Risk Factors Associated With Low-Birth-Weight Babies in Tertiary Health Care Facilities in Lahore, Pakistan: A Case-Control Study.

Introduction Low birth weight (LBW) is a well-known contributing factor to neonatal health, emphasizing the importance of maternal health and socio-economic conditions. The birth weight of a newborn is a major public health problem, which is more common in low-middle-income countries (LMICs). Objective The objective of this study is to assess the association of different socio-economic and maternal factors with LBW babies in Lahore. Methods This case-control study was carried out at the Obstetrics and Gynecological Department in Mayo Hospital, Lahore, Pakistan from September 25, 2023 to December 31, 2023. A total of 186 mothers who delivered in the maternity ward, categorized into two groups (93 cases and 93 controls), were included and data was collected with the help of a self-administered structured tool. A chi-square test was used to identify maternal risk factors significant for LBW babies. The strength of association between maternal risk factors and LBW babies was presented using the odds ratio (OR) with the respective 95% confidence interval (CI). Results The study revealed that maternal anemia [OR: 3.378, 95% CI: 1.568, 7.275] and inadequate nutritional status [OR: 1.031, 95% CI: 0.014, 0.071] were more likely to cause delivery of LBW babies. Regarding socio-demographic factors, household income < 25000 [OR: 5.185, 95% CI: 2.770, 9.707] and illiterate mothers [OR: 3.325, 95% CI: 1.820, 6.074] were associated with increased likelihood of LBW babies. Maternal age < 20 had a strong association [OR: 10.920, 95% CI: 2.455,48.575] with delivery of LBW children.  Conclusion The study concludes that multiple risk factors including anemia, inadequate nutritional status, household income < 25000, illiterate mother, and maternal age < 20 are strongly associated with LBW babies. It is apparent that a multimodal strategy is necessary to reduce the risk of LBW babies.

Associations between running mechanics, functional lower extremity strength, and stress urinary incontinence in parous female runners.

Background: Women with stress urinary incontinence (SUI) may have altered running mechanics and reduced hip muscle strength compared to women without SUI. Little research has examined running metrics and functional lower extremity strength of parous runners. Objective: To determine if stress urinary incontinence (SUI) severity correlates with running metrics and lower extremity muscle strength among parous women. Study Design: Cross-sectional observational study of 22 parous participants (mean age 39.8 years, with a mean of 3.4 pregnancies and 8.1 years interval since last delivery). Methods: Participants completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI), Urinary Distress Inventory (UDI) 6, Colorectal-Anal Distress (CRAD) Inventory 8, and Pelvic Organ Prolapse Distress Inventory (POPDI) 6, Questionnaire for Urinary Incontinence Diagnosis (QUID), and provided demographic, relevant running, and obstetric/gynecologic history information. After a brief warm-up, participants completed 30-second single leg sit to stand tests bilaterally and a standardized 10-minute treadmill run with pod cadence assessment. Pearson-product moment correlation coefficients were calculated (alpha = 0.05). Results: Prolonged ground contact times were associated with higher ICIQ-UI SF (r = 0.523, p = 0.015), POPDI-6 (r = 0.694, p < 0.001), and UDI-6 scores (r = 0.577, p = 0.006), while lower cadences were associated with higher POPDI-6 (r = -0.550, p = 0.010) and UDI-6 scores (r = -0.444, p=0.044). Conclusion: Parous female runners with more severe SUI and prolapse symptoms demonstrate altered running mechanics characterized by prolonged ground contact times and slower cadences.

Socioeconomic inequalities in contraceptive use among Brazilian women: A multilevel analysis stratified by parity.

Objective: To investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity. Methods: Cross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units. Results: Nulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women. Conclusions: The high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies. Implications for practice: The need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.

Improving radiological quantification of levator hiatus features with measures informed by statistical shape modeling.

