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1.
Rev Chil Pediatr ; 90(1): 36-43, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095217

RESUMO

INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.


Assuntos
Displasia Broncopulmonar/etiologia , Doenças em Gêmeos/etiologia , Retardo do Crescimento Fetal/fisiopatologia , Sepse Neonatal/etiologia , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/mortalidade , Estudos de Casos e Controles , Doenças em Gêmeos/diagnóstico , Doenças em Gêmeos/mortalidade , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Modelos Logísticos , Masculino , Sepse Neonatal/diagnóstico , Sepse Neonatal/mortalidade , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco
2.
J Affect Disord ; 245: 163-173, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30391772

RESUMO

BACKGROUND: Previous research has shown substantial heritability for depressive symptoms, yet, there are few genetically-informed studies which focused on developmental changes. The current study sought to model prototypical developmental trajectories of depressive symptoms from adolescence to adulthood and to elucidate genetic and environmental contributions to these changes. METHODS: The Add Health data set, a nationally representative sample of adolescents, was used. For the genetically-informed analyses, a subsample of N = 531 same-sex monozygotic and dizygotic male and female twin pairs was selected. Longitudinal development was modeled separately for two waves in early adolescence and for four waves from middle adolescence to young adulthood using a latent growth model (LGM). Both models were extended to twin models to estimate the effects of heritability and the environment. RESULTS: The rates of depressive symptoms peaked in mid-adolescence and then sharply declined as individuals moved from adolescence to young adulthood, leveling off in the twenties. The effects of the shared environment were substantial among early adolescents, but negligible for middle-to-late adolescents. An opposite pattern was found for heritability. The largest proportion of developmental changes was driven by nonshared environmental effects. LIMITATIONS: The study only used same-sex twins as there exist mixed findings regarding the possibility of qualitative or quantitative genetic effects. CONCLUSIONS: The salience of unique experiences and, to a lesser extent, heritable factors in affecting developmental changes in depressive symptoms underscore the need for targeting environments that place individuals with genetic predisposition at double the risk for the development of depression.


Assuntos
Transtorno Depressivo/etiologia , Doenças em Gêmeos/etiologia , Interação Gene-Ambiente , Gêmeos Dizigóticos/genética , Gêmeos Monozigóticos/genética , Adolescente , Depressão , Transtorno Depressivo/diagnóstico , Doenças em Gêmeos/diagnóstico , Feminino , Predisposição Genética para Doença , Humanos , Estudos Longitudinais , Masculino , Gêmeos
3.
PLoS One ; 13(6): e0198594, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29879175

RESUMO

BACKGROUND: The nature of the relationship between fatigue and its risk factors is poorly understood. In the present study the genetic and environmental association between anxiety-depression, musculoskeletal (MS) pain and fatigue was examined, and the role of neuroticism as a shared risk factor that may possibly explain the co-occurrence between these phenotypes was investigated in a combined cross-sectional and longitudinal twin design. METHODS: The sample consisted of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50-65 (mean = 57.11 years, SD = 4.5). Continuous measures of fatigue symptoms and the other phenotypes were employed. Using Cholesky modeling, genetic and environmental influences on the phenotypes, and the associations among them, were determined. Analyses were performed using measures of neuroticism obtained concurrently and 13-19 years earlier. RESULTS: Results from multiple regression analyses showed that neuroticism, anxiety-depression symptoms, and MS pain were all significantly associated with fatigue, controlling for sex, education, and general health indices. The best-fitting biometric models included additive genetic and individual-specific environmental effects. Heritabilities in the 0.40-0.53 range were demonstrated. Furthermore, while there was a considerable overlap in genetic risk factors between the four phenotypes, a substantial proportion of the genetic risk shared between anxiety-depression and fatigue, and between MS pain and fatigue, was independent of neuroticism. CONCLUSION: Evidence for a common underlying susceptibility to report fatigue symptoms, genetically linked to neuroticism, anxiety-depression, and MS pain, was found. Both unique and pleiotropic effects appear to be involved in the genetic architecture of the phenotypes.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Doenças em Gêmeos/epidemiologia , Fadiga/epidemiologia , Dor Musculoesquelética/epidemiologia , Neuroticismo , Ansiedade/complicações , Comorbidade , Estudos Transversais , Depressão/complicações , Suscetibilidade a Doenças , Doenças em Gêmeos/etiologia , Fadiga/etiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/complicações , Inventário de Personalidade/estatística & dados numéricos , Fenótipo , Fatores de Risco , Gêmeos/genética
5.
Circ Res ; 122(11): 1555-1564, 2018 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-29535164

