Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets.

BACKGROUND: Preterm birth (PTB) is a leading cause of child morbidity and mortality. Evidence suggests an increased risk with both maternal underweight and obesity, with some studies suggesting underweight might be a greater factor in spontaneous PTB (SPTB) and that the relationship might vary by parity. Previous studies have largely explored established body mass index (BMI) categories. Our aim was to compare associations of maternal pre-pregnancy BMI with any PTB, SPTB and medically indicated PTB (MPTB) among nulliparous and parous women across populations with differing characteristics, and to identify the optimal BMI with lowest risk for these outcomes. METHODS: We used three UK datasets, two USA datasets and one each from South Australia, Norway and Denmark, together including just under 29 million pregnancies resulting in a live birth or stillbirth after 24 completed weeks gestation. Fractional polynomial multivariable logistic regression was used to examine the relationship of maternal BMI with any PTB, SPTB and MPTB, among nulliparous and parous women separately. The results were combined using a random effects meta-analysis. The estimated BMI at which risk was lowest was calculated via differentiation and a 95% confidence interval (CI) obtained using bootstrapping. RESULTS: We found non-linear associations between BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 22.5 kg/m2 (95% CI 21.5, 23.5) among nulliparous women and 25.9 kg/m2 (95% CI 24.1, 31.7) among multiparous women, with values of 20.4 kg/m2 (20.0, 21.1) and 22.2 kg/m2 (21.1, 24.3), respectively, for MPTB; for SPTB, the risk remained roughly largely constant above a BMI of around 25-30 kg/m2 regardless of parity. CONCLUSIONS: Consistency of findings across different populations, despite differences between them in terms of the time period covered, the BMI distribution, missing data and control for key confounders, suggests that severe under- and overweight may play a role in PTB risk.

Elective labor induction vs expectant management of pregnant women at term and children's educational outcomes at 8 years of age.

OBJECTIVE: To estimate the effect of elective induction of labor at 39 weeks' gestation on children's educational outcomes as measured using the Australian National Assessment Program-Literacy and Numeracy (NAPLAN) tests in school year 3 (∼8 years of age), compared with expectant management. METHODS: We merged perinatal data on all infants born in South Australia from 1999 to 2008 with children's school assessment data from NAPLAN. The study population included all singleton infants born without a malformation at 39-42 weeks in vertex presentation. Children who had undertaken the NAPLAN test in school year 3 were included. We excluded births to women who had a contraindication to vaginal delivery and those with a condition possibly justifying elective delivery before 39 weeks. The outcome of interest was children's educational outcome as measured using NAPLAN, which includes five learning domains (reading, writing, spelling, grammar and numeracy). Each domain was categorized according to performance at or below vs above the national minimum standard (NMS). Average treatment effects (ATEs) of elective induction of labor at 39 weeks compared with expectant management on the proportion of children performing at/below the NMS for each domain were estimated using the augmented inverse-propensity-weighted estimator, accounting for potential confounders. RESULTS: Of 53 843 children born at 39-42 weeks in vertex presentation from 1999 to 2008 and who were expected to participate in the year-3 NAPLAN from 2008 to 2015, a total of 31 120 had at least one year-3 NAPLAN domain. Of these, 1353 children were delivered after elective induction of labor at 39 weeks while 29 767 children were born following expectant management. The ATEs (mean differences) of elective induction of labor at 39 weeks compared with expectant management on the proportion of children scoring at/below the NMS on each domain were 0.01 (95% CI, -0.02 to 0.03) for reading, 0.02 (95% CI, 0.00-0.04) for writing, 0.01 (95% CI, -0.01 to 0.04) for spelling, 0.02 (95% CI, -0.01 to 0.04) for grammar and 0.03 (95% CI, 0.00-0.05) for numeracy. CONCLUSION: Elective induction of labor at 39 weeks did not affect children's standardized literacy and numeracy testing outcomes at 8 years of age when compared with expectant management. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Cesarean birth is not associated with early childhood body mass index.

