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1.
Am J Bot ; 107(12): 1677-1692, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33315246

RESUMO

PREMISE: We tested 25 classic and novel hypotheses regarding trait-origin, trait-trait, and trait-environment relationships to account for flora-wide variation in life history, habit, and especially reproductive traits using a plastid DNA phylogeny of most native (96.6%, or 1494/1547 species) and introduced (87.5%, or 690/789 species) angiosperms in Wisconsin, USA. METHODS: We assembled data on life history, habit, flowering, dispersal, mating system, and occurrence across open/closed/mixed habitats across species in the state phylogeny. We used phylogenetically structured analyses to assess the strength and statistical significance of associations predicted by our models. RESULTS: Introduced species are more likely to be annual herbs, occupy open habitats, have large, visually conspicuous, hermaphroditic flowers, and bear passively dispersed seeds. Among native species, hermaphroditism is associated with larger, more conspicuous flowers; monoecy is associated with small, inconspicuous flowers and passive seed dispersal; and dioecy is associated with small, inconspicuous flowers and fleshy fruits. Larger flowers with more conspicuous colors are more common in open habitats, and in understory species flowering under open (spring) canopies; fleshy fruits are more common in closed habitats. Wind pollination may help favor dioecy in open habitats. CONCLUSIONS: These findings support predictions regarding how breeding systems depend on flower size, flower color, and fruit type, and how those traits depend on habitat. This study is the first to combine flora-wide phylogenies with complete trait databases and phylogenetically structured analyses to provide powerful tests of evolutionary hypotheses about reproductive traits and their variation with geographic source, each other, and environmental conditions.


Assuntos
Magnoliopsida , Flores , Magnoliopsida/genética , Melhoramento Vegetal , Polinização , História Reprodutiva , Wisconsin
2.
JAMA Netw Open ; 3(12): e2029245, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337493

RESUMO

Importance: Increasing evidence indicates that people are attempting their own abortions outside the formal health care system. However, population-based estimates of experience with self-managed abortion (SMA) are lacking. Objective: To estimate the prevalence of SMA attempts among the general US population. Design, Setting, and Participants: This cross-sectional survey study was fielded August 2 to 17, 2017 among English- and Spanish- speaking, self-identified female panel members from the GfK web-based KnowledgePanel. Women ages 18 to 49 years were approached to complete a 1-time survey. Data were analyzed from September 22, 2017, to March 26, 2020. Main Outcomes and Measures: SMA was defined as "some women may do something on their own to try to end a pregnancy without medical assistance. For example, they may get information from the internet, a friend, or family member about pills, medicine, or herbs they can take on their own, or they may do something else to try to end the pregnancy." SMA was assessed using the question, "Have you ever taken or used something on your own, without medical assistance, to try to end an unwanted pregnancy?" Participants reporting SMA were asked about methods used, reasons, and outcomes. Factors associated with SMA experience, including age, race/ethnicity, socioeconomic status, nativity, reproductive health history, and geography, were assessed. Projected lifetime SMA prevalence was estimated using discrete-time event history models, adjusting for abortion underreporting. Results: Among 14 151 participants invited to participate, 7022 women (49.6%) (mean [SE] age, 33.9 [9.0] years) agreed to participate. Among these, 57.4% (95% CI, 55.8%-59.0%) were non-Hispanic White, 20.2% (95% CI, 18.9%-21.5%) were Hispanic, and 13.3% (95% CI, 12.1%-14.5%) were non-Hispanic Black; and 15.1% (95% CI, 14.1%-16.3%) reported living at less than 100% federal poverty level (FPL). A total of 1.4% (95% CI, 1.0%-1.8%) of participants reported a history of attempting SMA while in the US. Projected lifetime prevalence of SMA adjusting for underreporting of abortion was 7.0% (95% CI, 5.5%-8.4%). In bivariable analyses, non-Hispanic Black (prevalence ratio [PR], 3.16; 95% CI, 1.48-6.75) and Hispanic women surveyed in English (PR, 3.74; 95% CI, 1.78-7.87) were more likely than non-Hispanic White women to have attempted SMA. Women living below 100% of the FPL were also more likely to have attempted SMA compared with those at 200% FPL or greater (PR, 3.43; 95% CI, 1.83-6.42). At most recent SMA attempt, 20.0% (95% CI, 10.9%-33.8%) of respondents used misoprostol, 29.2% (95% CI, 17.5%-44.5%) used another medication or drug, 38.4% (95% CI, 25.3%-53.4%) used herbs, and 19.8% (95% CI, 10.0%-35.5%) used physical methods. The most common reasons for SMA included that it seemed faster or easier (47.2% [95% CI, 33.0%-61.8%]) and the clinic was too expensive (25.2% [95% CI, 15.7%-37.7%]). Of all attempts, 27.8% (95% CI, 16.6%-42.7%) of respondents reported they were successful; the remainder reported they had subsequent facility-based abortions (33.6% [95% CI, 21.0%-49.0%]), continued the pregnancy (13.4% [95% CI, 7.4%-23.1%]), had a miscarriage (11.4% [95% CI, 4.2%-27.5%]), or were unsure (13.3% [95% CI, 6.8%-24.7%]). A total of 11.0% (95% CI, 5.5%-21.0%) of respondents reported a complication. Conclusions and Relevance: This cross-sectional study found that approximately 7% of US women reported having attempted SMA in their lifetime, commonly with ineffective methods. These findings suggest that surveys of SMA experience among patients at abortion clinics may capture only one-third of SMA attempts. People's reasons for attempting SMA indicate that as abortion becomes more restricted, SMA may become more common.