RESUMO

RATIONALE: One measure of protein glycosylation (GlycA) has been reported to predict higher cardiovascular risk by reflecting inflammatory pathways. OBJECTIVE: The main objective of this study is to assess the role of a comprehensive panel of IgG glycosylation traits on traditional risk factors for cardiovascular disease and on presence of subclinical atherosclerosis in addition to GlycA. METHODS AND RESULTS: We measured 76 IgG glycosylation traits in 2970 women (age range, 40-79 years) from the TwinsUK cohort and correlated it to their estimated 10-year atherosclerotic cardiovascular disease risk score and their carotid and femoral plaque measured by ultrasound imaging. Eight IgG glycan traits are associated with the 10-year atherosclerotic cardiovascular disease risk score after adjusting for multiple tests and for individual risk factors-5 with increased risk and 3 with decreased risk. These glycans replicated in 967 women from ORCADES cohort (Orkney Complex Disease Study), and 6 of them were also associated in 845 men. A linear combination of IgG glycans and GlycA is also associated with presence of carotid (odds ratio, 1.55; 95% confidence interval, 1.25-1.93; P=7.5×10-5) and femoral (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P=0.01) plaque in a subset of women with atherosclerosis data after adjustment for traditional risk factors. One specific glycosylation trait, GP18-the percentage of FA2BG2S1 glycan in total IgG glycans, was negatively correlated with very-low-density lipoprotein and triglyceride levels in serum and with presence of carotid plaque (odds ratio, 0.60; 95% confidence interval, 0.50-0.71; P=5×10-4). CONCLUSIONS: We find molecular pathways linking IgG to arterial lesion formation. Glycosylation traits are independently associated with subclinical atherosclerosis. One specific trait related to the sialylated N-glycan is negatively correlated with cardiovascular disease risk, very-low-density lipoprotein and triglyceride serum levels, and presence of carotid plaque.


Assuntos
Aterosclerose/complicações , Doenças Cardiovasculares/etiologia , Doenças em Gêmeos/etiologia , Imunoglobulina G/metabolismo , Adulto , Idoso , Aterosclerose/diagnóstico por imagem , Aterosclerose/metabolismo , Doenças Cardiovasculares/metabolismo , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/metabolismo , Estudos de Coortes , Intervalos de Confiança , Doenças em Gêmeos/metabolismo , Feminino , Artéria Femoral/diagnóstico por imagem , Glicosilação , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/metabolismo , Polissacarídeos/metabolismo , Medição de Risco , Fatores de Risco , Ultrassonografia
6.
BMJ Open ; 8(3): e018959, 2018 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-29550775

RESUMO

PURPOSE: The Nineteen and Up study (19Up) assessed a range of mental health and behavioural problems and associated risk factors in a genetically informative Australian cohort of young adult twins and their non-twin siblings. As such, 19Up enables detailed investigation of genetic and environmental pathways to mental illness and substance misuse within the Brisbane Longitudinal Twin Sample (BLTS). PARTICIPANTS: Twins and their non-twin siblings from Queensland, Australia; mostly from European ancestry. Data were collected between 2009 and 2016 on 2773 participants (age range 18-38, 57.8% female, 372 complete monozygotic pairs, 493 dizygotic pairs, 640 non-twin siblings, 403 singleton twins). FINDINGS TO DATE: A structured clinical assessment (Composite International Diagnostic Interview) was used to collect lifetime prevalence of diagnostic statistical manual (4th edition) (DSM-IV) diagnoses of major depressive disorder, (hypo)mania, social anxiety, cannabis use disorder, alcohol use disorder, panic disorder and psychotic symptoms. Here, we further describe the comorbidities and ages of onset for these mental disorders. Notably, two-thirds of the sample reported one or more lifetime mental disorder.In addition, the 19Up study assessed general health, drug use, work activity, education level, personality, migraine/headaches, suicidal thoughts, attention deficit hyperactivity disorder (ADHD) symptomatology, sleep-wake patterns, romantic preferences, friendships, familial environment, stress, anorexia and bulimia as well as baldness, acne, asthma, endometriosis, joint flexibility and internet use.The overlap with previous waves of the BLTS means that 84% of the 19Up participants are genotyped, 36% imaged using multimodal MRI and most have been assessed for psychological symptoms at up to four time points. Furthermore, IQ is available for 57%, parental report of ADHD symptomatology for 100% and electroencephalography for 30%. FUTURE PLANS: The 19Up study complements a phenotypically rich, longitudinal collection of environmental and psychological risk factors. Future publications will explore hypotheses related to disease onset and development across the waves of the cohort. A follow-up study at 25+years is ongoing.


