bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimates of the prevalence of childhood seizure disorders in communities where professional resources are scarce: results from Bangladesh, Jamaica and Pakistan
Authors: Durkin Maureen S. , Davidson Leslie L. , Hasan Z. Meher , Hasan Zaki , Hauser W. Allen , Khan Naila , Paul Tomlin J. , Shrout Patrick E. , Thorburn Marigold J. , Zaman Sultana
Published: April 2008

Summary. Although numerous estimates of the prevalence of seizure disorders in populations in the less developed world have now been published, these estimates are difficult to interpret due to lack of comparability of study methods and criteria for case definition. The results reported in this paper are from a large, collaborative study of disabilities in 2‐ to 9‐year‐old children in which standard research procedures and case definitions were used in three diverse populations (located in Bangladesh, Jamaica and Pakistan). A two‐phase study design (screening followed by professional evaluations) was used in this study allowing for the professional evaluation to serve as the criterion in the estimation of prevalence, even for rare disorders. As a result, the prevalence estimates reported here have a high degree of comparability across populations and exhibit unusually strong validity for population surveys. Febrile seizures were the most common type of seizure history in all three populations, with point estimates of lifetime prevalence ranging from 10.9 to 62.8 per 1000. The lifetime prevalence rates of epilepsy (recurrent unprovoked seizures) ranged from 5.8 to 15.5 per 1000. Lifetime prevalence rates of neonatal, all provoked and all unprovoked seizures, as well as estimates of the prevalence of active epilepsy, are also reported.
Survival and cerebral palsy in low birthweight infants: implications for perinatal care
Authors: Stanley Fiona J.
Published: April 2008

Summary. Whilst only about a third of all cerebral palsy occurs in children who had been of low birthweight, recent increases in the survival of low and very low birthweight infants have coincided with significant increases in the numbers of cerebral palsy children amongst them. This paper analyses data from the Western Australian Cerebral Palsy Register and from the Maternal and Child Health Research Data Base for stillbirths, neonatal deaths and survivors to address the issues of increased survival, cerebral palsy and timing of brain damage. The analysis is inconclusive but suggestive that both antenatal and postnatal complications are important in the increases in cerebral palsy in low birthweight infants. The good news is that this means that a certain proportion of postnatally damaged low birthweight survivors could possibly be prevented by better neonatal care. The bad news is that the remaining proportion have probably received their damage well before delivery and the possibilities for prevention are still remote. Further studies of low birthweight infants with cerebral palsy are urgently required. They should include antenatal factors, investigating the various aetiological pathways to preterm birth, randomised controlled trials of neonatal interventions and searching for better neonatal predictors of brain damage.
Mantel‐Haenszel techniques and logistic regression: always examine one's data first and don't overlook the simpler techniques
Authors: Zeiss E.E. , Hanley J.A.
Published: April 2008

Summary. The authors point out that, in addition to logistic regression, there are other, simpler techniques available for making an adjusted estimate of association between an outcome and a risk factor. Also, the consequence of mismodelling with regression, i.e. of missing the real relationship between an outcome and a risk factor, is illustrated with an example. The need to ‘examine one's data’ prior to performing multivariable techniques is emphasised.
Effects of maternal smoking upon neuropsychological development in early childhood: importance of taking account of social and environmental factors
Authors: Baghurst Peter A. , Tong Shi‐lu , Woodward Alistair , McMichael Anthony J.
Published: April 2008

Summary. Data from a prospective study of 548 children followed from birth to 4 years of age were analysed to determine whether maternal smoking during and/or after pregnancy affects children's neuropsychological development. The differences in mean developmental test scores between children whose mothers smoked and those of mothers who did not smoke were slight, with subscale scores only 2.4 to 4.1% lower in children whose mothers smoked. These differences were not statistically significant after adjustment for socio‐economic status, quality of home environment and mother's intelligence, suggesting that the social and environmental factors are major confounders of the association of exposure to maternal smoking and neuropsychological development in childhood. In order to gain a better understanding of this area, more precise measures of exposure to environmental tobacco smoke and comprehensive consideration of confounders will be required.
Low birthweight and risk of mild mental retardation by ages 5 and 9 to 11
Authors: McDermott Suzanne , Coker Ann L. , McKeown Robert E.
Published: April 2008

Summary.This prospective analysis assessed the risk of mild mental retardation (MMR) associated with low birthweight (LBW) in the Child Health and Development Studies. Scores of 50–70 on the Raven Progressive Matrices, a relatively culture‐free test of cognitive functioning, were used to categorise MMR. At the age of 5,13.8% of the 195 children with birthweights less than 2500 g (LBW) were MMR, whilst 4.2% of the 2293 children with normal birthweights (>2955 grams) were MMR. After adjusting for confounders (maternal age, race, education, prenatal alcohol use, maternal conditions, and congenital anomalies), the relative risk of MMR for LBW was 3.4 (95% CI 1.2–5.4). For children aged 9–11, 7.7% of 194 LBW children were MMR, compared with 6.2% of the 2546 with normal birthweights; the adjusted relative risk for LBW was 1.2 (95% CI 0.7–2.0). Although a strong association between LBW and MMR was observed for both blacks and non‐blacks at the age of 5, the association between birthweight and MMR was apparent only for blacks in the cohort of children aged 9–11. These findings suggest that race, a marker for environmental factors which were not measured in this study, may modify the LBW and MMR relationship.
When can cerebral palsy be prevented? The generation of causal hypotheses by multivariate analysis of a case‐control study
Authors: Blair Eve , Stanley Fiona
Published: April 2008

