Age at separation, residential mobility, and depressive symptoms among twins in late adolescence and young adulthood: a FinnTwin12 cohort study.

BACKGROUND: Separating with close siblings and leaving the parental home at an early age represents a major life event for an adolescent (reflected by age at separation in a twin pair) and may predispose them to poor mental health. This study aims to examine the association of age at separation and residential mobility on depressive symptoms in late adolescence and young adulthood and to explore possible underlying genetic effects. METHODS: Residential mobility consisted of the number and total distance of moves before age 17. Based on 3071 twins from the FinnTwin12 cohort, we used linear regression to assess the association of age at separation and residential mobility with General Behavior Inventory (GBI) scores at age 17 and in young adulthood. A higher GBI score indicated more depressive symptoms occurred. Then, the mixed model for repeated measures (MMRM) was used to visualize the scores' trajectory and test the associations, controlling for "baseline" state. Twin analyses with a bivariate cross-lagged path model were performed between the difference in GBI scores, between cotwins, and separation status for the potential genetic influence. RESULTS: Compared to twins separated before age 17, twins who separated later had significantly lower GBI scores at age 17 and in young adulthood. In MMRM, separation at a later age and a higher number of moves were associated with a higher GBI score in young adulthood. A small genetic effect was detected wherein GBI within-pair differences at age 17 were associated with separation status before age 22 (coefficient: 0.01). CONCLUSION: The study provides valid evidence about the influence of siblings and family on depressive symptoms in later adolescence and young adulthood while finding some evidence for a reverse direction effect. This suggests more caution in the interpretation of results. A strong association between residential mobility and depressive symptoms was affirmed, although further detailed research is needed.

Male twinning after the 2008 Obama election: A test of symbolic empowerment.

On November 4, 2008, Barack Obama was elected the first Black President of the United States. His campaign and electoral win served as a symbol of hope for a more just future, fostering an "Obama effect" that appears associated with improved well-being among non-Hispanic (NH) Black communities. Situating the Obama election within the symbolic empowerment framework, we consider the potentially protective role of the Obama election on NH Black fetal death, an important but understudied measure of perinatal health that has stark racial disparities. Using restricted-use natality files from the National Center for Health Statistics, we proxy fetal death using the male twin rate (number of twins per 1000 male live births). Male twins have a relatively high risk of in utero selection that is sensitive to maternal and environmental stressors, making the twin rate an important marker of fetal death. We then estimate interrupted time-series models to assess the relation between the Obama election and male twin rates among NH Black births across monthly conception cohorts (February 2003-October 2008). Greater-than-expected male twin rates signal less susceptibility to fetal loss. Results indicate a 4.5% higher male twin rate among all NH Black cohorts exposed in utero to the Obama election, after accounting for historical and NH white trends (p < 0.005). The greater-than-expected rates concentrated among births conceived in the months preceding Obama's nomination at the Democratic National Convention and Obama's presidential win. These results suggest a salutary perinatal response to election events that likely reduced NH Black fetal loss. They also indicate the possibility that sociopolitical shifts can mitigate persisting NH Black-NH white disparities in perinatal health.

Familial confounding or measurement error? How to interpret findings from sibling and co-twin control studies.

Epidemiological researchers often examine associations between risk factors and health outcomes in non-experimental designs. Observed associations may be causal or confounded by unmeasured factors. Sibling and co-twin control studies account for familial confounding by comparing exposure levels among siblings (or twins). If the exposure-outcome association is causal, the siblings should also differ regarding the outcome. However, such studies may sometimes introduce more bias than they alleviate. Measurement error in the exposure may bias results and lead to erroneous conclusions that truly causal exposure-outcome associations are confounded by familial factors. The current study used Monte Carlo simulations to examine bias due to measurement error in sibling control models when the observed exposure-outcome association is truly causal. The results showed that decreasing exposure reliability and increasing sibling-correlations in the exposure led to deflated exposure-outcome associations and inflated associations between the family mean of the exposure and the outcome. The risk of falsely concluding that causal associations were confounded was high in many situations. For example, when exposure reliability was 0.7 and the observed sibling-correlation was r = 0.4, about 30-90% of the samples (n = 2,000) provided results supporting a false conclusion of confounding, depending on how p-values were interpreted as evidence for a family effect on the outcome. The current results have practical importance for epidemiological researchers conducting or reviewing sibling and co-twin control studies and may improve our understanding of observed associations between risk factors and health outcomes. We have developed an app (SibSim) providing simulations of many situations not presented in this paper.

Second-versus first-born twin: comparison of short- and long-term outcomes.

