[Self-rated health status and its implications. Population study of pregnant women in Brno]. / Subjektivní hodnocení vlastního zdraví a jeho souvislosti. Populacní studie gravidních zen v Brne

OBJECTIVE: The subject of self-rated health status of women in fertile age has not yet been investigated in our country. As our study is longitudinal and the same questions-questionnaire items regarding self-rated health of the monitored women are repeated in each investigation phase, we are able to not only find out which factors are related but also verify how this relationship evolves with their ageing, life situation changes and growing up of their children. SETTING: Research Centre for Toxic Compounds in the Environment, Masaryk University, Brno. METHODS: Pregnant women from the Brno part of ELSPAC study rated their health status for the time period before becoming pregnant, for the first months of pregnancy and for the half of pregnancy. On the four-grade scale of self-reported health status the associations with their personal health-history (from prenatal questionnaires and prenatal and obstetrician health-care network) were investigated. RESULTS: The monitored women rated their pre-pregnancy health-status increasingly worse with increasing age and weight, increasing morbidity, increasing medicine consumption and with increasing number of injuries. Also their parents, siblings and children were more often ill and more often admitted in hospitals as in-patients. These women required more specialized care starting in their childhood, suffered more from infectious diseases, operations, injuries, stresses and break-ups of their original families. Their misunderstanding with parents was occurred with higher frequency, their upbringing was more strict, they suffered from school failures more often, they had problems with the police and premature pregnancies. According to the mothers education, especially the daughters of college educated women felt subjectively worse. Also women with basic level of education, problems at work, financial troubles, those who had many children and less adults in their household rated their health worse. They were also unemployed and dissatisfied with their housing situation. In partner relationships conflicts were present frequently including violence. They also suffered from depression, anxiety, neuroses, phobias and social isolation more often. They also attempted to become pregnant longer than other women and tolerated pregnancy worse. They noted more changes to themselves and experiences more stress. The worse their feelings were during the first months of pregnancy, the higher frequency of pregnancy difficulties, delivery pathologies and post-natal complications were present according to the health-status documentation. CONCLUSION: This paper brings a whole series of original findings of factors associated with self-rated health-status. The socio-economic position in the families of their own had a more substantial influence on the health-status of the monitored women compared to the position in the families where they grew up. The indicators - e.g. stress, social isolation, work, social support, education, income and household created gradients on the health-status scale which were overall highly significant.

[Child abuse in common family population--a longitudinal study]. / Týrání detí populaci bézných rodin--longitudinální studie.

BACKGROUND: Dunovský, Dytrych, Matejcek et al. have published their experience from their consulting and interventional activities, alongside with an analysis of the paediatric, psychological, psychiatric and social components of the child's development in the family and outside it, in a fundamental and still up-to-date paper (1, 2). In this elaborate they emphasized the necessity to map the occurrence, in our country, of pathological phenomena included in the CAN notion--a child that is abused and neglected. The background of the presented study lays in a retrospective investigation in an adult population. The subject of the study are men--the near future fathers of the investigated children, who have among other information specified within an extensive personal history if and how they were maltreated in their childhood. THE GOAL OF THE STUDY: A group of men maltreated in childhood is compared to a group which was not maltreated and the investigating team searched for indications as to how different were their natal families, their parents and their own selves and if any identifiable differences occurred later in their own families, relationships, conduct and health. METHODS: A comparative study was conducted in the group of fathers based on three consecutive questionnaire investigations, between those maltreated in childhood and those who were not maltreated (control). Fathers maltreated in childhood were identified based on the response variants (1-often, 2-sometimes, 3-never) to three questionnaire inquiries filled in before the birth of their children who are included in the ELSPAC (European Longitudinal Study of Pregnancy and Childhood) study. The data was provided by men whose wives with permanent residence in Brno gave birth from March 1st 1991 till June 30th 1992. RESULTS: According to three types of test it was found out that from the parents of the studied children 57.9% of the 3580 fathers and 48.3% of the 3848 mothers were physically or psychologically maltreated during childhood: boys were maltreated more often. Maltreated fathers as compared to control: a) were more often born prematurely (p < 0.05), in the childhood and adulthood they were ill more often (p < 0.01) and they were less resistant psychologically (p < 0.001); b) more often had parents with impaired health (p < 0.001) and worse partner relationships (p < 0.001); c) came from families which didn't differ according to the father's education or employment status. The mothers had secondary education more often (p < 0.01); d) had more often wives and children with worse health (p < 0.01); e) in their own families manifested more violence towards their own wives and children (p < 0.001), they maltreated them more often physically (p < 0.01) and psychologically (p < 0.01); f) manifested more often extra-family asocial behavior (p < 0.001); g) they felt less satisfied with their financial situation (p < 0.001), with their family life (p < 0.01) and life in general (p < 0.001). CONCLUSIONS: Men maltreated in childhood resembled their parents in the social and health aspect and in the partner relationships. Towards their children they acted similarly like their parents used to--violent behavior aimed at children and between partners transferred from one generation to the next.