Assuntos
Doenças em Gêmeos/etiologia , Transtornos Mentais/etiologia , Adolescente , Adulto , Comorbidade , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/metabolismo , Feminino , Estudo de Associação Genômica Ampla , Humanos , Hidrocortisona/análise , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/metabolismo , Prevalência , Queensland/epidemiologia , Fatores de Risco , Fatores Sexuais , Vitamina D/sangue , Adulto Jovem
7.
Semin Fetal Neonatal Med ; 23(2): 133-141, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29467101

RESUMO

In the decades since the introduction of ultrasound into routine obstetric practice, the advantages of ultrasound have moved beyond the simple ability to identify multiple pregnancies antenatally to the possibility of screening them for fetal anomalies, pre-eclampsia, preterm birth, and the complications specific to monochorionic pregnancies. Screening studies have often excluded twins because physiological differences impact on the validity and sensitivity of the screening tests in routine use in singletons, and therefore, the evidence of screening performance in multiple pregnancy lags behind the evidence from singleton pregnancies. In general, most pregnancy complications are more common in twin pregnancy, but screening tests are less accurate or well validated. In this review article we present the current state of the evidence and avenues for future research relating to the use of ultrasound and screening for complications in twin pregnancies, including the monochorionicity-related pathologies, such as twin-twin transfusion syndrome, selective growth restriction, twin anaemia-polycythaemia sequence and twin reversed arterial perfusion sequence.


Assuntos
Doenças em Gêmeos/diagnóstico por imagem , Medicina Baseada em Evidências , Sofrimento Fetal/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Gravidez de Gêmeos , Ultrassonografia Pré-Natal , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , Doenças em Gêmeos/embriologia , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/etiologia , Feminino , Sofrimento Fetal/embriologia , Sofrimento Fetal/epidemiologia , Sofrimento Fetal/etiologia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Risco , Ultrassonografia Pré-Natal/efeitos adversos , Ultrassonografia Pré-Natal/tendências
8.
BMC Pediatr ; 18(1): 41, 2018 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-29415681

RESUMO

BACKGROUND: Late Language Emergence (LLE) in the first two years of life is one of the most common parental concerns about child development and reasons for seeking advice from health professionals. LLE is much more prevalent in twins (38%) than singletons (20%). In studies of language development in twins without overt disability, adverse prenatal and perinatal environments have been reported to play a lesser role in the etiology of LLE than adverse postnatal environments. However, there is a lack of population-level evidence about prenatal and perinatal risk factors for LLE in twins. This study investigated the extent to which prenatal and perinatal risk factors were associated with LLE in a population-level sample of twins at age 2 without overt disability. METHODS: The sample comprised 473 twin pairs drawn from a population sample frame comprising statutory notifications of all births in Western Australia (WA), 2000-2003. Twin pairs in which either twin had a known developmental disorder or exposure to language(s) other than English were excluded. Of the 946 twins, 47.9% were male. There were 313 dizygotic and 160 monozygotic twin pairs. LLE was defined as a score at or below the gender-specific 10th percentile on the MacArthur Communicative Development Inventories: Words and Sentences (CDI-WS) (Words Produced). Bivariate and multivariable logistic regression was used to investigate risk factors associated with LLE. RESULTS: In the multivariable model, risk factors for LLE in order of decreasing magnitude were: Gestational diabetes had an adjusted odds ratio (aOR) of 19.5 (95% confidence interval (CI) 1.2, 313.1); prolonged TSR (aOR: 13.6 [2.0, 91.1]); multiparity (aOR: 7.6 [1.6, 37.5]), monozygosity (aOR: 6.9 [1.7, 27.9]) and fetal growth restriction (aOR: 4.6 [1.7, 12.7]). Sociodemographic risk factors (e.g., low maternal education, socioeconomic area disadvantage) were not associated with increased odds of LLE. CONCLUSIONS: The results suggest that adverse prenatal and perinatal environments are important in the etiology of LLE in twins at age 2. It is important that health professionals discuss twin pregnancy and birth risks for delayed speech and language milestones with parents and provide ongoing developmental monitoring for all twins, not just twins with overt disability.