Purpose: The measures that traditionally describe the levator hiatus (LH) are straightforward and reliable; however, they were not specifically designed to capture significant differences. Statistical shape modeling (SSM) was used to quantify LH shape variation across reproductive-age women and identify novel variables associated with LH size and shape. Approach: A retrospective study of pelvic MRIs from 19 nulliparous, 32 parous, and 12 pregnant women was performed. The LH was segmented in the plane of minimal LH dimensions. SSM was implemented. LH size was defined by the cross-sectional area, maximal transverse diameter, and anterior-posterior (A-P) diameter. Novel SSM-guided variables were defined by regions of greatest variation. Multivariate analysis of variance (MANOVA) evaluated group differences, and correlations determined relationships between size and shape variables. Results: Overall shape ( p < 0.001 ), SSM mode 2 (oval to T -shape, p = 0.002 ), mode 3 (rounder to broader anterior shape, p = 0.004 ), and maximal transverse diameter ( p = 0.003 ) significantly differed between groups. Novel anterior and posterior transverse diameters were identified at 14% and 79% of the A-P length. Anterior transverse diameter and maximal transverse diameter were strongly correlated ( r = 0.780 , p < 0.001 ), while posterior transverse diameter and maximal transverse diameter were weakly correlated ( r = 0.398 , p = 0.001 ). Conclusions: The traditional maximal transverse diameter generally corresponded with SSM findings but cannot describe anterior and posterior variation independently. The novel anterior and posterior transverse diameters represent both size and shape variation, can be easily calculated alongside traditional measures, and are more sensitive to subtle and local LH variation. Thus, they have a greater ability to serve as predictive and diagnostic parameters.

High rate of inadequate antenatal contacts among mothers in eastern Sudan: a cross-sectional study.

This study assesses the prevalence and determinants of inadequate (less than eight contacts) and late antenatal care (ANC) initiation (starting after 12 weeks) among mothers delivered at Gadarif Maternity Hospital in eastern Sudan. A hospital-based cross-sectional study was conducted at Gadarif Maternity Hospital. A questionnaire was used to collect sociodemographic, clinical, and obstetric data through face-to-face interviews. Seven hundred mothers were enrolled with the median (interquartile range) of mothers' age, and parity was 28(24-32) years and 3(2-5), respectively. Of these 700 mothers, 79.3 percent and 10.3 percent had inadequate and late ANC, respectively. In multivariable logistic regression analysis, being a housewife (adjusted odds ratio [AOR] 1.93, 95 percent CI 1.09, 3.43) was associated with inadequate ANC. High parity (AOR 1.27, 95 percent CI 1.07-1.52) was positively associated with late ANC initiation. There was no association between age, residence, education, preexisting medical disorder, and history of miscarriage) with inadequate or late ANC initiation In eastern Sudan, four out of five mothers did not comply with the World Health Organization's recommendation of a minimum of eight ANC contacts for positive pregnancy outcomes. This study is crucial for policy-makers to take further strategic actions to ensure adequate and early ANC initiation for all mothers in Sudan.

Reproductive factors and their association with physical and comprehensive frailty in middle-aged and older women: a large-scale population-based study.