Chronic morbidity in women, namely in pregnancy. (Comparative study between West, Central and East European centres).

18 chronic diseases were investigated in a population of 13,115 women living in six settings of West- (Avon UK, the Isle of Man), Central- (the Czech Republic and the Slovak Republic) and East-Europe (the Ukraine and Russia), that collaborate in the European Longitudinal Study of Pregnancy and Childhood (ELSPAC project). In prenatal questionnaires filled in after the first half of pregnancy, women reported 25,795 chronic diseases they ever suffered, out of them 11,188 having in present pregnancies. In the whole sample, lifelong prevalence was 11,2%, and prevalence in pregnancy 4,8% which means that 43,4% of all chronic diseases recurred in pregnancy. Up to mean age of 255 years in the whole sample, 39,6% women reported ever having indigestion, 29% back pains, 22,6% migraine, about 16% haemorrhoids, hay fever and eczema, about 10% varicose veins, anorexia nervosa, heavy depression and kidney diseases, over 5% rheumatism and 4% asthma. Less prevalent were infections of pelvic organs, febrile convulsions, joint inflammations, stomach ulcers, psoriasis and epilepsy. Lifetime prevalence of chronic diseases and their prevalence in pregnancy were the highest in the western zone and decreased eastwards, but recurrence grew in the opposite direction, being the highest in the eastern zone. The variation of each morbidity indicator is followed in all diseases between geographical zones as well as between individual study centres.

[Factors associated with development of boy's aggressiveness]. / Faktory asociované s vývojem agresivity chlapcu.

BACKGROUND: There is no doubt about the aggressiveness increase in the population. All mass-media keep informing us about this problem. Based on the project ELSPAC data we considered participation in a brawl as an expression of aggressiveness and estimated its gravity depending on the place of treatment. From the information given in the questionnaire (wide variety of information about the respondent's family, upbringing, health and psychic condition) we searched for relationships between these injuries and their gravity. METHODS AND RESULTS: 894 men out of 4.5 thousand ELSPAC study participants in Brno and the Znojmo district gave information about their injuries from brawls and they also stated if they were treated with the injury on the hospital bed, as an outpatient or only at home. The vast majority of the injuries happened between their 16th-18th year of age. CONCLUSIONS: Dysfunctional family, ineffective upbringing, scholarity defects, low education, higher morbidity in the personal history together with the higher up-to-date accident rate of the respondent and his family members were assessed as factors associated with brawl injury occurence. The injury gravity was however less often associated with these factors than the injury occurence.

[Birth weight and gestational age in relation to risk factors of social conditions and health status]. / Porodní hmotnost a délka tehotenství ve vztahu k rizikovým faktorum sociální a zdravotní povahy.

