Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959-1961

Context  Schizophrenia is a common major mental disorder. Intrauterine nutritional deficiency may increase the risk of schizophrenia. The main evidence comes from studies of the 1944-1945 Dutch Hunger Winter when a sharp and time-limited decline in food intake occurred. The most exposed cohort conceived during the famine showed a 2-fold increased risk of schizophrenia. Objective  To determine whether those who endured a massive 1959-1961 famine in China experienced similar results. Design, Setting, and Participants  The risk of schizophrenia was examined in the Wuhu region of Anhui, one of the most affected provinces. Rates were compared among those born before, during, and after the famine years. Wuhu and its surrounding 6 counties are served by a single psychiatric hospital. All psychiatric case records for the years 1971 through 2001 were examined, and clinical and sociodemographic information on patients with schizophrenia was extracted by researchers who were blinded to the nature of exposure. Data on number of births and deaths in the famine years were available, and cumulative mortality was estimated from later demographic surveys. Main Outcome Measures  Evidence of famine was verified, and unadjusted and mortality-adjusted relative risks of schizophrenia were calculated. Results  The birth rates (per 1000) in Anhui decreased approximately 80% during the famine years from 28.28 in 1958 and 20.97 in 1959 to 8.61 in 1960 and 11.06 in 1961. Among births that occurred during the famine years, the adjusted risk of developing schizophrenia in later life increased significantly, from 0.84% in 1959 to 2.15% in 1960 and 1.81% in 1961. The mortality-adjusted relative risk was 2.30 (95% confidence interval, 1.99-2.65) for those born in 1960 and 1.93 (95% confidence interval, 1.68-2.23) for those born in 1961. Conclusion  Our findings replicate the Dutch data for a separate racial group and show that prenatal exposure to famine increases risk of schizophrenia in later life.      

1960年(饥荒中期)出生人群成年后糖尿病患病率显著性增高

目的:本研究探讨生命早期食物短缺及营养不良对成年后糖尿病患病危险的影响,为国家制订糖尿病干预政策提供科学依据.方法:本研究运用重庆某医院体检中心资料,选取1959～1964年出生的4640例成人作为研究对象进行调查.其中将1959～1960年出生人群作为研究组,1962～1964年出生人群作为对照组,进行回顾性研究,比较两组人群平均血糖值和糖尿病的患病率以及分布状况.结果:本次调查的结果显示1960年出生人群的平均血糖(Blood slouse,BG)水平显著高于非饥荒年出生人群(P<0.05).饥荒年出生人群糖尿病患病率显著高于非饥荒年出生人群(P<0.05). 1960年出生人群糖尿病患病率最高为4.55%.1959、1960、1961年出生人群相对于非饥荒年出生人群的标化后相对危险度为3.33、3.48和3.45.结论:生命早期经历了食物短缺和营养不良等灾害可能会增加成年后患糖尿病的危险性.     

生命早期饥荒暴露对50岁成年人血脂、血糖水平的影响

目的：检测饥荒年出生人群50岁时总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白、空腹血糖水平,探讨生命早期营养对成人疾病的影响.方法：2011年从安徽省某大型三级甲等医院健康体检中心整群抽取出生于1957~1963年的体检者4理214名.按出生时间将研究对象分为3组,1957~1958年出生的982人为饥荒前暴露组;1959~1961年出生的1 233人为饥荒暴露组;1962~1963年出生的1 999人为饥荒后暴露组.比较组间空腹低密度脂蛋白、高密度脂蛋白、三酰甘油、总胆固醇和空腹血糖水平的差异及变化趋势.结果：不同年份出生的体检者总胆固醇、三酰甘油、低密度脂蛋白和高密度脂蛋白差异均有统计学意义（P〈0.05~P〈0.01）,而空腹血糖差异无统计学意义（P〉0.05）.饥荒前暴露组男性三酰甘油低于饥荒后暴露组（P〈0.01）.女性空腹血糖、总胆固醇和低密度脂蛋白水平饥荒前暴露组均高于饥荒暴露组和饥荒后暴露组（P〈0.05~P〈0.01）.结论：生命早期饥荒暴露可能对成年后血糖、血脂代谢产生影响,这种影响对50岁以上男女的影响可能更为显著.孕期女性合理膳食、均衡营养对从根源上预防子代成年后慢性代谢性疾病意义深远.     