Assuntos
Aborto Induzido , Gravidez não Desejada/psicologia , Autogestão , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Adulto , Estudos Transversais , Tomada de Decisões , Grupos Étnicos , Feminino , Humanos , Gravidez , Prevalência , História Reprodutiva , Autogestão/métodos , Autogestão/psicologia , Autogestão/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos/epidemiologia
3.
Medicine (Baltimore) ; 99(46): e23112, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181680

RESUMO

To determine the association between mammographic density (MD) and the risk of breast cancer (BC) in Chinese women and to investigate the role of fertility risk factors in regulating the relationship between MD and BC.We used Quantra software and the BI-RADS classification to assess MD in 466 patients and 932 controls. Conditional matched logistic multiple regression analysis was used to determine the relationship between MD and BC, and risk was evaluated with the odds ratio (OR) and 95% confidence interval (CI).The ORs for category 4 versus category 2 were 1.95 (95% confidence interval [95% CI] (1.42∼2.66)) and 1.76 (95% CI (1.28∼2.42)) for the BI-RADS and Quantra classifications, respectively. The ORs for category 5 volumetric breast density (VBD) versus category 2 VBD and 5 fibroglandular tissue volume (FGV) versus category 2 FGV were 1.63 (95% CI (1.20∼2.23)) and 1.92 (95% CI (1.40∼2.63)), respectively. Females with category 5 VBD whose age at menarche was ≤13 years had the highest risk of BC (OR = 2.16, 95% CI (1.24∼3.79)), and females with category 5 FGV whose age at menarche was = 15 years had the lowest risk of BC (OR = 1.65, 95% CI (1.05∼2.62)). Females with categories 3-5 VBD and categories 3-5 FGV had reduced risks of BC with increasing number of births. Females with category 5 VBD had an increased risk of BC with increasing age at first childbirth (the OR increased from 1.49 to 1.95). Those with category 5 VBD had a reduced risk of BC with increasing breastfeeding duration (the OR decreased from 2.08 to 1.55). Females with category 5 FGV had a reduced risk of BC with increasing breastfeeding duration (the OR decreased from 4.12 to 1.62).Both the BI-RADS density classification and Quantra measures indicated that MD is positively associated with the risk of BC in Chinese women and that associations between MD and BC risk differ by age at menarche, parity, age at first childbirth and breastfeeding duration.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico , Mama , Mamografia/métodos , Medição de Risco/métodos , Fatores Etários , Mama/diagnóstico por imagem , Mama/patologia , Aleitamento Materno/estatística & dados numéricos , Neoplasias da Mama/epidemiologia , China/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Menarca , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , História Reprodutiva , Software
4.
BMJ ; 371: m3377, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004347

RESUMO

OBJECTIVES: To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. DESIGN: Cohort study using linked electronic maternity records. PARTICIPANTS: 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. MAIN OUTCOME MEASURE: A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. RESULTS: Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). CONCLUSIONS: Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.


Assuntos
Parto Obstétrico , Complicações do Trabalho de Parto , Paridade , Nascimento a Termo , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez/epidemiologia , Melhoria de Qualidade , História Reprodutiva , Medição de Risco , Fatores de Risco
5.
Stud Health Technol Inform ; 273: 104-108, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087598

RESUMO

Prediction of a labor due date is important especially for the pregnancies with high risk of complications where a special treatment is needed. This is especially valid in the countries with multilevel health care institutions like Russia. In Russia medical organizations are distributed into national, regional and municipal levels. Organizations of each level can provide treatment of different types and quality. For example, pregnancies with low risk of complications are routed to the municipal hospitals, moderate risk pregnancies are routed to the reginal and high risk of complications are routed to the hospitals of the national level. In the situation of resource deficiency especially on the national level it is necessary to plan admission date and a treatment team in advance to provide the best possible care. When pregnancy data is not standardized and semantically interoperable, data driven models. We have retrospectively analyzed electronic health records from the perinatal Center of the Almazov perinatal medical center in Saint-Petersburg, Russia. The dataset was exported from the medical information system. It consisted of structured and semi structured data with the total of 73115 lines for 12989 female patients. The proposed due date prediction data-driven model allows a high accuracy prediction to allow proper resource planning. The models are based on the real-world evidence and can be applied with limited amount of predictors.


