bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of silymarin on the resolution of liver fibrosis induced by carbon tetrachloride in rats
Authors: Tsai J. H. , Liu J. Y. , Wu T. T. , Ho P. C. , Huang C. Y. , Shyu J. C. , Hsieh Y. S. , Tsai C. C. , Liu Y. C.
Published: April 2008

Summary.  Silymarin, a standardized extract of the milk thistle (Silybum marianum), has a long tradition as a herbal remedy, and was introduced as a hepatoprotective agent a few years ago. However, the therapeutic effects of silymarin remain undefined. Carbon tetrachloride (CCl4) is a xenobiotic used extensively to induce oxidative stress and is one of the most widely used hepatic toxins for experimental induction of liver fibrosis in the laboratory. In this study, we investigated the restoration of the CCl4‐induced hepatic fibrosis by high dose of silymarin in rats. After treatment with oil (as normal group; n = 6) or CCl4 [as model (n = 7) and therapeutic (n = 7) groups] by intragastric delivery for 8 weeks for the induction of liver fibrosis, the rats in the normal and model group were administered orally normal saline four times a week for 3 weeks whilst the therapeutic group received silymarin (200 mg/kg). The histopathological changes were observed with Masson staining. The results showed that the restoration of the CCl4‐induced damage of liver fibrosis in the therapeutic group was significantly increased as compared to that in the model group. Moreover, silymarin significantly decreased the elevation of aspartate aminotransferase (AST), alanine aminotransferase, and alkaline phosphatase in serum, and also reversed the altered expressions of α‐smooth muscle actin in liver tissue. Therefore, these findings indicated that silymarin may have the potential to increase the resolution of the CCl4‐induced liver fibrosis in rats.
The epidemiology of childhood eczema: II. Statistical analyses to identify independent early predictors
Authors: Peters Tim J. , Golding Jean
Published: April 2008

Summary. Amongst a nationally representative sample of singletons born in one week of April 1970 for whom information was available, 12.3% were reported by their mothers as having developed eczema at some time before their fifth birthday. Data from both the birth and the five‐year follow‐up surveys have been analysed to identify the independent early predictors of this (reported) condition in 11 920 children.

Using an initial set of possible predictors suggested by previous analyses of these data, the dominant risk characteristics have been identified as: a positive maternal history of eczema; a positive maternal history of asthma or hay fever; higher parental educational qualifications and the mother originating from the West Indies or Africa. There were also increased risks for children of mothers born in England (relative to the rest of the United Kingdom) and for children of mothers who used contraceptives in the 18 months prior to the index pregnancy.

There was no protective effect of breast‐feeding even among children whose mothers had a history of allergy.
Is perinatal mortality still a good indicator of perinatal care?
Authors: Field D.J. , Smith Heather , Mason Elizabeth , Milner A.D.
Published: April 2008

Summary

The increasing influence of very immature infants on perinatal mortality rates (PMR) led us to question the usefulness of this parameter in assessing perinatal care. To examine this further we have compared the incidence of perinatal asphyxia amongst mature babies (greater than or equal to 35 weeks gestation) for two geographically‐defined populations of over 500 000 people. Both areas have a teaching hospital‐based maternity service and comparable perinatal mortality rates. The incidence of severe post‐asphyxia1 encephalopathy showed a marked excess in one population (1.93 vs 0.61 per 1000 births), which was not obviously explicable. Taken in conjunction with the figures for stillbirth in labour, this represented a 2.8 times greater risk for either fetal death in labour or severe asphyxia1 insult. It would appear that perinatal mortality rates do not accurately reflect important differences in those perinatal outcomes most likely to be affected by perinatal care.
The Christchurch Child Development Study: a review of epidemiological findings
Authors: Fergusson D.M. , Horwood L.J. , Shannon F.T. , Lawton J.M.
Published: April 2008