STUDY QUESTION: Are women's reproductive factors associated with physical frailty and comprehensive frailty in middle-age and later life? SUMMARY ANSWER: Early menarche at <13 years, age at menopause <45 years, surgical menopause, experiencing miscarriage and a shorter reproductive period of <35 years were associated with increased odds of frailty, while having two or three children was related to decreased likelihood of frailty. WHAT IS KNOWN ALREADY: Evidence has shown that women are frailer than men in all age groups and across different populations, although women have longer lifespans. Female-specific reproductive factors may be related to risk of frailty in women. STUDY DESIGN SIZE DURATION: A population-based cross-sectional study involved 189 898 women from the UK Biobank. PARTICIPANTS/MATERIALS SETTING METHODS: Frailty phenotype and frailty index were used to assess physical frailty and comprehensive frailty (assessed using 38 health indicators for physical and mental wellbeing), respectively. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CI between reproductive factors and likelihood of physical frailty and comprehensive frailty. Restricted cubic spline models were used to test the non-linear associations between them. In addition, we examined the combined effect of categorized age at menopause and menopause hormone therapy (MHT) on frailty. MAIN RESULTS AND THE ROLE OF CHANCE: There was a J-shape relationship between age at menarche, reproductive period, and frailty; age at menarche <13 years and >16 years, and reproductive period <35 years or >40 years were all associated with increased odds of frailty. There was a negative linear relationship between menopausal age (either natural or surgical) and odds of frailty. Surgical menopause was associated with 30% higher odds of physical frailty (1.34, 1.27-1.43) and 30% higher odds of comprehensive frailty (1.30, 1.25-1.35). Having two or three children was linked to the lowest likelihood of physical frailty (0.48, 0.38-0.59) and comprehensive frailty (0.72, 0.64-0.81). Experiencing a miscarriage increased the odds of frailty. MHT use was linked to increased odds of physical frailty in women with normal age at natural menopause (after 45 years), while no elevated likelihood was observed in women with early natural menopause taking MHT. LIMITATIONS REASONS FOR CAUTION: The reproductive factors were self-reported and the data might be subject to recall bias. We lacked information on the types and initiation time of MHT, could not identify infertile women who later became pregnant, and the number of infertile women may be underestimated. Individuals participating in the UK Biobank are not representative of the general UK population, limiting the generalization of our findings. WIDER IMPLICATION OF THE FINDINGS: The reproductive factors experienced by women throughout their life course can potentially predict frailty in middle and old age. Identifying these reproductive factors as potential predictors of frailty can inform healthcare providers and policymakers about the importance of considering a woman's reproductive history when assessing their risk for frailty. STUDY FUNDING/COMPETING INTERESTS: This work was supported by the National Key Research and Development Program of China (2022YFC2703800), National Natural Science Foundation of China (82273702), Science Fund Program for Excellent Young Scholars of Shandong Province (Overseas) (2022HWYQ-030), Taishan Scholars Project Special Fund (No. tsqnz20221103), and the Qilu Young Scholar (Tier-1) Program (202099000066). All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Is Vaginal Laxity Associated with Vaginal Parity and Mode of Delivery?

INTRODUCTION AND HYPOTHESIS: Vaginal laxity (VL) is a common symptom of pelvic floor dysfunction. Although VL has become a frequent topic for research in the last decade, its pathogenesis is still not well understood. The objective was to determine whether vaginal parity or mode of delivery is associated with vaginal laxity. METHODS: This was a retrospective observational study involving women seen in a tertiary urogynecology clinic between May 2016 and November 2018 with symptoms of pelvic floor dysfunction. Patients underwent a standardized interview, clinical examination (POP-Q), and four-dimensional (4D) pelvic floor ultrasound (PFUS). Data regarding vaginal parity and the mode of delivery were based on patient-reported information. Archived 4D-PFUS volumes were analyzed offline to evaluate levator hiatal area on Valsalva. RESULTS: Data from 1,051 patients were analyzed. VL was reported by 236 women (23%) who were younger on average (mean age 54 vs 59 years, p < 0.001) and less likely to be menopausal (530 out of 815 [65.0%] vs.129 out of 236 [54.7%]), p = 0.004]. Symptoms of prolapse were much more common in the VL group (214 out of 236 [91%] vs 316 out of 815 [39%], p = < 0.001) and on imaging mean levator hiatal area (HA) on Valsalva was larger (31 vs 26 cm2, p = 0.01). Vaginal parity was associated with VL symptoms (235 out of 236 [99%] vs 767 out of 815 [94%], p = 0.008), but neither VL prevalence nor bother increased with higher parity. Women who delivered vaginally were three times more likely to complain of VL than those who delivered only by cesarean section. CONCLUSIONS: Vaginal laxity was found to be more prevalent in vaginally parous women. This effect seems to be largely attributable to the first delivery. Instrumental delivery was not shown to increase association with VL compared with normal vaginal delivery.

