Association of childhood rhabdomyosarcoma with neurofibromatosis type i and birth defects

Rhabdomyosarcoma (RMS) is an uncommon malignant soft tissue sarcoma whose cause is largely unknown. Reported risk factors include genetic alterations (e.g., p53 mutations, a defective gene at 11p15.5, or specific chromosomal translocation of t(2:13)), and parents' use of drugs around the time of conception. We present results from a national, case-control study of 249 RMS cases (170 males and 79 females) and 302 controls (196 males and 106 females). The cases, aged 0–20 years at diagnosis, were identified via the Intergroup RMS Study-III during 1982–1988. Controls were selected by random digit telephone dialing. As a supplement to the original study, information on genetic diseases and birth defects (BD) was collected from the subjects' parents by telephone interview. Fifty-six (22.5%) cases and 55 (18.2%) controls were reported to have genetic diseases or BD (odds ratio [OR] = 1.30,95% confidence interval [CI] = 0.85–2.02, P = .21). The case group had a significantly higher frequency of neurofibromatosis type I (NF1) than did the control group, i.e., five cases (2.0%) had NF1 vs. zero controls (P = .02). The case group also had a higher frequency of major BDs than did the control group (6.0% vs. 2.6%, OR = 2.36, 95% CI = 0.92–6.52, P = .05). However, this excess was only observed in males (7.6% vs. 2.6%, OR = 3.16, 95% CI = 1.02–10.41, P = .02). Among the 15 cases having both RMS and major BDs, six (40.0%) had both conditions in the same regional anatomic site: Two (13.3%) had both in the extremities, two (13.3%) in the genitourinary system, and two in the head and neck. These findings suggest that common genetic mechanisms or in utero exposures may be invilved in the development of many childhood tumors and congenital abnormalities. ©1995 Wiley-Liss, Inc.     

Maternity services and TBAs in Addis Ababa: biosocial factors related to birth place and outcome of pregnancy

The use of maternity services in Addis Ababa was assessed througha household probability sample survey in 1983. For 9315 women,9954 pregnancies were reported over a two-year period from September1981. This study analyses the antenatal care and deliveriesof 8724 women. Antenatal care coverage was 70%; 40% of birthstook place in hospital; 16% in MCH clinics; 44% at home of which19% were attended by traditional birth attendants (TBAs). Serviceswere under-utilized by women of low socio-economic status: 1:5women giving birth at home had no antenatal care and 50% ofthese delivered unaided. Maternal mor tality was threefold amongwomen who delivered at home without a TBA (410.7 per 100 000live births) compared to those attended by TBAs. The stillbirth/neonataldeath ratio of home deliveries conducted by TBAs was 0.5:1.Prospects and options for extension of care for disadvantagedpregnant women are discussed.     

孕妇社会学特征对新生儿出生体重和身长的影响

目的:探讨孕妇社会学特征及相关因素对新生儿出生体重和身长的影响,为降低低出生体重儿和巨大儿的发生、建立孕期保健临床护理路径提供依据。方法:由专人调查分娩孕妇的一般情况、年龄、职业、受教育程度、孕期居住地、孕次、产前保健次数等指标,孕妇分娩后立即测量新生儿体重和身长。结果:新生儿出生体重及身长与孕妇年龄、孕次无统计学关联。新生儿出生体重及身长在不同职业组间差异具有统计学意义(F=6.84,P=0.0 012;F=3.98,P=0.0 192);新生儿出生体重及身长在不同受教育程度组间差异具有统计学意义(F=5.27,P=0.0 014;F=4.37,P=0.0 047;)新生儿出生体重与孕妇居住地具有统计学关联(t=2.57,P=0.0 108);新生儿出生身长与孕妇居住地无统计学关联(t=1.69,P=0.0 922)。新生儿出生体重和身长在不同产前保健次数的孕妇组间有统计学差异(F=10.07,P<0.0 001;F=9.55,P<0.0 001)。结论:孕妇年龄和孕次未影响新生儿出生体重和身长;受教育程度、孕妇的职业、居住地、产前保健次数可以不同程度地影响新生儿出生体重和身长。应重视孕妇社会学特征及相关因素对新生儿出生体重和身长的影响,并提供适时干预。     