Assuntos
Doenças em Gêmeos/etiologia , Transtornos do Desenvolvimento da Linguagem/etiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adulto , Pré-Escolar , Doenças em Gêmeos/diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Modelos Logísticos , Estudos Longitudinais , Masculino , Análise Multivariada , Gravidez , Complicações na Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Austrália Ocidental
9.
J Craniofac Surg ; 29(3): 599-602, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29381639

RESUMO

The diagnosis of unilateral condylar hyperplasia (UCH) requires a combined assessment consisting of clinical, radiological, and histopathological examination. The etiology of this condition is unknown. The purpose of this study is to report a rare case of UCH in a monozygotic twin. A 15-year-old girl was referred to our department complaining of facial asymmetry and malocclusion. Computed tomography and single-photon emission computed tomography imaging reveal enlargement of the left condyle and condylar neck, and an increased uptake that was diagnosed as active UCH. During the investigation of family and co-twin facial profile, no cases of UCH were identified. From the case reported in this study, the authors raise a hypothesis that can exist some environmental factor that is related in the development of condylar hyperplasia given the occurrence of this disease in one of twins.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Doenças em Gêmeos/etiologia , Assimetria Facial/etiologia , Má Oclusão/etiologia , Côndilo Mandibular/patologia , Adolescente , Doenças Ósseas/complicações , Feminino , Humanos , Hiperplasia/complicações , Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Masculino , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Gêmeos Monozigóticos
10.
BJOG ; 125(9): 1164-1170, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29119673

RESUMO

OBJECTIVES: To investigate the efficacy of antenatal corticosteroid (ACS) therapy on short-term neonatal outcomes in preterm twins, and further document the influence of the ACS-to-delivery interval. DESIGN: EPIPAGE-2 is a nationwide observational multicentre prospective cohort study of neonates born between 22 and 34 completed weeks of gestation. SETTING: All French maternity units, except in a single administrative region, between March and December 2011. POPULATION: A total of 750 twin neonates born between 24 and 31 weeks of gestation. METHODS: Exposure to ACSs was examined in four groups: single complete course, with an ACS administration-to-delivery interval of ≤7 days; single complete course, with an ACS-to-delivery interval of >7 days; repeated courses; or no ACS treatment. MAIN OUTCOME MEASURES: Neonatal outcomes analysed were severe bronchopulmonary dysplasia, periventricular leukomalacia or intraventricular haemorrhage grade III/IV, in-hospital mortality, and a composite indicator of severe outcomes. RESULTS: Compared with no ACSs, in multivariable analysis, a single course of ACSs with an administration-to-delivery interval of ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (aOR 0.2; CI 95% 0.1-0.5), in-hospital mortality (0.3; 0.1-0.6), and the composite indicator (0.1; 0.1-0.3), whereas a single course of ACDs with an administration-to-delivery interval of >7 days did not significantly reduce the frequency of in-hospital mortality (0.7; 0.3-1.8). No significant differences in terms of benefit or risk were found when comparing repeated courses with a single complete course. CONCLUSION: In preterm twins, a single complete course of antenatal corticosteroids was associated with an improvement of severe neurological outcome, whereas reduced in-hospital mortality was seen only when the ACS-to-delivery interval was ≤7 days. TWEETABLE ABSTRACT: A single complete course of antenatal steroids reduced severe neurological morbidity in preterm twins (24-31 weeks).


Assuntos
Corticosteroides/administração & dosagem , Doenças em Gêmeos/prevenção & controle , Doenças do Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/métodos , Gêmeos , Displasia Broncopulmonar , Hemorragia Cerebral Intraventricular/etiologia , Hemorragia Cerebral Intraventricular/prevenção & controle , Doenças em Gêmeos/etiologia , Esquema de Medicação , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/etiologia , Leucomalácia Periventricular/etiologia , Leucomalácia Periventricular/prevenção & controle , Masculino , Mortalidade Perinatal , Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
11.
Depress Anxiety ; 35(2): 132-139, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29283198