Associations of parity and cognitive decline, depression, and chronic comorbidity in West China: Results from WCHAT study.

OBJECTIVE: To investigate the associations between parity (the number of offspring a female has borne) and cognitive function, depression, and chronic comorbidity in Western China. METHODS: A total of 846 women aged 50-55 years were included in the current analysis. Cognitive status was measured using a 10-item short portable mental status questionnaire (SPMSQ). Depressive symptoms were assessed using the 15-item geriatric depression scale (GDS-15). Other characteristics were self-reported. The associations between parity and cognitive decline, depression, and chronic comorbidity were analyzed using univariable and multivariable models. Multivariable models were adjusted for age, ethnic group, occupation, marital status, educational level, lifestyle factors, and sleeping time. RESULTS: Among the enrolled women, 26.71% were either childless or had one child, 47.40% had two children, 18.32% had three children, and 7.57% had ≥4 children. Compared to women with low parity, women with two or more children exhibited a higher risk of cognitive decline. Moreover, having four or more children was significantly associated with depression and chronic comorbidity. After adjusting covariates, women with three or more children exhibited a higher risk of cognitive decline than those with low parity. However, high parity was not significantly associated with depression or chronic comorbidity after adjustment for covariates. CONCLUSION: Our study showed that ≥3 children was associated with cognitive decline in women. Longitudinal studies are needed to evaluate this conclusion and to investigate the mechanisms involved. More importantly, families and societies should pay more attention to women's long-term health outcomes related to fertility.

Factors affecting asthma control in pregnancy: A cross-sectional study.

Background and Objective: Asthma control in pregnant women remains of utmost importance; suboptimal control can have adverse repercussions on both fetal and maternal health. The objective was to identify the factors that affect asthma control in pregnant Pakistani women presenting to a tertiary care hospital. Methods: This descriptive, cross-sectional research was conducted at KRL General Hospital between 1st November 2022 to 30th April 2023. Non-probability technique was used to sample one hundred and forty-five pregnant women with confirmed bronchial asthma irrespective of their trimester presented. Data regarding demographics and factors affecting asthma control was collected. Results: The mean age was 30.39 ± 4.33 years, with two-thirds (65%) being multiparous. Approximately 48% of participants were non-compliant with treatment, and less than 40% achieved adequate asthma control. A chi-squared test applied showed that multiparity (p = 0.003), treatment compliance (p < 0.001), BMI (p < 0.001), and proper inhaler technique (p < 0.001) were statistically significant factors affecting asthma control in pregnant women while, the level of education and household income did not exhibit a significant association. Multiple regression analysis qualified higher BMI, multiparity, treatment compliance, and inhaler technique as significant predictors of asthma control amongst pregnant women. Conclusion: Ensuring asthma control during pregnancy is important. This study identified BMI, multiparity, inhaler technique, and treatment compliance as factors that affect asthma control in pregnant women. Addressing these factors through regular antenatal check-ups can significantly mitigate risks and promote the optimal health of both maternal and fetal lives.

Impact of State Telehealth Parity Laws for Private Payers on Hypertension Medication Adherence Before and During the COVID-19 Pandemic.