PURPOSE: An ancient description of the competition between twins for first breath is found in the biblical story of Jacob and Esau (Genesis 25:26) when Jacob pulled his older brother's heel in the hope of becoming firstborn but to no avail. In this study, we sought to evaluate the short and long-term outcomes of twin pairs, comparing between the second- and first-born twin. METHODS: A population-based cohort study, including dichorionic twin deliveries occurring between the years 1991 and 2021 at Soroka University Medical Center. A General estimation equation (GEE) was applied to adjust for confounders. The incidence of offspring's hospitalizations due to various medical conditions was compared. Kaplan-Meier survival analyses compared cumulative morbidity. Cox proportional hazards models were used to control for confounders. RESULTS: 5507 twin deliveries met the inclusion criteria. Second-born twins had higher rates of cesarean deliveries, statistically significant in the GEE multivariable analysis. More first-twin fetuses were experiencing non-reassuring fetal heart rate patterns, although other obstetrical outcomes as well as mortality rates were comparable between groups. Second twins weighed lower than their older sibling (mean difference 33 g) and were more frequently SGA and low birthweight (1500-2500 g); (p < 0.05). Later during childhood, offspring of twin deliveries experienced notable morbidity due to infectious (23.8-24.1%), respiratory (10.5-10.9%), neurological (7.0-7.8%) and cardiovascular pathologies (1.7-1.9%) during childhood, that was unaffected by birth order. CONCLUSION: Other than birthweight differences, the birth order of dichorionic twins is not associated with adverse neonatal health indices, nor does it predict excess risk for morbidity during childhood.

Twin parenting experience - reshaping the family web

Being a parent of twin siblings is a major challenge for parents and requires a family restructuring to adapt to a new family environment. Objective: To understand the experiences of parents of twins and meanings attri-buted to them. Methods: a qualitative study was conducted, having the symbolic interactionism as a theoretical referential and the interpretative interactionism as the methodologi-cal referential. Twenty-nine parents with children under 4 years participated in this study. A semi-structured interview was conducted for data collection. Results: The twins family responses to parenting challenges are conditioned by the management and articulation of their difficulties, their strengths and personal re-sources. There is a clear choice in being a family with children that privileges nego-tiation and involvement of the couple in caring for the family, or, at least, part of the family, meaning the children and playing the parenting role. Conclusions: The family grows as a complex web, including its elements and inte-ractions. The symbolic construction evidences the way the family adjusts to this en-vironment of twin parenting. The health professionals should be able to anticipate the needs of families going through this process.

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Prevalencia de la lactancia materna en un centro de salud de Zaragoza (España). Factores sociosanitarios que la condicionan / Breastfeeding prevalence in a Zaragoza (Spain) primary health care centre. Socioeconomic factors related

Objetivo: describir la situación actual de la lactancia materna (LM) en nuestro centro de salud y analizar los factores sociosanitarios que condicionan su mantenimiento, para promover planes de mejora en los próximos años. Material y métodos: estudio descriptivo retrospectivo de la población controlada desde el nacimiento en el CS de Santa Isabel de Zaragoza durante tres años (2010-2012) y seguimiento en su primer año de vida (n=570). Resultados: la duración media de la LM exclusiva es de 2,5 meses, yde la LM total de 5,1 meses. Las tasas de lactancia pasan de un 86,3% al nacimiento a un 74% al mes; al 40,7% a los seis meses y al 14,2% al año. Los factores asociados a una mayor duración de la LM exclusiva son: mayor peso al nacimiento, mayor edad gestacional, embarazo único y parto eutócico. La asistencia al grupo de crianza y al de preparación al parto, junto con la mayor edad materna, se relacionan con mayores tasas de LM total. Conclusiones: la prevalencia de LM en nuestro medio es superior a la que muestran los datos previa- mente disponibles en España, pero se encuentra por debajo de los publicados en Aragón. Las tasas de LM sufren un descenso en el primer mes, por dificultades en la instauración de la lactancia y hacia el cuarto-sexto mes, con la incorporación de la madre al trabajo. Los factores que influyen negativamente en las tasas de LM exclusiva son: bajo peso, prematuridad, gemelaridad y parto distócico/cesárea; mientras que la asistencia al grupo de preparación al parto, al grupo de crianza y las madres más añosas son las que presentan lactancias más prolongadas (AU)

