The limitations of some European healthcare databases for monitoring the effectiveness of pregnancy prevention programmes as risk minimisation measures.

PURPOSE: Pregnancy prevention programmes (PPPs) exist for some medicines known to be highly teratogenic. It is increasingly recognised that the impact of these risk minimisation measures requires periodic evaluation. This study aimed to assess the extent to which some of the data needed to monitor the effectiveness of PPPs may be present in European healthcare databases. METHODS: An inventory was completed for databases contributing to EUROmediCAT capturing pregnancy and prescription data in Denmark, Norway, the Netherlands, Italy (Tuscany/Emilia Romagna), Wales and the rest of the UK, to determine the extent of data collected that could be used to evaluate the impact of PPPs. RESULTS: Data availability varied between databases. All databases could be used to identify the frequency and duration of prescriptions to women of childbearing age from primary care, but there were specific issues with availability of data from secondary care and private care. To estimate the frequency of exposed pregnancies, all databases could be linked to pregnancy data, but the accuracy of timing of the start of pregnancy was variable, and data on pregnancies ending in induced abortions were often not available. Data availability on contraception to estimate compliance with contraception requirements was variable and no data were available on pregnancy tests. CONCLUSION: Current electronic healthcare databases do not contain all the data necessary to fully monitor the effectiveness of PPP implementation, and thus, special data collection measures need to be instituted.

Exacerbations of asthma during pregnancy: Impact on pregnancy complications and outcome.

Asthma is common among pregnant women, and the incidence of asthma exacerbations during pregnancy is high. This literature review provides an overview of the impact of exacerbations of asthma during pregnancy on pregnancy-related complications. The majority of published retrospective studies reveal that asthma exacerbations during pregnancy increase the risk of pre-eclampsia, gestational diabetes, placental abruption and placenta praevia. Furthermore, these women also have higher risk for breech presentation, haemorrhage, pulmonary embolism, caesarean delivery, maternal admission to the intensive care unit and longer postpartum hospital stay. Asthma has been associated with increased risk of intrauterine growth retardation, small-for-gestational age, low birth weight, infant hypoglycaemia and preterm birth, but more recent prospective studies have not revealed significant associations with regard to these outcomes. In conclusion, asthma exacerbations during pregnancy are associated with complications of pregnancy, labour and delivery. Prevention of exacerbations is essential to reduce the risk of complications and poor outcome.

Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population-based study in six European regions.

OBJECTIVE: To explore the prescribing patterns of selective serotonin reuptake inhibitors (SSRIs) before, during and after pregnancy in six European population-based databases. DESIGN: Descriptive drug utilisation study. SETTING: Six electronic healthcare databases in Denmark, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. POPULATION: All women with a pregnancy ending in a live or stillbirth starting and ending between 2004 and 2010. METHODS: A common protocol was implemented across databases to identify SSRI prescriptions issued (UK) or dispensed (non-UK) in the year before, during or in the year following pregnancy. MAIN OUTCOME MEASURES: The percentage of deliveries in which the woman received an SSRI prescription in the year before, during or in the year following pregnancy. We also compared the choice of SSRIs and changes in prescribing over the study period. RESULTS: In total, 721 632 women and 862,943 deliveries were identified. In the year preceding pregnancy, the prevalence of SSRI prescribing was highest in Wales [9.6%; 95% confidence interval (CI95 ), 9.4-9.8%] and lowest in Emilia Romagna (3.3%; CI95 , 3.2-3.4%). During pregnancy, SSRI prescribing had dropped to between 1.2% (CI95 , 1.1-1.3%) in Emilia Romagna and 4.5% (CI95 , 4.3-4.6%) in Wales. The higher UK pre-pregnancy prescribing rates resulted in higher first trimester exposures. After pregnancy, SSRI prescribing increased most rapidly in the UK. Paroxetine was more commonly prescribed in the Netherlands and Italian regions than in Denmark and the UK. CONCLUSIONS: The higher SSRI prescribing rates in the UK, compared with other European regions, raise questions about differences in the prevalence and severity of depression and its management in pregnancy across Europe.

Energy and nutrient deposition and excretion in the reproducing sow: model development and evaluation.