BACKGROUND: Telehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension medication adherence remains uncertain. METHODS: Data from the 2016 to 2021 Merative MarketScan Commercial Claims and Encounters Database were used to construct the study cohort, which included nonpregnant individuals aged 25 to 64 years with hypertension. We coded telehealth parity laws related to hypertension management in all 50 US states and the District of Columbia, distinguishing between payment and coverage parity laws. The primary outcomes were measures of antihypertension medication adherence: the average medication possession ratio; medication adherence (medication possession ratio ≥80%); and average number of days of drug supply. We used a generalized difference-in-differences design to examine the impact of these laws. RESULTS: Among 353 220 individuals (mean [SD] age, 49.5 (7.1) years; female, 45.55%), states with payment parity laws were significantly linked to increased average medication possession ratio by 0.43 percentage point (95% CI, 0.07-0.79), and an increase of 0.46 percentage point (95% CI, 0.06-0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI, 0.11-4.17) in prescription supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, gross domestic product per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI, 0.19-4.07) in days of prescription supply but did not significantly increase the average medication possession ratio or probability of medication adherence. CONCLUSIONS: State telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension.

Factors Associated with Postpartum Depression among Women in Eastern Sudan: A Cross-Sectional Study.

Background and Objectives: Postpartum depression is one of the most common complications of childbirth. While the epidemiology of postpartum depression has been extensively studied in African countries, there is little published data on the topic in Sudan. In addition, no studies have been conducted in Eastern Sudan. This study aims to evaluate the factors associated with postpartum depression among Sudanese women in Gadarif in Eastern Sudan. Materials and Methods: A cross-sectional study (using the systematic random sampling technique) of women presenting to Gadarif Maternity Hospital for postnatal follow-up within six weeks of childbirth was conducted. A questionnaire was used to collect sociodemographic information, and the Edinburgh Postnatal Depression Scale was used to assess postpartum depression. Results: Three hundred women were enrolled in the study. The median (interquartile) age and parity were 30.0 (25.0-34.0) years and 2 (1-4). Thirty-one (10.3%) of the women had postpartum depression. A univariate analysis showed that a past history of depression was the only factor associated with postpartum depression (OR = 3.04, 95% CI = 1.03-8.97). Other investigated factors (age, parity, educational level, occupation, history of previous miscarriage or intrauterine fetal death, a family history of depression, financial support, medical insurance, whether the pregnancy was planned or not, and if the gender of the newborn was known before delivery) were not associated with postpartum depression. Conclusions: The current study showed that 1 out of 10 women had postpartum depression that was associated with a past history of depression. Factors that have been reported to be associated with postpartum depression in African countries (age, parity, education, and occupation) were not found to be associated in this study. Mental health assessment needs to be employed for women in their antenatal and postpartum periods.

Maternal APOE ε2 as a possible risk factor for elevated prenatal Pb levels.

Lead (Pb) is a global contaminant associated with multiple adverse health effects. Humans are especially vulnerable during critical developmental stages. During pregnancy, exposure to Pb can occur through diet and release from maternal bones. Apolipoprotein E gene (APOE) variants (ɛ2, ɛ3, ɛ4 alleles) may influence sex steroid hormones, bone metabolism, and Pb kinetics. We examined the interplay among maternal APOE (mAPOE) genotypes, fetal sex, parity, and Pb in maternal and cord blood (mB-Pb, CB-Pb) using linear regression models. Our study involved 817 pregnant women and 772 newborns with measured adequate levels of zinc and selenium. We compared carriers of the ε2 and ε4 alleles to those with the ε3/ε3 genotype. The geometric means (range) of mB-Pb and CB-Pb were 11.1 (3.58-87.6) and 9.31 (1.82-47.0) ng/g, respectively. In cases with female fetuses, the maternal mAPOE ε2 allele was associated with higher, while the mAPOE ε4 allele was associated with lower mB-Pb and CB-Pb levels. Nulliparity increased the strength of the observed associations. These findings highlight the significance of mAPOE genetics, fetal sex, and parity in prenatal Pb kinetics. Notably, the maternal ε2 allele may increase the risk of Pb exposure.

Perinatal outcomes in grand multiparous women stratified by parity- A large multicenter study.