Congenital Abnormalities in Children Born in Alberta During 1961: A Survey and a Hypothesis

In Alberta, the provincial average for neonatal congenital physical abnormalities discovered at birth increased from 7.9 per 1000 births in 1959 to 13.8 per 1000 births in 1961.

Drugs taken by mothers during pregnancy were tabulated, including the antiemetic and tranquillizer agents, but no relationship was demonstrated between their use and damage to the fetus.

A significant relation was apparent, however, between the incidence of congenital malformations and the extent of precipitation in the area concerned. In Northern Alberta, where precipitation is highest, 15.5 per 1000 children born in 1961 showed physical defects. In Southern Alberta, where precipitation is lowest, 11.9 children per 1000 births were born with physical defects.

Increases of radioactive dust containing cesium-137, cerium-144 and strontium-90 were associated with above-ground Soviet thermonuclear Arctic explosions during recent years. The hypothesis is advanced that children born in Alberta in 1962 will show a greater incidence of physical deformities than those born in 1961, owing to greater rainfall during 1961 and 1962.

     

重庆市饥荒时期出生人群代谢综合征现时患病情况调查

目的:代谢综合征(MS)是重大的社会问题,通过调查重庆市1959/1961年出生人群MS患病状况,了解历经饥荒的中国人早年营养状况与成年后患MS的关系,为采取有效的预防和控制措施提供依据.方法:采自2005/2008年上半年重庆医科大学附属第一医院体检中心体检资料,选取1959/1961年出生的3482例体检人群作为研究对象进行整群抽样,运用SAS9.1分析MS发生情况.结果:重庆市饥荒年出生人群中MS患病率为11.52%,其中男性16.41%,女性3.78%.与同样采用CDS诊断标准、同样出生于饥荒年年龄段的我国2002年MS调查结果(男性患病率为10.06%,女性患病率为3.2%)相比,明显高于全国水平.本调查男性患病率高于女性,差异有统计学意义.MS诊断标准中各单一指标均未超标的只占总人数的1/3左右(31.85%),其中男性462例,占总人数的13.27%;女性647例,占总人数的18.58%.代谢异常(MA)的人群中诊断指标:1种异常占35.07%、2种异常占21.57%、3种及以上异常的占11.52%,对MS的危险因素进行单因素及多因素的Logistic回归分析显示高危因素,除超重和肥胖的影响外,...     

青少年母亲所生婴儿的死亡率及其危险因素

目的 :描述 1980～ 2 0 0 0年美国内华达州青少年母亲所生婴儿死亡率和变动趋势 ,并探索婴儿死亡的危险因素。方法 :利用 1980～ 2 0 0 0年内华达州出生 /死亡登记数据库资料进行分析。共有 42 1964名出生登记资料 ,包括 5 5 419名10～ 2 0岁青少年母亲所生婴儿登记资料。利用多因素Logistic回归模型分析婴儿死亡的危险因素和联系强度。结果 :该州1980～ 2 0 0 0年青少年母亲所生婴儿的死亡率变动范围为 5 .69～ 14 .72 /10 0 0 ,年平均死亡率为 9.5 1/10 0 0 ,显著高于 2 0岁及以上母亲所生婴儿的死亡率 ( 6.14 /10 0 0 )。婴儿死亡率在1980～ 2 0 0 0年间总体呈下降趋势。黑种人母亲的婴儿死亡率最高 ,为 16.0 7/10 0 0 ,显著高于白种人、本土美国人、亚裔和其他种族人。婴儿死亡率总体随着出生时母亲的年龄增长而下降 ,母亲 13～ 16岁时 ,随年龄降低明显 ;16岁以后缓慢降低 ,并维持在一定水平 ,40岁以后又显著上升 ;提示母亲年龄 16岁可能是一个重要的切割点。本研究同时得出 ,先天性畸形足、Meconiumaspirationsyndrome、先天性心脏畸形、RepeatC section、辅助通气少于 3 0min、出生体重、母亲吸烟、母亲产前护理开始时间等因素与婴儿死亡呈显著正关联 ,OR分别为 2 4.2 5、10 .68、10 .2 3、4.73、     

Opioid overdose mortality in Australia, 1964-1997: birth-cohort trends.