Air and nutrient emissions from swine operations raise environmental concerns. During the reproduction phase, sows consume and excrete large quantities of nutrients. The objective of this study was to develop a mathematical model to describe energy and nutrient partitioning and predict manure excretion and composition and methane emissions on a daily basis. The model was structured to contain gestation and lactation modules, which can be run separately or sequentially, with outputs from the gestation module used as inputs to the lactation module. In the gestating module, energy and protein requirements for maintenance, and fetal and maternal growth were described. In the lactating module, a factorial approach was used to estimate requirements for maintenance, milk production, and maternal growth. The priority for nutrient partitioning was assumed to be in the order of maintenance, milk production, and maternal growth with body tissue losses constrained within biological limits. Global sensitivity analysis showed that nonlinearity in the parameters was small. The model outputs considered were the total protein and fat deposition, average urinary and fecal N excretion, average methane emission, manure carbon excretion, and manure production. The model was evaluated using independent data sets from the literature using root mean square prediction error (RMSPE) and concordance correlation coefficients. The gestation module predicted body fat gain better than body protein gain, which was related to predictions of body fat and protein loss from the lactation model. Nitrogen intake, urine N, fecal N, and milk N were predicted with RMSPE as percentage of observed mean of 9.7, 17.9, 10.0, and 7.7%, respectively. The model provided a framework, but more refinements and improvements in accuracy of prediction (particularly urine N) are required before the model can be used to assess environmental mitigation options from sow operations.

Predicting milk yield and composition in lactating sows: a Bayesian approach.

The objective of this study was to develop a framework describing the milk production curve in sows as affected by parity, method of milk yield (MY) determination, litter size (LS), and litter gain (LG). A database containing data on LS, LG, dietary protein and fat content, MY, and composition measured on more than 1 d during lactation and method for determining MY from peer reviewed publications and individual sow data from 3 studies was constructed. A Bayesian hierarchical model was developed to analyze milk production data. The classical Wood curve was used to model time trends in MY during lactation, and it was re-parameterized expressing the natural logarithm of MY values at d 5, 20, and 30 as functional parameters. The model incorporated random effects of experiment, sow nested within experiment, and fixed effects of LS, LG, parity, and method through the functional parameters of the Wood curve. A second set of models were constructed to analyze milk composition data, including day in milk, LS, dietary protein, and fat contents. Four scenarios with different LG and LS were constructed using the framework to estimate the energy output in milk at different days during lactation. The estimated energy output was compared with energy output values calculated using the 1998 NRC method. Milk yield was underestimated by approximately 20% with the weigh-suckle-weigh technique compared with the deuterium oxide dilution technique (P < 0.001). The mean LG and LS for the dataset were 2.05 kg/d (1.0; 3.3) and 9.5 piglets (5; 14), respectively. The MY was affected by LS on d 5 and 20 (P < 0.001) and by LG on d 20 (P < 0.001) and d 30 (P = 0.004). The mean time to peak lactation was 18.7 d (SD = 1.06) postpartum and mean MY at peak lactation was 9.23 kg (SD = 0.14). The average protein, lactose, and fat content of milk was 5.22 (SD = 0.06), 5.41 (SD = 0.08), and 7.32% (SD = 0.17%), respectively. The NE requirement for lactation increased from d 5 to 20 because of increased MY. Requirements also increased with increasing LG and LS. The framework could be used to predict energy and protein requirements for lactation under different production expectations and can be incorporated into a whole animal model for determination of energy and nutrient requirements for lactating sows, which can optimize sow performance and longevity.

Effects of nutrient supply, plasma metabolites, and nutritional status of sows during transition on performance in the next lactation.