OBJECTIVE: To assess the effect of each additional delivery among grand multiparous (GMP) women on maternal and neonatal outcomes. METHODS: A multi-center retrospective cohort study that examined maternal and neonatal outcomes of GMP women (parity 5-10, analyzed separately for each parity level) compared to a reference group of multiparous women (parity 2-4). The study population included grand multiparous women with singleton gestation who delivered in one of four university-affiliated obstetrical centers in a single geographic area, between 2003 and 2021. We excluded nulliparous, those with parity > 10 (due to small sample sizes), women with previous cesarean deliveries (CDs), multifetal gestations, and out-of-hospital deliveries. The primary outcome of this study was postpartum hemorrhage (PPH, estimated blood loss exceeding 1000 ml, and/or requiring blood product transfusion, and/or a hemoglobin drop > 3 g/Dl). Secondary outcomes included unplanned cesarean deliveries, preterm delivery, along with other adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariable logistic regression. RESULTS: During the study period, 251,786 deliveries of 120,793 patients met the inclusion and exclusion criteria. Of those, 173,113 (69%) were of parity 2-4 (reference group), 27,894 (11%) were of parity five, 19,146 (8%) were of parity six, 13,115 (5%) were of parity seven, 8903 (4%) were of parity eight, 5802 (2%) were of parity nine and 3813 (2%) were of parity ten. GMP women exhibited significantly higher rates of PPH starting from parity eight. The adjusted odds ratios (aOR) were 1.19 (95 % CI: 1.06-1.34) for parity 8, 1.17 (95 % CI: 1.01-1.36) for parity 9, and 1.39 (95 % CI: 1.18-1.65) for parity 10. Additionally, they showed elevated rates of several maternal and neonatal outcomes, including placental abruption, large-for-gestational age (LGA) neonates, neonatal hypoglycemia, and neonatal seizures. Conversely, they exhibited decreased risk for other adverse maternal outcomes, including preterm deliveries, unplanned cesarean deliveries (CDs), vacuum-assisted delivery, and third- or fourth-degree perineal tears and small-for-gestational age (SGA) neonates. The associations with neonatal hypoglycemia, and neonatal seizure were correlated with the number of deliveries in a dose-dependent manner, demonstrating that each additional delivery was associated with an additional, significant impact on obstetrical complications. CONCLUSION: Our study demonstrates that parity 8-10 is associated with a significantly increased risk of PPH. Parity level > 5 correlated with increased odds of placental abruption, LGA neonates, neonatal hypoglycemia, and neonatal seizures. However, GMP women also demonstrated a reduced likelihood of certain adverse maternal outcomes, including unplanned cesarean, preterm deliveries, vacuum-assisted deliveries, SGA neonates, and severe perineal tears. These findings highlight the importance of tailored obstetrical care for GMP women to mitigate the elevated risks associated with higher parity.

Parity, infertility, age at first birth and risk of atrial fibrillation: data from the HUNT study.

AIMS: Although parity, infertility, and age at first birth are important for later development of cardiovascular disease, research on their association with atrial fibrillation (AF) is limited. METHODS: We linked data from the population-based HUNT study, the Medical Birth Registry of Norway (MBRN) and validated medical records from local hospitals. A total of 24,015 women aged 45 years or older were followed for verified incident AF. Parity and age at first birth were retrieved from the MBRN or from self-reported questionnaires in the HUNT. History of infertility was self-reported on the HUNT questionnaire. Cox-proportional hazard models were used to calculate hazard ratios (HR) for the multivariable-adjusted associations of parity, infertility, and age at first birth with risk of AF. RESULTS: During a median follow-up of 12.8 years, 1,448 (6.0%) participants developed AF. Women with higher parity (four or more births vs. two births) were at 21% higher risk of AF (HR 1.21, 95% confidence interval (CI), 1.05-1.39). History of infertility was also associated with risk of AF (HR 1.20, 95% CI, 1.02-1.42). Among parous women, younger age at first birth (<20 years vs. 20-29 years) was associated with a 20% higher risk of AF (HR 1.20, 95% CI, 1.03-1.40). CONCLUSION: Women with four or more births, or a history of infertility, or younger age at first birth have approximately a 20% higher risk of AF among women over 45 years old.