The Christchurch Child Development Study is a longitudinal study of a birth cohort of 1265 New Zealand children who have been studied over an 11‐year period using data from multiple sources including parental interview, medical records, teacher questionnaires and direct testing of children. The article provides a review of the major lines of epidemiological research examined in the Study. These include: breast feeding and child health; parental smoking and child health; the effects of low level lead exposure; childhood asthma; nocturnal bladder control; the effects of early hospital admission; the distribution of child health services; and the consequences of private medical insurance. In addition a number of general topics (sample attrition, measurement error, individual differences and causal inference) relating to longitudinal designs are discussed briefly. It is concluded that the longitudinal design is a powerful and cost‐effective method of gathering data for general paediatric epidemiological purposes but that research in this area would benefit from an increased use of emerging methods of statistical modelling.
Acute abdominal pain and appendicitis in north east Thailand
Authors: Chatbanchai W. , Hedley A.J. , Ebrahim S.B.J. , Areemit S. , Hoskyns E.W. , de Dombal F.T.
Published: April 2008

Summary. In a survey of emergency admissions to hospital in rural Thailand, acute appendicitis was the commonest cause of acute abdominal pain. Estimates of the incidence of appendicitis, in two series comprising a total of 356 patients, at 3.2 and 3.7 per 10000 population per year, were relatively high compared with reports from other warm climate countries. In comparison with 1825 cases in studies sponsored by the Organisation Mondiale de Gastroenterologie (OMGE), Thai patients with acute appendicitis were older, presented late and experienced more complications than those in 14 other countries. In Khon Kaen only 2–3% of the cases were children aged 0–9 years, compared with 9–26% in the OMGE series. In patients admitted to hospital with acute abdominal pain in Thailand, acute appendicitis was diagnosed more often than non‐specific abdominal pain. The converse was true in the OMGE series. This may reflect the longer distances travelled to hospital by many patients and delays between onset of symptoms and admission to hospital. Acute appendicitis was the commonest definitive diagnosis in both series.

This survey indicates that relatively high rates of acute appendicitis may occur in populations eating traditional diets. The results are consistent with the recently described hypothesis of an infective aetiology and increases in appendicitis rates may be expected in people born since the introduction of improvements in environmental sanitation. Further studies are needed to examine trends in the incidence of appendicitis in populations eating traditional diets with both high and low fibre content and to investigate the significance of changing social and environmental factors.
The social origins of Perthes' disease of the hip
Authors: Hall A.J. , Barker D.J.P. , Lawton D.
Published: April 2008

Summary. Four hundred and ninety‐two children with Perthes' disease of the hip were identified from the records of the Family Fund which gives financial help to families of disabled children. Their social circumstances were compared with those of other children referred to the Fund. The relative risk of Perthes' disease increased with lower social class, living in a council house, parental unemployment and a larger sibship size. These findings support other evidence that the disease is caused by dietary deficiencies acting in the prenatal or early postnatal period. The Family Fund may be a useful source of information for paediatric epidemiology in Britain.
Sudden unexplained infant deaths among American Indians and Whites in North and South Dakota
Authors: Oyen Nina , Bulterys Marc , Welty Thomas K. , Kraus Jess F.
Published: April 2008

Summary. Differences in risk factors for sudden unexplained infant death (SUID) were studied among American Indian and White infants in North and South Dakota. From 1977 to 1984, the incidence of SUID was 3.9 times higher among Indians compared with Whites. Indian SUID cases appeared to die at a slightly younger age than Whites, and the association of male gender and young maternal age with SUID was weak or absent among Indians. Low maternal education and late or no prenatal care were strongly related to SUID in both races. The Indian‐White risk ratio was unaltered by adjustment for birthweight and maternal age but declined to 2.5 (95% confidence intervals = 1.9, 3.4) when adjusted for maternal education and trimester prenatal care began.
Using logistic regression in perinatal epidemiology: an introduction for clinical researchers. Part 2: the logistic regression equation
Authors: Brand R.
Published: April 2008

