Sexuality and Demographic Change: Documenting Family Formation Trajectories and Cohort Change in the LGB Population.

Narratives of demographic shifts overlook how societal changes shape the family trajectories of sexual minorities. Using sequence analysis, we describe how partnering and parenthood evolve over the life course of lesbian, gay, and bisexual (LGB) women and men in the United Kingdom (N = 455) and how the types of these family trajectories changed across two birth cohorts (born before 1965 and in 1965-1979). We find five distinct trajectories between ages 18 and 40, wherein two thirds of the sample belonged to a family trajectory that did not involve living with children. Partnership-centered trajectories became more common across cohorts, and this increase came at the expense of trajectories characterized by singlehood among gay men and lesbian women. However, parenthood trajectories became less common among all LGB groups. Furthermore, family trajectories became more complex across cohorts, including more transitions, which coincides with trends in the general population. Yet we also find that family trajectories became less diverse among lesbian women and bisexual men, in contrast to the trend among gay men and the general population. The results demonstrate the dynamic, complex, and diverse nature of LGB individuals' family lives and why existing narratives of family-related demographic change should explicitly consider sexual minorities in demographic narratives.

Linking internal and international migration over the life course: A sequence analysis of individual migration trajectories in Europe.

Because internal and international migration are typically conceptualized and measured separately, empirical evidence on the links between these two forms of population movement remains partial. This paper takes a step towards integration by establishing how internal and international migration precede one another in various sequenced relationships from birth to age 50 in 20 European countries. We apply sequence and cluster analysis to full retrospective migration histories collected as part of the Survey of Health, Ageing and Retirement in Europe in 2008-09 and 2017, for individuals born between 1950 and 1965. The results show that nearly all international migrants engage in internal mobility at some point in their lives. However, individual migration trajectories are delineated by the order of internal and international moves, the duration and timing of stays abroad, and the extent to which individuals engage in return international migration. Institutional and economic conditions shape the diversity of migration experiences.

Heterogeneity in Family Life Course Patterns and Intra-Cohort Wealth Disparities in Late Working Age.

Considering soaring wealth inequalities in older age, this research addresses the relationship between family life courses and widening wealth differences between individuals as they age. We holistically examine how childbearing and marital histories are associated with personal wealth at ages 50-59 for Western Germans born between 1943 and 1967. We propose that deviations from culturally and institutionally-supported family patterns, or the stratified access to them, associate with differential wealth accumulation over time and can explain wealth inequalities at older ages. Using longitudinal data from the German Socio-Economic Panel Study (SOEP, v34, waves 2002-2017), we first identified typical family trajectory patterns between ages 16 and 50 with multichannel sequence analysis and cluster analysis. We then modelled personal wealth ranks at ages 50-59 as a function of family patterns. Results showed that deviations from the standard family pattern (i.e. stable marriage with, on average, two children) were mostly associated with lower wealth ranks at older age, controlling for childhood characteristics that partly predict selection into family patterns and baseline wealth. We found higher wealth penalties for greater deviation and lower penalties for moderate deviation from the standard family pattern. Addressing entire family trajectories, our research extended and nuanced our knowledge of the role of earlier family behaviour for later economic wellbeing. By using personal-level rather than household-level wealth data, we were able to identify substantial gender differences in the study associations. Our research also recognised the importance of combining marital and childbearing histories to assess wealth inequalities. Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-021-09601-4.

Mothers, fathers and the intergenerational transmission of gender ideology.

Traditional gender beliefs play an important role in (re-)producing gender inequalities, and trends towards gender egalitarianism have stalled. As such, identifying factors that contribute to individuals upholding traditional versus egalitarian gender attitudes is an important scholarly endeavour. While previous studies have identified critical predictors-such as religion, education and parenthood-intergenerational influences have received comparatively little empirical attention. Drawing upon gender-socialization theory, we derive hypotheses about how parental attitudes towards gender are transmitted to their children, considering differences between mothers' and fathers' influences, parental (dis)agreement in attitudes, and moderation by child's gender. We test these hypotheses using high-quality data from a national sample of Australian 14/15-year-old adolescents (Longitudinal Study of Australian Children, n = 1806). We find substantial intergenerational associations in gender ideology. Paternal and maternal attitudes exert a similar degree of influence on their children's attitudes, and have complementary rather than cumulative effects. While fathers' attitudes influence sons' and daughters' attitudes equally, mothers' attitudes influence daughters' attitudes more than sons'.