RESUMO

BACKGROUND: To examine shared genetic and environmental risk factors across PTSD symptoms and resilience. METHODS: Classical twin study of 2010-2012 survey data conducted among 3,318 male twin pairs in the Vietnam Era Twin Registry. Analyses included: (a) estimates of genetic and environmental influences on PTSD symptom severity (as measured by the PTSD Checklist) and resilience (assessed with the Connor-Davidson Resilience Scale-10); (b) development of a latent model of traumatic stress, spanning both PTSD and resilience; and (c) estimates of genetic and environmental influences on this spectrum. RESULTS: The heritability of PTSD was 49% and of resilience was 25%. PTSD and resilience were correlated at r = -.59, and 59% of this correlation was attributable to a single genetic factor, whereas the remainder was due to a single non-shared environment factor. Resilience was also influenced by common and unique environmental factors not shared with PTSD, but there was no genetic factor specific to resilience. Confirmatory factor analysis supported the Development of a revised phenotype reflecting the broader dimension of traumatic stress, with biometric models suggesting increased heritability (66%) of this spectrum compared to PTSD or resilience individually. CONCLUSIONS: Genetic factors contribute to a single spectrum of traumatic stress reflecting resilience at one end and high symptom severity at the other. This carries implications for phenotype refinement in the search for molecular genetic markers of trauma-related psychopathology. Rather than focusing only on genetic risk for PTSD, molecular genetics research may benefit from evaluation of the broader spectrum of traumatic stress.


Assuntos
Suscetibilidade a Doenças , Doenças em Gêmeos , Sistema de Registros , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos , Idoso , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/etiologia , Doenças em Gêmeos/genética , Doenças em Gêmeos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/genética , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Veteranos/estatística & dados numéricos
12.
J Matern Fetal Neonatal Med ; 31(5): 682-688, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28274162

RESUMO

PURPOSE: To compare neonatal outcomes of twins delivered <33 weeks' gestation in tertiary centers in Canada according to the mode of birth and presentation. MATERIALS AND METHODS: This retrospective cohort from the Canadian Neonatal Network database studied preterm twins born from 24 + 0 to 32 + 6 weeks' gestation between 2005 and 2012. Twins were grouped by the mode of birth: both vaginal, combined vaginal/cesarean section (CS), and both CS. Additionally, twins were grouped by the mode of presentation: both vertex, vertex/breech, breech/vertex, and both breech. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurological injury [intraventricular hemorrhage grade 3/4 or periventricular leukomalacia], bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis). RESULTS: Of the 6636 twins, 1934 (29%) were delivered vaginally, 418 (6%) by combined vaginal birth/CS, and 4284 (65%) were born by CS. The composite did not differ between the groups. However, severe neurological injury was decreased (adjusted odds ratio [AOR], 0.77; 95% confidence interval [CI], 0.61-0.98) and respiratory distress syndrome (AOR, 1.34; 95%CI, 1.15-1.56) was increased when both the twins were delivered by CS. CONCLUSIONS: Preterm twin infants born via CS experienced less severe neurological injury when compared to those delivered vaginally, but had an increase in respiratory distress syndrome.


Assuntos
Parto Obstétrico/efeitos adversos , Doenças em Gêmeos/etiologia , Doenças do Prematuro/etiologia , Apresentação no Trabalho de Parto , Adulto , Canadá/epidemiologia , Parto Obstétrico/métodos , Doenças em Gêmeos/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Modelos Logísticos , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Risco
13.
Int J Paediatr Dent ; 28(2): 198-206, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28833715

RESUMO

BACKGROUND: The etiology of molar-incisor hypomineralization (MIH) remains unknown. Studies indicate that it is multifactorial, and that genetic and environmental factors are involved. Research with twins provides important subsidy to investigate the Influence of genetics and environmental factors that act during pregnancy on the etiology of alterations. AIM: This cross-sectional study evaluated the agreement of molar incisor hypomineralization (MIH) between monozygotic and dizygotic twin pairs and the association with environmental factors. DESIGN: The sample consisted of 167 pairs of twins (8-15 years old), 94 monozygotic and 73 dizygotic. The parents answered a questionnaire on sociodemographic data and pre-, peri-, and postnatal health. A dental examination was performed by two calibrated examiners (Kappa ≥0.88) for MIH diagnosis, following the criteria proposed by the European Academy of Pediatric Dentistry in 2003. RESULTS: The prevalence of MIH was 29.3%. There was greater concordance of MIH between monozygotic twins for affected first molars and permanent incisors (P = 0.0012) and pairs of twins assessed (P = 0.0211). The presence of MIH was associated with family income between one and two wages (P = 0.009, prevalence ratio [PR] = 3.82, confidence interval [CI 95%] 1.40-10.44), above two wages (P = 0.007, PR = 4.60, 95% CI: 1.51-14.05), and gestational hemorrhage (P = 0.032, PR = 5.70, 95% CI: 1.16-28.14). CONCLUSIONS: The greater concordance in the diagnosis of MIH among monozygotic twins indicates a genetic influence, although environmental factors, such as family income and hemorrhage during pregnancy, are also associated with the occurrence of MIH.


