Exercise as a risk factor for infertility with ovulatory dysfunction.

To examine the relation of regular vigorous exercise to ovulatory infertility, we interviewed 346 infertile women, in whom there was evidence of ovulatory failure, regarding their exercise patterns during the year preceding their unsuccessful effort to conceive. Their responses were compared with similar exercise histories in women who had successfully conceived at the time the infertile women started trying to become pregnant. Vigorous exercise for an hour or more per day was reported more commonly in nulligravid cases (n = 187) than by their primiparous controls. The difference was particularly great in the subgroup of cases without additional evidence of tubal dysfunction (relative risk = 6.2, 90% confidence interval = 1.0 - 39.8). This association was not seen among infertile women who had previously been pregnant. Vigorous exercise for an average of less than one hour per day was not associated with either primary or secondary infertility.     

开颅手术后颅内感染风险预测模型构建及效果评价

 目的 运用logistic回归分析构建神经外科开颅手术后颅内感染风险预测模型并进行效果评价。方法 选取某院神经外科2019年1月—2021年6月行开颅手术的患者为研究对象,根据术后是否发生颅内感染分为病例组和对照组,采用logistic回归分析开颅手术后颅内感染发生的危险因素并构建风险预测模型,通过Hosmer-Lemeshow拟合优度检验和受试者工作特征(ROC)曲线对其效果进行综合评价。结果 共纳入778例开颅手术患者,121例发生术后颅内感染,发病率为15.55%;logistic多因素回归分析结果显示,幕下手术、脑室引流时间≥3 d、使用明胶海绵≥3片、出血量≥300 mL、切口脑脊液漏是开颅手术后颅内感染的独立危险因素(均P<0.05);开颅手术后颅内感染的风险预测模型为:logit (P)=5.408＋0.833×(幕下手术)＋0.083×(脑室引流时间)＋1.059×(使用明胶海绵)＋0.456×(出血量)＋2.821×(切口脑脊液漏);Hosmer-Lemeshow拟合优度检验结果显示颅内感染的预测概率和实际发病率比较,差异无统计学意义(P=0.768);logistic回归风险预测模型验证准确率为86.00%,ROC曲线下面积为0.847,95%CI为0.814~0.878。结论 幕下手术、脑室引流时间≥3 d、使用明胶海绵≥3片、出血量≥300 mL、切口脑脊液漏是神经外科开颅手术后颅内感染的独立危险因素,运用logistic回归分析构建的风险预测模型对术后颅内感染的预测效果较好。     

输卵管性不孕的高危因素分析

目的:探讨输卵管性不孕(TFI)的病因,并为其预防和临床治疗提供参考依据。方法:采用病例-对照研究方法,病例组为在弋矶山医院确诊为输卵管性不孕妇女,对照组为在妇产科人流妇女。两者均填写统一调查表,并检测衣原体(CT)、支原体(UU)。资料采用非条件Logistic回归分析。结果;病例组衣原体、支原体感染(25.7%、18.8%)明显高于对照组(6.7%、2.5%)。危险因素为:初次性生活年龄20岁(OR:3.373)、性伴侣数1人(OR:3.056)、人流史(OR:1.057)、输卵管妊娠史(OR:6.579)、宫颈炎(OR:2.890)、盆腔炎史(OR:6.488)、结核史(OR:4.986)、阑尾炎史(OR:4.915)。结论:UU、CT感染,初次性生活年龄过小、性伴侣多、输卵管妊娠史、宫颈炎、盆腔炎史、结核史、阑尾炎史是输卵管性不孕的危险因素。人流史与TFI无显著相关。     