Assuntos
Aprendizado de Máquina , História Reprodutiva , Registros Eletrônicos de Saúde , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Federação Russa
6.
Obstet Gynecol ; 136(4): 745-755, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925617

RESUMO

OBJECTIVE: To investigate subsequent birth rates, maternal and neonatal outcomes for women with a history of placenta accreta spectrum (placenta accreta, increta, and percreta). METHODS: A population-based record linkage study of women who had a first, second, or third birth in New South Wales from 2003 to 2016 was conducted. Data were obtained from birth and hospital records and death registrations. Women with a history of placenta accreta spectrum were matched to women without, on propensity score and parity, to compare outcomes with women who had similar risk profiles. Modified Poisson regression models were used to calculate adjusted relative risk (aRR) for a range of maternal and neonatal outcomes. RESULTS: We identified recurrent placenta accreta spectrum in 27/570 (4.7%, 95% CI 3.0-6.5%) of second and 9/119 (7.6%, 95% CI 2.8-12.3%) of third pregnancies after placenta accreta spectrum in the preceding birth, with an overall recurrence rate of 38/689 (5.5%, 95% CI 3.9-7.5%, compared with the population prevalence of 25.5/10,000 births (95% CI 24.6-26.4). Subsequent births after placenta accreta spectrum had higher risk of postpartum hemorrhage (aRR 1.51, 95% CI 1.19-1.92), transfusion (aRR 2.13, 95% CI 1.17-3.90), cesarean delivery (aRR 1.19, 95% CI 1.02-1.37), manual removal of placenta (aRR 6.92, 95% CI 3.81-12.55), and preterm birth (aRR 1.43, 95% CI 1.03-1.98), with lower risk of small for gestational age (aRR 0.64, 95% CI 0.43-0.96), compared with similar-risk births. CONCLUSION: Women with a history of placenta accreta spectrum have increased risk of maternal morbidity, preterm birth, and placenta accreta spectrum in the subsequent pregnancy compared with similar-risk women with no previous placenta accreta spectrum, although the absolute risks are generally low. These findings may be used to inform counseling of women on the risks of future pregnancies.


Assuntos
Cesárea , Parto Obstétrico , Histerectomia , Placenta Acreta , Hemorragia Pós-Parto , Nascimento Prematuro , Adulto , Austrália/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Cesárea/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Recém-Nascido , Masculino , Placenta Acreta/epidemiologia , Placenta Acreta/terapia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Sistema de Registros/estatística & dados numéricos , História Reprodutiva , Risco Ajustado/métodos , Fatores de Risco
7.
Eur J Epidemiol ; 35(9): 871-878, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32767022

RESUMO

There are conflicting finds in the literature regarding the association of female estrogen status and the incidence of Parkinson's disease (PD). We aimed to investigate whether female reproductive factors are associated with PD. Using the Korean National Health Insurance System database, 4,729,546 postmenopausal women without PD were identified. The new incidence of PD was defined as subjects with an ICD-10 code for PD (G20) and with a rare intractable disease registration code for PD (V124). The Cox proportional hazard models were used to evaluate the associations of various reproductive factors with incidence of PD. During the median follow-up of 5.84 years, 20,816 individuals were diagnosed with PD. An increased risk of PD was observed in subjects with a later age at menarche (≥ 17 years) compared with reference subjects (13 years ≤ age at menarche ≤ 14 years) (adjusted hazard ratio, aHR 1.10, 95% confidence interval, CI 1.05-1.16). As age at menopause increased, risk of PD decreased (P for trend 0.019). Consistently, decreased risk of PD was observed (aHR 0.91, 95% CI 0.85-0.96) in subjects with longer duration of fertility (≥ 40 years of age) compared with shorter duration of fertility (< 30 years of age). Hormone replacement therapy and oral contraceptives independently increased the risk of PD by 17% and 7%, respectively. Female reproductive factors are independent risk factors for PD, with higher risk associated with shorter lifetime exposure to endogenous estrogen.


Assuntos
Anticoncepcionais Orais/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversos , Menarca , Menopausa , Doença de Parkinson/epidemiologia , História Reprodutiva , Adulto , Idoso , Estudos de Coortes , Anticoncepcionais Orais/administração & dosagem , Feminino , Terapia de Reposição Hormonal/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Doença de Parkinson/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
8.
Womens Health (Lond) ; 16: 1745506520949727, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842920