Cesarean birth leads to a markedly different microbiome compared to vaginal birth, and the microbiome has been implicated in childhood obesity. Among mothers who had a previous cesarean, we compared anthropometry of 3- to 6-year-old children who were subsequently born by cesarean section versus vaginal birth. This large population-based study involved linking de-identified administrative perinatal and anthropometric data. Children's weight and height were collected at community-based clinics and converted to age- and sex-adjusted z-scores of height-for-age (HFAz), weight-for-age (WFAz) and BMI-for-age (BMIz). The average treatment effect (ATE) of cesarean versus vaginal birth was calculated from augmented inverse probability weighted analyses accounting for a wide range of confounding variables. There was little evidence of an effect of cesarean birth on HFAz (ATE = 0.26 95%CI -0.35, 0.87, n = 3993), WFAz (ATE = 0.35, 95%CI -0.19, 0.89, n = 4817) or BMIz (ATE = 0.11, 95%CI -0.25, 0.46, n = 3909). Cesarean section was not associated with anthropometry among children aged 3-6 years.

A whole-of-population study of term and post-term gestational age at birth and children's development.

OBJECTIVE: To examine the risk of poor child development according to week of gestation at birth, among children born ≥ 37 weeks' gestation. DESIGN: Population-based study using linked data (n = 12,601). SETTING: South Australia. POPULATION: All births ≥ 37 weeks' gestation. METHODS: Relative risks of developmental vulnerability for each week of gestation were calculated with adjustment for confounders and addressing missing information. MAIN OUTCOME MEASURES: Child development was documented by teachers during a national census of children attending their first year of school in 2009, using the Australian Early Development Index (AEDI). Children scoring in the lowest 10% of the AEDI were categorised as developmentally vulnerable. RESULTS: The percentage of children vulnerable on one or more AEDI domains for the following gestational ages 37, 38, 39, 40, 41, 42-45 weeks was 24.8, 22.3, 20.6, 20.0, 20.4 and 24.2, respectively. Compared with children born at 40 weeks, the adjusted relative risks [(95% confidence interval (CI)] for vulnerability on ≥ 1 AEDI domain were; 37 weeks 1.13 (0.99-1.28), 38 weeks 1.05 (0.96-1.15), 39 weeks 1.02 (0.94-1.12), 41 weeks 1.00 (0.90-1.11) and 42-45 weeks 1.20 (0.84-1.72). CONCLUSIONS: Children born at 40-41 weeks' gestation may have the lowest risk of developmental vulnerability at school entry, reinforcing the importance of term birth in perinatal care. Early term or post-term gestational age at birth can help clinicians, teachers and parents recognise children with potential developmental vulnerabilities at school entry.

Are trajectories of self-regulation abilities from ages 2-3 to 6-7 associated with academic achievement in the early school years?

BACKGROUND: The aim of this study was to estimate the association between two key aspects of self-regulation, 'task attentiveness' and 'emotional regulation' assessed from ages 2-3 to 6-7 years, and academic achievement when children were aged 6-7 years. METHODS: Participants (n = 3410) were children in the Longitudinal Study of Australian Children. Parents rated children's task attentiveness and emotional regulation abilities when children were aged 2-3, 4-5 and 6-7. Academic achievement was assessed using the Academic Rating Scale completed by teachers. Linear regression models were used to estimate the association between developmental trajectories (i.e. rate of change per year) of task attentiveness and emotional regulation, and academic achievement at 6-7 years. RESULTS: Improvements in task attentiveness between 2-3 and 6-7 years, adjusted for baseline levels of task attentiveness, child and family confounders, and children's receptive vocabulary and non-verbal reasoning skills at age 6-7 were associated with greater teacher-rated literacy [B = 0.05, 95% confidence interval (CI) = 0.04-0.06] and maths achievement (B = 0.04, 95% CI = 0.03-0.06) at 6-7 years. Improvements in emotional regulation, adjusting for baseline levels and covariates, were also associated with better teacher-rated literacy (B = 0.02, 95% CI = 0.01-0.04) but not with maths achievement (B = 0.01, 95% CI = -0.01-0.02) at 6-7 years. For literacy, improvements in task attentiveness had a stronger association with achievement at 6-7 years than improvements in emotional regulation. CONCLUSIONS: Our study shows that improved trajectories of task attentiveness from ages 2-3 to 6-7 years are associated with improved literacy and maths achievement during the early school years. Trajectories of improving emotional regulation showed smaller effects on academic outcomes. Results suggest that interventions that improve task attentiveness when children are aged 2-3 to 6-7 years have the potential to improve literacy and maths achievement during the early school years.