妊娠晚期邻苯基苯酚暴露与新生儿体格指标的关系

目的 探讨孕妇妊娠晚期尿中邻苯基苯酚(o-phenylphenol,OPP)水平与新生儿出生体格指标之间联系。方法 选取某县1 100对孕妇-新生儿,采集孕妇分娩前尿样并完成调查问卷,测定尿中OPP浓度,结合新生儿体格指标进行统计分析。结果 孕妇尿中OPP的检出率为100%,中位值为0.35 μg/L,肌酐校正后中位值为0.54 μg/g,暴露水平稍高于国外类似研究报道。广义线性模型分析显示,孕妇尿中OPP肌酐校正浓度对数可能与新生儿出生身长(β=-0.670,P=0.006)及头围(β=-0.505,P=0.001)呈一定的负相关。按新生儿性别分层后,OPP水平可能与男童身长、体重及头围呈一定程度的负相关(P<0.05),而女童则未发现任何相关。结论 该地区孕妇普遍暴露于OPP,其妊娠晚期OPP水平可能与男性新生儿出生身长、体重及头围呈一定负相关。     

Association of low birth weight with passive smoke exposure in pregnancy

In a prospective study of 3,891 antenatal patients at Yale-New Haven Hospital between 1980 and 1982, one fourth (23.6%) had not smoked cigarettes during pregnancy but had been exposed to sidestream smoke for at least two hours per day. Among the nonsmokers, passive smoke exposure was significantly related to delivering a low birth weight (less than 2,500 g) newborn. This relation only occurred in term (greater than or equal to 37 weeks) deliveries. Compared with unexposed women, the relative risk of low birth weight after adjustment for confounding factors was 2.17 (95% confidence interval (CI) = 1.05-4.50). Those exposed to passive smoke delivered infants 24 g lighter on average. There was no additive effect of passive smoking on smokers themselves. Repeating the analysis on all women with term deliveries, therefore, resulted in a slightly diminished risk of low birth weight due to passive smoking of 1.52 (95% CI = 0.90-2.56). The risk of low birth weight at term due to direct cigarette smoking was 3.54 (95% CI = 1.62-7.71). Gestational age was unrelated to passive smoking, which appears to exert its effect primarily through growth retardation in term newborns.     

Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua

Background: Studies have shown that influenza vaccination during pregnancy reduces the risk of influenza disease in pregnant women and their offspring. Some have proposed that maternal vaccination may also have beneficial effects on birth outcomes. In 2014, we conducted an observational study to test this hypothesis using data from two large hospitals in Managua, Nicaragua.Methods: We conducted a retrospective cohort study to evaluate associations between influenza vaccination and birth outcomes. We carried out interviews and reviewed medical records post-partum to collect data on demographics, influenza vaccination during pregnancy, birth outcomes and other risk factors associated with adverse neonatal outcomes. We used influenza surveillance data to adjust for timing of influenza circulation. We assessed self-reports of influenza vaccination status by further reviewing medical records of those who self-reported but did not have readily available evidence of vaccination status. We performed multiple logistic regression (MLR) and propensity score matching (PSM).Results: A total of 3268 women were included in the final analysis. Of these, 55% had received influenza vaccination in 2014. Overall, we did not observe statistically significant associations between influenza vaccination and birth outcomes after adjusting for risk factors, with either MLR or PSM. With PSM, after adjusting for risk factors, we observed protective associations between influenza vaccination in the second and third trimester and preterm birth (aOR: 0.87; 95% confidence interval (CI): 0.75–0.99 and aOR: 0.66; 95% CI: 0.45–0.96, respectively) and between influenza vaccination in the second trimester and low birth weight (aOR: 0.80; 95% CI: 0.64–0.97).Conclusions: We found evidence to support an association between influenza vaccination and birth outcomes by trimester of receipt with data from an urban population in Nicaragua. The study had significant selection and recall biases. Prospective studies are needed to minimize these biases.     