RESUMO

OBJECTIVES: maternal and neonatal mortality in Ethiopia is a major reproductive health problem. Obstructed labor is one of the leading causes of maternal, fetal, and neonatal morbidity in developing countries. The evidence regarding its determinants at the tertiary level of care is sparse. Therefore, this study aimed to study the determinants of obstructed labor among women attending intrapartum care in Amhara region referral hospitals. METHODS: A Hospital-based unmatched case-control study was conducted from March 1stto August 30, 2017. Cases were women whose labor was obstructed (n = 270), and controls were women whose labor was not obstructed (n = 540). Both cases and controls were selected randomly, and a proportional to size allocation was made to the referral hospitals selected for the study. A binary and a multivariable logistic regression model was computed to identify the determinant factors at 95% CI. RESULTS: The mean age of the study participants was 27.66 years (27.4 ± 5.44 for cases and 28.15 ± 6.16 for controls), ranging between 16 and 45 years. Relatively, higher proportions of cases than controls were unable to read and write (58.5%) and were urban residents (53.7%). Distance from hospital, distance from health center, mothers inability to read and write, mothers primary level of education, more than 28 weeks of gestation at the first visit of antenatal care, 37 to 42 weeks at admission, above 42 weeks at admission, women of a merchant spouse, and history of pregnancy-related complications were the positive determinants of obstructed labor. However, mothers whose gestational age was 16 to 28 weeks at the first antenatal care visit were 62% less likely to be exposed to obstructed labor. CONCLUSIONS: Obstetric, service-related, and system factors were predictors of obstructed labor. Improving women's literacy status, health service access, and utilization will help reduce obstructed labor.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , História Reprodutiva , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Maternidades , Hospitais Estaduais , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Assistência Perinatal , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
9.
BMC Health Serv Res ; 20(1): 540, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539855

RESUMO

BACKGROUND: This study compares subsequent birth outcomes in migrant women who had already had a child before arriving in Norway with those in migrant women whose first birth occurred in Norway. The aim of this study was to investigate the associations between country of first birth and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in parous migrant and Norwegian-born women. METHODS: National population-based study including second and subsequent singleton births in Norway from 1990 to 2016. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. Neonatal outcomes were compared between births to: 1) migrant women with a first birth before immigration to Norway (n = 30,062) versus those with a first birth after immigration (n = 66,006), and 2) Norwegian-born women with a first birth outside Norway (n = 6205) versus those with a first birth in Norway (n = 514,799). Associations were estimated as crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using multiple logistic regression. RESULTS: Migrant women with a first birth before immigrating to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (22-31 gestational weeks; aOR = 1.27; CI 1.09-1.48), moderately preterm birth (32-36 gestational weeks; aOR = 1.10; CI 1.02-1.18), post-term birth (≥42 gestational weeks; aOR = 1.19; CI 1.11-1.27), low Apgar score (< 7 at 5 min; aOR = 1.27; CI 1.16-1.39) and stillbirth (aOR = 1.29; CI 1.05-1.58). Similar results were found in the sample of births to Norwegian-born women. CONCLUSIONS: The increased odds of adverse neonatal outcomes for migrant and Norwegian-born women who had their first births outside Norway should serve as a reminder of the importance of taking a careful obstetric history in these parous women to ensure appropriate care for their subsequent pregnancies and births in Norway.


Assuntos
Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Migrantes/estatística & dados numéricos , Adulto , Ordem de Nascimento , Emigração e Imigração , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Noruega , Razão de Chances , Morte Perinatal , Gravidez , Sistema de Registros , História Reprodutiva , Natimorto/epidemiologia
10.
PLoS One ; 15(6): e0235114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574188

RESUMO

Nursing and weaning periods are poorly understood in cetaceans due to the difficulty of assessing underwater behaviour in the wild. However, the onset and completion of weaning are critical turning points for individual development and survival, with implications for a species' life history including reproductive potential. δ15N and δ13C deposited in odontocete teeth annuli provide a lifetime record of diet, offering an opportunity to investigate variation and trends in fundamental biology. While available reproductive parameters for beaked whales have largely been inferred from single records of stranded or hunted animals and extrapolated across species, here we examine the weaning strategy and nursing duration in northern bottlenose whales (Hyperoodon ampullatus) by measuring stable isotopes deposited in dentine growth layer groups (GLGs). Using a collection of H. ampullatus teeth taken from whales killed during the whaling era (N = 48) and from two stranded specimens, we compared ontogenetic variation of δ15N and δ13C found in annual GLGs across all individuals, by sex and by region. We detected age-based trends in both δ15N and δ13C that are consistent across regions and males and females, and indicate that nursing is prolonged and weaning does not conclude until whales are 3-4 years old, substantially later than previous estimates of 1 year. Incorporating a prolonged period of maternal care into H. ampullatus life history significantly reduces their reproductive potential, with broad implications for models of beaked whale life history, energetics and the species' recovery from whaling.


Assuntos
Dentina/metabolismo , Marcação por Isótopo/métodos , Reprodução/fisiologia , Baleias/fisiologia , Animais , Animais Recém-Nascidos , Isótopos de Carbono/metabolismo , Feminino , Geografia , Islândia , Masculino , Terra Nova e Labrador , Isótopos de Nitrogênio/metabolismo , História Reprodutiva
11.
BMC Public Health ; 20(1): 789, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460822