Summary. Causal hypotheses for spastic cerebral palsy were sought by comparing a population based sample of 183 cases with 549 matched controls. A time‐ordered multivariate analysis was used to distinguish confounders and consequences of disease from possible causes, which could be single factors or sequences of factors. Eighteen factors were identified as having an association with spasticity that did not arise by confounding with other identified factors nor as a consequence of the disease. Nearly half the cases (48.6%) but only 14.4% of controls experienced one or more of these factors, but no one factor was experienced by > 11%, and most by < 5%, of cases. Those factors identified as occurring before labour commenced affected 35% of all cases. The proportion of cases experiencing identified factors and the distribution of those factors between epochs varied with gestation of delivery and with description and severity of impairment. The possible timing of causes in cases without identified factors and the role of preterm birth and poor intrauterine growth are discussed. We conclude that there were many pathways to spastic cerebral palsy many of which could not be identified. Each contributed only a small proportion and many may have been multifactorial. Intrapartum initiation of the aetiological pathway was relatively unimportant, being likely in about 9% of cases, but the majority of pathways commenced predelivery.
Examining potential demographic risk factors for congenital cardiovascular malformations on a time‐developmental model
Authors: Gensburg Lenore J. , Marshall Elizabeth G. , Druschel Charlotte M.
Published: April 2008

Summary. A descriptive epidemiological study of congenital cardiovascular malformations (CCM) was performed to evaluate the use of a model which groups selected cardiac lesions according to time of embryonic origin. Infants born from 1983–1986 to residents of New York State excluding New York City and reported to the Congenital Malformation Registry (CMR) were first grouped into those with (n=299) and without (n=4424) chromosome anomalies. Infants were then categorised according to the time of gestation of their earliest occurring CCM into one of the seven cardiac groups of the model. The categories were analysed by infant race, gender, birthweight, gestation, maternal age and education, and the presence of additional malformations. The group without chromosomal anomalies showed an increasing proportion of non‐whites, females, and preterm births and a decreasing proportion of infants with other malformations in the embryonically later categories. The group with chromosomal anomalies was too small to exhibit any significant demographic patterns. The findings suggest associations between characteristics of the infant and the embryonic period in which the CCM occurred, thus demonstrating the usefulness of a time‐based model. Further research should concentrate on confirming these associations with more complete data and on investigating their biological bases.
Factors associated with high risk of perinatal and neonatal mortality: an interim report on a prospective community‐based study in rural Sudan
Authors: Ibrahim S.A. , Babiker Abdel G. , Amin I.K. , Omer M.I.A. , Rushwan H.
Published: April 2008

Summary. In a community‐based prospective study, 6275 deliveries resulting in 6084 livebirths, 150 stillbirths (SB) and 167 neonatal deaths (NND) were monitored over a period of 3 years. The risk of an unfavourable outcome (SB or NND) in multiple pregnancies was more than ninefold that of singletons. Teenage mothers and those over 34 years of age ran nearly twice the risk of having an unfavourable outcome of pregnancy compared with mothers aged 20–29 years. First pregnancy and grandmultiparity (greater than eight previous pregnancies) carried a similar risk of an unfavourable outcome compared with mothers with 1–4 previous pregnancies. The most serious risk factor was the adverse outcome of the previous pregnancy. Compared with mothers whose last outcome had resulted in a livebirth surviving at least 30 days, mothers with a previous SB had seven times the risk (adjusted for age and parity) of SB and more than twice the risk of NND in the current pregnancy. Maternal illiteracy was associated with significantly higher risk of NND, and this rate decreased with increasing years of education. Frequency of antenatal visits had a marginally significant effect on the SB rate. Socioeconomic factors, diet and iron supplementation during pregnancy did not seem to affect the outcome.
Thirty years of retinoblastoma (1960–89): changing patterns of incidence
Authors: Parkes S.E. , Amoaku W.M.K. , Muir K.R. , Willshaw H.E. , Mann J.R.
Published: April 2008

Summary. This study of a 30‐year population‐based dataset investigates further an earlier observation that the incidence of sporadic bilateral retinoblastoma appeared to be increasing in recent years in the West Midlands Health Authority Region (WMHAR).

Stringent measures were applied to ensure complete ascertainment of all cases of retinoblastoma in children in the region, resulting in a total of 117 cases diagnosed during the period 1960–89 in the WMHAR. Hospital case notes were abstracted and follow‐up data obtained. Incidence rates were calculated.