Separation and Elevated Residential Mobility: A Cross-Country Comparison.

This study investigates the magnitude and persistence of elevated post-separation residential mobility (i.e. residential instability) in five countries (Australia, Belgium, Germany, the Netherlands, and the UK) with similar levels of economic development, but different welfare provisions and housing markets. While many studies examine residential changes related to separation in selected individual countries, only very few have compared patterns across countries. Using longitudinal data and applying Poisson regression models, we study the risk of a move of separated men and women compared with cohabiting and married individuals. We use time since separation to distinguish between moves due to separation and moves of separated individuals. Our analysis shows that separated men and women are significantly more likely to move than cohabiting and married individuals. The risk of a residential change is the highest shortly after separation, and it decreases with duration since separation. However, the magnitude of this decline varies by country. In Belgium, mobility rates remain elevated for a long period after separation, whereas in the Netherlands, post-separation residential instability appears brief, with mobility rates declining rapidly. The results suggest that housing markets are likely to shape the residential mobility of separated individuals. In countries, where mortgages are easy to access and affordable rental properties are widespread, separated individuals can rapidly adjust their housing to new family circumstances; in contrast, in countries with limited access to homeownership and small social rental markets, separated individuals experience a prolonged period of residential instability.

Interdependencies in Mothers' and Daughters' Work-Family Life Course Trajectories: Similar but Different?

Women's life courses underwent substantial changes in the family and work domains in the second half of the twentieth century. The associated fundamental changes in opportunity structures and values challenged the importance of families of origin for individual life courses, but two research strands suggest enduring within-family reproduction of women's family behavior and work outcomes. We revisit this issue by studying two complementary types of intergenerational associations in women's combined work-family trajectories. On the one hand, we examine similarities across mothers' and daughters' work-family trajectories to address the direct within-family reproduction of female life courses (intergenerational persistence). On the other hand, we examine systematic associations between work-family trajectories that are typical in each generation to address intergenerational interdependencies beyond direct reproduction that account for individual and societal constrains and opportunities that each generation faced (intergenerational correspondence). We use a within-dyad approach to sequence analysis and examine combined work-family trajectories between ages 18 and 35 of two generations of women, born in 1930-1949 and in 1958-1981, within the same family drawn from the German Socio-Economic Panel. Overall, we find evidence of small but nontrivial persistence in work-family trajectories across generations that is partly attributed to within-family mechanisms of reproduction. In addition, we find correspondence across typical trajectory patterns of each generation, without daughters necessarily resembling their mothers' trajectories. The strength of the intergenerational associations varies by social background. Our research improves and broadens our understanding of the reproduction of female life courses across generations.

Childhood family structure and complexity in partnership life courses.

This study investigated the associations between childhood living arrangements and complex adult partnership trajectories. The authors defined first union dissolution as the event initiating a complex partnership life course, and measured the level of complexity using a weighted cumulative index of subsequent partnership episodes. The analyses were based on a representative sample of the German population born in 1971-73 from the German Family Panel and used multivariate hurdle models to estimate the probability of experiencing the initiation of a complex partnership trajectory, as well as the level of complexity. Results showed that respondents who did not grow up with both biological parents (i.e. those who experienced an alternative family structure) had both a greater likelihood of experiencing the dissolution of their own first union, and followed more complex subsequent partnership trajectories. These associations varied across types of (alternative) family structures experienced during childhood and according to the level of parental partnership (in)stability. This study contributes to our understanding of contemporary partnership complexity and its precursors using a long term life course theoretical and methodological frame. We acknowledge that continuities and disruptions in the development of adult (complex) partnership trajectories can be linked to a growing diversity of family structure in childhood. Thereby, we expand knowledge on intergenerational interdependencies of family instability and complexity beyond the reproduction of the event of union dissolution.

Chronic conditions, couple-level factors and union dissolution.

This paper examines the association between chronic illness and union dissolution by examining rich, longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. Using competing-risks discrete-time event-history models on longitudinal, dyadic data, we find the risk of union dissolution to be approximately 40 percent higher when either partner reports an illness than in the absence of an illness. We then examine whether the observed associations are mediated by variations in paid work, housework, financial stress and time stress. Financial stress is the factor that contributes most to the indirect associations between dissolution and partner's health condition, but overall these factors account for only 18.5 percent of the association between chronic illness and relationship dissolution. Our results provide further insight into the factors undermining relationship stability and highlight the importance of reducing financial stress associated with chronic illness.

Fertility Intentions and Residential Relocations.