RESUMO

BACKGROUND: The One-Child Policy led to the imbalance of the sex ratio at birth (SRB) in China. After that, Two-Child Policy was introduced and gradually liberalized at three stages. If both the husband and wife of one couple were the only child of their parents, they were allowed to have two children in policy (BTCP). If only one of them was the only child, they were allowed to have two children in policy (OTCP). The Universal Two-Child Policy (UTCP) allowed every couple to have two children. The objective of this study was to explore the changing trend of SRB at the stages of Two-Child Policy, to analyze the effect of population policy on SRB in terms of maternal age, delivery mode, parity, maternal education, delivery hospital, and to figure out what factors have greater impact on the SRB. METHODS: The data of the study came from Hebei Province Maternal Near Miss Surveillance System, covered the parturients delivered at 28 gestation weeks or more in 22 hospitals from January 1, 2013 to December 31, 2017. We compared the SRB at different policy stages, analyzed the relationship between the SRB and population policy by logistic regression analysis. RESULTS: Total 270,878 singleton deliveries were analyzed. The SRB, 1.084 at BTCP, 1.050 at OTCP, 1.047 at UTCP, declined rapidly (χ2 = 15.97, P < 0.01). With the introduction of Two-Child Policy, the percentage of parturients who were 30-34, ≥35 years old rose significantly, and the percentage of multiparous women increased significantly (40.7, 47.2, 56.6%). The neonatal mortality declined significantly (8.4‰, 6.7‰, 5.9‰, χ2 = 44.49, P < 0.01), the mortality rate of female infant gradually declined (48.2, 43.7, 43.9%). The logistic regression analysis showed the SRB was correlated to the three population policy stages in terms of maternal age, delivery mode, parity, maternal education, delivery hospital. CONCLUSIONS: The SRB has declined to normal level with the gradually liberalizing of Two-Child Policy in China. Advanced maternal age, cesarean delivery, multiparous women, middle level education, rural hospital are the main factors of effect on the decline of the SRB.


Assuntos
Coeficiente de Natalidade/tendências , Parto Obstétrico/tendências , Paridade , Política Pública/tendências , Adulto , Cesárea/tendências , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Idade Materna , Gravidez , História Reprodutiva , Razão de Masculinidade
12.
Sci Rep ; 10(1): 5984, 2020 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-32249826

RESUMO

Little is known about the epidemiological and clinicopathological characteristics of endometrial endometrioid carcinoma (EEC) coexisting with or arising in adenomyosis (EEC-A or EEC-AIA) due to their rarity. This study compared EEC-A and EEC-AIA with endometrial carcinoma without adenomyosis. Cases of endometrial cancer treated at the study center from June 1, 2010, to June 1, 2017, were reviewed. The epidemiological, clinicopathological characteristics and survival outcomes were compared among three groups of endometrioid subtypes: group A, stage IA endometrial carcinoma patients without coexisting adenomyosis; group B, patients with EEC-A; and group C, patients with EEC-AIA. Among the 2080 patients reviewed, groups A, B, and C included 1043, 230 and 28 patients, respectively. Patients in group A and group B had similar clinicopathological and survival outcomes. Patients in group C were significantly younger and had less gravidity and parity than patients in groups A and B. More tumors from group C were grade 1, and they had a smaller maximum diameter and less mismatch repair deficiency than those from groups A and B. After a median follow-up of 57.0 months, the 5-year disease-free survival (DFS) rates of groups A, B and C were 96%, 91% and 100% (p = 0.045), respectively; the 5-year overall survival (OS) rates were 98%, 93% and 100%, respectively (p = 0.001), in the Kaplan-Meier analysis. However, these difference disappeared in a subgroup of stage IA patients in univariate and multivariate analysis. Cox regression analysis in stage IA patients also revealed no significant differences in survival outcome across the three groups. In conclusion, EEC-AIA exhibited specific clinicopathological characteristics that were probably associated with favorable survival outcomes. The characteristics and survival outcomes of EEC-A were similar to those of EEC without adenomyosis in stage IA patients.


Assuntos
Adenomiose/patologia , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Adenomiose/complicações , Adenomiose/mortalidade , Adulto , Fatores Etários , Carcinoma Endometrioide/complicações , Carcinoma Endometrioide/mortalidade , Intervalo Livre de Doença , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Prognóstico , História Reprodutiva , Estudos Retrospectivos , Taxa de Sobrevida
13.
Cancer Causes Control ; 31(5): 403-416, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32130573

RESUMO

PURPOSE: The risk of being diagnosed with contralateral breast cancer (CBC) is an important health issue among breast cancer survivors. There is an increasing interest in the effect of lifestyle and reproductive factors on CBC risk, since these factors may partly be modifiable. We performed a systematic review and meta-analysis and aimed to evaluate the impact of lifestyle and reproductive factors on CBC risk in population-based breast cancer studies. METHODS: The PubMed electronic database was searched up to 2nd November 2019, for relevant publications. Of the included studies, a meta-analysis per lifestyle or reproductive factor was performed. RESULTS: Thirteen out of 784 publications were used for the meta-analysis. Body mass index (≥ 25 vs. < 25 kg/m2; RR = 1.22; 95% CI 1.01-1.47) was associated with increased CBC risk. The estimates for alcohol use (ever vs. never; RR = 1.15; 95% CI 1.02-1.31) and age at primiparity (≥ 25 vs. < 25 years; RR = 1.06; 95% CI 1.02-1.10) also showed an association with increased CBC risk. For parity (≥ 4 vs. nulliparous; RR = 0.56; 95% CI 0.42-0.76) and age at menopause (< 45 vs ≥ 45 years; RR = 0.79; 95% CI 0.67-0.93), results from two studies suggested a decreased CBC risk. We observed no association between CBC and smoking, age at menarche, oral contraceptive use, gravidity, breastfeeding, or menopausal status. Overall, the number of studies per risk factor was limited (n = 2-5). CONCLUSIONS: BMI is a modifiable risk factor for CBC. Data on the effect of other modifiable lifestyle and reproductive factors are limited. For better counseling of patients on lifestyle effects, more studies are urgently needed.