The overall incidence remained constant over the 30‐year period, but that of sporadic bilateral tumours increased, with a corresponding decline in familial cases. There was a statistically significant excess seen in Asian children.
Preterm delivery and low birthweight among refugees in Greece
Authors: Malamitsi‐Puchner Ariadne , Tzala Lia , Minaretzis Dimitrios , Michalas Stylianos , Aravantinos Denis
Published: April 2008

Summary. Recently Greece received a large number of refugees mainly from Eastern European countries, Middle East, Africa and the Pontus region. Refugee status, implying psychosocial adversities and financial problems, has traditionally been associated with unfavourable pregnancy outcome. This study aimed to compare the incidence of preterm delivery and low birthweight among 638 refugees and 1231 indigenous women giving birth at the same hospital in Athens. Conditional logistic regression was used in the analysis to account for parity and delivery date (matching variables) as well as controlling explicitly for maternal age and gender of the neonate. It was demonstrated that refugee status did not overall influence the occurrence of preterm delivery or low birthweight, thus implying that these two variables are not sensitive or early indicators of the adverse effects of psychosocial stress suffered by refugees.
Contribution of developmental disabilities to childhood mortality in the United States: a multiple‐cause‐of‐death analysis
Authors: Boyle Coleen A. , Decouflé Pierre , Holmgreen Patricia
Published: April 2008

Summary. Although developmental disabilities are among the major chronic health problems affecting children in the United States, the contribution of developmental disabilities to childhood mortality is unknown. To investigate the magnitude of this contribution, multiple cause‐of‐death data were examined for US children, aged 1–19 years, for 1980 and 1983–1989. The following conditions were included as developmental disabilities: autism, attention deficit disorder, learning disorders, mental retardation, cerebral palsy, epilepsy, muscular dystrophy, blindness and deafness. Based on underlying cause only, it was found that developmental disabilities were the fifth leading cause of nontraumatic death for children between 1 and 14 years of age and the third leading cause of non‐traumatic death for children between 15 and 19 years. When a multiple cause approach was used to define developmental disability‐related deaths (i.e. when contributing as well as underlying cause was considered), the number of such deaths nearly doubled. On the basis of both underlying‐ and multiple‐cause analyses, cerebral palsy was the developmental disability most frequently cited as a cause of death. Mental retardation ranked second according to the multiple‐cause approach but only fourth according to the underlying‐cause approach. The least frequent causes of death (autism, attention deficit disorder, learning disorders, blindness, and deafness) were the ones most likely to be coded as contributing rather than underlying causes. Developmental disability‐related mortality rates were highest among children aged 1–4 and 15–19 years, highest among blacks and lowest among racial groups other than blacks and whites, and higher among males than females. Although results of multiple‐cause‐of‐death analyses more accurately reflect the proportion of deaths related to developmental disabilities, even this approach may underestimate the degree to which mortality is associated with a developmental disability.
Past obstetric history and risk of perinatal death in Jamaica
Authors: Greenwood Rosemary , Samms‐Vaughan Maureen , Golding Jean , Ashley Deanna
Published: April 2008

Summary. Singleton survivors born to multigravidae in the whole island of Jamaica in 2 months (September‐October 1986) were compared with singleton perinatal deaths occurring to multigravidae throughout the island in the 12‐month period September 1986 to August 1987. Past obstetric history was obtained from the mothers using a structured questionnaire. Deaths were categorised using the Wigglesworth classification. Logistic regression was used to compare current outcomes in women who had had at least one previous pregnancy.

Antepartum fetal deaths were associated with (1) outcome of last pregnancy; (2) previous Caesarean section; (3) previous stillbirth; and (4) increasing gravidity. In the presence of these factors maternal age ceased to be statistically significant. Deaths from immaturity were strongly associated with the past obstetric history, with increased risks for pregnancies to mothers with a history of previous miscarriage, perinatal death and premature live births. In general, however, the higher the gravidity the lower the risk. In the presence of these factors, maternal age showed no significant association. Intrapartum asphyxia was also associated with the outcome of the last pregnancy, history of prior stillbirth or neonatal death. First pregnancies were at significantly higher risk than second pregnancies (P < 0.05).

For perinatal deaths as a whole, and in the presence of maternal age, the following were statistically significant independent factors: (1) the outcome of the immediately preceding pregnancy (high risks associated with prior miscarriage, stillbirth and premature live births); (2) previous Caesarean section (increased risk); (3) previous perinatal deaths; and (4) more than one prior early fetal loss.

The results indicated that prior poor obstetric history bears similar risks of subsequent adverse outcome in the developing as in the developed world. There was no variation in risk, however, with interpregnancy interval or previous termination. Much of the variation in risk of perinatal death with maternal age among multigravidae appears largely to be secondary to past obstetric history.
The epidemiology of antepartum fetal death in Jamaica
Authors: Greenwood Rosemary , Foster‐Williams Karen , Ashley Deanna , Keeling Jean , Golding Jean
Published: April 2008

Summary. All perinatal deaths occurring over a 12‐month period on the island of Jamaica were classified using the Wigglesworth schema. In all, there were 584 antepartum fetal deaths (incidence 10.7 per 1000 total births).