This research addresses the question of whether fertility intentions (before conception) are associated with residential relocations and the distance of the relocation. We empirically tested this using data from two birth cohorts (aged 24-28 and 34-38 in the first survey wave) of the German Family Panel (pairfam) and event history analysis. Bivariate analyses showed that coupled individuals relocated at a higher rate if they intended to have a(nother) child. We found substantial heterogeneity according to individuals' age and parental status, particularly for outside-town relocations. Childless individuals of average age at family formation-a highly mobile group-relocated at a lower rate if they intended to have a child. In contrast, older individuals who already had children-the least-mobile group-relocated at a higher rate if they intended to have another child. Multivariate analyses show that these associations are largely due to adjustments in housing and other living conditions. Our results suggest that anticipatory relocations (before conception) to adapt to growing household size are importantly nuanced by the opportunities and rationales of couples to adjust their living conditions over the life course. Our research contributes to the understanding of residential mobility as a by-product of fertility decisions and, more broadly, evidences that intentions matter and need to be considered in the analysis of family life courses.

Individuals' openness to migrate and job mobility.

In this article we extend the scope of the interdependence between migration and job mobility: We investigate whether an individual's openness to migrate not only increases the probability of migration but also the likelihood to conduct a job search and exhibit job mobility. Using data from a three-wave panel study, which allows the analysis of temporal links between decision-making and subsequent events regarding migration and job mobility, a joint estimation of multiple equations is performed. We show that considering migration as an option for the future, which is our indicator of individuals' openness to migrate, is positively associated with both migration and job mobility. It even increases job mobility independently of whether migration takes place or not. These findings contribute significantly to our body of knowledge about the interdependence of migration and job mobility. Additionally, they enhance our understanding of the mechanisms behind a common selectivity of migrants and job mobile individuals.

Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000.

BACKGROUND: It has been suggested that selective sentinel node (SN) biopsy alone can be used to manage early breast cancer, but definite evidence to support this notion is lacking. The aim of this study was to investigate whether refraining from completion axillary lymph node dissection (ALND) suffices to produce the same prognostic information and disease control as proceeding with completion ALND in early breast cancer patients showing micrometastasis at SN biopsy. METHODS: This prospective, randomized clinical trial included patients with newly diagnosed early-stage breast cancer (T<3.5 cm, clinical N0, M0) who underwent surgical excision as primary treatment. All had micrometastatic SN. Patients were randomly assigned to one of the two study arms: complete ALND (control arm) or clinical follow-up (experimental arm). Median follow-up was 5 years, recurrence was assessed, and the primary end point was disease-free survival. RESULTS: From a total sample of 247 patients, 14 withdrew, leaving 112 in the control arm and 121 in the experimental arm. In 15 control subjects (13%), completion ALND was positive, with a low tumor burden. Four patients experienced disease recurrence: 1 (1%) of 108 control subjects and 3 (2.5%) of 119 experimental patients. There were no differences in disease-free survival (p=0.325) between arms and no cancer-related deaths. CONCLUSIONS: Our results strongly suggest that in early breast cancer patients with SN micrometastasis, selective SN lymphadenectomy suffices to control locoregional and distant disease, with no significant effects on survival.

Factors affecting surgical margins in nonpalpable breast tumors excised with the radioguided occult lesion localization approach.

AIM: Most breast surgeons generally assume that obtaining negative margins in nonpalpable tumors is a matter of concern. The aim of this study was to examine whether it is easier to obtain negative margins in palpable tumors than in nonpalpable tumors excised with the radioguided occult lesion localization (ROLL) technique. METHODS: A retrospective review was made of nonpalpable breast cancers excised with the ROLL technique (ROLL group, n = 83) and palpable breast cancers in which breast conservative therapy was performed (Palpable group, n = 77). The margin status and the size of the minimum margin obtained when it was negative were reviewed. RESULTS: The percentage of resections with negative margins was similar in both groups: 51.9% in the Palpable group and 61.4% in the ROLL group. There was no difference between the two groups in the minimum margin obtained: mean ± SD, 5.53 ± 3.146 mm in the Palpable group and 5.96 ± 3.039 mm in the ROLL group. Risk factors for failing to obtain negative margins were analyzed in both groups and were similar. These risk factors included histological grade, extensive intraductal carcinoma and c-erbB2 status. CONCLUSION: It is concluded that excision of nonpalpable breast tumors with the ROLL approach obtains similar results for margins as conservative surgery performed for palpable tumors.