Does an early childhood intervention affect cardiometabolic risk in adulthood? Evidence from a longitudinal study of preschool attendance in South Australia.

OBJECTIVES: There is an expectation that a positive social, cognitive and behavioural trajectory from early childhood developmental interventions will lead to improved population health and reduced health inequalities. However, there is limited direct evidence for this. The aim of this study was to assess the effect of participation in the South Australian Kindergarten Union preschool programme on adult cardiovascular biomedical risk factors. Kindergarten Union preschools delivered high-quality, comprehensive services to children aged 2-4 years and their families, including education, parenting and health services. STUDY DESIGN: Retrospective population-based cohort study. METHODS: The effect of attendance at a Kindergarten Union preschool on a range of cardiometabolic risk factors was assessed using data from the North West Adelaide Health Study 1999-2007. The study sample was taken from participants in the 2007 survey (n = 1064, 44.8% attended preschool) who lived in South Australia as children and were born during the years 1937-1969. RESULTS: Preschool attendance had a beneficial effect on hypertension in adulthood [prevalence ratio 0.82, 95% confidence interval (CI) 0.69-0.97] and an indication of benefit on hypercholesterolaemia (prevalence ratio 0.86, 95% CI 0.71-1.05), but had no effect on dyslipidaemia, central obesity, high fasting blood glucose or metabolic syndrome. CONCLUSIONS: This study found that preschool attendance was associated with reduced risk of hypertension in adulthood, but no effect was seen for the other cardiometabolic factors. These findings may reflect differing causal pathways and trajectories of these risk factors from childhood to adulthood, but confirmation from other studies is required.

Associations between dietary patterns at 6 and 15 months of age and sociodemographic factors.

BACKGROUND/OBJECTIVES: Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) have previously shown that dietary patterns are observable by 3 years. However, it is not clear when dietary patterns emerge. We aimed to describe dietary patterns in early life and their associations with maternal and infant sociodemographic characteristics. SUBJECTS/METHODS: Principal component analysis was applied to diet questionnaires of ALSPAC participants at 6 months (n = 7052) and 15 months (n = 5610) to extract dietary patterns. The sociodemographic factors associated with dietary patterns were investigated using regression analyses. RESULTS: Four dietary patterns were extracted at both 6 and 15 months. A traditional-style pattern characterized by home-prepared meats, vegetables and desserts, a second pattern characterized by ready-prepared baby foods and a third pattern characterized by discretionary foods such as biscuits, sweets and crisps were identified at both ages. At 6 months, the fourth pattern was characterized predominantly by breastfeeding and at 15 months, by contemporary-style foods including herbs, legumes, nuts, raw fruit and vegetables. Higher maternal age and education, number of siblings and lower body mass index (BMI) was associated with higher scores on the breastfeeding or meat, vegetables and desserts patterns, whereas higher discretionary food pattern scores were associated with younger maternal age, lower education, higher BMI and more siblings. Associations between sociodemographic factors and the ready-prepared baby food pattern scores were inconsistent across ages. CONCLUSIONS: Dietary patterns emerge from infancy and are associated with sociodemographic characteristics.

Can attending preschool reduce the risk of tobacco smoking in adulthood? The effects of Kindergarten Union participation in South Australia.