Assuntos
Hipoplasia do Esmalte Dentário/etiologia , Adolescente , Brasil/epidemiologia , Criança , Estudos Transversais , Hipoplasia do Esmalte Dentário/epidemiologia , Hipoplasia do Esmalte Dentário/genética , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/etiologia , Doenças em Gêmeos/genética , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Gêmeos Dizigóticos/estatística & dados numéricos , Gêmeos Monozigóticos/estatística & dados numéricos
14.
J Matern Fetal Neonatal Med ; 31(16): 2164-2169, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28573880

RESUMO

OBJECTIVE: Recent studies have shown that for twin pregnancies with a cephalic presenting first twin, planned vaginal delivery is not associated with adverse short-term neonatal outcomes, as compared to planned cesarean delivery. Our objective was to compare long-term outcomes in twins, based on planned mode of delivery. STUDY DESIGN: This was a prospective, observational cohort of twin pregnancies delivered by a single MFM practice. All the patients with a twin pregnancy >34 weeks delivered from 2005-2014 were surveyed regarding pediatric outcomes at or after 2 years of life. The survey was mail-based, with phone follow-up for nonresponses or for clarification of answers. Using chi-square, Student's t-tests, and regression analysis we compared outcomes between women who planned a vaginal (with active management of the second stage) versus cesarean delivery. The main outcome measures were: (1) a composite of major adverse outcomes (death, cerebral palsy, necrotizing enterocolitis, chronic renal, heart, or lung disease); (2) a composite of minor adverse outcomes (learning disability, speech therapy, occupational therapy, physical therapy). RESULTS: Five hundred and thirty-two women met inclusion criteria and 354 (66.5%) responded. 178 (50.3%) women planned to have a cesarean delivery (100% of whom had a cesarean delivery) and 176 (49.7%) women planned to have a vaginal delivery (83% of whom had a vaginal delivery). The average age of the children at the time of the survey was 5.9 years. There were no differences in any pediatric outcomes between the two groups. After controlling for maternal age, IVF, obesity, and preeclampsia, the planned mode of delivery was not associated with a composite of major adverse outcomes (aOR 0.673, 95% CI 0.228, 1.985), nor a composite of minor adverse outcomes (aOR 0.767, 95% CI 0.496, 1.188). CONCLUSIONS: Planned vaginal delivery with active management of the second stage of labor in twin pregnancies >34 weeks is not associated with adverse childhood outcomes.


Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos/estatística & dados numéricos , Gêmeos , Adulto , Parto Obstétrico/efeitos adversos , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Intenção , Masculino , Gravidez , Estudos Retrospectivos , Gêmeos/estatística & dados numéricos
15.
Eur J Public Health ; 27(4): 659-664, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28633449

RESUMO

Background: This study investigated the associations between night work, sleep and disability pension (DP) due to musculoskeletal disorders (MSD), while controlling for several confounding factors including both genetic factors and shared family background. Methods: The study sample consisted of 27 165 Swedish twin individuals born in 1935-58 with comprehensive survey data on sociodemographic, health and lifestyle factors. Night work was assessed as years of working hours at night at least every now and then, and categorized into 'not at all, 1-10 years and over 10 years'. Data on DP with MSD (ICD-diagnoses M00-M99) were obtained from the National Social Insurance Agency. Follow-up was from the time of the interview in 1998-2003 until 2013. Information on the length and quality of sleep was available for a sub-sample of twins (n = 1684). Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: During the follow-up, 1338 (5%) participants were granted DP due to MSD. Both 1-10 years (HR 1.33, 95% CI 1.17-1.53) and over 10 years of night work (HR 1.39 95% CI 1.18-1.64) increased the risk of future DP. The associations were not affected by health, lifestyle or sleep factors. In the discordant twin pair analysis, the associations between night work and DP due to MSD attenuated. Conclusions: Night work was associated with increased risk of DP due to MSD independently from health and lifestyle factors. Familial confounding could not be ruled out.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Doenças em Gêmeos/etiologia , Doenças Musculoesqueléticas/etiologia , Pensões/estatística & dados numéricos , Jornada de Trabalho em Turnos/efeitos adversos , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Suécia/epidemiologia , Gêmeos Dizigóticos/estatística & dados numéricos , Gêmeos Monozigóticos/estatística & dados numéricos
16.
J Matern Fetal Neonatal Med ; 30(24): 2974-2977, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27936998