Assuntos
Neoplasias da Mama/etiologia , Estilo de Vida , Segunda Neoplasia Primária/etiologia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Paridade , Gravidez , História Reprodutiva , Fatores de Risco , Adulto Jovem
14.
Rehabilitación (Madr., Ed. impr.) ; 54(1): 3-10, ene.-mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196634

RESUMO

OBJETIVO: Principal, evaluar la eficacia de la electroestimulación percutánea del tibial posterior (P-PTNS) en incontinencia urinaria de urgencia (IUU) e incontinencia fecal (IF) refractarias al tratamiento de primera línea. Secundario, determinar factores predictores de respuesta al tratamiento. Estudio analítico longitudinal prospectivo de 2 años de duración en pacientes con IUU e IF tratados con P-PTNS. MATERIAL Y MÉTODO: Pacientes con IUU e IF tratados con P-PTNS y que responden al diario miccional/defecatorio, cuestionarios de severidad y calidad de vida. Se excluyen pacientes con IUU neurogénica, que abandonan el tratamiento o no responden a los cuestionarios. Variables demográficas, clínicas (hábito miccional/defecatorio pre- y postratamiento), escalas de severidad pre- y postratamiento (ICIQ-SF, Sandvick y Wexner), mejoría subjetiva y calidad de vida (IQOL y FIQL pre- y postratamiento). Análisis estadístico con SPSS v19. RESULTADOS: Muestra de 21 pacientes en dos grupos: -Grupo IUU, 9 pacientes. Tras P-PTNS mejoría estadísticamente significativa de frecuencia miccional diurna (p = 0,018) y nocturna (p = 0,016), urgencias/día (p = 0,018), pérdidas/día (p = 0,027), ICIQ-SF y Sandvick (p = 0,018), y calidad de vida IQOL (p = 0,012). Esta mejoría se relaciona con el ejercicio (p = 0,039) y prolapso (p = 0,05). -Grupo IF, 12 pacientes. Tras P-PTNS mejoría estadísticamente significativa de frecuencia defecatoria (p = 0,027), incontinencia (p = 0,012), Wexner (p = 0,007), y FIQL en sus 4 dimensiones (estilo de vida, conducta, vergüenza p = 0,005; y depresión p = 0,008). Esta mejoría se relaciona con edad (p = 0,048), tiempo de evolución (p = 0,044) y prolapso (p = 0,026). CONCLUSIONES: La P-PTNS es eficaz en IUU e IF refractarias al tratamiento convencional; la respuesta al tratamiento está influenciada por distintos factores


OBJECTIVE: The main aim of this study was to assess the efficacy of percutaneous posterior tibial nerve electrostimulation (P-PTNS) in urge urinary incontinence (UUI) and faecal incontinence (FI) refractory to first-line treatment. A secondary aim was to identify predictors of treatment response. To do this, we performed a 2-year analytical, longitudinal and prospective study in patients with UUI and FI treated with P-PTNS. MATERIAL AND METHODS: We included patients with UUI and FI who were treated with P-PTNS and who completed the bladder/faecal incontinence diary and severity and quality of life questionnaires. We excluded patients with neurogenic UUI and those who abandoned treatment or did not complete the questionnaires. We assessed demographic and clinical variables (micturition/defecation habits pre- and postreatment), severity scales before and after treatment (ICIQ-SF, Sandvick and Wexner), subjective improvement and quality of life (IQOL and FIQL pre- and postreatment). The statistical analysis was conducted using SPSS v19. RESULTS: The sample consisted of 21 patients divided into 2 groups: -UUI group, 9 patients. After P-PTNS, there was a statistically significant improvement in diurnal (p=.018) and nocturnal (p=.016) urinary frequency, urgencies/day (p=.018), urine leakage/day (p=.027), ICIQ-SF and Sandvick (p=.018), and IQOL (p=.012). This improvement was related to exercise (p=.039) and prolapse (p=.05). -Group FI, 12 patients. After P-PTNS, there was a statistically significant improvement in defecation frequency (p=.027), incontinence (p=.012), Wexner scale (p=.007), and FIQL in its 4 dimensions (lifestyle, behaviour, embarrassment p=.005; and depression p=.008). This improvement was related to age (p=.048), time since onset (p=.044) and prolapse (p=.026). CONCLUSIONS: The P-PTNS is effective in UUI and FI refractory to conventional treatment. Treatment response is affected by several factors