Summary. In Part 1 basic concepts were introduced as a preparation for an introductory explanation of logistic regression. Logistic regression is a statistical modelling technique, designed for the estimation of the simultaneous effects of predictors on the risk of a certain dichotomous outcome variable where each effect is estimated while adjusting for the effect of the other factors considered. The basic concepts ‐ odds, odds ratio, confounding and interaction ‐ were introduced in such a way that they naturally lead to the concept of logistic regression. In Part 2 the concepts are translated into simple equations. By studying these equations the equivalence between such mathematical expressions and the underlying clinical assessment of risk will become clear.
Drinking and smoking at 3 months postpartum by lactation history
Authors: Little Ruth E. , Lambert M. Dow , Worthington‐Roberts Bonnie
Published: April 2008

Summary. A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied.) Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.
Invasive Haemophilus influenzae infections among children in Rochester, Minnesota: a population‐based study
Authors: Guess H.A. , Trippel S.J. , Corder E.H. , Broughton D.D. , Melton L.J.
Published: April 2008

Summary. The incidence of invasive Haemophilus influenzae infections was studied among all residents of Rochester, Minnesota, under 20 years of age during the period 1975–1983. The incidence in children under 5 years of age was 115 and 64 cases per 100 000 children per year for all invasive cases and for meningitis, respectively. These rates are among the highest reported for an essentially all‐Caucasian population in the United States, while the ratio of meningitis to non‐meningitis cases (1.1:1) is among the lowest. This suggests possible under‐ascertainment of non‐meningitis cases in previous US studies of Haemophilus influenzae infections.
Birth to ten: child health in South Africa in the 1990s. Rationale and methods of a birth cohort study
Authors: Yach D. , Cameron N. , Padayachee N. , Wagstaff L. , Richter L. , Fonn S.
Published: April 2008

Summary. Birth to Ten is a longitudinal birth cohort study which began in April 1990 in the Johannesburg/Soweto area of Transvaal, South Africa. In this paper, the reason for the initiation of the study and its location in the current sociopolitical context is discussed. The health status of South African children in terms of infant mortality, morbidity (notifiable diseases) and nutritional status is described and mention is made of measures of psychological health and the importance of environmental pollution on health. The existing health service infrastructure in the study area is described and the fragmentation of health services between races, between preventive and curative services and on a geographical basis is highlighted. The study objectives, design, population, inclusion and exclusion criteria, methods of measurement and logistics are described.
Cohort reconstruction: which infants can be restudied at school age?
Authors: McCormick Marie C. , Baker Judith , Brooks‐Gunn Jeanne , Turner JoAnna , Workman‐Daniels Kathryn , MD George J. Peckham
Published: April 2008

Summary. Longer‐term follow‐up of infants with specific health concerns, such as low birthweight, is critical to assessing the effect of medical interventions. This report examines the approach of reconstructing previously studied cohorts in terms of the factors discriminating between respondents and non‐respondents. Follow‐up was attempted during 1987–1988 for 1875 children born during a 6‐month period in 1978 in three geographically defined regions in the United States, for whom 1‐year assessments of health and developmental status were obtained at 1 year of age as part of a previous study. For a 25% sample, participation involved a clinic visit for developmental assessments; for the remainder an interview by telephone or home visit. Follow‐up was obtained for 72.5% of the cohort. Refusal rates were low (7%); most non‐response was due to an inability to locate the families. Predictors of non‐response reflected primarily low socio‐economic status; completion rates were not influenced by mode of assessment. The role of a tracing agency is discussed. We conclude that cohort reconstruction is feasible with response rates comparable to some prospective studies with ongoing cohort maintenance.
The Bedouin Infant Feeding Study: study design and factors influencing the duration of breast feeding
Authors: Naggan Lechaim , Forman Michele R. , Sarov Batia , Lewando‐Hundt Gillian , Zangwill Linda , Chang David , Berendes Heinz W.
Published: April 2008

