摘要:

Summary.Understanding how pregnancy‐induced hypertension affects fetal growth could suggest a particular biological mechanism leading to intrauterine growth retardation (IUGR) and improve our understanding about how other exposures affect the risk of IUGR. It is hypothesised that hypertension reduces uteroplacental perfusion and through this route inhibits fetal growth.1‐2Definitions and associated incidence rates are given. The findings from the epidemiological literature on hypertension in pregnancy and fetal growth are then critically discussed and summarised. Finally, the steps to be taken next in this area of research are outli

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00048.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00049.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary.In order to provide additional data and perspective to current clinical, policy, and legal debates surrounding the prenatal use of cocaine in the USA, a retrospective cohort study was conducted to examine effects of cocaine on selected perinatal outcomes, and to compare the relative risks of adverse perinatal outcomes among users of cocaine and users of cigarettes. Using data from a large urban perinatal registry, relative risks of selected perinatal outcomes were determined for maternal cocaine users who were non‐smokers of cigarettes, and used no marijuana, heroin, amphetamines, or alcohol(n= 64), and for cigarette smokers who do not use illicit drugs or alcohol during pregnancy(n= 3209). When compared with women with no recorded prenatal exposure to drugs or cigarettes(n= 13043), cocaine users had higher risks than smokers for the following adverse outcomes: low birthweight [Relative Risk (RR) 5.3, 95% Confidence Interval (CI) 3.0–9.3], small‐for‐ges‐tational age (SGA) [RR4.2, 95% CI 2.4–7.3], prematurity [RR4.0, 95% CI 2.3–7.0], abruptio placentae [RR = 10.0,95% CI 3.5–29.0], placenta prae‐via [RR = 2.4, 95% CI 0.3–17.8] and perinatal death [RR = 5.3, 95% CI 1.9–15.2]. Smokers who did not use any drugs experienced most of the same adverse perinatal outcomes as cocaine users, but the magnitude of risk was greater in cocaine users than in smokers for all outcomes. However, given the greater numbers of cigarette smokers than cocaine users in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cigarette smokers. The data support current concern about the risk of cocaine, and current efforts to provide treatment to pregnant cocaine users. The data also underline the continued substantial risks of cigarette smoking to large numb

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00050.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary..Rates of depression were studied in a sample of over 9000 women who were participants in the Avon Longitudinal Study of Pregnancy and Childhood. Assessments of depression were made at 18 and 32 weeks gestation, and at 8 and 32 weeks postpartum. Changes in depressive status across time were modelled using latent Markov modelling methods. This analysis showed that when classification errors were taken into account there was relatively high stability in diagnostic status during pregnancy and after pregnancy. However, the transition from late pregnancy to the early postnatal period showed evidence of increased instability and remission of depression. The net effects of this were that rates of depression tended to decline following childbirth. The implications of these results for a series of issues including measurement errors in depression reports and the prevalence of depression before and after childbirth are discussed.

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00051.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary.This study investigates how the timing of the development of limb reduction defects (LRDs) is associated with selected demographic, medical variables and defect characteristics. The LRD cases (n= 281) were ascertained from the Congenital Malformations Registry of New York State among 1983‐87 births. Cases were classified according to five stages of gestation based on when their earliest LRD developed. A control group consisted of a systematic random sample (n= 327) of non‐malformed livebirths. Demographic and LRD characteristics were abstracted from birth certificates and medical charts. Among LRDs, the defects that occurred in the earlier stages of gestation were found to be more complex involving syndromes, multiple limbs, and previous maternal medical problems, compared with those developing in the later stages. Middle or late stage LRDs tended to occur more often with syndactyly than early stage LRDs, and had significantly higher frequencies of non‐white infants compared with controls. In addition, some perinatal complications, preterm delivery and low birthweight were positively associated with any LRD. Our findings suggest that the timing of a disturbance in limb development is important in terms of LRD characteristics. Demographics did not vary consistently with the stage of LRD development. Further studies testing this classification technique are sugg