Effects of milk supplementation with conjugated linoleic acid (isomers cis-9, trans-11 and trans-10, cis-12) on body composition and metabolic syndrome components.

The effects of conjugated linoleic acid (CLA) on body weight and body composition in man are controversial. The aim of this study was to investigate the effects of milk supplementation with CLA on body composition and on the biochemical parameters of the metabolic syndrome. This was a randomised, double-blind, placebo-controlled trial. Subjects were randomised to a daily intake of 500 ml milk supplemented with 3 g CLA (using a mixture of the bioactive isomers cis-9, trans-11 and trans-10, cis-12, marketed as Tonalin, Naturlinea; Central Lechera Asturiana) or placebo for 12 weeks. Sixty healthy men and women (aged 35-65 years) with signs of the metabolic syndrome participated (BMI 25-35 kg/m2). Dual-energy X-ray absorptiometry was used to measure body composition (week 0 baseline and week 12). Total fat mass in the CLA-milk subgroup with a BMI < or = 30 kg/m2 decreased significantly while no changes were detected in the placebo group (approximately 2 %, P = 0.01). Trunk fat mass showed a trend towards reduction (approximately 3 %, P = 0.05). CLA supplementation had no significant effect on the parameters of the metabolic syndrome, nor was it associated with changes in haematological parameters or renal function. The supplementation of milk with 3 g CLA over 12 weeks results in a significant reduction of fat mass in overweight but not in obese subjects. CLA supplementation was not associated with any adverse effects or biological changes.

The impact of reducing stavudine dose versus switching to tenofovir on plasma lipids, body composition and mitochondrial function in HIV-infected patients.

BACKGROUND: Stavudine (d4T)-containing regimens are associated with a potential for lipoatrophy and dyslipidaemia. We assessed the safety and efficacy of reducing the dose of stavudine compared with switching to tenofovir or maintaining the standard dose of d4T. METHODS: Clinically stable HIV-infected patients receiving antiretroviral therapy containing stavudine 40 mg twice daily with a plasma HIV RNA < 200 copies/ml for at least 6 months were randomized to maintain stavudine 40 mg twice daily (d4T40 arm), to reduce to 30 mg twice daily (d4T30 arm), or to switch from d4T to tenofovir (TDF arm). RESULTS: Fifty-eight (93% male) patients were included: 22 in the d4T40 arm, 19 in the d4T30 arm and 17 in TDF arm. At baseline, median time on d4T was 6 years (interquartile range [IQR] 2.6-7.1), median age 43 years (IQR 36-51) and median CD4+ T-cell count was 587/mm3 (IQR 329-892). At week 24, median limb fat changes (g) were as follows: d4T40 = -182 (95% CI: -469- -5); d4T30 = 527 (95% CI: -343-694); and TDF = 402 (95% CI: 130-835; d4T40 versus TDF, P = 0.0003). Significant differences between median values of laboratory parameters were detected: triglycerides (mg/dl): d4T40 = 19; d4T30 = -23 and TDF = -79 (d4T40 versus TDF, P = 0.03); and total cholesterol (mg/dl): d4t40 = 22, d4T30 = -4, and TDF = -28 (d4T40 versus TDF, P = 0.04). No significant difference was observed in mitochondrial function assessed in peripheral blood mononuclear cells. CONCLUSIONS: Although both strategies were associated with a trend toward a decrease in plasma lipids and an increase in body fat, the only significant changes were observed among those who switched to tenofovir.

[Feasibility of the sentinel lymph node technique in cervical and vulvar cancers]. / Aplicabilidad de la técnica del ganglio centinela en carcinomas de cérvix y de vulva.

BACKGROUND AND OBJECTIVE: Our goal was to investigate the feasibility of identifying the sentinel lymph node (SLN) in patients undergoing surgery for cervical and vulvar carcinomas. We also evaluated the advantages that such procedure can offer in this kind of tumors. PATIENTS AND METHOD: We detected the sentinel lymph node through preoperative lymphoscintigraphy (Technetium-99m colloid) and intraoperative visualization with blue dye by a hand-held or laparoscopic gamma-probe in 7 patients with invasive cervical carcinoma (clinical stage Ib1) and in 6 patients with vulvar carcinoma (clinical stages Ib and II) . RESULTS: At least one sentinel lymph node was identified in each patient. SNL was more commonly found in patients with invasive cervical carcinoma. We observed neoplastic infiltration in 3 nodes, all of them corresponding to cases of vulvar carcinoma. CONCLUSIONS: Sentinel lymph node identification is a feasible technique in the management of vulvar and cervical carcinomas. Our preliminary data show that SLN in gynecological carcinomas have similar uses as in other anatomical sites, identifying women in whom lymph node dissection can be avoided.