Objective: to describe the current situation of breastfeeding (BF) in our primary care health center and analyze the socioeconomic factors conditioning its maintenance, in order to promote improvement opportunities for the upcoming years. Materials and methods: descriptive retrospective study of the population monitored from birth date at the Santa Isabel health center (Zaragoza) for 3 years (2010-2012), and followed up until 12 months of age (N:570). Results: the mean duration of exclusive BF is 2.5 months, and of total BF 5.1 months. The rate of BF is 86.3% at birth, 74% at the 1st month of age, 40.7% at the 6th, and 14.2% at the age of 12 months. Factors related to longer exclusive BF are: larger birth weight and gestational age, singleton pregnancy, and normal childbirth. Higher rates of BF are correlated to mothers’ attendance to childbirth and breast- feeding classes as well as to older mothers. Conclusions: prevalence of BF in our primary care health center is higher than the previously published data for Spain, but lower than the data for Aragon. BF rates decrease at the 1st month of life as a result of problems at the beginning of BF; and at the 4th-6th month due to mothers returning to work. Factors against exclusive BF are: low weight at birth, prematurity, multiple birth and dystocia/cesarean birth. Attendance of childbirth and breastfeeding classes and older mothers are factors related to longer BF (AU)

Obesidad, actividad física y dolor lumbar: un análisis genéticamente informativo / Obesity, physical activity and low back pain: a genetically informative analysis

Objetivo: Analizar la relación entre obesidad, actividad física y dolor lumbar a través de un estudio transversal de gemelos caso-control. Material y método: La muestra general la componen 1.613 individuos gemelos, de entre 47 y 73 años, y participantes en el Registro de Gemelos de Murcia. Los datos fueron obtenidos mediante entrevista telefónica y se recogió información sobre dolor de espalda, datos antropométricos y actividad física. La cigosidad fue evaluada mediante cuestionario. El análisis caso-control se realizó sobre 199 parejas completas y discordantes para dolor lumbar. Resultados: La prevalencia del dolor lumbar en la muestra total fue del 33,1% (mujeres: 36,4%; varones: 29,1%). El Índice de Masa Corporal (IMC) fue de 27.2 (DE: 4,3). En la muestra general, ser mujer, IMC elevado, frecuencia baja de actividad física moderada e intensa y sedentarismo se asociaron con mayor riesgo de padecer dolor lumbar. Sin embargo, todas las asociaciones perdieron significación estadística en el análisis caso-control. Conclusión: Es necesario considerar las características individuales o grupales al valorar el papel del IMC o la actividad física en la prevención del dolor lumbar. Esto incluye la necesidad de tener en cuenta el papel de los factores genéticos en futuras investigaciones sobre esta relación (AU)

Objective: Our main objective was to analyse the relationship between obesity, physical activity and low back pain using a cross-sectional co-twin design. Material and method: The total sample comprised 1,613 subjects, aged 47 to 73, from the Murcia Twin Registry. Data were obtained through telephone interview, and information about back pain, anthropometric data and physical activity was collected. One-hundred and ninety-nine pairs complete and discordant for low back pain were available for the case-control analysis. Results: Prevalence of low back pain was 33.1% (females: 36.4%; males: 29.1%). Mean Body Mass Index (BMI) was 27.2 (SD: 4.3). For the general sample, being female, a high BMI, low frequency of moderate or intense physical activity and sedentarism were associated to a higher risk of low back pain. However, all associations lost statistical significance in the case-control analyses. Conclusion: Individual and group characteristics must be considered when evaluating the role of BMI or physical activity on prevention of low back pain. This includes the need to take into account the role of genetic factors in future research about this relationship (AU)

Pronóstico perinatal y materno de las gestaciones gemelares concebidas mediante fecundación in vitro, en relación con las obtenidas espontáneamente / Perinatal and maternal outcomes in twin pregnancies resulting from in vitro fertilization versus spontaneous conception

Objetivo: Conocer el pronóstico de gestaciones gemelares concebidas mediante fecundación in vitro (GG-FIV) comparado con el de las espontáneas (GGE). Material y métodos: Realizamos un estudio de cohortes históricas en el Complejo Hospitalario Universitario de Albacete, durante los años 2001, 2002 y 2003, comparando los resultados neonatales de los embarazos gemelares obtenidos por FIV (n = 44) con gestaciones gemelares espontáneas (n = 109). El resultado principal estudiado es la mortalidad perinatal, y los resultados secundarios son: morbilidad fetal (enfermedad neonatal, Apgar < 7, pH arterial acidótico, ingresos en una unidad neonatal), parto pretérmino, complicaciones maternas y tipo de parto. Resultados: No hay diferencias en la morbimortalidad perinatal entre ambas cohortes. Hay una mayor incidencia de parto pretérmino en el grupo de gestaciones gemelares espontáneas que en las gemelares espontáneas (el 75,2 frente al 52%; p = 0,006). La incidencia de diabetes gestacional es mayor en el grupo de gestaciones por FIV (el 25,5 frente al 9,7%; p = 0,01). Conclusiones: No encontramos diferencias en la morbimortalidad perinatal ni materna de gestaciones gemelares obtenidas mediante FIV en relación con las espontáneas