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00052.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary.Our previous research has shown that the sudden infant death syndrome (SIDS) rate for Aboriginal infants in Western Australia (WA) is markedly higher than that for non‐Aboriginal infants. The aim of this study was to identify factors that may be important in explaining this disparity. A case‐control study was conducted based on routinely collected data for the population of WA singleton births from 1980 to 1990 inclusive. Cases were infants bom and classified as dying from SIDS in WA (Aboriginal n = 88; non‐Aboriginal n = 409). Controls were infants born in WA and not classified as dying from SIDS; 2% samples of both Aboriginal and non‐Aboriginal infants were included. The risk of dying from SIDS in Aboriginal infants was 3.86 times [95% confidence interval (CI) = 2.98 to 5.02] that in non‐Aboriginal infants. Statistically significant univariable risk factors for SIDS in Aboriginal infants were preterm birth, low birthweight and small‐for‐gestarional‐age; for non‐Aboriginal infants they included these factors as well as single marital status, young maternal age, parity of one or greater and male sex. Comparing Aboriginal with non‐Aboriginal controls, most of the risk factors were more common in the Aboriginal population. Multiple logistic regression analysis indicated that Aboriginal infants were 1.43 times [95% CI = 1.04 to 1.95]more likely to die from SIDS than non‐Aboriginal infants. Differences in the risk factor profile for Aboriginal and non‐Aboriginal infants were sought using interaction terms. The only important differences were that the risk of SIDS in Aboriginal infants, unlike that in non‐Aboriginal infants, appeared not to be strongly related to male sex or to single marital status. Thus, the results show that the disparity between the incidence of SIDS in the Aboriginal and non‐Aboriginal populations can be explained largely, although not totally, by the high prevalence of routinely recorded risk factors in the Aboriginal population. A limitation of this study is that data on the postnatal nsk factors of prone sleeping, maternal smoking and non‐breastfeeding were unavailable. The residual excess risk for Aboriginal infants may be a result of these recognised postnatal risk factors and /or other infant care practices that are not routinely recorded in our data base, or to underlying social and economic conditions. Further study of all these potent

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00053.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary.As little is known about the aetiology of cancer in children, analysis of time trends may be useful. Recent data on time trends for paediatric cancers are very limited. We report here on trends in the incidence of 15 categories of cancer in children under 15 years of age from 1970 to 1989, using data from the Greater Delaware Valley Pediatric Tumor Registry in the US. Total cancer incidence increased 1% per year (P>0.001). Neither acute lymphocytic leukaemia, acute myelocytic leukaemia, nor total leukaemia incidence changed significantly. In contrast, the incidence of central nervous system (CNS) tumours rose 2.7% per year (P>0.001). All three subgroups of this category, glioma, primitive neuroectodermal tumour (PNET)/medulloblastoma, and other CNS tumours, showed increases. For glioma and PNET/medulloblastoma, trends differed by age, race, and/or gender. Among the other childhood cancers, significant increases were observed for non‐Hodgkin lymphoma and neuroblastoma. For osteosarcoma and retinoblastoma, no overall change in incidence was observed, although decreases were observed in some age and race subgroups. The rise in CNS tumour incidence confirms previous reports from the US and Great Britain. The lack of change for acute lymphocytic leukaemia conflicts with other data from the US, but diagnostic changes appear to explain at least part of the discrepancy. The increase in neuroblastoma has also been observed in Great Britain. In contrast to our finding, investigators in the US and Great Britain have reported no rise in non‐Hodgkin lymphoma. Analyses for more of the childhood cancers from other registries would aid in detecting and interpreting incidence trends in recent ye

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00054.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Summary.The paper presents the study design of the development and organisation of an EU/WHO multicentre study on the promotion of children's early psychosocial development through primary health care services. The aim of the programme is to develop training for primary health care workers (PHCWs) that improves their ability to assess factors relevant to children's psychosocial development and gives them preventive approaches to foster that development, building on the families' strengths. The focus is on the period from conception to the end of the second year of the child's life. Two main components are the training of die PHCWs and the semi‐structured interviews that guide the workers in practice. The training has content and structure that is feasible within primary health care resources working in collaboration with mental health services. The programme is evaluated in terms of (a) the impact of training on both the PHCWs' knowledge and attitudes with regard to infant behaviour and development, and on practice as assessed by the delivery of the semi‐structured interview; and (b) the effect of the intervention on maternal well‐being, infant language development and behaviour, home environment and mother‐infant interaction. The programme is taking place in Cyprus, Greece, the Federal Republic of Yugoslavia, Portugal, Slovenia and

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00055.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00056.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Book reviewed in this article:Nelson Textbook of Pediatrics 15th Edition. Editors: W. E. Nelson, R. E. Behrman, R. M. Kliegman and A. M. Arvin. Philadelphia: W. B. Saunders, 1996Annual Review of Public Health 1995, Volume 16. Edited byG.S. Omenn, J. E. Fielding and L. B. Lave. Palo Alto, California, USA: Annual Reviews, 1995Tackling Inequalities in Health: An agenda for action. Edited by Michaela Benzeval, Ken fudge and Margaret Whitehead. London: King's Fund, 1995

ISSN:0269-5022    

DOI:10.1111/j.1365-3016.1996.tb00057.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY