Influence of perinatal care regionalisation on the referral patterns of intermediate- and high-risk pregnancies

OBJECTIVE(S): To use the delivery site according to the birth weight as a marker of changes in the referral practices after regionalisation of perinatal care. STUDY DESIGN: Analysis of the distribution of low birth weight infants according to the level of care in Rhone-Alpes from 1998 to 2000 and analysis of the birth rate heterogeneity according to the delivery site characteristics. RESULTS: The distribution of infantsbirth rates corresponded to the private, the lower-flow, and the more distant from neonatal intensive care units facilities. For infantsbirth rate was four times the level 2 (P=0.0006) and five times the level 1 (P<0.0001) rates. For infants 1500-2000 g, level 3 birth rate was twice the level 2 (P=0.0096) and 3.6 times the level 1 (P<0.0001) rates. Birth rates were always significantly higher in university than in private facilities. CONCLUSION(S): Supervising level 3 is insufficient to show the effect of regionalisation. A more accurate analysis of intermediate-risk referral determinants is needed to reach a more demand/supply adequacy.     

Increase in low-birth-weight infants in Japan and associated risk factors, 1980-2000

AIM: To investigate possible factors related to the recent rise in prevalence of low-birth-weight (LBW) infants in Japan. METHODS: A data set comprising 11,746 infants from the Children and Infant Growth Surveys (1980, 1990, and 2000) was analyzed. RESULTS: The proportion of LBW infants was 4.2% in 1980, 6.1% in 1990, and 8.3% in 2000. The maternal smoking prevalence increased from 6.5% in 1990 to 10.9% in 2000. When multivariate logistic regression analysis was applied to estimate the risk for LBW from 1990 to 2000, the following were selected as independent factors: preterm delivery, early term delivery, female sex of the infant, maternal primiparity, multiple gestation, maternal short stature, older maternal age (>24 years), and maternal smoking. The population attributable fraction (PAF) of preterm plus early term delivery and multiple gestations to LBW was 85.1% in 1990, and 89.3% in 2000. The PAF of maternal smoking was 6.4% in 1990, and 7.4% in 2000. CONCLUSIONS: The increase in preterm deliveries and multiple gestations were found to be the important factors with regard to the increase in LBW infants in Japan. The increased prevalence of maternal smoking was not substantially associated with the increase in LBW infants.     

Recognition of and response to postpartum hemorrhage in rural northern India

This study describes the results of a Morbidity and Performance Assessment (MAP) conducted to provide insight into the medical factors contributing to maternal and newborn morbidity and mortality in a rural district of northern India, and to use these insights to develop a locally appropriate, community-based safe motherhood program The MAP study was based on verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a family member) participated in the study. This article describes a subsample of women who reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor knowledge of danger signs; poor problem recognition during labor, birth, and the immediate postpartum period; and a low level of health seeking that was consistent with poor recognition. Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs were generally not associated with problem recognition and health seeking. The case fatality rate was 4%. These findings suggest an urgent need to understand the phenomenon of problem recognition and to integrate this into the design of interventions to reduce delays in health seeking.     

A relation between seasonal temperature and the birth rate of schizophrenic patients

The relation between schizophrenia birth rates and environmental temperature was studied in patients born in England and Wales during 1921–1955 and first admitted there in 1970–1977. A methodological difficulty due to varying age-incidence was avoided by the use of indices independent of yearly changes in rates. Birth rates in the second quarter and in the first half of the year showed high negative correlations with mean temperatures of the first quarter and first half of the year. Comparison of years with the coldest and with the warmest seasons showed the schizophrenia birth rate to be consistently higher in the coldest years. No comparable relations between birth rates and temperature were found for patients with affective psychosis, neurosis or personality disorder. The findings indicate an association between schizophrenia birth rates and temperature of a kind similar to that between infant death rates and temperature during the years 1921–55. Some implications are discussed.     

Characteristics of births in each cycle of the bimodal monthly distribution in cystic fibrosis

The bimodal monthly birth distribution of patients with cystic fibrosis (CF) in Victoria, Australia, is shown to be similar within and among sibships, so that intrafamilial concentration of births around March (mode 1) or September (mode 2) cannot explain the observed periodic pattern. Mode 2 children are subject to a higher stillbirth rate and have younger maternal ages than mode 1 children. A sample of persons dying with CF in England and Wales displaying a similar bimodal birth pattern is shown to have a reduced infant survival rate for males of mode 2. These findings suggest that two annual cycles are a more appropriate model than a six-monthly cycle. An attempt is made to equate mode 1 in the northern hemisphere with mode 2 in the southern hemisphere by pointing out the high perinatal death rate in the former and the high still-birth rate in the latter.     