Association of childhood cancer with residential traffic density

Data from a recently completed case-referent study of childhood cancer were used to explore a possible role of environmental exposures from traffic exhaust. The street addresses of 328 cancer patients and 262 population-based referents were used to assign traffic density (vehicles per day) as a marker of potential exposure to motor vehicle exhaust. An odds ratio of 1.7 [95% confidence interval (95% CI) 1.0-2.8] was found for the total number of childhood cancers and 2.1 (95% CI 1.1-4.0) for leukemias in a contrast of high and low traffic density addresses (greater than or equal to 500 versus less than 500 vehicles per day). Stronger associations were found with a traffic density cutoff score of greater than or equal to 10,000 vehicles per day, with imprecise odds ratios of 3.1 (95% CI 1.2-8.0) and 4.7 (95% CI 1.6-13.5) for the total number of cancers and leukemias, respectively. Adjustment for suspected risk factors for childhood cancer did not substantially change these results. Though the results are inconclusive, the identified association warrants further evaluation.     

儿童抑郁症状及其行为与家庭因素的相关性

探讨儿童抑郁症状与其自身行为表现及家庭因素之间的关系,为抑郁患儿的综合防治提供新视角.方法 从青岛大学附属医院儿童保健门诊招募58名诊断为抑郁状态的儿童作为病例组,同期按年龄、性别匹配选择88名健康儿童作为对照组,采用抑郁自评量表(Self-rating Depression Scale,SDS)、儿童行为量表(Child Behaviour Checklist,CBCL)、症状自评量表90项(Symptom Self-evaluation Scale,SCL-90)调查两组儿童抑郁情绪表现、行为表现及家庭因素,采用SPSS 22.0软件对数据进行统计描述和分析.结果 病例组儿童CBCL量表总得分高于对照组儿童(43.29±30.93,20.24 ±12.93),阳性因子数量高于对照组(2.57±3.14,0.97±1.80).差异均有统计学意义(t值分别为6.17,3.89,P值均<0.01).病例组内向行为、外向行为、抑郁、强迫、多动、攻击及社交退缩得分高于对照组(t值分别为3.70,2.41,5.68,2.34,2.25,2.60,2.29,P值均<0.01).病例组儿童家长SCL-90量表躯体化、敌对、恐怖得分高于对照组(17.58±4.05,15.81±4.00;9.66 ±2.67,8.69±2.45;8.03±1.49,7.50±0.88)(t值分别为2.33,2.17,2.40,P值均<0.05).儿童SDS量表得分与CBCL量表总得分、阳性因子数量、内向行为、外向行为、抑郁、强迫、多动、攻击及社交退缩得分呈正相关,与父母婚姻状况呈负相关(r值分别为0.51,0.42,0.42,0.30,0.51,0.29,0.36,0.32,0.39,-0.31,P值均<0.01).结论 抑郁症状是儿童普遍存在的情绪障碍,会对学习、社会生活能力等方面有明显影响.在抑郁儿童的综合防治中要充分考虑患儿行为干预、家长心理疏导等因素,以更好帮助儿童心理健康成长.     

Association between missed appointment and related factors of patients with cancer in a tertiary hospital

For the hospital administration, 1 major responsibility is to prevent the outflow of existing patients and minimize losses because of the failure of patients with cancer to attend appointments. We analyzed the association between no‐show rates and characteristics of patients with cancer at a tertiary hospital in Seoul using patient affair data. Among the 680 190 patients, no‐show rates were 4.39% and 3.37% for males and females, respectively. Male patients with colon and rectum, pancreas, and liver cancer had higher no‐show rates (5.81%, 5.8%, and 5.1%). Among females, pancreas, colon and rectum, and liver cancer were associated with high no‐show rates (5.65%, 5.44%, and 4.92%). For both males and females, liver (males: OR = 2.02; 95% CI: 1.68‐2.44; females: OR = 1.91; 95% CI: 1.60‐2.28) and pancreas (males: OR = 1.98; 95% CI: 1.57‐2.50; females: OR = 1.97; 95% CI: 1.61‐2.42) cancer were associated with high no‐show rates. To reduce the rate of no‐shows, hospitals should establish and enforce “missed appointment” policies as well as its effect upon health outcome.     