A higher number of births and younger age at first birth are associated with a higher risk of cardiovascular disease (CVD). However, there is limited evidence on the associations between parity, age at first birth and atrial fibrillation (AF). Moreover, the association between infertility and AF remains largely unexplored. We have investigated the association between parity, infertility, age at first birth and AF in the population-based cohort from Norway (the HUNT study) among women over 45 years old. Our findings reveal that women with four or more births, or a history of infertility, or younger age at first birth have approximately a 20% higher risk of AF.

New quantum LDPC codes based on projective geometry.

With the progress in techniques for correcting errors in quantum computing, quantum low density parity check (QLDPC) codes have gained increasing significance within the field of quantum error correction. This paper focuses on different strategies for the construction of QLDPC codes, which are based on all points and lines as well as partial points and lines from projective geometry. Finally, a series of simulation analyses are presented.

Unmutated RRAS2 emerges as a key oncogene in post-partum-associated triple negative breast cancer.

BACKGROUND: Breast cancer (BC) is the most common cancer in women, with triple negative BC (TNBC) accounting for 20% of cases. While early detection and targeted therapies have improved overall life expectancy, TNBC remains resistant to current treatments. Although parity reduces the lifetime risk of developing BC, pregnancy increases the risk of developing TNBC for years after childbirth. Although numerous gene mutations have been associated with BC, no single gene alteration has been identified as a universal driver. RRAS2 is a RAS-related GTPase rarely found mutated in cancer. METHODS: Conditional knock-in mice were generated to overexpress wild type human RRAS2 in mammary epithelial cells. A human sample cohort was analyzed by RT-qPCR to measure RRAS2 transcriptional expression and to determine the frequency of both a single-nucleotide polymorphism (SNP rs8570) in the 3'UTR region of RRAS2 and of genomic DNA amplification in tumoral and non-tumoral human BC samples. RESULTS: Here we show that overexpression of wild-type RRAS2 in mice is sufficient to develop TNBC in 100% of females in a pregnancy-dependent manner. In human BC, wild-type RRAS2 is overexpressed in 68% of tumors across grade, location, and molecular type, surpassing the prevalence of any previously implicated alteration. Still, RRAS2 overexpression is notably higher and more frequent in TNBC and young parous patients. The increased prevalence of the alternate C allele at the SNP position in tumor samples, along with frequent RRAS2 gene amplification in both tumors and blood of BC patients, suggests a cause-and-effect relationship between RRAS2 overexpression and breast cancer. CONCLUSIONS: Higher than normal expression of RRAS2 not bearing activating mutations is a key driver in the majority of breast cancers, especially those of the triple-negative type and those linked to pregnancy.

The Interplay between Tunneling and Parity Violation in Chiral Molecules.

In this review, the concepts of quantum tunneling and parity violation are introduced in the context of chiral molecules. A particle moving in a double well potential provides a good model to study the behavior of chiral molecules, where the left well and right well represent the L and R enantiomers, respectively. If the model considers the quantum behavior of matter, the concept of quantum tunneling emerges, giving place to stereomutation dynamics between left- and right-handed chiral molecules. Parity-violating interactions, like the electroweak one, can be also considered, making possible the existence of an energy difference between the L and R enantiomers, the so-called parity-violating energy difference (PVED). Here we provide a brief account of some theoretical methods usually employed to calculate this PVED, also commenting on relevant experiments devoted to experimentally detect the aforementioned PVED in chiral molecules. Finally, we comment on some ways of solving the so-called Hund's paradox, with emphasis on mean-field theory and decoherence.

Characterization of Removal Reasons for Nurse Sows and the Associated Removal Due to Their Extended Lactation Length in Hyperprolific Farrow-Wean Herds.