Comparison of the 558 singleton deaths with 9919 singleton survivors revealed, using logistic regression, strong associations with union (marital) status, maternal employment status, the composition of the household, the sole use of a toilet by the household, the parish of residence, whether the mother was trying to get pregnant and the mother's age (the older the mother the higher the risk). Independent of these factors were strong statistically significant relationships with syphilis, diabetes, maternal anaemia, third‐trimester bleeding, highest diastolic blood pressure of 90mm or more and highest proteinuria of ++ or more. Mothers who had taken prophylactic iron were at substantially lower risk compared with those who had not. We conclude that appropriate identification and treatment of syphilis, diabetes, anaemia and hypertension give the best chance of reduction of the high antepartum fetal death rate on the island.
Perinatal deaths as a result of immaturity in Jamaica
Authors: McCaw‐Binns Affette , Greenwood Rosemary , Coard Kathleen , Ashley Deanna , Golding Jean
Published: April 2008

Summary. During the 12‐month period from 1 September 1986 to 31 August 1987 an attempt was made to collect information on all perinatal deaths occurring on the island of Jamaica. Of the 2069 late fetal and early neonatal deaths identified, 19% fell into the Wigglesworth1 definition of ‘deaths from immaturity’. Twins were 11 times more likely to die of immaturity than were singletons, and twins comprised 18% of all deaths in this group.

Comparison of the singleton deaths from immaturity, with 9919 singletons born on the island during the 2‐month period of September and October 1987 and who survived the first 7 days, revealed several strong risk factors. These included history of previous miscarriages, stillbirth, early neonatal death or preterm delivery, and complications of bleeding and hypertension (highest diastolic, proteinuria and eclampsia all having independent associations). None of these factors ‘explained’ a strong negative relationship with the number of young children in the household. There was an apparent protective effect of maternal folic acid ingestion which warrants further investigation.
A multicentre study of perinatal mortality in Nepal
Authors: Geetha T. , Chenoy Rashna , Stevens D. , Johanson R. B.
Published: April 2008

Summary. A prospective survey was carried out in two Kathmandu hospitals and two rural districts to establish urban and rural perinatal mortality rates (PNMRs) for these four centres in Nepal and to ascertain the causes of perinatal mortality. All perinatal deaths occurring over a 1‐year period in the four centres were included (during which time there was a total of 14 967 births). Cause of death was established by contemporary review of hospital case records or by structured questionnaire (‘verbal autopsy’) in the rural areas. The PNMRs in the hospitals were 48.0 and 23.7 per thousand total births respectively, whilst those of the rural settings were 96.2 and 42.5 per thousand births. Perinatal asphyxia, low birthweight and infection were the most common causes but many of the deaths were unexplained. The high mortality rates were felt to reflect the difficult circumstances of childbirth in Nepal. It was concluded that a number of interventions would appear appropriate, but that these should be introduced in a scientific manner.
Determination of intra‐ and inter‐individual variability and its effect on the number of days required to assess the usual intake of a 1‐year‐old infant population
Authors: Bellù R. , Ortisi M. T. , Riva E. , Giovannini M.
Published: April 2008

Summary. Diet variability influences the accuracy of the assessment of the relationship between nutrient intake and disease. The present study investigates intra‐ and inter‐individual variability in an infant population at 12 months. The mothers of 79 infants completed a 7‐day weighted food record. No significant difference in nutrient intake was observed between males and females. For some nutrients an intra‐/inter‐individual variability ratio < 1 was found. Adjustment for total calorie intake slightly altered the intra‐/inter‐individual variability ratio of many nutrients. An error margin of 10% or less for calories can be expected within an 18‐day study. Most nutrients however would need to be studied for over 30 days to give an error margin ≤10%. For dietary cholesterol, vitamins A, B6, C, and E, bracketing the error within the 10% margin would require an unrealistic time frame. Adjustments for calorie intake reduced the number of days in the dietary record for some nutrients. A lower intra/inter‐individual variability ratio was seen when data for adults and older infants were compared.
Childhood neurological disorders in twins
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: April 2008

Summary. In order to examine neurological outcome in twins, a multicentre prospective cohort study of infants was used. Women entered at the first prenatal visit, with follow‐up of offspring to the age of 7 years. Outcome measures were death, cerebral palsy, seizure disorders including neonatal, febrile or nonfebrile, and intelligence quotient. Among a total of 52364 livebirths, there were 1079 twins. Overall, rates of fetal or neonatal death and cerebral palsy were higher in twins. Neonatal and febrile seizures occurred with similar frequency in twins as in singletons. Although twins were much more likely than singletons to be low in birthweight, twins < 2500 g were not at higher risk for cerebral palsy than low birthweight singletons. The risk of cerebral palsy and of nonfebrile seizure disorders was similar in monozygous and dizygous pairs, and in like‐sex and unlike‐sex pairs. Death of one twin was associated with higher rates of cerebral palsy and of nonfebrile seizure disorders in survivors, but not with lowered intelligence. Data from this cohort suggest that low birthweight and survival status of the co‐twin are dominant predictors of childhood neurological morbidity in twins.
Assessing the contribution of birth asphyxia to cerebral palsy in term singletons
Authors: Yudkin Patricia L. , Johnsont Ann , Clover Linda M. , Murphy Karl W.
Published: April 2008

Summary. In a geographically‐based study, we investigated the risk of cerebral palsy following intrapartum asphyxia at term, and the contribution of intrapartum asphyxia at term to the overall rate of cerebral palsy. We used stringent criteria for identifying intrapartum asphyxia, while recognising that the initial hypoxial insult might have occurred in the antenatal period.