OBJECTIVE: To examine trends in rates of opioid overdose deaths from 1964 to 1997 in different birth cohorts. DESIGN: Age-period-cohort analysis of national data from the Australian Bureau of Statistics. MAIN OUTCOME MEASURES: Annual population rates of death attributed to opioid dependence or accidental opioid poisoning in people aged 15-44 years, by sex and birth cohort (in five-year intervals, 1940-1944 to 1975-1979). RESULTS: The rate of opioid overdose deaths increased 55-fold between 1964 and 1997, from 1.3 to 71.5 per million population aged 15-44 years. The rate of opioid overdose deaths also increased substantially over the eight birth cohorts, with an incidence rate ratio of 20.70 (95% confidence interval, 13.60-31.46) in the 1975-1979 cohort compared with the 1940-1944 cohort. The age at which the cumulative rate of opioid overdose deaths reached 300 per million fell in successive cohorts (for men, from 28 years among those born 1955-1959 to 22 years among those born 1965-1974; for women, from 33 years among those born 1955-1959 to 27 years among those born 1965-1969). CONCLUSIONS: Heroin use in Australia largely began in the early 1970s and rates of heroin use have markedly increased in birth cohorts born since 1950.     

三胎及三胎以上妊娠围产儿管理与结局分析

目的探讨三胎及三胎以上妊娠围产儿的临床处理和结局。方法回顾性分析1996年至2005年17例三胎及三胎以上妊娠共55例围产儿的管理方法及结局。结果前5年（1996年至2000年）和后5年（2001年至2005年）的规律产前检查率（1／6,8／11）差异有统计学意义（P〈0．05）;各种产科并发症的发生率差异无统计学意义;分娩时平均孕周分别为（32．7±2．8）周和（35．1±1．9）周,差异有统计学意义（P〈0．05）;新生儿平均出生体重分别为（1561±471）g和（1987±453）g,差异有统计学意义（P〈0．01）。剖宫产率后5年高于前5年,但差异无统计学意义。两组新生儿并发症主要为肺透明膜病、新生儿窒息、感染性疾病、颅内出血、肺出血,其发生率后5年较前5年明显下降,差异均有统计学意义（P〈0．05）;呼吸暂停、低体温发生率后5年较前5年明显下降,但差异无统计学意义。前5年新生儿死亡12例（60％）,后5年新生儿死亡8例（23％）,差异有统计学意义（P〈0．01）。结论规律产前检查,积极防治妊娠并发症,提前住院以延长孕周,增加出生体重,提倡产儿联合,重视早产儿并发症的防治,可以改善三胎及三胎以上妊娠围产儿的结局。     

2006—2008年芜湖市高危人群HIV抗体筛查分析

目的分析芜湖市2006—2008年疾控初筛中心实验室对各类人群艾滋病病毒（HIV）抗体筛查数据以及医疗机构、采供血机构送复查数据,初步评估现行筛查检测策略,为制定有效的防治措施提供信息与依据。方法2006—2008年依据《全国艾滋病检测技术规范（2004版）》规定的检测流程与方法分别对个类人群进行HIV抗体初筛、复检和确认。结果2006年各类人群检测阳率为0．4％;2007年各类人群检测阳率为0．2％;2008年各类人群检测阳率为0．4％。在各类人群筛查中,外来育龄妇女、公安司法机关被监管人员、门诊及术前检测者、MSM是发现HIV感染者的主要途径,在发现的HIV感染者中分别占17．2％、15．5％、13．8％、13．8％。献血员在发现的感染者中占12．1％,自愿咨询门诊求询者（VCT）在发现的感染者中占10．3％,吸毒者在发现的感染者中占6．9％,性病哨点在发现的感染者申占6．9％,HIV感染者配偶及子女在发现的感染者中占3．4％。结论在自愿咨询门诊求询者、MSM、戒毒所及美沙酮门诊、公安司法机关被监管人员、献血员、门诊及术前检测者、性病哨点、外来育龄妇女及暗娼中,进行HIV抗体筛查是发现HIV感染的重要手段。     