女性不孕症危险因素的病例对照研究

目的探讨不孕症妇女在生活和工作环境中接触的可能危险因素。方法采用病例对照研究,于2012年10月8日—2013年1月8日在北京大学第三医院门诊进行问卷调查,内容包括个人基本情况、个人生活习惯、环境中接触到的可疑危险因素等情况。确诊不孕症为不孕组,回收有效问卷352例;同期自然妊娠孕妇为对照组,回收有效问卷413例。结果单因素分析显示,被动吸烟、吃油炸食品、用塑料制品饭盒、不经常体育锻炼、经常使用香水、指甲油、染发、烫发、熬夜、肥胖、有毒有害化学物、噪声接触、粉尘接触、长期在空调环境中工作、居室不常通风、居住地环境不佳对不孕有影响;非条件多因素Logistic回归分析表明,文化程度高、失眠（OR=2．6,95％CI：1．7～4．O）、吃油炸食品（OR=2．0,95％CI：1．2—3．3）、月经不规律（OR=3．1,95％CI：1．8～5．3）、有粉尘接触史（OR=2．4,95％ CI：1．0～5．6）、居住地环境质量差（OR=1．9,95％CI：1．4～2．7）为不孕症的危险因素。结论女性不孕症的发生与自身疾病、生活习惯和环境接触的危险因素有关。对育龄女性加强宣教针对性,减少上述危险因素的接触,可预防不孕的发生。     

Causes of infertility as predictors of subsequent cancer risk

BACKGROUND: Although studies have found elevated risks of certain cancers linked to infertility, the underlying reasons remain unclear. METHODS: In a retrospective cohort study of 12,193 U.S. women evaluated for infertility between 1965 and 1988, 581 cases of cancer were identified through 1999. We used standardized incidence ratios (SIRs) to compare cancer risk with the general population. Analyses within the cohort estimated rate ratios (RRs) associated with infertility after adjusting for other risk predictors. RESULTS: Infertility patients demonstrated a higher cancer risk than the general population (SIR = 1.23; 95% confidence interval [CI] = 1.1-1.3), with nulligravid (primary infertility) patients at even higher risk (1.43; 1.3-1.6). Particularly elevated risks among primary infertility patients were observed for cancers of the uterus (1.93) and ovaries (2.73). Analyses within the cohort revealed increased RRs of colon, ovarian, and thyroid cancers, and of melanomas associated with endometriosis. Melanomas were linked with anovulatory problems, whereas uterine cancers predominated among patients with tubal disorders. When primary infertility patients with specific causes of infertility were compared with unaffected patients who had secondary infertility, endometriosis was linked with distinctive excesses of cancers of the colon (RR = 2.40; 95% CI = 0.7-8.4), ovaries (2.88; 1.2-7.1), and thyroid (4.65; 0.8-25.6) cancers, as well as melanomas (2.32; 0.8-6.7). Primary infertility due to anovulation particularly predisposed to uterine cancer (2.42; 1.0-5.8), and tubal disorders to ovarian cancer (1.61; 0.7-3.8). Primary infertility associated with male-factor problems was associated with unexpected increases in colon (2.85; 0.9-9.5) and uterine (3.15; 1.0-9.5) cancers. CONCLUSIONS: The effects of infertility may extend beyond gynecologic cancers. Thyroid cancers and melanomas deserve specific attention, particularly with respect to endometriosis.     

Recreational drug use and the risk of primary infertility

Recreational drug (marijuana, lysergic acid diethylamide or LSD, speed, cocaine, and "other") exposures of women with primary infertility were compared with those of a matched control group of women with proven fertility. Women who reported smoking marijuana had a slightly elevated risk for infertility due to an ovulatory abnormality (RR = 1.7, 95% CI = 1.0 to 3.0). The risk was greatest among women who had used marijuana within one year of trying to become pregnant (RR = 2.1, 95% CI = 1.1 to 4.0). No consistent frequency or duration of use effects could be demonstrated, and the risk was confined to low-frequency users. Risks associated with the use of other drugs were not elevated. The risk of infertility from a tubal abnormality associated with cocaine use was greatly increased (RR = 11.1, 95% CI = 1.7 to 70.8). Our results are consistent with animal studies suggesting that smoking marijuana may cause a transient disruption of ovulatory function. The possibility that cocaine exposure influences the development of tubal infertility needs further investigation.     