BACKGROUND: Innovative strategies beyond the health system are required to reduce the prevalence of smoking. Early child development interventions are examples of interventions that can help set children on positive social and educational trajectories, which in turn may also reduce the prevalence of smoking. The aim of this study was to examine the effect of attendance at Kindergarten Union preschools on tobacco smoking in adulthood. METHODS: Kindergarten Union preschools delivered comprehensive services to children and their families, including education, parenting and health services, with a number of features consistent with contemporary ideas of high-quality service delivery. Using a retrospective cohort design with data from the North West Adelaide Health Study, this study examined different aspects of smoking behaviour in adults aged 34-67 years who attended a Kindergarten Union preschool at some stage between 1940 and 1972. Data were analysed using generalised linear model poisson regression with robust variance estimates, adjusting for both child and adult socio-economic factors and history of parental smoking. RESULTS: People who attended preschool had a reduced risk of ever smoking (prevalence ratio 0.87, 95% CI 0.77 to 0.98) and a reduced risk of current smoking in adulthood (prevalence ratio 0.77 (95% CI 0.59 to 1.00)), compared with those who did not attend preschool. There was no effect of preschool attendance on age at smoking uptake, age at quitting or the probability of quitting smoking. CONCLUSION: Attendance at the high-quality Kindergarten Union preschools was associated with a reduction in the initial uptake of smoking and thus the probability of being a current smoker. Among their other potential social benefits, high-quality, universal preschool programmes have the potential to help reduce smoking prevalence across the population.

Does attendance at preschool affect adult health? A systematic review.

BACKGROUND: Early child development interventions can set children on positive social and educational trajectories. The aim of this review was to examine the evidence for the adult health impacts of centre-based preschool interventions for preschoolers. METHODS: Medline, Embase, ERIC, Psych Info, Sociological Abstracts, the Cochrane Library, C2-SPECTR and the Head Start database were searched (1980-2008), and reference lists were searched for articles missed by the electronic search. RESULTS: The 12 eligible articles reviewed reported multi-faceted interventions and involved disadvantaged populations in all but one study. Limitations included a restricted range of health outcomes, reliance on self-report measures (11 studies), small sample sizes (nine studies with <100 in each arm) and a relatively young adult age at follow-up. There were positive intervention effects across the majority of behavioural outcomes, and a suggestion of a reduction in symptoms of depression. Non-communicable disease outcomes (e.g. diabetes mellitus) tended to have adverse or near-zero effect estimates. CONCLUSIONS: The reviewed articles provide some support for the role of early childhood interventions to improve health behaviours but not chronic disease outcomes. Population health researchers should become more involved in the evaluation of preschool interventions as there is great potential for broad population health benefit.

Differential expression of glycine receptor subunits in the rat basolateral and central amygdala.

The amygdalar complex is a limbic structure that plays a key role in emotional processing and fear conditioning. Although inhibitory transmission in the amygdala is predominately GABA-ergic, neurons of the amygdala are also known to express glycine receptors. The subtype and function of these glycine receptors within the synaptic circuits of the amygdala are unknown. In this study, we have investigated the relative expression of the four major glycine receptor subunits (alpha1-3 and beta) in the rat basolateral (BLA) and central amygdala (CeA), using real-time PCR and protein biochemistry. We demonstrate that alpha1, alpha2, alpha 3, and beta subunits are all expressed in the BLA and CeA with alpha2 being the predominant alpha-subunit in both nuclei. Electrophysiological recordings from BLA and CeA neurons in acute brain slices indicated that differences in relative expression of these subunits were correlated with the pharmacological properties of native glycine receptors expressed on these neurons. We conclude that glycine receptors assembled in BLA neurons are largely alpha 1 beta-containing heteromultimers whereas receptors assembled in neurons of the central amygdala are primarily alpha 2 beta-, alpha 3 beta- or alpha 1 beta-containing heteromultimers, with a minor component of alpha2 or alpha 3 homomeric receptors also expressed.

Association of diarrhoea, poor hygiene and poor social conditions in childhood with blood pressure in adulthood.