The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System

CONTEXT: The World Health Organization defines preterm birth as birth at less than 37 completed gestational weeks, but most studies have focused on very preterm infants (birth at <32 weeks) because of their high risk of mortality and serious morbidity. However, infants born at 32 through 36 weeks are more common and their public health impact has not been well studied. OBJECTIVE: To assess the quantitative contribution of mild (birth at 34-36 gestational weeks) and moderate (birth at 32-33 gestational weeks) preterm birth to infant mortality. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study using linked singleton live birth-infant death cohort files for US birth cohorts for 1985 and 1995 and Canadian birth cohorts (excluding Ontario) for 1985-1987 and 1992-1994. MAIN OUTCOME MEASURES: Relative risks (RRs) and etiologic fractions (EFs) for overall and cause-specific early neonatal (age 0-6 days), late neonatal (age 7-27 days), postneonatal (age 28-364 days), and total infant death among mild and moderate preterm births vs term births (at >/=37 gestational weeks). RESULTS: Relative risks for infant death from all causes among singletons born at 32 through 33 gestational weeks were 6.6 (95% confidence interval [CI], 6.1-7.0) in the United States in 1995 and 15.2 (95% CI, 13.2-17.5) in Canada in 1992-1994; among singletons born at 34 through 36 gestational weeks, the RRs were 2.9 (95% CI, 2.8-3.0) and 4.5 (95% CI, 4.0-5.0), respectively. Corresponding EFs were 3.2% and 4.8%, respectively, at 32 through 33 gestational weeks and 6.3% and 8.0%, respectively, at 34 through 36 gestational weeks; the sum of the EFs for births at 32 through 33 and 34 through 36 gestational weeks exceeded those for births at 28 through 31 gestational weeks. Substantial RRs were observed overall for the neonatal (eg, for early neonatal deaths, 14.6 and 33.0 for US and Canadian infants, respectively, born at 32-33 gestational weeks; EFs, 3.6% and and 6. 2% for US and Canadian infants, respectively) and postneonatal (RRs, 2.1-3.8 and 3.0-7.0 for US and Canadian infants, respectively, born at 32-36 gestational weeks; EFs, 2.7%-5.8% and 3.0%-7.0% for the same groups, respectively) periods and for death due to asphyxia, infection, sudden infant death syndrome, and external causes. Except for a reduction in the RR and EF for neonatal mortality due to infection, the patterns have changed little since 1985 in either country. CONCLUSIONS: Mild- and moderate-preterm birth infants are at high RR for death during infancy and are responsible for an important fraction of infant deaths. JAMA. 2000;284:843-849     

A Study of Sepsis in Surgical Wounds

Published records of the frequency of wound sepsis are often unreliable sources of information on the general frequency of this complication because of unstandardized methods of reporting and because of the various views of different investigators as to what constitutes sepsis. A method of infection reporting, its study and analysis are outlined. A survey of postoperative infections by this method for the years 1959, 1960 and 1961 revealed infection rates of 2.02%, 1.20% and 1.14%, respectively. For the same period the percentages of wound infections caused by Staph. aureus were 83.06%, 69.8% and 51.8%, respectively. The most prevalent phage types were 55/53/54 and 52/80/81/82, although types 80/81/82 and 80 were also involved. Infections with Gram-negative organisms were encountered more often in 1961 than in 1959. The majority of these were of mixed type, and followed abdominal surgery.

There is need for more comprehensive study and analysis of postoperative wound sepsis and its complications. It was apparent from this study that, statistically, a relatively low rate of postoperative infections may mask a high rate following a specific surgical procedure.

     

The effect of female age on the likelihood of a live birth from one in-vitro fertilisation treatment

OBJECTIVE: To determine the chance of at least one live birth from one round of in-vitro fertilisation (IVF) treatment and the effect of the woman's age on that likelihood. DESIGN: Retrospective analysis of outcomes from IVF treatment that did not involve donated gametes, but which included embryos cryopreserved in the retrieval cycle. SETTING AND PATIENTS: All IVF patients (median age, 36 years; range, 22-48 years) who attended a private IVF clinic in Sydney for an egg retrieval between 1 January 1998 and 31 December 1998, and had embryo placements (fresh and cryostored) performed up to 30 June 2001. MAIN OUTCOME MEASURE: Independently audited live births surviving the neonatal period. RESULTS: 565 women had 648 egg retrievals during the period. The age of peak utilisation of IVF was 39 years. For women aged 34 years or less, the chance of a live birth from one round of egg retrieval and IVF treatment was 52.4% (95% CI, 47%-59%). For women aged 35-44 years, there was a linear decline in the live birth rate, and no babies were born from retrievals at age 45 years and over. There was an age-dependent rise in the frequency of miscarriages, from 10.5% (95% CI, 5%-18%) for women under 35 years, to 16.1% (95% CI, 9%-25%) for those 35-39 years, and 42.9% [95% CI, 24%-63%] for those over 40 years (P < 0.001). A third of the first births resulted from embryo transfers performed after a period of cryostorage. CONCLUSION: As fertility with IVF falls from the age of 34 years, and the age of peak IVF utilisation is 39 years, many Australian women are seeking IVF at an age when the likelihood of a live birth is reduced.     