RESUMO

OBJECTIVE: To compare the maternal and neonatal outcome of dichorionic diamniotic in vitro fertilization (IVF) twin and spontaneous twin pregnancies. MATERIAL AND METHODS: Maternal and fetal data of all consecutive dichorionic-diamniotic twin pregnancies delivered in our institution between January 2009 and May 2015 were abstracted from medical records and pregnancy outcome of IVF twin was compared to spontaneous twin. RESULTS: Overall 708 twin pregnancies (449 IVF and 259 spontaneous) were included. Women in the IVF group were 2 years older and more frequently nulliparous. The rate of pregnancy induced hypertension and preeclampsia (PIH/PET) was three times higher in the IVF group than in the spontaneous group. The rate of preterm births, before 37 weeks of gestation and the rate of cesarean section were higher in the IVF group. These results were confirmed by multivariate analysis. The neonatal outcome was similar in both the groups except for a lower mean newborn birthweight in the IVF group. CONCLUSION: Women with IVF twins are at a significantly higher risk of having preterm births, PIH/PET and cesarean section but there was no significant adverse effect on neonatal outcome except for a lower mean newborn birth weight.


Assuntos
Fertilização In Vitro/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos/estatística & dados numéricos , Gêmeos Dizigóticos , Adulto , Índice de Apgar , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/etiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Mães/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Estudos Retrospectivos , Gêmeos Dizigóticos/estatística & dados numéricos
17.
Arthritis Care Res (Hoboken) ; 69(5): 616-624, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27390149

RESUMO

OBJECTIVE: To assess the incidence of chronic persistent rheumatoid arthritis (RA) in a population-based cohort of twins and to determine the impact of smoking. METHODS: In a historical cohort study on twins born in 1920 to 1982, we identified 157 cases of RA among 45,280 responders (response rate 80%). Information on smoking was obtained by questionnaire and interview. A mixed-effects Poisson regression model was used to estimate incidence rate ratios with age, sex, smoking duration, and smoking intensity as covariates. We used the SplitLexis procedure in the Epi R package to study a possible effect of period or cohort in addition to age on the variation of the incidence. RESULTS: The annual incidence of chronic persistent RA was 18.8 per 100,000 person-years, ages 15-73 years (females 25.2, males 12.0), increasing with age to a maximum at age 60 years in females and age 70 years in males. The incidence rate ratio among ever-smoking patients was 1.96 (95% confidence interval [95% CI] 1.43-3.76), 1.93 (95% CI 1.00-3.7) after 30 pack-years, and 1.034 (P < 0.001) per year of smoking, implying a doubling of risk after 20 years regardless of sex and smoking intensity. We did not detect significant period or cohort effects. CONCLUSION: The incidence of chronic persistent RA is lower than the incidence figures reported in inception cohorts. Smoking duration, but not intensity, doubled the risk of RA after 20 years of smoking in both sexes.


Assuntos
Artrite Reumatoide/epidemiologia , Artrite Reumatoide/etiologia , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/etiologia , Fumar/efeitos adversos , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/epidemiologia , Fatores de Tempo , Adulto Jovem
18.
J Cardiovasc Med (Hagerstown) ; 18(5): 378-380, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-20404741

RESUMO

A congenital coronary artery fistula (CAF) is a rare form of heart disease in which a coronary artery and a cardiac chamber or another vascular structure communicate. CAF could worsen ventricular perfusion and function, favoring ventricular ischemia and arrhythmias. To our knowledge, this is the first report of CAF, draining in the pulmonary artery, in two asymptomatic dizygotic twin brothers, diagnosed by echocardiography. Dizygotic twins are siblings with different genes exposed to the same environmental experience during the pregnancy. The occurrence of CAF (with similar instrumental findings) in both twin brothers could depend on a poorly identified environmental factor during pregnancy.