BACKGROUND: The participants of European Longitudinal Study of Pregnancy and Childhood (ELSPAC) are women permanently resident in Brno, whose expected term of delivery corresponded with the prelimited period. In midpregnancy, 3327 of them filled in two research questionnaires with data concerning their marital status, health, education, dwelling, their up-bringing and stress in childhood as the essential information for the study of birth weight and gestational age variations of expected newborns. METHODS AND RESULTS: Sharing the flat with the parental generation, heating with solid fuel or gas and more smokers at home meant the risk for antenatal development of foetus. A certain influence seemed to have the number of rooms, too. Education of the mother-to-be as well as that of her partner and partly of her mother, too, determined the birth weight. To a certain degree, partner's position in employment and his health status played also a role. An important factor predetermining the birth weight and gestational age was the marital status of the mother: in the best situation were children born in complete families and greatly handicapped were offsprings of single mothers not living with their partners. CONCLUSIONS: Small influence on the prenatal development had the medical history of mothers, character of the upbringing in their original families and presence stressogenic events occurring in their girlhood up to 18 years of age.

[Birth weight and gestational age in relation to the course of pregnancy]. / Porodní hmotnost a gestacní vek ve vztahu k prubehu gravidity.

BACKGROUND: In midpregnancy, more than 3000 women in Brno filled in the questionnaires for the ELSPAC study. They informed of their health, activities, stress and psychological state during this pregnancy. METHODS AND RESULTS: Out of medical documentation, the results from routine prenatal examinations were extracted and records concerning all disorders occurred during the gravidity. After delivery, information coming from both sources were linked to the birth weight (BW) and gestational age (GA) data of newborns and analysis of variance was performed. In statistically significant relations the differences were stated in BW (grams) and in GA (weeks) between the group means and sample means for boys, girls and all newborns together. BW, GA or both values were significantly lower after taking some medicaments, alcohol drinking, in offsprings of mothers who felt feeble around the quickening, who worked part time, who were in leading position in their employments, who experienced serious disease, who tempted a suicide, who worried that the foetus might be handicapped in any way and who did not take their future motherhood for a priority. Heavier were newborns of women who married during pregnancy and longer GA had children of those who took folic acid. The relation of neurotic symptoms to the outcome of pregnancy was not found and stressogenic events showed only a limited effect on it. A strong deficit in BW and GA followed after premature abruption of placenta, after eclampsia, placenta praevia, cervical cerclage, partus premature imminens, bleeding in the 2nd trimester, hypertension and hospitalization, namely when repeated. BW only was lower with IUGR, oligohydramnion, and higher BW followed after oedemas. GA only was affected in those whose mothers omitted the sonographic examination and who were obliged to have a special diet. CONCLUSIONS: When newborns BWs were divided into 8 classes by 500 g and some maternal characters followed across the scale, significant trends were found in maternal heights, in all their weight indicators including maternal BW as well as in the weight gain in pregnancy, in the highest means found during pregnancy of systolic and diastolic blood pressures and in the lowest haemoglobin levels.

[Characteristics of pregnancy, labor and low birth weight neonates. Part II]. / Charakteristiky gravidit, porodu a novorozencu s nízkou porodní hmotností. Cást II.

BACKGROUND: The study wants to find out the characteristics of pregnancies, deliveries and newborns with low birth weight (LBW) compared to the newborns with birth weight of 2500 g and more, in respect with the specific situation of the twins. METHODS AND RESULTS: The records from antenatal clinics and maternity hospitals about 5500 children born within strictly given time limit of 16 months during the years 1991-1992 to mothers with permanent habitation in Brno were evaluated. Children and their families are participating on still running prospective longitudinal study ELSPAC aimed to finding the determinants of the healthy development. The low birth weight occurred in 5.42% of children. There were altogether 48 pairs of twins, the low birth weight occurred in 52.6% of them. Compared to mothers who delivered the children with birth weight of 2500 g and more, the mothers of children with low birth weight entered the prenatal care later, with less consultations, had more complications both during their pregnancies and the deliveries and their children showed more often different kinds of neonatal morbidity. Mothers of the twins were cooperating with antenatal clinics better than other mothers of children with low birth weight. On the other hand, they were suffering from anaemia and hypertension more often than mothers of single children. Comparison of the somatic and functional signs has shown that the twins were less handicapped than the whole set of newborns with low birth weight. The twins with low birth weight formed 16.7% of the set. CONCLUSIONS: The study of the Brno newborn population shows the quantitative differences in the risks, which have influenced the courses and the results of the pregnancies ending by deliveries of children with low birth weight. Results are compared to those whith deliveries of children the birth weight of 2500 g and more.