In the first part of the investigation, a cohort of 160 term, singleton infants, with a low (≤ 3) 1‐minute Apgar score, was followed to the age of 5 years. Six infants in the cohort had presumed intrapartum asphyxia, of whom two died in the neonatal period, three had spastic quadriparesis, profound developmental delay and visual impairment, and one was unimpaired. The frequency of cerebral palsy associated with birth asphyxia was estimated as one in 3700 full‐term livebirths.

To assess the impact of birth asphyxia on the overall rate of cerebral palsy, all cases of cerebral palsy born in the study period were identified. Of the 30 cases, the three identified in the follow‐up study were the only ones whose impairment could be attributed to birth asphyxia in a full‐term birth. Birth asphyxia at term therefore was associated with 10% [95% confidence interval (CI) 2.1,26.5] of all cases of cerebral palsy and with 20% (95% CI 4.3,48.1) of the 15 cases of cerebral palsy in children born at term.
Achieving equal probability of selection under various random sampling strategies
Authors: Peters Tim J. , Eachus Jenny I.
Published: April 2008

Summary. The underlying objective of epidemiological investigations is to extrapolate results from a sample to the relevant population. The simplest way of achieving this is to adopt a sampling strategy in which each individual in the population has the same chance of being selected ‐that is, to employ an ‘equal probability of selection method’ (epsem). The easiest ways of achieving this are to use simple random sampling or stratified random sampling with a constant sampling fraction. These strategies are often impracticable, however, particularly in large investigations covering a wide geographical area where resource implications dictate a more complex approach such as multi‐stage or cluster sampling. Following detailed definitions and appropriate illustrations of these terms, the main purpose of this paper is to provide a working guide of how to achieve epsem using these various random sampling techniques. In brief, for multi‐stage sampling with the rare feature of equal‐sized first stage units, epsem is achieved by applying the above simple or stratified approaches to the first stage units. Even in the more realistic scenario of unequal first stage units, the same options apply provided that a fixed proportion of second stage units are to be selected (cluster sampling is in fact just one example of this, with 100% sampling of second stage units). If on the other hand a fixed number of second stage units are to be selected then for epsem the first stage units should be selected with each one having a probability proportionate to its size.
The intergenerational relationship between mother's birthweight, infant birthweight and infant mortality in black and white mothers
Authors: Sanderson Maureen , Emanuel Irvin , Holt Victoria L.
Published: April 2008

Summary. The relationship between the birthweight of white and black mothers and the outcomes of their infants were examined using the 1988 National Maternal and Infant Health Survey. White and black women who were low birthweight themselves were at increased risk of delivering very low birthweight (VLBW), moderately low birthweight (MLBW), extremely preterm and small size for gestational age (SGA) infants. Adjustment for the confounding effects of prepregnant weight and height reduced the risks of all these outcomes slightly, and more substantially reduced the maternal birthweight associated risk of moderately low birthweight among white mothers. There was little effect of maternal birthweight on infant birthweight‐specific infant mortality in white mothers; however, black mothers who weighed less than 4 lbs at birth were at significantly increased risk of delivering a normal birthweight infant who subsequently died. Although the risks for the various outcomes associated with low maternal birthweight were not consistently higher in black mothers compared with white mothers, adjustment for prepregnant weight and height had a greater effect in white mothers than in black mothers. We suggest that interventions to reduce the risks for adverse pregnancy outcomes associated with low maternal birthweight should attempt to optimise prepregnant weight and foster child health and growth.
Fumes from the spleen
Authors: de Tocqueville Alexis
Published: April 2008

Human institutions are so imperfect by their nature that in order to destroy them it is almost always enough to extend their underlying ideas to the extreme.
Risk factors for cryptorchidism: a nested case‐control study
Authors: Berkowitz Gertrud S. , Lapinski Robert H.
Published: April 2008

Summary. .A nested case‐control study of cryptorchidism (i.e. undescended testicles) was undertaken as part of a hospital‐based cohort study of 6699 singleton male neonates in New York City. Since some of the cryptorchid infants experienced spontaneous descent of their testes, separate analysis was performed for this third group of late descenders' (n= 140). Cases (n= 63) represented infants whose testes remained undescended at the one year assessment. Controls (n=219) represented the next male infant who was delivered immediately after an infant who was cryptorchid at birth. The only independent risk factors for cryptorchidism were Asian ethnic group (adjusted odds ratio (OR) = 3.90,95% confidence interval (CI) = 1.22‐12.41), swollen legs or feet during pregnancy (adjusted OR=2.16, 95% CI = 1.15‐4.04), a family history of cryptorchidism (adjusted OR=4.32, 95% CI = 1.91‐9.80), low birthweight (adjusted OR = 4.10, 95% CI = 1.39‐12.08), and use of analgesics during pregnancy (adjusted OR = 1.93/95% CI = 1.03‐3.62). Multiple logistic regression analysis was also performed to identify those factors that were associated with late testicular descent. In this analysis the independent risk factors were black or Hispanic ethnicity (adjusted OR = 2.05, 95% CI = 1.09‐3.83), a family history of cryptorchidism (adjusted OR = 4.25,95% CI = 1.84‐9.78), consumption of cola‐containing drinks during the pregnancy (adjusted OR = 2.09, 95% CI = 1.10‐3.99), a low birthweight delivery (adjusted OR = 9.78, 95% CI = 3.39‐28.20), and preterm birth (adjusted OR = 4.01, 95% CI = 1.66‐9.70).
Congenital malformations in newborns of women with established and gestational diabetes in Washington State, 1984–91
Authors: Janssen Patricia A. , Rothman Ivan , Schwartz Stephen M.
Published: April 2008