This study aimed to characterize and quantify reasons for the removal of nurse sows and identify the removal associated with their extended lactation length (ELL). A total of 100,756 removed nurse sows within a period of 2016-2022 from 53 sow herds in the Midwest USA were analyzed. Reproductive failure was the most common removal reason (χ2 = 8748.421, p < 0.001) affecting P1, P2, and P3 nurse sows. Failure to conceive and absence of estrus were the main causes of reproductive failure (χ2 = 352.480, p < 0.001) affecting P1 and P2 nurse sows and P1 and P5 nurse sows, respectively. When P2 and P6 nurse sows had an ELL of 0-7 d, they faced a high chance (χ2 = 13.312, p = 0.021) of removal due to conception failure and failure to return to heat, respectively. When P2 and P5 nurse sows had an ELL of 8-14 d, they were highly vulnerable (χ2 = 59.847, p < 0.001) to removal due to failure to conceive and showing heat, respectively. Finally, when ELL was at 15-21 days, P4 and P5 nurse sows were more likely (χ2 = 41.751, p < 0.001) to be removed due to failure to express heat, whereas at the same time, P2 and P3 nurse sows experienced the same removal threat due to failing to conceive. These results could help producers manage nurse sow systems.

A Narrative Review of the Role of Estrogen (Receptors) in Melanoma.

In this narrative review, we attempt to provide an overview of the evidence regarding the role of estrogen (receptors) in cutaneous melanoma (CM). We reviewed 68 studies and 4 systematic reviews and meta-analyses published from 2002 up to and including 2022. The prevailing presence of estrogen receptor ß (ERß) instead of estrogen receptor α (ERα) in CM is notable, with ERß potentially playing a protective role and being less frequently detected in progressive cases. While men with CM generally experience a less favorable prognosis, this distinction may become negligible with advancing age. The role of oral contraceptives (OC) and hormone replacement therapy (HRT) in CM remains controversial. However, recent studies tend to associate the use of these exogenous hormones with a heightened risk of CM, mostly only when using estrogen therapy and not in combination with progesterone. On the contrary, the majority of studies find no substantial influence of in vitro fertilization (IVF) treatment on CM risk. Reproductive factors, including younger age at first childbirth, higher parity, and shorter reproductive life, show conflicting evidence, with some studies suggesting a lower CM risk. We suggest an important role for estrogens in CM. More research is needed, but the integration of estrogens and targeting the estrogen receptors in melanoma therapy holds promise for future developments in the field.

Association between Age at First Birth and Long-Term Dental Caries Experience among Women in the United States.

Background: Pregnant women are at a higher risk of caries compared to nonpregnant women, and higher parity is a risk factor for untreated caries and tooth loss. However, it is unknown whether the timing of birth is associated with dental caries experience over time. Materials and Methods: This study is a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES), 2011-2018. The study population included nonpregnant women 20 years of age or older, who had available data on the oral health examination and age at first birth (AFB). Dental caries experience was defined as the DMFT score (sum of the number of decayed, missing due to caries, and filled permanent teeth). The associations between AFB and DMFT scores were assessed using Poisson regression to compute incidence rate ratios (IRRs) and the associated 95% confidence intervals (CIs). Results: This study included 6,553 women (mean age 53.4 years, SD 15.7). The mean DMFT index score was 13.1 ± 7.4, with younger AFB groups generally having higher mean scores. After adjusting for sociodemographic variables, time since last dental visit, and reproductive health factors, women with an AFB of <18 years (IRR, 1.10; 95% CI, 1.01-1.21) or 18-20 years (IRR, 1.11; 95% CI, 1.01-1.21) had significantly higher DMFT index scores compared to those with an AFB of 30-32 years. Conclusions: This study suggests that younger maternal AFB may be associated with greater dental caries experience. More rigorous studies are necessary to determine how to improve oral health outcomes during pregnancy and postpartum.