Genetic Studies in Azoospermic Patients with the Klinefelter Pattern of Testicular Biopsy

Genetische Studien bei Azoospermie-Patienten mit Klinefelter-Syndrom-Symptomatik
Bei 82 Männern mit Azoospermie und Klinefelter-Symptomatik in der Hodenbiopsie wurden genetische, histopathologische, anthropometrische und klinische Untersuchungen durchgeführt. Die Ergebnisse deuten daraufhin, daß die Geschlechtschromatinwerte nicht als Ersatz für die Chromosomenanalyse gelten können, wenn ein Mosaik ausgeschlossen werden soll. Die Untersuchung zeigt weiterhin eine deutliche phaenotypische Überlappung zwischen chromatinpositiven und chromatinnegativen Befunden mit Klinefelter-Symptomatik. Diese Überlappung kommt vor bei dem klinischen Erscheinungsbild, welches durch die Anthropometrie dokumentiert wird und durch die histopathologischen Befunde der Hodenbiopsie, vor allem aber betrifft es die Bedeutung der genetischen Befunde. Fälle ohne Chromosomenaberration, bei denen die Autoren einen Umweltfaktor für aetiologisch bedeutsam halten, werden als Phaenokopien der genetischen Störung beschrieben.     

Handedness: An alternative hypothesis

Handedness data collected during the Hawaii Family Study of Cognition were congruent with similar data from major published studies. Mixed-model segregation analysis did not detect a significant major gene or polygenes contributing to handedness and partitioned the total phenotypic variation into 10–20% genetic and 80–90% environmental components. No relationship between handedness and cognitive ability was detected, but significant relationships between birth stress and offspring handedness were found. There was a significant decline in the percentage of left-handed individuals grouped by advancing age. A hypothesis of handedness is proposed in which left-handedness results from a combination of genotype, birth experience, and maternal example.The results reported here were made possible by collaboration of a group of investigators (G. C. Ashton, R. C. Johnson, M. P. Mi, and M. N. Rashad at the University of Hawaii, and J. C. DeFries, G. E. McClearn, S. G. Vandenberg, and J. R. Wilson at the University of Colorado) supported by National Science Foundation Grant GB 34720 and National Institute of Child Health and Human Development Grant HD 06669.     

Retardation of Prenatal Brain Growth of Guinea Pigs by Disulfiram1

ABSTRACT: Guinea pigs were given disulfiram (125 mg/kg) orally once each morning of days 17–19 or 19–21 of pregnancy. Brain weight was reduced in the offspring whose mother was dosed during days 19–21 of pregnancy. Females of both experimental groups were found to have smaller brains compared with the expected brain weight of similar body weight female controls. Male offspring of both experimental groups did not display any obvious reduction in brain weight.     

Bone Mineral Content in Preterm Infants at Age 4 to 16

Using photon absorptiometry the forearm bone mineral content (BMC) was determined in 75 children aged 4 to 16, who all had a low birth weight. Forty-five of them were born preterm AGA (27 boys, 18 girls, mean weight 1580 g; range 920-2060 g) and 30 preterm SGA (17 boys, 13 girls, mean weight 1510; range 940-2130 g). The results were compared with a control group of children of the same age, and analyses of covariance with age, height and weight as the covariant factors were performed. The BMC, weight and height did not differ between the children born AGA or SGA. Irrespective of AGA or SGA, the BMC was significantly decreased in boys but the difference was less pronounced and less significant when height and weight were used as covariant factors. Boys who had been born preterm had a less BMC than the control boys for their age but the were also somewhat shorter and lighter than expected with regard to their age.     

Birth characteristics and adult cancer incidence: Swedish cohort of over 11,000 men and women

Associations between larger size at birth and increased rates of adult cancer have been proposed but few empirical studies have examined this hypothesis. We investigated overall and site-specific cancer incidence in relation to birth characteristics in a Swedish population-based cohort of 11,166 singletons born in 1915-1929 for whom we have detailed obstetric data and who were alive in 1960. A total of 2,685 first primary cancers were registered during follow-up from 1960 to 2001. A standard deviation (SD) increase in birth weight for gestational age (GA) was associated with (sex-adjusted) increases of 13% (95% CI = 0.03-0.23) in the rates of digestive cancers and of 17% (95% CI = 0.01-0.35) in the rates of lymphatic cancers. Women who had higher birth weights also had increased rates of breast cancer under age 50 years (by 39% per SD increase; 95% CI = 0.09-0.79), but reduced rates (by 24%; 95% CI = 0.07-0.38) of endometrial (corpus uteri) cancer at all ages. There was no evidence of associations with other cancer sites. For overall cancer incidence, men had an 8% increased risk at all ages per SD increase in birth weight for GA while women only had an increased risk under age 50 years (mainly driven by the association with breast cancer). These findings provide evidence of a modest association of birth size and adult cancer risk, resulting from positive associations with a few cancer sites and a possible inverse association with endometrial cancer.