Summary. We examined the relationship between diabetes in pregnancy and the development of congenital malformations, in a population‐based retrospective study using birth certificate data for all livebom children delivered from 1984 until 1991 in Washington State. Births to mothers with established and gestational diabetes numbered 1511 and 8869 respectively. For comparison we selected 8934 births to mothers without diabetes. The prevalence of congenital malformations in neonates was 7.2%, 2.8% and 2.1% among mothers with established diabetes, gestational diabetes, and without diabetes, respectively. Newborns of mothers with established diabetes were more likely to have a congenital malformation than newborns of non‐diabetic mothers (prevalence odds ratio = 4.0; 95% confidence interval 3.1–5.1). In contrast, there was only a slightly higher prevalence of congenital malformations among newborns of mothers with gestational diabetes (prevalence odds ratio = 1.3; 95% CI 1.0–1.6). The association with maternal established diabetes was greater for neonates with multiple malformations (7.8; 95% CI 3.3–18.1) than for single malformations (2.9–95% CI 2.1–3.9). Four to seven fold associations were observed with skeletal, cleft lip/palate, neural tube and heart abnormalities. The association of established diabetes with congenital malformations was nearly twice as strong among female neonates (prevalence odds ratio = 5.4; 95% CI 3.7–8.0) than among male neonates (prevalence odds ratio = 3.1; 95% CI 2.2–4.5). No such variation was observed for associations with gestational diabetes. This study enlarges on previous work relating congenital anomalies to established diabetes and supports the possibility of a weak association with gestational diabetes.
Energy and macronutrient intake of one‐year‐old South African urban children: The Birth to Ten (BTT) Study
Authors: MacKeown J. M. , Cleaton‐Jones P. E. , Perdraut G. G.
Published: April 2008

Summary.With the changing situation in South Africa, new, reliable, longitudinal nutritional information on young children is needed. Part of the objective of the Birth to Ten (BTT) Study (1990–2000) in the Soweto‐Johannesburg area, is to assess the nutrient intake of children. For each of the 2059 one‐year‐old children mean nutrient intake was determined using food frequency intakes, determined through interviewing parents or guardians. Urban ‘coloured’ children had the highest daily intake of all the macronutrients, energy being significantly higher than the other groups. Urban black children had the lowest macronutrient intake and energy was significantly lower than that of white children. All groups consumed a typical westernised diet, low in unrefined carbohydrate (47–49% of energy), but high in protein (200% of Recommended Dietary Allowances (RDA)) and fat (38–40% of energy). Among the ‘black’, ‘coloured’ and ‘white’ clinics a difference of approximately 300 kcal/day was noted between the highest and the lowest energy intakes, Pimville and Mofolo showing significantly higher differences among the ‘black’ clinics. Among the ‘coloured’ clinics Westbury had a significantly higher energy intake than Eldorado Park. Results have indicated that one‐year‐old ‘coloured’ and white children had adequate nutrient intakes, but black and Indian had inadequate energy intakes based on RDA and excluding the contribution of breast milk.
Reproductive risk factors for epilepsy among ten‐year‐old children in metropolitan Atlanta
Authors: Kuenneth Christina A. , Boyle Coleen , Murphy Catherine C. , Yeargin‐Allsopp Marshalyn
Published: April 2008

Summary. .The elements of a woman's reproductive history that may be associated with her risk of having a child who develops epilepsy have not been well described. To examine these possible associations, we used a multiple‐source case ascertainment method to identify ten‐year‐old children with epilepsy who were living in the metropolitan Atlanta area in 1985‐87; same‐age control children were selected from public schools. To obtain reproductive history and other information, we interviewed 107 mothers of children with epilepsy and 408 mothers of control children. Twenty‐nine children with a known intrauterine or postnatal aetiology were excluded from the analysis. We computed adjusted odds ratios for reproductive history characteristics, controlling for the race of the child, maternal education, census block group income, maternal pregnancy history and family history of a developmental disability. Our analyses indicated that mothers of children with epilepsy not only had more previous live births, but more previous adverse reproductive outcomes including spontaneous abortions, very low birthweight infants and infants with birth defects. The risk was especially strong for maternal history of a child with a birth defect. The specific types of birth defects reported in excess include central nervous system defects (specifically spina bifida) and Down's syndrome.
Cocaine and cigarettes: a comparison of risks
Authors: Kistin Naomi , Handler Arden , Davis Faith , Ferre Cynthia
Published: April 2008