Summary. A longitudinal study of infant feeding practices, growth and morbidity among Bedouin Arab infants residing in the Negev, Israel, was conducted during a 3‐year period (1981–1983). Follow‐up samples were restricted to healthy newborns. The majority of newborns are breast fed at birth but, by 2 months, 50% are also introduced to a milk supplement. Based on the bivariate analysis using the logrank test to examine the factors associated with exclusive versus partial breast feeding during the first 6 months, those born during the wet cool months are exclusively breast fed longer than those born during the dry season. More traditional women, living in tents rather than houses or huts, exclusively breast feed for at least 6 months. In a multiple logistic regression model, parity, house type and birth season are independently associated with the odds of exclusively breast feeding for the first 6 months of life. Factors influencing the duration of any breast feeding for the first 18 months include: house type, place of residence, birthweight, and whether the infant was stunted at 6 months.
Sudden infant death syndrome and weather temperature
Authors: Mitchell E.A. , Stewart A.W. , Cowan S.F.
Published: April 2008

Summary. The relationship between the days on which sudden infant death syndrome (SIDS) occurred and the daily minimum temperature was examined in Auckland (1979–1984) and Christchurch (1979–1987). There was a marked winter excess of deaths in both regions. There was a significant negative correlation between the monthly mean minimum temperature and SIDS rate for both regions (r= ‐ 0.43, n= 347, P < 0.0001). The monthly mean minimum temperature describes SIDS mortality equally as well as the three variables of daily minimum temperature, season and geographical location. There was a significant association of SIDS with minimum temperature 4 and 5 days prior to the death after adjusting for the effect of monthly mean minimum temperature. The days preceding death were on average colder than the other days, but the effect was small, especially when compared with the magnitude of the temperature differences between consecutive months.
Perinatal deaths: relevance of Wigglesworth's classification
Authors: Raghuveer Geetha
Published: April 2008

Summary. Out of a total of 4572 births over a period of 16 months occurring at St Philomena's Hospital, Bangalore, India, which has level II nursery facilities, there were 196 perinatal deaths. Perinatal mortality was 42.9/1000 total births. Case fatality rate was 12.4% for those born with a birthweight between 1501 to 2000 g, 35.5% for those between 1001 to 1500 g and 100% for those less than 1001 g. These deaths were grouped according to Wigglesworth's classification: 20% were due to prematurity and 24% to birth asphyxia. These two categories contributed to almost half of the perinatal deaths. Classification of perinatal deaths using Wigglesworth's classification appeared to be a practical and problemoriented system. It also carried clear implications for improving perinatal care. The adoption of this method of classification by all major hospitals is recommended so that easy comparisons can be drawn over time and between different centres.
The epidemiology of electric and magnetic field exposures in the power frequency range and reproductive outcomes
Authors: Hatch Maureen
Published: April 2008

Summary. Some laboratory studies have reported effects of extremely low frequency electric and magnetic fields on calcium homeostasis and pineal gland function which potentially could have consequences for reproductive health. The purpose of this review is to report results of research to date in humans on maternal, paternal and fetal exposure to the 50–60 Hz fields associated with electricity, and to propose populations, endpoints and strategies for future research.
Trisomy and age at menopause: predicted associations given a link with rate of oocyte atresia
Authors: Kline Jennie , Levin Bruce
Published: April 2008

Summary. The association of trisomy with advancing maternal chronological age suggests that some aspect of physiological ageing is accelerated in women with trisomic pregnancies. This paper develops a quantitative theoretical model based on the hypothesis that trisomy risk is primarily a function of the size of the oocyte pool and, in particular, that risk is increased in women with accelerated rates of oocyte atresia and hence smaller pools at given chronological ages. Since the rate of oocyte atresia is a determinant of age at menopause, this hypothesis leads to the prediction that women who have had trisomic pregnancies reach menopause earlier than women who have not. We used data relating chronological age to oocyte number, trisomy and menopause to deduce the distribution of oocyte atresia rates in all women and in women with trisomic pregnancies. Given certain simplifying assumptions, we predict that associations between trisomy and age at menopause will vary with a woman's age at the time of trisomy such that trisomies at 34–43 years will be associated with a 1–3.4 year earlier onset of menopause, while trisomies at younger or older ages will have no or little association with age at menopause. This model, while vulnerable to the uncertainties that attend its assumptions, provides a testable prediction that permits separation of one aspect of physiological age from chronological age.
The California Cerebral Palsy Project
Authors: Grether Judith K. , Cummins Susan K. , Nelson Karin B.
Published: April 2008