Aplicabilidad de la técnica del ganglio centinela en carcinomas de cérvix y de vulva / Feasibility of the sentinel lymph node technique in cervical and vulvar cancers

Fundamento y objetivo: Los objetivos del presente trabajo son, por un lado, estudiar la aplicabilidad de las técnicas de ganglio centinela (GC) en un grupo de pacientes con cáncer de cérvix y cáncer de vulva en estadios iniciales, y, por otro, valorar las ventajas que el procedimiento puede ofrecer en estos tumores en función de nuestros resultados preliminares. Pacientes y método: Practicamos la técnica de GC mediante trazador radiactivo en combinación con colorante vital en 7 pacientes con cáncer de vulva (estadios clínicos Ib y II) y 6 pacientes con cáncer de cérvix en estadio Ib1, en 2 casos mediante abordaje laparoscópico. Los hallazgos obtenidos con la técnica no modificaron el tratamiento previsto en cada caso, que se realizó de acuerdo con protocolos preestablecidos. En el estudio histológico del GC se aplicaron técnicas de ultraestadificación. Resultados: Identificamos GC en todos los casos, excepto en una paciente con adenocarcinoma endocervical. El número de GC identificados por paciente fue mayor en los casos de cáncer de cérvix. Tres GC mostraron infiltración neoplásica, uno con micrometástasis, en 3 pacientes con cáncer de vulva. Ningún ganglio no centinela resultó metastásico. No constatamos complicaciones asociadas al procedimiento. Conclusiones: La técnica de GC es aplicable en carcinomas de cérvix y vulva. A partir de nuestros resultados preliminares coincidimos con otros autores en que su aplicación en los tumores ginecológicos estudiados puede aportar beneficios similares a los descritos para tumores de otras localizaciones

Background and objective: Our goal was to investigate the feasibility of identifying the sentinel lymph node (SLN) in patients undergoing surgery for cervical and vulvar carcinomas. We also evaluated the advantages that such procedure can offer in this kind of tumors. Patients and method: We detected the sentinel lymph node through preoperative lymphoscintigraphy (Technetium-99m colloid) and intraoperative visualization with blue dye by a hand-held or laparoscopic gamma-probe in 7 patients with invasive cervical carcinoma (clinical stage Ib1) and in 6 patients with vulvar carcinoma (clinical stages Ib and II) . Results: At least one sentinel lymph node was identified in each patient. SNL was more commonly found in patients with invasive cervical carcinoma. We observed neoplastic infiltration in 3 nodes, all of them corresponding to cases of vulvar carcinoma. Conclusions: Sentinel lymph node identification is a feasible technique in the management of vulvar and cervical carcinomas. Our preliminary data show that SLN in gynecological carcinomas have similar uses as in other anatomical sites, identifying women in whom lymph node dissection can be avoided

Severity of cholestasis and advanced histological stage but not menopausal status are the major risk factors for osteoporosis in primary biliary cirrhosis.

BACKGROUND: Since primary biliary cirrhosis (PBC) is usually diagnosed in postmenopausal women with minor cholestasis, it has been questioned whether PBC itself represents a further risk for osteoporosis. AIM: To assess the prevalence and risk factors for osteoporosis in an unselected series of women with PBC. PATIENTS AND METHODS: 142 women with PBC (age: 54.3+/-0.8 years) and an age-matched control group. Osteoporosis was established by densitometry (bone mineral density below -2.5 T-score). Age, duration and severity of PBC, body mass index, menopausal status, histological stage and markers of bone turnover were assessed. RESULTS: Prevalence of osteoporosis was higher in PBC (32.4%) than in normal women (11. 1%) (RR: 3.83, 95%CI: 2.59-5.67, P<0.001). Osteoporosis was associated with older age, menopausal status, body mass index, longer PBC duration, advanced histological stage, high bilirubin and alkaline phosphatase, and low albumin and prothrombin index. Regression analysis identified older age, higher Mayo risk score, lower body mass index and advanced histological stage but not menopause as the independent risk factors for osteoporosis. CONCLUSIONS: Osteoporosis is more prevalent in women with PBC than in the general population. Age and severity of the disease, but not menopausal status, are the main risk factors for osteoporosis in this liver disease.