The impact of lifestyle risk factors on female infertility

BACKGROUND: Over 2 million couples in the United States are infertile. The literature reflects a number of potential lifestyle risks that have been associated with the development of this condition; however, few studies have investigated these risks concurrently.With knowledge of the importance of behavioral threats to fertility, women's health care providers will be in a better position to screen and assist women to modify their fertility risks. OBJECTIVES: The objectives of this study were (1) to identify lifestyle factors associated with infertility in women by comparing a sample of infertile women with a group of fertile women and (2) to offer recommendations to women's health providers, on counseling women at risk for infertility. METHODS: A re-examination of the 1995 National Survey of Family Growth (NSFG) allowed for the investigation of lifestyle factors associated with infertility in women. Using a conceptual model of health behavior to guide the selection of variables, together with multiple logistic regression techniques, an explanatory model of infertility was estimated on a sample of 824 women between the ages of 16 and 45 years. RESULTS: Factors directly related to infertility included increasing age, a history of an ectopic pregnancy, current smoking, obesity, and self reported health status. Protective effects were associated with a history of condom use and having had a Pap smear in the last year. CONCLUSIONS AND IMPLICATIONS: Routine well-women visits offer an excellent opportunity to begin to address the impact of selected risk factors for infertility. Clinicians can utilize these visits to target appropriate interventions for initiating, repeating, and reinforcing messages on fertility risk.     

Alternative evaluation metrics for risk adjustment methods

Risk adjustment is instituted to counter risk selection by accurately equating payments with expected expenditures. Traditional risk‐adjustment methods are designed to estimate accurate payments at the group level. However, this generates residual risks at the individual level, especially for high‐expenditure individuals, thereby inducing health plans to avoid those with high residual risks. To identify an optimal risk‐adjustment method, we perform a comprehensive comparison of prediction accuracies at the group level, at the tail distributions, and at the individual level across 19 estimators: 9 parametric regression, 7 machine learning, and 3 distributional estimators. Using the 2013–2014 MarketScan database, we find that no one estimator performs best in all prediction accuracies. Generally, machine learning and distribution‐based estimators achieve higher group‐level prediction accuracy than parametric regression estimators. However, parametric regression estimators show higher tail distribution prediction accuracy and individual‐level prediction accuracy, especially at the tails of the distribution. This suggests that there is a trade‐off in selecting an appropriate risk‐adjustment method between estimating accurate payments at the group level and lower residual risks at the individual level. Our results indicate that an optimal method cannot be determined solely on the basis of statistical metrics but rather needs to account for simulating plans' risk selective behaviors.     

输卵管阻塞性不孕症宫腹腔镜术后应用欣可聆插管通液效果观察

[目的] 观察输卵管阻塞性不孕症宫腹腔镜联合术后,用欣可聆注射液进行彩色超声引导下宫腔镜输卵管插管通液的临床效果。[方法] 选择宫腹腔镜术后至少一侧输卵管通畅的不孕症患者160例,按入院先后依次编入观察组和对照组,每组80例,观察组术后第1次月经干净后3~7 d应用欣可聆注射液,行彩色超声引导下宫腔镜输卵管插管通液;对照组不给予任何药物,采取期待疗法。比较两组术后1年妊娠情况。术后1年未妊娠者,于月经干净后3~7 d行子宫输卵管碘佛醇造影检查,观察比较两组输卵管通畅情况。[结果] 术后1年,观察组正常宫内妊娠率为68.75%高于对照组的51.25%,差异有统计学意义(χ²=5.104,P=0.024);两组异位妊娠率比较,差异无统计学意义(P>0.05);观察组未妊娠者输卵管双侧通畅率为40.9%,显著高于对照组的14.2%(P<0.05);双侧不通发生率为9.1%,非常显著低于对照组的42.8%(P<0.01);两组总通畅率比较,差异无统计学意义(P>0.05)。[结论] 输卵管阻塞性不孕症宫腹腔镜联合术后第1次月经干净后3~7 d,用欣可聆注射液行彩色超声引导下宫腔镜输卵管插管通液,可以降低盆腔的再次粘连,维持输卵管的通畅,提高妊娠率,可以作为宫腹腔镜术后的后续治疗方法,值得临床推广应用。     

中国肾移植受体术后医院感染危险因素文献的方法学与报告质量评价

 

目的 评价中国肾移植受体医院感染影响因素中文文献的方法学和报告质量。方法 检索中国知识基础设施工程（CNKI）、万方数据库、中文科技期刊数据库三个数据库自建库至2019年7月31日发表的关于肾移植受体术后医院感染危险因素的文献,分别使用NOS量表和STROBE声明评价纳入文献的方法学与报告质量。结果 共32篇文献纳入本研究,10篇文献报道了供体方面的危险因素,32篇文献均报道了受体方面的危险因素。方法学质量评价结果显示缺失偏倚分析以及随访信息,报告质量评价结果显示未全面报告参与者信息、偏倚分析、资助来源等。结论 中国发表的肾移植患者术后医院感染危险因素的中文文献质量尚可,方法学与报告规范存在提升空间。

     

Obesity increases the risk of spontaneous abortion during infertility treatment

OBJECTIVE: This study examines the relationship between body mass and the risk of spontaneous abortion in a large cohort of patients who received infertility treatment. RESEARCH METHODS AND PROCEDURES: This is a retrospective study using data on pregnancies (n = 2349) achieved after treatment in a tertiary medical center from 1987 to 1999. One pregnancy per subject was included, and the subjects were stratified into five body mass groups based on body mass index (BMI): underweight, <18.5 kg/m(2); normal, 18.5 to 24.9 kg/m(2); overweight, 25 to 29.9 kg/m(2); obese, 30 to 34.9 kg/m(2); and very obese, > or =35 kg/m(2). Logistical regression analysis was used. RESULTS: The overall incidence of spontaneous abortion was 20% (476 of 2349). The effect of BMI on the risk of spontaneous abortion was significant after adjusting for several independent risk factors. Compared with the reference group (BMI 18.5 to 24.9 kg/m(2)), underweight women had a similar risk of spontaneous abortion, whereas there was progressive increase of risk in overweight, obese, and very obese groups (p < 0.05, p < 0.01, and p < 0.001, respectively). DISCUSSION: Of all known risk factors for spontaneous abortion, the control of obesity has great significance because it is noninvasive, potentially modifiable, possibly amenable to low cost, and self-manageable by patients. This study established a positive relationship between BMI and the risk of spontaneous abortion in women who became pregnant after assisted reproductive technology treatment.     

Dietary fatty acid intakes and the risk of ovulatory infertility

BACKGROUND: Pharmacologic activation of the peroxisome proliferator-activated receptor gamma (PPAR-gamma) improves ovulatory function in women with polycystic ovary syndrome, and specific dietary fatty acids can affect PPAR-gamma activity. OBJECTIVE: The objective of the study was to assess whether the intakes of total fat, cholesterol, and major types of fatty acids affect the risk of ovulatory infertility. DESIGN: We conducted a prospective cohort study of 18 555 married, premenopausal women without a history of infertility who attempted a pregnancy or became pregnant between 1991 and 1999. Diet was assessed twice during follow-up by using a food-frequency questionnaire. RESULTS: During follow-up, 438 incidents of ovulatory infertility were reported. In logistic regression analyses, intakes of total fat, cholesterol, and most types of fatty acids were not related to ovulatory infertility. Each 2% increase in the intake of energy from trans unsaturated fats, as opposed to that from carbohydrates, was associated with a 73% greater risk of ovulatory infertility after adjustment for known and suspected risk factors for this condition [relative risk (RR) = 1.73; 95% CI: 1.09, 2.73]. Obtaining 2% of energy intake from trans fats rather than from n-6 polyunsaturated fats was associated with a similar increase in the risk of ovulatory infertility (RR = 1.79; 95% CI: 1.11, 2.89). In addition, obtaining 2% of energy from trans fats rather than from monounsaturated fats was associated with a more than doubled risk of ovulatory infertility (RR = 2.31; 95% CI: 1.09, 4.87). CONCLUSION: trans Unsaturated fats may increase the risk of ovulatory infertility when consumed instead of carbohydrates or unsaturated fats commonly found in nonhydrogenated vegetable oils.     