Objective: To determine the outcomes of twin pregnancies resulting from in vitro fertilization (IVF) compared with those resulting from spontaneous conception. Material and methods: We performed a historical cohort study comparing neonatal outcomes of twin pregnancies resulting from IVF (n = 44) with those resulting from spontaneous conception (n = 109) in the Complejo Hospitalario Universitario de Albacete (Spain) in 2001, 2001 and 2003. The primary variable was perinatal mortality. Secondary variables were fetal morbidity (neonatal abnormalities, Apgar < 7, acidotic arterial pH, admission to the neonatal unit), preterm delivery, maternal complications, and type of delivery. Results: No differences in perinatal mortality and morbidity were found between spontaneous twin pregnancies and twins resulting from assisted reproductive techniques. The rate of preterm labor was significantly higher in spontaneous twin pregnancies (75.2 versus 52%; p = 0.006). The incidence of gestational diabetes was significantly higher in twin pregnancies resulting from IVF than in spontaneous twin pregnancies (25.5 versus 9.7%; p = 0.01). Conclusions: Perinatal and maternal outcomes in twin pregnancies resulting from IVF are similar to those of spontaneous twin pregnancies

Manejo del parto del segundo gemelo / Management of second twin delivery

Objetivos: Valoración de los resultados perinatales en un estudio retrospectivo del manejo del parto del segundo gemelo, cuando se ha producido un parto vaginal del primer gemelo, en los partos gemelares asistidos por vía vaginal en el Hospital Universitario Materno Infantil de Canarias (HUMIC), durante el período comprendido desde el 1 de enero de 1998 al 31 de diciembre de 2002. Material y métodos: Análisis de 455 partos gemelares, sobre un total de 37.803 partos, desde el 1-01-1998 al 31-12-2002. Se revisaron de forma retrospectiva todos los partos gemelares por vía vaginal atendidos en dicho período. Se excluyeron los partos triples y los gemelos asistidos mediante cesárea. Se evaluaron los siguientes parámetros: número total de partos gemelares, total de recién nacidos (RN) vivos, número de partos gemelares por vía vaginal, edad materna, paridad, edad gestacional, tipo de parto, tipo de parto del segundo gemelo, peso, sexo del RN, test de Apgar, pH arterial menor de 7,10, ingreso en la unidad de cuidados intensivos neonatales (UCIN) y mortalidad. Resultados: El número de partos gemelares atendidos en dicho período fue de 454, con 902 RN vivos. El número de partos gemelares por vía vaginal fue de 262. La edad materna fue de 77,9 por ciento entre 17-34 años. La mayoría primíparas, con 135 casos (51,5 por ciento). La edad gestacional en el momento del parto fue del 39,3 por ciento de menos de 37 semanas. En cuanto a la forma del parto del segundo gemelo, 134 (51,1 por ciento) fueron eutócicos, 60 (22,9 por ciento) de versión interna y gran extracción podálica, 41 (15,6 por ciento) podálicos vía vaginal y 27 (10,3 por ciento) mediante fórceps. En cuanto a los recién nacidos, la mayoría fueron varones (133 casos), y 141 (54,6 por ciento) presentaron un peso inferior a 2.500 g. Los resultados perinatales fueron buenos, con el 96,4 por ciento de los gemelos con test de Apgar a los 5 minutos superior a 7, pH arterial mayor de 7,10 en el 79,07 por ciento, y el 26,7 por ciento ingresó en el servicio de neonatología (AU)

Gestación gemelar / Twin pregnancy

Objetivo: Evaluar las características y las complicaciones de las gestaciones gemelares controladas en nuestro servicio durante el embarazo, el parto y el posparto. Material y método: Estudio retrospectivo de 149 gestaciones gemelares desde 1997 a 2001, controladas en la consulta de embarazo de alto riesgo. Resultados: La placentación más frecuente fue la bicorial-biamniótica (75, por ciento). El 30,2 por ciento de las gestantes ingresó por amenaza de parto prematuro. El 39,5 por ciento de los partos fueron pretérmino y hubo que realizar cesárea al 35,6 por ciento de las gestantes. El 66,8 por ciento de los recién nacidos pesó menos de 2.500 g; el 46,6 por ciento precisó ingreso en la unidad neonatal, y el 3,7 por ciento de los fetos y recién nacidos falleció antes del parto o en los primeros 28 días tras éste. Discusión: Las gestaciones gemelares conllevan un aumento de las complicaciones gestacionales, así como un mayor índice de cesáreas y un menor peso de los recién nacidos (AU)