Assuntos
Fístula Artério-Arterial/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças em Gêmeos/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Exposição Materna/efeitos adversos , Artéria Pulmonar/diagnóstico por imagem , Gêmeos Dizigóticos , Fístula Artério-Arterial/etiologia , Anomalias dos Vasos Coronários/etiologia , Doenças em Gêmeos/etiologia , Feminino , Humanos , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Artéria Pulmonar/anormalidades , Fatores de Risco
19.
J Affect Disord ; 207: 221-227, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27723547

RESUMO

BACKGROUND: Cigarette smoking and depression are major public health concerns, but longitudinal research on the association between smoking and antidepressant use is scarce. The purpose of this study was to investigate, whether smoking predicts antidepressant medication during a 10-year follow-up. METHODS: A questionnaire was administered to Finnish adult twins in 1990. Antidepressant prescription data during 1995-2004 were obtained from the register of the Finnish Social Insurance Institution and linked to the survey data. Cox Proportional Hazard Models among 10,652 individuals (1075 cases, 9577 controls) assessed the risk for depression in the cohort, whereas within-pair comparisons of smoking twins with their non-smoking co-twins controlled for shared familial influences. RESULTS: Daily smokers had a significantly elevated likelihood for having antidepressant prescriptions in the follow-up. Based on the analysis among those without baseline depression, heavy daily smokers had a significantly elevated likelihood (HR 1.56, 95% CI 1.17-2.08) for antidepressant prescription when adjusted for all confounders. Similar analysis using pairs discordant for antidepressant medication confirmed that daily smoking twins had a higher likelihood for prescriptions (HR 1.98, 95% CI 1.11-3.54) compared with their non-smoking co-twins. The estimates were for MZ pairs (HR 1.78, 95% CI 0.48-6.55) and DZ pairs (HR 1.92, 95% CI 0.99-3.72), respectively. LIMITATIONS: Changes in smoking status after baseline cannot be accounted for. Reversed association between depression and smoking cannot be ruled out. CONCLUSION: Daily smoking predicts antidepressant medication, even when controlling for essential confounders and familial factors. This study highlights the need of systematically assessing depressive symptoms among smokers.


Assuntos
Antidepressivos/uso terapêutico , Depressão/etiologia , Doenças em Gêmeos/etiologia , Fumar/psicologia , Adulto , Estudos de Casos e Controles , Depressão/tratamento farmacológico , Doenças em Gêmeos/tratamento farmacológico , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
20.
Am J Case Rep ; 17: 720-729, 2016 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-27721367

RESUMO

BACKGROUND Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) present with profound fatigue, flu-like symptoms, pain, cognitive impairment, orthostatic intolerance, and post-exertional malaise (PEM), and exacerbation of some or all of the baseline symptoms. CASE REPORT We report on a pair of 34-year-old monozygotic twins discordant for ME/CFS, with WELL, the non-affected twin, and ILL, the affected twin. Both twins performed a two-day cardiopulmonary exercise test (CPET), pre- and post-exercise blood samples were drawn, and both provided stool samples for biochemical and molecular analysis. At peak exertion for both CPETs, ILL presented lower VO2peak and peak workload compared to WELL. WELL demonstrated normal reproducibility of VO2@ventilatory/anaerobic threshold (VAT) during  CPET2, whereas ILL experienced an abnormal reduction of 13% in VAT during  CPET2. A normal rise in lactate dehydrogenase (LDH), creatine kinase (CK), adrenocorticotropic hormone (ACTH), cortisol, creatinine, and ferritin content was observed following exercise for both WELL and ILL at each CPET. ILL showed higher increases of resistin, soluble CD40 ligand (sCD40L), and soluble Fas ligand (sFasL) after exercise compared to WELL. The gut bacterial microbiome and virome were examined and revealed a lower microbial diversity in ILL compared to WELL, with fewer beneficial bacteria such as Faecalibacterium and Bifidobacterium, and an expansion of bacteriophages belonging to the tailed dsDNA Caudovirales order.  CONCLUSIONS Results suggest dysfunctional immune activation in ILL following exercise and that prokaryotic viruses may contribute to mucosal inflammation and bacterial dysbiosis. Therefore, a two-day CPET and molecular analysis of blood and microbiomes could provide valuable information about ME/CFS, particularly if applied to a larger cohort of monozygotic twins.


Assuntos
Doenças em Gêmeos/etiologia , Doenças em Gêmeos/fisiopatologia , Síndrome de Fadiga Crônica/etiologia , Síndrome de Fadiga Crônica/fisiopatologia , Microbioma Gastrointestinal , Gêmeos Monozigóticos , Adulto , Humanos , Masculino
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