Summary. In order to provide additional data and perspective to current clinical, policy, and legal debates surrounding the prenatal use of cocaine in the USA, a retrospective cohort study was conducted to examine effects of cocaine on selected perinatal outcomes, and to compare the relative risks of adverse perinatal outcomes among users of cocaine and users of cigarettes. Using data from a large urban perinatal registry, relative risks of selected perinatal outcomes were determined for maternal cocaine users who were non‐smokers of cigarettes, and used no marijuana, heroin, amphetamines, or alcohol (n= 64), and for cigarette smokers who do not use illicit drugs or alcohol during pregnancy (n= 3209). When compared with women with no recorded prenatal exposure to drugs or cigarettes (n= 13043), cocaine users had higher risks than smokers for the following adverse outcomes: low birthweight [Relative Risk (RR) 5.3, 95% Confidence Interval (CI) 3.0–9.3], small‐for‐ges‐tational age (SGA) [RR4.2, 95% CI 2.4–7.3], prematurity [RR4.0, 95% CI 2.3–7.0], abruptio placentae [RR = 10.0,95% CI 3.5–29.0], placenta prae‐via [RR = 2.4, 95% CI 0.3–17.8] and perinatal death [RR = 5.3, 95% CI 1.9–15.2]. Smokers who did not use any drugs experienced most of the same adverse perinatal outcomes as cocaine users, but the magnitude of risk was greater in cocaine users than in smokers for all outcomes. However, given the greater numbers of cigarette smokers than cocaine users in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cigarette smokers. The data support current concern about the risk of cocaine, and current efforts to provide treatment to pregnant cocaine users. The data also underline the continued substantial risks of cigarette smoking to large numbers of pregnant women.
Changes in depression during and following pregnancy
Authors: Fergusson David M. , Horwood L. John , Thorpe Karen
Published: April 2008

Summary. .Rates of depression were studied in a sample of over 9000 women who were participants in the Avon Longitudinal Study of Pregnancy and Childhood. Assessments of depression were made at 18 and 32 weeks gestation, and at 8 and 32 weeks postpartum. Changes in depressive status across time were modelled using latent Markov modelling methods. This analysis showed that when classification errors were taken into account there was relatively high stability in diagnostic status during pregnancy and after pregnancy. However, the transition from late pregnancy to the early postnatal period showed evidence of increased instability and remission of depression. The net effects of this were that rates of depression tended to decline following childbirth. The implications of these results for a series of issues including measurement errors in depression reports and the prevalence of depression before and after childbirth are discussed.
Sudden infant death syndrome in Australian Aboriginal and non‐Aboriginal infants: an analytical comparison
Authors: Alessandri Louisa M. , Read Anne W. , Burton Paul R. , Stanley Fiona J.
Published: April 2008

Summary. Our previous research has shown that the sudden infant death syndrome (SIDS) rate for Aboriginal infants in Western Australia (WA) is markedly higher than that for non‐Aboriginal infants. The aim of this study was to identify factors that may be important in explaining this disparity. A case‐control study was conducted based on routinely collected data for the population of WA singleton births from 1980 to 1990 inclusive. Cases were infants bom and classified as dying from SIDS in WA (Aboriginal n = 88; non‐Aboriginal n = 409). Controls were infants born in WA and not classified as dying from SIDS; 2% samples of both Aboriginal and non‐Aboriginal infants were included. The risk of dying from SIDS in Aboriginal infants was 3.86 times [95% confidence interval (CI) = 2.98 to 5.02] that in non‐Aboriginal infants. Statistically significant univariable risk factors for SIDS in Aboriginal infants were preterm birth, low birthweight and small‐for‐gestarional‐age; for non‐Aboriginal infants they included these factors as well as single marital status, young maternal age, parity of one or greater and male sex. Comparing Aboriginal with non‐Aboriginal controls, most of the risk factors were more common in the Aboriginal population. Multiple logistic regression analysis indicated that Aboriginal infants were 1.43 times [95% CI = 1.04 to 1.95] more likely to die from SIDS than non‐Aboriginal infants. Differences in the risk factor profile for Aboriginal and non‐Aboriginal infants were sought using interaction terms. The only important differences were that the risk of SIDS in Aboriginal infants, unlike that in non‐Aboriginal infants, appeared not to be strongly related to male sex or to single marital status. Thus, the results show that the disparity between the incidence of SIDS in the Aboriginal and non‐Aboriginal populations can be explained largely, although not totally, by the high prevalence of routinely recorded risk factors in the Aboriginal population. A limitation of this study is that data on the postnatal nsk factors of prone sleeping, maternal smoking and non‐breastfeeding were unavailable. The residual excess risk for Aboriginal infants may be a result of these recognised postnatal risk factors and /or other infant care practices that are not routinely recorded in our data base, or to underlying social and economic conditions. Further study of all these potential risk factors is warranted.
Increasing incidence of childhood cancer: report of 20 years experience from the Greater Delaware Valley Pediatric Tumor Registry
Authors: Bunin Greta R. , Feuer Eric J. , Witmar Philip A. , Meadows Anna T.
Published: April 2008