The aim of the present study was to evaluate the effects of nutrient supply, plasma metabolites, and nutritional status of sows during the transition from gestation to lactation on performance of piglets during the colostral period and throughout lactation. Forty second-parity sows were fed 1 of 4 gestation diets containing a different quantity of dietary fiber (171 to 404 g/kg of DM) from mating until d 108 of gestation. From d 108 of gestation until weaning (d 28 of lactation), sows were fed 1 of 5 lactation diets with a different quantity of dietary fat [3 or 8% with different proportions of medium- (MCFA) and long-chain fatty acids (LCFA)]. Blood was obtained by jugular venipuncture on d 108 and 112 of gestation and on d 1 of lactation, and concentrations of plasma glucose, NEFA, lactate, acetate, propionate, butyrate, and fatty acids were analyzed. Piglet growth and mortality were noted throughout lactation. Piglet mortality during the colostral period (0 to 24 h) was affected by the lactation diets and was positively related to sow backfat (d 108) and plasma lactate (d 112) and negatively related to mean piglet birth weight (P < 0.05). Mean piglet live BW gain (LWG) was recorded in the periods 0 to 24 h, 7 to 10 d, 14 to 17 d, and 17 to 28 d relative to parturition as indirect measures of colostrum yield (0 to 24 h), milk yield in early lactation (d 7 to 10), and at peak lactation (d 14 to 17 and d 17 to 28). Effects of gestation and lactation diets on studied sow traits were tested on selected days during the transition period and the next lactation, and tested statistically on separate days. The LWG in the colostral period was positively correlated with mean piglet birth weight (P < 0.001), plasma concentrations of propionate and MCFA (P < 0.05), and plasma acetate and butyrate (P < 0.1) on d 1 of lactation. The LWG in early lactation was inversely correlated with plasma lactate on d 108 (P < 0.05), plasma glucose on d 112, and backfat thickness on d 108 (P < 0.10). The LWG at peak lactation was positively correlated with MCFA intake of the sow on d 113 to 115 and backfat thickness on d 108 during the transition, and negatively correlated with intake of LCFA and ME intake on d 108 to 112 (P < 0.05). In conclusion, feeding and body condition of sows during the transition from gestation to lactation is important for neonatal piglet survival, lactation performance of sows, and piglet growth during the next lactation.

Socio-demographic factors, reproductive history and risk of osteoarthritis in a cohort of 4.6 million Danish women and men.

OBJECTIVE: Studies addressing possible socio-demographic and reproductive factors in the aetiology of osteoarthritis (OA) are few. We studied possible influences of educational level, household income, marital status and parenting patterns on OA risk overall and at anatomical sites. METHOD: We linked national register data about socio-demographic variables, reproductive histories and OA hospital contacts to a cohort of 4.6 million Danes. Ratios of first OA hospitalisation rates (RRs) were calculated using Poisson regression. RESULTS: Overall, 100,437 women and 92,020 men had a first OA hospital contact during 91.5 million person-years between 1982 and 2008. Short education, low income and married status were significantly associated with increased OA risk, and persons with children were at higher risk of OA(overall) (RR=1.10 in women; RR=1.22 in men), OA(knee) (RRs 1.14; 1.28), OA(back) (RRs 1.18; 1.33), and OA(hand) (RRs 1.21; 1.43), but not of OA(hip) (RRs 0.96; 1.00) than persons without children. The RR of OA(overall) increased by a factor of 1.05 in women and 1.04 in men per additional child, most notably for OA(knee) in women (1.10 per child). CONCLUSION: Risk of OA hospitalisation was highest among married persons and persons with short education or low income. The similar or even stronger associations with reproductive factors in men than women suggest that unmeasured lifestyle factors rather than biological factors associated with pregnancy might explain the higher OA risk in persons with children. However, the particularly strong association between parity and risk of OA(knee) in women is compatible with a role of pregnancy-associated factors.

EBV-associated gastric carcinoma in high- and low-incidence areas for nasopharyngeal carcinoma.

BACKGROUND: Approximately 10% of gastric carcinomas are associated with Epstein-Barr virus (EBV). The Inuit in Greenland have a high incidence of EBV-associated nasopharyngeal carcinoma. METHODS: We conducted a population-based case-control study comparing gastric carcinomas in Greenland and in Denmark. RESULTS: The prevalence rate of EBV-associated gastric carcinomas was 8.5% in both populations. CONCLUSION: The findings of this study argue against a general susceptibility to EBV-associated carcinomas among the Inuit.

False-negative cerebral radionuclide flow study, in brain death, caused by a ventricular drain.

A radionuclide cerebral blood flow study demonstrated normal flow in the face of clinical and electrical brain death in a patient who had a ventricular drain. After the drain became obstructed and was removed, a further radionuclide study demonstrated no flow, confirming the role of the drain in the earlier false-negative studies.