An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania

CONTEXT: Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE: To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN: Cross-sectional review of records and survey, conducted in February and March 1998. SETTING: Mtendeli refugee camp, Tanzania. PARTICIPANTS: For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES: Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS: The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS: Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.     

Down's syndrome. Recent trends in the United States

The crude incidence of Down's syndrome (DS) in the United States is currently about 1/1,000 births. Reduction in the proportion of births to women 35 years and older can account for a halving of the estimated percentage of DS births to this age group and a drop in the estimated crude incidence of DS from 1.33/1,000 births in 1960 to 0.99/1,000 births in 1978. Epidemiologic studies suggest that among women 35 years and older, the risk of having a child with DS has not changed. With the present distribution of maternal ages, prenatal diagnosis among women 35 years and older can result in no more than a 20% decrease in the crude incidence of DS. With continued use of prenatal diagnosis among older gravidas, upward of 80% of DS births will occur to younger mothers.     

Long-Stay Patients in Canadian Mental Hospitals, 1955-1963

Changes in the number and characteristics of patients in Canadian mental hospitals during 1955-1963 were studied in order to assess the future need for long-term hospital care.

Despite marked increases in the number of first admissions and readmissions, the average number of patients in hospital decreased 6% from 49,537 in 1955 to 46,498 in 1963.

Patients who were “long stay” in 1955 continued to leave hospital at the same rate during the years 1960-1963 as during 1955-1959. No “hard core” of long-stay patients with reduced potential for discharge seemed to have formed by 1963.

Since 1955 the number of “admissions” remaining continuously hospitalized has progressively decreased for the elderly and for patients with psychoses. No build-up of new long-stay patients from patients with repeated short admissions was evident.

The estimate of the Royal Commission on Health Services that the ratio of patients in mental hospitals could be reduced from 3.0 per 1000 in 1961 to 1.5 per 1000 by 1971 seems feasible.

     

Perinatal and postneonatal mortality among Indigenous and non-Indigenous infants born in Western Australia, 1980-1998

OBJECTIVE: To describe cause-specific perinatal and postneonatal mortality for Indigenous and non-Indigenous infants using a new classification system. DESIGN: Total population retrospective cohort study. PARTICIPANTS AND SETTING: All registered births in Western Australia of birthweight greater than 399 g from 1980 to 1998, inclusive. MAIN OUTCOME MEASURES: Rates and time trends for all births 1980-1998, and cause-specific rates for births 1980-1993 of fetal, neonatal and postneonatal mortality among Indigenous and non-indigenous infants, using a classification system designed for use in perinatal, postneonatal and childhood deaths. RESULTS: For Indigenous infants born 1980-1998, the mortality rate before the first birthday was 2.7 times (95% CI, 2.5-2.9 times) that for non-Indigenous infants. Indigenous infants born 1980-1993 had a higher mortality rate in all cause-of-death categories. The highest relative risk was for deaths attributable to infection (8.1; 95% CI, 6.5-10.0) which occurred primarily in the postneonatal period; the source of the infection was less likely to be identified in Indigenous deaths. From 1980-1998, the rate of neonatal deaths decreased at a greater rate for Indigenous than for non-Indigenous infants. However, while stillbirth and sudden infant death syndrome rates for non-Indigenous births fell, they remained static for Indigenous births. CONCLUSIONS: The new classification system, which considers the underlying rather than immediate cause of death, enables investigation of the causes of all deaths, from stillbirths to childhood. This system has highlighted the comparative importance of infection as a cause of death for Indigenous infants, particularly in the postneonatal period.     

Decline in the incidence of neural tube defects after the national fortification of flour (1997-2005)

OBJECTIVE: To evaluate the effect of flour fortification with folic acid on the incidence of neural tube defects (NTDs) in babies. We also report the pattern of NTDs, and we compare it with those reported previously. METHODS: All babies who were born with NTDs at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia between 1997 and 2005 were included in the study. The incidence of NTDs was compared between the eras before flour fortification (1997-2000) and the eras after fortification. RESULTS: We have observed a decline in NTD incidence in the last decade from 1.9/1000 live births (1997-2000) to 0.76/1000 live births (2001-2005). Forty-two babies were born with NTDs with a male to female ratio of 1.1:1. Sixty percent received folic acid during pregnancy, but none pre-conception. Eighty-three percent of the cases had myelomeningocele (MMC), 12% had encephalocele, 2.5% had meningocele, and another 2.5% had anencephaly. Ninety-one percent of MMC patients had severe physical disability. Thirty-two children (91%) had hydrocephalus, which required shunting in the neonatal period and 22 children (63%) had clubfeet. CONCLUSION: After folic acid flour fortification, there was an apparent decline in the incidence of NTDs in babies born at KAUH. However, the incidence is still high and associated with serious morbidity. This stresses the need for innovative programs to increase folic acid consumption by women of childbearing age, to reduce NTDs.     

Infective endocarditis. Olmsted County, Minnesota, 1950 through 1981

Strict criteria were used to identify all definite, probable, and possible cases of endocarditis in residents of Olmsted County, Minnesota, from 1950 through 1981. The mean annual age- and sex-adjusted incidence rates per 100,000 person-years were 3.8 for total cases and 3.2 for definite and probable cases only. Total rates were 4.3 for 1950 through 1959, 3.3 for 1960 through 1969, and 3.9 for 1970 through 1981. Rheumatic heart disease was the underlying disorder in 26% of cases, with a shift noted during 1970 through 1981 to involvement of prosthetic rather than natural valves in these patients. Mitral valve prolapse was identified in 17% of cases. No source of infection could be identified in 41% of cases, including half of those cases with rheumatic or congenital heart disease. In cases diagnosed prior to autopsy, the 60-day fatality fell from 46% during 1950 through 1959 to 22% and 26% during 1960 through 1969 and 1970 through 1981, respectively.     

The health and developmental status of very low-birth-weight children at school age.

OBJECTIVE--To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights. DESIGN--Inception cohort. SETTING/PARTICIPANTS--Participants were selected from two previously studied multisite cohorts: very low-birth-weight (less than or equal to 1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible. MAIN OUTCOME MEASURES--The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores. RESULTS--Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight. CONCLUSIONS--Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.     

Postneonatal deaths in North Carolina, 1959-1963

The data presented indicate that the disturbing upward trend in infant mortality in North Carolina has been arrested and possibly reversed during the 1959 through 1963 period. Information obtained from death certificates indicates that infections accounted for slightly more than half (52.4%) of the postneonatal deaths occurring in the study periods. The most common type of infection was influenza and pneumonia, followed by gastroenteritis and colitis, infective and parasitic disease, meningitis, and acute respiratory infections, in that order of frequency. Infections were responsible for a greater percentage of the postneonatal deaths among nonwhite (58.5%) than amon white infants (40.7%). the postneonatal death rate from infections was 13.4 for nonwhite infants and 2.2 for white infants. The next most common cause of postneonatal mortality -- congenital malformations -- was relatively more important in the white race, being responsible for approximately 25% of white deaths and only 6% of nonwhite deaths. I11 defined and unknown causes ranked 3rd in importance, with postneonatal death rates of 3.0 for nonwhite and .4 for white infants. Accidents, wich ranked 4th, were responsible for approximately 10% of the postneonatal deaths in each race. In both races, the risk of postneonatal death was greater in infants born to younger mothers, partiuclarly those under age 20. For the infants of mothers under age 15, the postneonatal death rate was 3 times as high as for those of 20-24 year old mothers. Beginning with age 20, the risk of postneonatal mortality decreases gradually as maternal age increases up to 35 years, when it begins to rise again in the white race. In nonwhite races, the decline continoues to age 40. Infants born to young mothers of nonwhite races suffer relatively higher postneonatal mortality than do their white counterparts. The postneonatal mortality rate is lowest for 1st born infants of both races. Among nonwhites, it is highest for the 2nd born; in the white race, it rises with each successive birth, with the exception of the 5th. Postneonatal mortality among very small white infants (those weighing less thatn 1500 gm at birth) was some 7 times that of infants weighing more than 2500 gm; it was even higher in nonwhite races being nearly 2 1/2 times that of the white group and appoproximately 4 times higher than the rate for nonwhite infants weighing more than 2500 gm at birth. The risk of postneonatal death for nonwhite infants born illegitimately was 1 1/2 times as great for those born in wedlock. Among white infants, the risk was almost twice as great for those born out of wedlock.