Summary. As little is known about the aetiology of cancer in children, analysis of time trends may be useful. Recent data on time trends for paediatric cancers are very limited. We report here on trends in the incidence of 15 categories of cancer in children under 15 years of age from 1970 to 1989, using data from the Greater Delaware Valley Pediatric Tumor Registry in the US. Total cancer incidence increased 1% per year (P > 0.001). Neither acute lymphocytic leukaemia, acute myelocytic leukaemia, nor total leukaemia incidence changed significantly. In contrast, the incidence of central nervous system (CNS) tumours rose 2.7% per year (P> 0.001). All three subgroups of this category, glioma, primitive neuroectodermal tumour (PNET)/medulloblastoma, and other CNS tumours, showed increases. For glioma and PNET/medulloblastoma, trends differed by age, race, and/or gender. Among the other childhood cancers, significant increases were observed for non‐Hodgkin lymphoma and neuroblastoma. For osteosarcoma and retinoblastoma, no overall change in incidence was observed, although decreases were observed in some age and race subgroups. The rise in CNS tumour incidence confirms previous reports from the US and Great Britain. The lack of change for acute lymphocytic leukaemia conflicts with other data from the US, but diagnostic changes appear to explain at least part of the discrepancy. The increase in neuroblastoma has also been observed in Great Britain. In contrast to our finding, investigators in the US and Great Britain have reported no rise in non‐Hodgkin lymphoma. Analyses for more of the childhood cancers from other registries would aid in detecting and interpreting incidence trends in recent years.
The presence of DRB1*01 allele in multiple myeloma patients is associated with an indolent disease
Authors: Alcoceba M. , Marín L. , Balanzategui A. , Sarasquete M. E. , Martín‐Jiménez P. , Chillón M. C. , Corral R. , Pérez‐Persona E. , Fernández‐Calvo F. J. , Hernández J. M. , Bladé J. , Lahuerta J. J. , González M. , San Miguel J. F. , García‐Sanz R.
Published: April 2008

The human leukocyte antigen (HLA) system could play an essential role in multiple myeloma (MM) disease control. This report describes the results comparing HLA‐DRB1 phenotypic frequencies in 181 MM patients (53 smoldering/indolent MM and 128 symptomatic MM patients) and healthy individuals. Higher DRB1*01 phenotypic frequencies were found in the smoldering patients compared with symptomatic MM patients (38% vs 14%, P = 0.001) and with the healthy individuals (38% vs 22%, P = 0.01). Additionally, higher DRB1*07 phenotypic frequencies were found in symptomatic MM compared with control population (38% vs 28%, P = 0.01). The present data suggest that HLA‐DRB1*01 individuals may have a better ability to efficiently present myeloma‐related antigens to immunocompetent cells, which could favor a better immune response against the tumor. This would translate into a more appropriate disease control associated with more indolent disease and prolonged survival.
Recurrent pancreatitis after renal transplantation in a child
Authors: Cho Min Hyun , Hong Eun Hui , Lee Hwan Seok , Ko Cheol Woo
Published: April 2008

Abstract:  A five‐yr‐old girl, who was a renal transplant recipient, presented with nausea, vomiting, epigastric discomfort, papules, and vesicles on her body. She was diagnosed with acute pancreatitis and varicella zoster infection because her serum amylase and lipase levels were positive. Fourteen months later, she was readmitted with nausea, vomiting, and epigastric pain similar to the previous symptoms and was diagnosed with acute pancreatitis. This case report indicates that acute pancreatitis can be one of a number of complications following pediatric renal transplantation and can recur because of various causes.
Chronic high Epstein‐Barr viral load carriage in pediatric liver transplant recipients
Authors: Green Michael , Soltys Kyle , Rowe David T. , Webber Steven A. , Mazareigos George
Published: April 2008

Abstract:  Development of EBV disease and PTLD is usually accompanied by the detection of a high EBV load in peripheral blood. However, many children undergoing primary EBV infection following LTx will maintain chronically elevated EBV loads in the absence of clinical symptoms. To better understand this phenomenon, we retrospectively reviewed the records of children undergoing LTx at our center from 1997 to 2007 to identify chronic high EBV load carriers in this population. A CHL state was defined by the presence of a high load for >50% of samples for greater than or equal to six months following either asymptomatic or complete clinical resolution of EBV disease/PTLD. A total of 35 CHL carriers were identified. Pretransplant serologies were available for 29 of the 35; 22/29 (76%) were EBV negative prior to LTx; eight of these 22 developed their CHL state at the time of their primary EBV infection. Fourteen of the 35 had EBV disease (n = 7) or PTLD (n = 7) prior to development of the CHL state. Only one of 35 CHL carriers developed PTLD or lymphoma while they were a high load carrier. In all, 23/35 resolved their CHL state without apparent sequelae while 11 children continue to be asymptomatic high load carriers. These data provide important information about the outcome of chronic EBV high load carriage in pediatric liver transplant recipients.
Percutaneous retrograde colangiography of segment III bile duct, through the previously catheterized segment II bile duct, in 15‐month‐old patient after partial liver transplantation with two separate bilio‐enteric anastomoses
Authors: Miraglia Roberto , Maruzzelli Luigi , Caruso Settimo , Spada Marco , Luca Angelo , Gridelli Bruno
Published: April 2008

Abstract:  We report one case of percutaneous retrograde colangiography of segment III bile duct, through the previously catheterized segment II bile duct, in 15‐month‐old patient after partial liver transplantation and two separate biliary anastomoses. The retrograde diagnostic cholangiogram confirmed the suspicion of anastomotic stricture and distended the bile ducts, which were easily punctured with percutaneous approach with a 20 Ga Chiba needle.