The sociodemographic factors related with the adolescent pregnancy

ObjectiveThe adolescent pregnancy is one of the most important problems in the 21st century. The adolescent pregnancies pose more health risks to both mothers and babies when compared with the adult pregnancies. Of all the births in the world, 11% are given by the adolescents. The aim of the study was to determine the sociodemographic factors concerning with the adolescent pregnancy.MethodsThis study was conducted at 18 primary health care centers in Mersin, Turkey. The adolescent group was comprised of pregnant women younger than 19 years, the adult group was comprised of pregnants aged between 20–29 years. The questionnaire was conducted with face-to-face interviews.ResultsRespondents included 107 pregnant adolescents and 110 pregnant adults. The median age of adolescent group and adult group was 18 and 26 years, respectively. About 61.7% of the pregnant adolescents and 94.5% of the pregnant adults were officially married. In the adolescent group, the family frequency without social security was more than that in the adult group. In the adult group, the frequency of opposing the adolescent pregnancy for their families was more than that in the adolescent group. The adolescent pregnancy among sisters and friends of the adolescent pregnants was more frequent compared with that in the adult group.ConclusionsThe family frequency without social security was more in the adolescent group. This situation is certain to cause more problems for the adolescents in benefiting from the health care services. We are absolutely think that efforts should be made so as to improve the society in terms of social and cultural aspects.     

Association of childhood obesity with maternal exposure to ambient air polycyclic aromatic hydrocarbons during pregnancy

There are concerns that prenatal exposure to endocrine-disrupting chemicals increases children's risk of obesity. African-American and Hispanic children born in the Bronx or Northern Manhattan, New York (1998-2006), whose mothers underwent personal air monitoring for polycyclic aromatic hydrocarbon (PAH) exposure during pregnancy, were followed up to ages 5 (n = 422) and 7 (n = 341) years. At age 5 years, 21% of the children were obese, as were 25% of those followed to age 7 years. After adjustment for child's sex, age at measurement, ethnicity, and birth weight and maternal receipt of public assistance and prepregnancy obesity, higher prenatal PAH exposures were significantly associated with higher childhood body size. In adjusted analyses, compared with children of mothers in the lowest tertile of PAH exposure, children of mothers in the highest exposure tertile had a 0.39-unit higher body mass index z score (95% confidence interval (CI): 0.08, 0.70) and a relative risk of 1.79 (95% CI: 1.09, 2.96) for obesity at age 5 years, and they had a 0.30-unit higher body mass index z score (95% CI: 0.01, 0.59), a 1.93-unit higher percentage of body fat (95% CI: 0.33, 3.54), and a relative risk of 2.26 (95% CI: 1.28, 4.00) for obesity at age 7 years. The data indicate that prenatal exposure to PAHs is associated with obesity in childhood.     

Association of childhood leukemia with maternal age, birth order, and paternal occupation. A case-control study

Previous investigations have drawn conflicting conclusions concerning the association between childhood leukemia and maternal age, birth order, socioeconomic status, and paternal occupation. In this study, 255 childhood leukemia cases diagnosed in California between 1975 and 1980 were individually matched with two living controls on the basis of sex, date of birth, and county of birth. Data were derived from subjects' birth certificates. Socioeconomic status and paternal benzene exposure were determined from the paternal occupation stated on the birth certificate. Hispanics and males were overrepresented in the case group. Cases were also less likely to be of birth order one. No difference was found between case and control groups for maternal age or paternal occupation. Analyses with stratification on age, sex, and leukemia cell type are reported.     