Biological and social traits associated with twinning among Caucasoids and Negroids

Os prontuários das mäes de gêmeos causasóides (589) e negróides (142) nascidos entre 1984 e 1993 e de um grupo controle de mäes de crianças nascidas de parto único (1267 caucasóides e 248 negróides) na maior maternidade de Campinas, SP, Brasil (Maternidade de Campinas) foram investigados para a análise das seguintes informaçöes: categoria da internaçäo hospitalar (clínica particular, INSS e indigentes), estado civil, idade materna, ocorrência de trabalho de parto, tipo de parto, paridade (partos anteriores), abortamentos espontâneos anteriores ao parto, idade gestacional e peso e estatura dos gêmeos e dos nascituros únicos. As principais conclusöes foram as seguintes: 1) as mäes caucasóides usufruiram, em maior proporçäo, de internaçäo hospitalar de categoria mais alta, mas a gemelaridade näo mostrou associaçäo com a classe social das parturientes; 2) a proporçäo de mulheres casadas entre as mäes caucasóides foi maior do que entre as negróides, e as mäes caucasóides de gêmeos incluíram maior proporçäo de mulheres casadas do que as que tiveram parto único; 3) näo se constatou diferença entre caucasóides e negróides quanto a idade média materna, ocorrência de trabalho de parto, tipo de parto, taxa de abortos espontâneos anteriores e idade gestacional; 4) quando comparadas as mäes que tiveram parto único, as mäes de gêmeos foram, em média, dois anos mais velhas, entraram menos freqüentemente em trabalho de parto, foram submetidas mais freqüentemente à cirurgia cesariana e tiveram maior taxa de abortos espontâneos, enquanto que os gêmeos tiveram menor idade média gestacional (três semanas) que os nascidos de parto único; 5) as mulheres caucasóides tiveram menor paridade que as negróides e as mäes de gêmeos maior paridade que as de partos únicos; 6) os gêmeos mostraram peso médio e estatura média menor que os nascidos de parto único, os recém-nascidos do sexo masculino mostraram peso levemente superior aos do sexo feminino, sendo os negróides mais leves e menores do que os caucasóides ao nascimento.

Análisis descriptivo de partos gemelares: Hospital de San Javier 1986-1991 / Descriptive analysis of twin labors: Hospital of San Javier 1986-1991

En el Hospital de San Javier, catalogado como tipo 4, se efectuó estudio retrsopectivo de los partos gemelares entre los años 1986 y 1991 con el objeto de evidenciar la realidad local en este tema y proponer conductas para mejorar la atención entregada a nuestra comunidad. Se recopiló la información del libro de registro de partos de nuestra maternidad. En el universo estudiado (5.304 partos), 35 partos fueron gemelares (0,66 por ciento), lo que se acerca a las cifras de la literatura nacional e internacional (menos del 1 por ciento). El porcentaje de partos gemelares fue resuelto por vía vaginal (63 por ciento), lo que concuerda con una conducta obstétrica actual en condiciones ideales. En relación a la puntuación del test de Apgar no encontramos diferencia importante entre los gemelos nacidos por vía alta o baja; si destacamos la existencia de recién nacidos con asfixia severa, en 3 casos (7 por ciento) de los naciods por vía vaginal. Concluímos que con los antecedentes expuestos podemos proponer, como conducta, la interrupción programada y electiva por vía cesárea de las madres embarazadas con gemelos, debido a lo distante que nos encontramos de una situación y realidad de trabajo ileal

The contribution of twins to perinatal mortality in Jamaica

The Jamaican Perinatal Mortality Survey collected data that have been used in this paper to estimate: (1) the rate of multiple deliveries on the island; (2) the way in which this varies with demographic features; and (3) the causes of perinatal mortality among twins on the island. The survey consisted of two phases: a study of all births in the months of September and October 1986 (the cohort months) and a study of all perinatal deaths in the 12 months from 1 September 1986 to 31 August 1987. Among the 10408 pregnancies in the cohort months, 99 (1.0 percent) were multiple pregnancies. The Twinning rate showed statistically significant trends with maternal age and parity but no association with social factors. Among the 2020 perinatal deaths occurring in the 12-month period, 173 (8.6 percent) were twins, with particularly high contribution to the Wigglesworth group 'deaths from immaturity'. Mortality rate of twins was significantly lower if mothers resided in areas where there were good obstetric and paediatric facilities (Summary)