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Incontinência Urinária de Urgência/terapia , Incontinência Fecal/terapia , Nervo Tibial , Estimulação Elétrica Nervosa Transcutânea/métodos , Qualidade de Vida , Modalidades de Fisioterapia , Estudos Prospectivos , Questionário de Saúde do Paciente/estatística & dados numéricos , História Reprodutiva
15.
Female Pelvic Med Reconstr Surg ; 26(2): 141-145, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990803

RESUMO

OBJECTIVES: This study aimed to identify differences in severity of overactive bladder (OAB) symptoms in women of different races and ethnicities using urodynamic study (UDS) parameters. METHODS: We performed a 5-year retrospective chart review from January 2014 to January 2019 of women 18 years and older who endorsed OAB symptoms and underwent UDS at a racially and ethnically diverse academic urban medical center. Logistic and linear regressions were used to examine the associations of various UDS parameters between racial/ethnic groups, after adjusting for age, diabetes, and parity. RESULTS: A total of 161 women with an average age of 59 years were included in the study. The racial/ethnic composition of the group was Hispanic (62%), black (24%), and white (11%). Symptoms on presentation included urgency and/or frequency (11.8%), urge incontinence (23.0%), or mixed urinary symptoms (65.2%). Black and Hispanic women presented with differing symptoms (urgency/frequency vs mixed urinary symptoms). Half of the patients (n = 82) had detrusor overactivity. Compared with whites, blacks were 3.4-fold more likely to have detrusor overactivity (95% confidence interval, 0.99-11.40) and had lower volumes at time of "strong desire" (-102.6 mL, P = 0.003). Hispanics had on average 75.88 mL less volume at sensation of "strong desire" (P = 0.016) than did whites. CONCLUSIONS: Our study suggests that minority race and ethnicity may be associated with worse performance on certain UDS parameters. Future studies should aim to understand if these differences are due to genetic, disease-related, behavioral, and/or socioeconomic factors and whether these differences are associated with worse subjective OAB.


Assuntos
Bexiga Urinária Hiperativa , Incontinência Urinária de Urgência , Urodinâmica/fisiologia , Afro-Americanos/estatística & dados numéricos , Autoavaliação Diagnóstica , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , História Reprodutiva , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/etnologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/diagnóstico , Incontinência Urinária de Urgência/etnologia , Incontinência Urinária de Urgência/fisiopatologia
16.
Cancer Res ; 80(5): 1210-1218, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31932455

RESUMO

Repeated exposure to the acute proinflammatory environment that follows ovulation at the ovarian surface and distal fallopian tube over a woman's reproductive years may increase ovarian cancer risk. To address this, analyses included individual-level data from 558,709 naturally menopausal women across 20 prospective cohorts, among whom 3,246 developed invasive epithelial ovarian cancer (2,045 serous, 319 endometrioid, 184 mucinous, 121 clear cell, 577 other/unknown). Cox models were used to estimate multivariable-adjusted HRs between lifetime ovulatory cycles (LOC) and its components and ovarian cancer risk overall and by histotype. Women in the 90th percentile of LOC (>514 cycles) were almost twice as likely to be diagnosed with ovarian cancer than women in the 10th percentile (<294) [HR (95% confidence interval): 1.92 (1.60-2.30)]. Risk increased 14% per 5-year increase in LOC (60 cycles) [(1.10-1.17)]; this association remained after adjustment for LOC components: number of pregnancies and oral contraceptive use [1.08 (1.04-1.12)]. The association varied by histotype, with increased risk of serous [1.13 (1.09-1.17)], endometrioid [1.20 (1.10-1.32)], and clear cell [1.37 (1.18-1.58)], but not mucinous [0.99 (0.88-1.10), P-heterogeneity = 0.01] tumors. Heterogeneity across histotypes was reduced [P-heterogeneity = 0.15] with adjustment for LOC components [1.08 serous, 1.11 endometrioid, 1.26 clear cell, 0.94 mucinous]. Although the 10-year absolute risk of ovarian cancer is small, it roughly doubles as the number of LOC rises from approximately 300 to 500. The consistency and linearity of effects strongly support the hypothesis that each ovulation leads to small increases in the risk of most ovarian cancers, a risk that cumulates through life, suggesting this as an important area for identifying intervention strategies. SIGNIFICANCE: Although ovarian cancer is rare, risk of most ovarian cancers doubles as the number of lifetime ovulatory cycles increases from approximately 300 to 500. Thus, identifying an important area for cancer prevention research.