围生儿出生缺陷监测结果及相关因素分析

1998～2002年对5 750例围生儿进行出生缺陷监测.检出出生缺陷75例,出生缺陷发生率13.04‰.男婴出生缺陷发生率为14.02‰,高于女婴的发生率12.34‰.四肢及趾指畸形的发生率最高(3.83‰),其次为全身积液和水肿(2.61‰),再次为神经系统(2.26‰).缺陷儿母亲妊娠期并发症明显高于正常妊娠妇女.职业、文化程度和孕早期感冒及用药是导致出生缺陷的重要影响因素.提示,应继续开展出生缺陷监测及病因学研究,加强健康教育和普及优生知识,提高产前诊断技术,预防出生缺陷发生,提高人口整体素质.     

Maternal childhood cardiometabolic risk factors and pregnancy complications

PurposeThe influence of childhood health on later-life health outcomes is increasingly hypothesized but rarely tested. We examined the relationship between cardiometabolic indicators in childhood and risk of pregnancy-induced hypertension, preeclampsia, and gestational diabetes.MethodsChildhood measurements from 755 women in the Bogalusa Heart Study included body mass index, systolic and diastolic blood pressure (SBP and DBP), low- and high-density lipoprotein cholesterol, total cholesterol, triglycerides, insulin, and glucose. Average childhood values were estimated by area under the curve computed from longitudinal quadratic random-effects growth models to account for the unequally spaced repeated measures. Women reported pregnancy complications, and medical records were linked to interview data where possible. Log-Poisson models predicted adjusted risk associated with an interquartile range increase in cardiometabolic indicators.ResultsElevated childhood insulin was associated with 10%–15% increased risk across the three outcomes. Elevated childhood SBP was associated with preeclampsia (SBP RR = 1.50, 95% CI: 1.13, 2.01) and SBP, DBP, and body mass index predicted pregnancy-induced hypertension (SBP RR = 2.15, 95% CI: 1.65, 2.82; DBP RR = 1.83, 95% CI: 1.38, 2.43; BMI RR = 1.67, 95% CI: 1.41, 1.98). Blood pressure mediated the association between childhood body mass index and pregnancy-induced hypertension.ConclusionsResults suggest the potential long-term impact of early-life cardiometabolic profiles on complications of pregnancy.     

围生儿出生缺陷监测结果及相关因素分析

1998-2002年对5 750例围生儿进行出生缺陷监测。检出出生缺陷75例,出生缺陷发生率13.04‰。男婴出生缺陷发生率为14.02‰,高于女婴的发生率12.34‰。四肢及趾指畸形的发生率最高(3.83‰),其次为全身积液和水肿(2.61‰),再次为神经系统(2.26‰)。缺陷儿母亲妊娠期并发症明显高于正常妊娠妇女。职业、文化程度和孕早期感冒及用药是导致出生缺陷的重要影响因素。提示,应继续开展出生缺陷监测及病因学研究,加强健康教育和普及优生知识,提高产前诊断技术,预防出生缺陷发生,提高人口整体素质。     

染色体三体妊娠发生相关因素病例-对照研究

目的通过对比胎儿染色体正常孕妇与胎儿染色体核型为标准三体孕妇在妊娠方式、盆腔手术史、月经是否规律、正常生育次数、自然流产次数、人工流产次数、毒物接触史等方面是否存在差异,了解三体妊娠发生的高危因素。方法从2011年1月至2018年2月在内蒙古医科大学附属医院妇产科行羊水穿刺的1 098例患者中,选取标准三体妊娠孕妇77例作为研究组,为每位孕妇选择1名与其年龄相同,胎儿染色体正常的孕妇做对照组。通过条件逻辑回归分析,比较两组间是否在妊娠方式、盆腔手术史、月经是否规律、正常生育次数、自然流产次数、人工流产次数、毒物接触史方面存在差异。结果条件逻辑回归分析结果显示,月经不规律与三体妊娠发生存在关联(OR=5.596;95%CI 1.921-17.196,P=0.003);在三体妊娠组中,有盆腔手术史者的比例(11.7%)高于对照组(3.7%),但差异无统计学意义(P=0.057)。结论月经不规律是三体妊娠发生的高危因素,有盆腔手术史较无盆腔手术史易发生三体妊娠。     