女性不孕症影响因素的病例对照研究

目的 探讨已婚育龄妇女不孕症的影响因素及其变化情况.方法 采用以省级医院为基础的配对病例对照研究,按年龄(±2岁)配对,共收集383对病例和对照,进行统一的问卷调查.用EpiData 3.0软件建立数据库,应用SPSS 11.5软件进行单因素和多因素条件logistic回归分析.结果 多凶素条件logistie回归分析表明,盆腔感染性疾病史(0R=7.078,95%CI:3.462～14.467)、末次妊娠产后或流产后并发症史(0R=3.674,95%CI:1.690～7.986)、药物治疗史(0R=23.576,95%CI:12.324～45.102)、痛经(0R=1.622,95%CI:1.161～2.266)、性交痛(0R=2.447,95%CI:1.201～4.986)、每月性生活次数(0R=1.416,95%CI:1.048～1.913)及精神压力(0R=2.146,95%CI:1.662～2.771)可能是女性不孕症的危险因素,而文化程度(0R=0.522,95%CI:0.391～0.696)可能为其保护因素.结论 预防和治疗盆腔感染,严格掌握治疗药物的适应证,重视生殖健康的宣传教育,提倡晚婚晚育,避免婚前性生活等可能减少女性不孕症的发生.     

女性不孕相关危险因素的病例对照研究

目的:探讨女性不孕的相关危险因素.方法:应用病例对照对女性不孕的相关危险因素进行研究和分析,选择228例不孕妇女为病例组,同期早孕妇女225例为对照组;采用问卷调查的方式收集数据,应用条件logistic回归分析从差异有统计学意义的结果中分析出不孕相关危险因素.结果:肥胖、受教育程度低、无工作、睡眠质量不高、入睡障碍、睡眠时间不足可能是导致不孕症的危险因素.结论:应加强对育龄期妇女的生殖健康知识教育,增强育龄期妇女体质,鼓励全职主妇进入社会工作,控制肥胖,改善睡眠以降低不孕症的发生率.     

Cancer risk after sterilization with transcervical quinacrine: updated findings from a Chilean cohort

Background

Dating back to the 1970s, thousands of women worldwide have voluntarily been sterilized with transcervical insertion of quinacrine pellets. The safety and efficacy of the technology are still being assessed today; in particular, better estimates on the incidence of human cancers are now feasible.

Methods

We conducted a cohort study of 1492 women in Santiago and Valdivia, Chile, who received transcervical quinacrine pellets for contraceptive sterilization between l977 and l989. We periodically interviewed women with the last interviews in 2006-2007 and reviewed their medical records. We calculated age and site-specific incidence of invasive cancers and compared the observed cases to the number of expected cases based on data from the Cali, Colombia, cancer registry, gathered by the International Agency for Research on Cancer.

Results

During 23,894 person-years of follow-up, 41 invasive cancers were identified, including 16 new cases that had occurred since the previous analysis. Ten cases of cervical cancer were observed, compared with 12.1 expected. Since the initial study's confirmation of a single case of leiomyosarcoma, no other uterine cancers have been diagnosed. We would expect 2.0 uterine cancers during this number of observed women-years. One case of ovarian cancer was diagnosed, compared with 3.1 expected.

Conclusion

Rates of cancer among women exposed to intrauterine quinacrine are similar to population-based rates.     

Cancer risk assessment for arsenic exposure through oyster consumption

Risk is assessed on the basis of assumptions, but this practice might not be well received by the general public. To avoid miscommunication, the assumptions should be stated clearly in reporting the results. Recently, a report on an assessment of the cancer risk associated with consumption of oysters caused a panic among consumers in Taiwan and produced significant effects on related industries. A group of researchers measured the arsenic content in oysters in the Taiwan area and conducted a cancer risk assessment accordingly. The results, published in a research article in an international journal, included a lifetime cancer risk estimate of 5.10/10(-4) as calculated based on the assumption that a person consumes oysters with the highest arsenic level (19.3 mg/g dry weight) at the highest rate (139 g/day) for 30 years. A national newspaper in Taiwan translated part of the article and published results that focused on the finding that this estimate was more than 500 times higher than what would be considered acceptable by the U.S. Environmental Protection Agency. As a result, most consumers stopped purchasing oysters, and the related industries suffered substantial losses. The newspaper's omission of the key assumptions in the risk assessment and the extreme assumptions made in the risk assessment led to this tragedy. This event demonstrated the importance of careful communication of risk assessment results.