BACKGROUND: Previous research has suggested that dehydration in infancy may lead to high blood pressure in later life because of sodium retention. The purpose of this study was to examine the effect of poor hygiene of the child, poor social and poor housing conditions at home and diarrhoea in childhood as proxies for dehydration on high blood pressure in later life. METHODS: Data were from a subset of participants in the Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based cohort study in eastern Finland. Information on childhood factors was collected from school health records (n=952), from the 1930s to the 1950s. Adult data were obtained from baseline examinations of the Kuopio Ischaemic Heart Disease Risk Factor Study cohort (n=2682) in 1984-1989. RESULTS: Men who had poor hygiene in childhood had on average 4.07 mm Hg (95% CI 0.53 to 7.61) higher systolic blood pressure than men who had good or satisfactory hygiene in childhood in the age-adjusted analysis. Reports of diarrhoea were not associated with adult blood pressure. CONCLUSIONS: The authors' findings suggest that poor hygiene and living in poor social conditions in childhood are associated with higher systolic blood pressure in adulthood. Reported childhood diarrhoea did not explain the link between hygiene and high blood pressure in adulthood.

Is the association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review.

OBJECTIVE: To update a systematic review on the association between childhood socioeconomic circumstances and cause-specific mortality. Studies published since 2003 include a far greater number of deaths than was previously available justifying an update of the previous systematic review. METHODS: Individual-level studies examining childhood socioeconomic circumstances and adult overall and cause-specific mortality published between 2003 and April 2007. RESULTS AND CONCLUSIONS: The new studies confirmed that mortality risk for all causes was higher among those who experienced poorer socioeconomic circumstances during childhood. As already suggested in the original systematic review, not all causes of death were equally related to childhood socioeconomic circumstances. A greater proportion of new studies included women and showed that a similar pattern is valid for both genders. In addition, the new studies show that this association persists among younger birth cohorts, despite temporal general improvements in childhood conditions across successive birth cohorts. The difficulties of establishing a particular life-course model were highlighted.

Explaining age-specific inequalities in mortality from all causes, cardiovascular disease and ischaemic heart disease among South Korean male public servants: relative and absolute perspectives.

OBJECTIVE: To examine age-specific patterns in the ability of major cardiovascular risk factors to explain relative and absolute socioeconomic inequalities in mortality from all causes, cardiovascular disease (CVD), and ischaemic heart disease (IHD). DESIGN: Prospective cohort study. SETTING: South Korea. SUBJECTS: 575 377 male public servants aged 30-64 with 16 998 deaths between 1995 and 2003. MAIN OUTCOMES: All-cause, CVD, and IHD mortality. RESULTS: Four cardiovascular risk factors (cigarette smoking, blood pressure, fasting serum glucose, and serum total cholesterol) were significantly associated with mortality risk. Changing relationships in socioeconomic distribution of risk factors with age were observed. The magnitude of reduction in percent change in absolute risk was greater than that in relative risk. While the risk factors explained only 15.2% of excess RR for all-cause mortality in low-income men aged 30-44, the absolute excess risk of all-cause mortality was reduced by 48.3% when the risk factors were removed from the whole population. This pattern was generally true for all causes, CVD, and IHD, and true for all age groups and risk factors examined. Cigarette smoking and hypertension were the leading contributors in explaining relative and absolute inequality in mortality. CONCLUSION: Policy efforts to eliminate major cardiovascular risk factors in the general population may have a significant effect on reducing the absolute burden of socioeconomic inequality in mortality. Policy efforts to attenuate socioeconomic inequality in cardiovascular risk factors need to be directed to younger age groups in South Korea.

The "Americanisation" of migrants: evidence for the contribution of ethnicity, social deprivation, lifestyle and life-course processes to the mid-20th century Coronary Heart Disease epidemic in the US.