早产相关因素的临床分析

目的 探讨不同孕周早产相关因素及早产对母婴妊娠结局的影响.方法 随机选取2015年1月至12月在南京医科大学附属南京妇幼保健院分娩的1010例早产病例进行回顾性分析,同时随机选取同期的1010例足月分娩病例为对照.比较不同孕周早产(早、中、晚期早产)的相关因素,不同孕周早产儿的并发症和早产的母婴结局.结果 ①胎膜早破在早、中、晚期早产中均占首要因素(分别为44.44%、49.43%、52.86%),其余存在明显相关性的因素为子宫因素、多胎妊娠、胎位异常、妊娠期糖尿病、妊娠期高血压及胎盘因素;②早产组中孕妇年龄在18岁以下或35岁以上、有人工流产史、有早产史和运用辅助生殖技术受孕的人数显著高于对照组(χ2值分别为4.21、10.53、7.21、57.87,均P<0.05);③不同孕周早产儿新生儿呼吸窘迫综合征(NRDS)、新生儿颅内出血(NICH)、新生儿高胆红素血症(NHB)、新生儿肺炎、新生儿坏死性小肠结肠炎(NEC)的发生率不同(χ2值分别为418.89、31.65、45.54、104.69和8.14,均P<0.05),其中NRDS、NICH及新生儿肺炎的发生率随着孕周的增加显著降低,NRDS早期和中期(χ2值分别为78.16、436.51和79.83)、早期和晚期(χ2值分别为8.15、30.31和4.76)、中期和晚期组(χ2值分别为15.43、108.52和19.61)相比较,均P<0.05);NHB在早期与中期早产儿中差异没有统计学差异(χ2=0.41,P>0.05),但早期组及中期组早产儿的NHB发生率明显高于晚期早产组(χ2值分别为23.56、35.47,P<0.05);NEC在早期早产儿中发生率明显高于中期及晚期早产组(χ2值分别为5.66、5.81,均P<0.05),在中期与晚期早产儿中NEC的发生率未见统计学差异(χ2=0.40,P>0.05);④早产组和对照组相比,其产后出血、剖宫产、新生儿窒息及死亡的发生率明显增高,差异有统计学意义(χ2值分别是35.24、43.99、17.51、49.67,均P<0.05).结论 早产是多因素综合作用的结果,重视产前检查及孕期保健,及早识别早产的危险因素,积极采取干预措施,改善早产儿预后,是提高妇幼保健质量的保证.     

Maternal partiality in attachment with multiple birth children and the related factors

Multiple births are associated with an increased risk of child abuse and neglect. It is reported that only one child is abused in almost cases, and most abusers are the mothers. Maternal partiality regarding attachment has been suggested as the reason for this tendency. This study investigated the prevalence of this phenomenon in families with multiple birth children and identified factors associated with increased risk. The subjects were 231 mothers of multiple birth children. The following results were obtained. 1. Overall, 10.0% of mothers with multiple birth children reported that they didn't equally attach themselves to all their offspring. 2. Mothers who didn't equally attach themselves exhibited significantly poor health conditions and a higher frequency of upper respiratory infections, compared with mothers who demonstrated no partiality. Moreover, they were more likely to complain of severe fatigue (physical and mental) and poor sleeping conditions. 3. The mothers who didn't equally attach themselves to all their multiple birth children had a higher rate of handicapped children. CONCLUSION: Mothers who do not equally attach themselves to all their multiple birth children show poor health conditions and a higher frequency of upper respiratory infections, and complain of severe fatigue and poor sleeping conditions. They also have a higher rate of handicapped children.