Z) ranging from 1.40–0.03. In contrast, mortality rates for unspecked hardyhead were constant across the larval period, with a mean -Z of 0.