We investigated the contribution of the large-scale immigration of White Europeans into the US between 1850 and 1930 to the timing and extent of the epidemic pattern of heart disease between 1900 and 1980. The analyses are based on data collected through the United States Federal Census from 1850 to the present. The hardcopy historical record confirms that census reports themselves and related monographs were concerned from 1850 with excessive mortality from heart disease of immigrants, particularly of Northern European origin and initially at least, their first-generation native-born children. Our analysis of the electronic database indicates a strong relationship between the percentage of US population foreign born and native born of foreign parentage and age adjusted mortality from heart disease. We identified a lag of 50 years giving the maximum linear correlation coefficient for men (r(2) = 0.92), and for women a shorter lag of 38 years and an earlier decline in Coronary Heart Disease (CHD) rates (r(2) = 0.96). Both the rise and fall of the CHD epidemic over an 80-year period correspond closely to the rise and fall of the foreign population in previous years. For the foreign born only, age adjusted negative binomial general estimated equation (GEE) models calculate the relative risk of dying of heart disease per 10% increase in proportion foreign born. There is an independent influence for men until 1930 and for women throughout the period from 1910 onwards. We conclude there is an impact of immigration on the pattern of the epidemic, mediated through a combination of factors, such as accumulated life-course susceptibility, deprived socio-economic conditions upon arrival, and the enthusiastic uptake of behaviours related to the classic risk factors of smoking, high saturated fat and salt diet. Our analysis provides a more contextualised understanding of the scale and timing of the epidemic of CHD in the US.

Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures.

STUDY OBJECTIVE: To examine trends in educational mortality and morbidity inequalities in Korea. DESIGN: Census data (1990, 1995, 2000) and death certificate data (1990-91, 1995-96, 2000-01) were used for mortality. For morbidity, four waves (1989, 1992, 1995, and 1999) of Social Statistics Survey from Korea's National Statistical Office were used. Morbidity indicators were self rated health and self reported illness in the past two weeks. Trends were studied using indices for both the relative and absolute size of socioeconomic inequalities in health. SETTING: South Korea. Patients (or Participants): Representative annual samples of the adult population aged 30-59 in Korea. MAIN RESULTS: Based on trends in relative index of inequalities, the relative level of socioeconomic mortality inequality remained virtually unchanged in men and women in the past 10 years. Meanwhile, inequalities in self rated health have increased over time in both sexes. Most of the total increase in health inequalities happened between 1995 and 1999. Inequalities in self reported acute illness increased in the past 10 years. CONCLUSIONS: The rise in inequalities in morbidity requires increased social discourse and policy discussions about health inequalities in Korean society.

Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmö, Sweden.

STUDY OBJECTIVE: The principle of equity aims to guarantee allocation of healthcare resources on the basis of need. Therefore, people with a low income and persons living alone are expected to have higher healthcare expenditures. Besides these individual characteristics healthcare expenditure may be influenced by country of birth. This study therefore aimed to investigate the role of country of birth in explaining individual healthcare expenditure. DESIGN: Multilevel regression model based on individuals (first level) and their country of birth (second level). SETTING: The city of Malmö, Sweden. PARTICIPANTS: All the 52 419 men aged 40-80 years from 130 different countries of birth, who were living in Malmö, Sweden, during 1999. MAIN RESULTS: At the individual level, persons with a low income and persons living alone showed a higher healthcare expenditure, with regression coefficients (and 95% confidence intervals) being 0.358 (0.325 to 0.392) and 0.197 (0.165 to 0.230), respectively. Country of birth explained a considerable part (18% and 13%) of the individual differences in the probability of having a low income and living alone, respectively. However, this figure was only 3% for having some health expenditure, and barely 0.7% with regard to costs in the 74% of the population with some health expenditure. CONCLUSIONS: Malmö is a socioeconomically segregated city, in which the country of birth seems to play only a minor part in explaining individual differences in total healthcare expenditure. These differences seem instead to be determined by individual low income and living alone.

Biochemical and physiological validation of a corticosteroid radioimmunoassay for plasma and fecal samples in oldfield mice (Peromyscus polionotus).