Assuntos
Neoplasias Ovarianas/epidemiologia , Ovário/imunologia , Ovulação/imunologia , Idoso , Anticoncepcionais/administração & dosagem , Tubas Uterinas/imunologia , Tubas Uterinas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/prevenção & controle , Ovário/patologia , Ovulação/efeitos dos fármacos , Modelos de Riscos Proporcionais , Estudos Prospectivos , História Reprodutiva , Medição de Risco , Fatores de Risco
18.
J Womens Health (Larchmt) ; 29(2): 148-157, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31794347

RESUMO

Background: Excessive weight gain during pregnancy is common and has been shown to be associated with increased long-term maternal weight. However, less is known on whether there is a cumulative effect of excessive gestational weight gain (GWG) over multiple pregnancies. Methods: Data from the Study of Women's Health Across the Nation were used, restricted to parous women with no history of stillbirth or premature birth. The effect of the number of excessive GWG pregnancies on body mass index (BMI) in midlife (age 42-53) was analyzed using multivariable linear regression. Fully adjusted models included parity, inadequate GWG, demographic, and behavioral characteristics. Results: The 1181 women included in this analysis reported a total of 2693 births. Overall, 466 (39.5%) were categorized as having at least one pregnancy with excessive GWG. The median BMI at midlife was 26.0 kg/m2 (interquartile range 22.5-31.1). In fully adjusted models, each additional pregnancy with excessive GWG was associated with 0.021 higher estimated log BMI (p = 0.031). Among women with 1-3 births, adjusted mean (95% confidence interval) BMI for those with 0, 1, 2, and 3 excessive GWG pregnancies was 25.4 (24.9-25.9), 26.8 (26.1-27.5), 27.5 (26.6-28.4), and 28.8 (27.3-30.5), respectively. Conclusions: In this multiethnic study of women with a history of term live births, the number of pregnancies with excessive GWG was associated with increased maternal BMI in midlife. Our findings suggest that prevention of excessive GWG at any point in a woman's reproductive history can have an impact on long-term maternal health.


Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação , Obesidade/epidemiologia , História Reprodutiva , Adulto , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Paridade , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
19.
J Matern Fetal Neonatal Med ; 33(1): 142-148, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29890876

RESUMO

Background: Neonatal hemochromatosis (NH) is a rare but serious disease causing fulminant hepatic failure. The recurrence rate of NH in a subsequent infant of a mother with an affected infant is 70-90%. Recently, antenatal maternal high-dose intravenous immunoglobulin (IVIG) treatment has been reported to be effective for preventing NH recurrence. However, data on the IgG concentrations during this treatment are limited.Objective: We report a Japanese experience and present a pharmacokinetic simulation model of IgG during IVIG treatment.Methods: Women with histories of pregnancy diagnosed with NH were treated with IVIG weekly from the second trimester until the end of gestation. Serum IgG levels during treatment were collected frequently and pharmacokinetics were simulated by a two-compartment model.Results: Six women were included during eight pregnancies. None experienced severe adverse events. Three out of eight infants showed temporary liver dysfunction, but none required any treatment. A simulation study showed that the estimated trough and peak levels of IgG concentrations during IVIG were 2000-3000 and 4000-5000 mg/dl, respectively.Conclusion: This treatment prevented the recurrence of NH in siblings in Japanese women. We examined the details of serum IgG concentrations and introduced a new pharmacokinetic simulation model of IgG concentrations during IVIG treatment.


Assuntos
Hemocromatose/prevenção & controle , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/farmacocinética , Cuidado Pré-Natal/métodos , Prevenção Secundária/métodos , Adulto , Quimioprevenção/métodos , Relação Dose-Resposta a Droga , Feminino , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Recém-Nascido , Infusões Intravenosas , Japão , Gravidez , Resultado da Gravidez , Recidiva , História Reprodutiva , Estudos Retrospectivos , Irmãos , Resultado do Tratamento
20.
Int J Cancer ; 146(4): 929-942, 2020 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-31050823

RESUMO

Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. During a mean follow-up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric noncardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI ≥30 vs. 18.5-25 kg/m2 : HR = 1.94, 95% CI: 1.25-3.03) and women (HR = 2.66, 95% CI: 1.15-6.19); however, adjustment for waist-to-hip ratio (WHR) attenuated these associations. After mutual adjustment for BMI and HC, respectively, WHR and waist circumference (WC) were associated with EA in men (HR = 3.47, 95% CI: 1.99-6.06 for WHR >0.96 vs. <0.91; HR = 2.67, 95% CI: 1.52-4.72 for WC >98 vs. <90 cm) and women (HR = 4.40, 95% CI: 1.35-14.33 for WHR >0.82 vs. <0.76; HR = 5.67, 95% CI: 1.76-18.26 for WC >84 vs. <74 cm). WHR was also positively associated with GC in women, and WC was positively associated with GC in men. Inverse associations were observed between parity and EA (HR = 0.38, 95% CI: 0.14-0.99; >2 vs. 0) and age at first pregnancy and GNC (HR = 0.54, 95% CI: 0.32-0.91; >26 vs. <22 years); whereas bilateral ovariectomy was positively associated with GNC (HR = 1.87, 95% CI: 1.04-3.36). These findings support a role for hormonal pathways in upper gastrointestinal cancers.


Assuntos
Neoplasias Esofágicas/epidemiologia , Neoplasias Gástricas/epidemiologia , Antropometria , Distribuição da Gordura Corporal , Estudos de Coortes , Neoplasias Esofágicas/classificação , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , História Reprodutiva , Fatores de Risco , Neoplasias Gástricas/classificação
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