The measurement of fecal steroids provides an increasingly important noninvasive technique for assessing reproduction, environmental stress, and aggression in populations of captive and free-living animals. In this paper, we validated the corticosterone (CORT) 125I-radioimmunoassay (ICN Pharmaceuticals) for plasma and fecal samples in a small rodent species, the oldfield mouse (Peromyscus polionotus subgriseus). The biochemical validations indicated that the assays accurately measured CORT concentrations in the plasma and corticosteroid concentrations in the feces. Physiological validation demonstrated that: (1) blood samples collected within 3 min of disturbing an animal's cage represented "baseline" CORT concentrations, and (2) fecal corticosteroid concentrations collected over a 24-h period closely tracked plasma CORT concentrations approximately 4 h earlier. These results demonstrate that the plasma CORT and fecal corticosteroid assays are sensitive enough to detect biologically meaningful alterations in corticosteroid concentrations in oldfield mice.

Poor mobilization of peripheral blood stem cells is a risk factor for worse outcome in lymphoma patients undergoing autologous stem cell transplantation.

The effect of poor blood stem cells mobilization on the outcome of autologous stem cell transplantation (ASCT) has not been well studied. Our aim is to evaluate poor mobilization as a prognostic factor in lymphoma patients undergoing ASCT. We analyzed 90 consecutive patients with Hodgkin's (HD) and non-Hodgkin's lymphoma (NHL) who underwent ASCT. Poor mobilization was defined as the inability to obtain > or = 1 x 10(6) CD34+ cells/kg ideal body weight with two large volume aphereses. Patients were divided into 2 groups: group 1 = poor mobilizers, and group 2 = good mobilizers. The poor mobilizers received lower median transplant CD34+ cell dose (2 x 10(6) vs. 4.5 x 10(6)/kg for good mobilizers, P = 0.001), were more heavily pretreated (P = 0.01), and required higher number of aphereses for PBSC collection (P = 0.0006). The median progression-free survival (PFS) in groups 1 and 2 was 10 and 41 months (P = 0.04), while the median overall survival (OS) was 38 months and not reached (P = 0.02), respectively. Univariate analysis showed that > or = 3 pre-transplant treatments, CD34+ cell dose < or = 2 x 10(6), elevated LDH before transplant, and poor mobilization were significant prognostic factors for poor PFS, while only the first three were significant for worse OS. Multivariate analysis using these same four factors revealed that number of pre-transplant treatments (HR = 6.03, P = 0.001), CD34+ cell dose (HR = 0.1, P = 0.0007) were the only independent predictive factors for worse overall outcome. In conclusion, our data show that poor mobilization could indicate poor outcome in lymphoma patients undergoing ASCT, however, it is more likely to be a reflection of the heavy pre-transplant therapy and lower CD34+ cell dose re-infused in this group of patients.

Concentrations of four fecal steroids in wild baboons: short-term storage conditions and consequences for data interpretation.

One source of both bias and "noise" in fecal steroid analysis is temporal change in steroid concentrations resulting from duration or conditions of fecal sample storage. However, no consensus currently exists regarding correct procedures or precautions necessary for fecal sample storage, and conditions vary widely within field endocrinology literature. This study considered the effects of short-term, weeks-long, storage conditions on quantifiable fecal testosterone (fT), glucocorticoids (fGC), estrogens (fE), and progestagen (fP) metabolite concentrations in wild baboons (Papio cynocephalus). Quadruplicate subsamples of fecal samples (n=29) collected at Amboseli National Park and its environs were subjected to four different storage conditions prior to lyophilization, in order to determine the effects of storage on subsequent steroid concentrations, as assessed by 125I radioimmunoassays. As expected, the best alternative to the "initial condition" of lyophilization at three days after collection was to freeze fecal samples at -20 degrees C for two weeks prior to lyophilization. This storage method resulted in no significant change from initial steroid concentrations for fE, fT, or fP, although fGC showed a slight but significant decline. Storage for two weeks in a charcoal refrigerator caused a mean increase in all four steroid concentrations. However, the results from this storage condition were robust in terms of practical questions asked of the data: fE and fP values still reflected pregnant versus non-pregnant states in baboon females; a fGC profile constructed by age class resembled that created from the samples from the initial condition, although slightly inflated across age classes; and there were only moderate changes in relative fT concentrations across adult males. Knowledge of the effects of storage upon each steroid analyzed within one's study is a necessary component in determining the optimal compromise for storage protocol in a particular research project.