Summary. The California Cerebral Palsy Project (CACP) is a population‐based study of 192 children with moderate or severe congenital cerebral palsy who were born between 1983 and 1985 in four San Francisco Bay area counties and who were alive and residing in California at age 3 years. Initial ascertainment of cases was based on records of two agencies known to enrol virtually all CACP‐eligible children. Final case status was established by standardised clinical examination in 67% of cases and extensive record review in 33%. The 192 cases gave a prevalence at age 3 of 1.23/1000 survivors. Twins were 10% of the cases with a prevalence of 6.7/1000. Overall, 53% of the cases had birthweight ≥ 2500 g and 28% had birthweight <1500g. There was no association between birthweight and severity of functional impairment and no consistent association between birthweight and the presence of associated disabilities. The CACP prevalence is lower than that reported in other studies and is believed to be due to the more stringent case inclusion criteria employed for this research data base.
Standardised method of follow‐up assessment of preterm infants at the age of 5 years: use of the WHO classification of impairments, disabilities and handicaps: Report from the collaborative Project On Preterm and Small for gestational age infants (POPS) in The Netherlands, 1983
Authors: Schreuder Anneke M. , Veen Sylvia , Ens‐Dokkum Martina H. , Verloove‐Vanhorick S. Pauline , Brand Ronald , Ruys Jan H.
Published: April 2008

Summary. A nationwide, prospective study was initiated in The Netherlands in 1983, involving 1338 liveborn infants with a gestational age <32 weeks and/or a birthweight <1500g. Pre‐ and perinatal data, methods and results of follow‐up until the corrected age of 2 years have been published previously. In this paper, methods of follow‐up at the age of 5 years are described. At that age, 966 children were alive, of which 927 (96%) were assessed during a home visit 2 to 6 weeks after their fifth birthday by three specially trained paediatricians. A questionnaire served to collect data on medical history, respiratory function, behaviour and socio‐economic factors. Standardised tests were carried out covering the following 10 areas: congenital malformations, neuromotor function, mental development, hearing, visual function, language and speech development, behaviour, musculoskeletal system, respiratory tract and ENT problems, and growth. The outcome was recorded for separate areas and for the child as a whole using the WHO classification of impairments, disabilities and handicaps.
Caesarean section rates in an African country
Authors: Muylder Xavier De , Amy Jean‐Jacques
Published: April 2008

Summary. The use of caesarean section (C.S.) has been analysed in the 12 hospitals of the Midlands Province of Zimbabwe during a 2‐year period. Maternal mortality rate, perinatal mortality rate, low birthweight rate, percentage of high risk pregnancy, C.S. rate and instrumental delivery rate have been extracted for each hospital. The rate of C.S. delivery varied between 2.2 and 16.8 per 100 deliveries but was not correlated with the number of high‐risk pregnancies. Increased use of C.S. was not linked to better perinatal results. An important determinant of the C.S. rate appears to be the physician and the ratio between the rate of instrumental deliveries (ID) and C.S. differentiated the 12 hospitals into two groups. Although there was no difference in the number of high risk patients in these two groups, outcomes were much better in the hospitals with a high ID rate than in the hospitals with a high C.S. rate, suggesting that attitudes of medical staff can influence both the mode of delivery and the perinatal outcome in a developing country.
Confounding or intermediate effect? An appraisal of iatrogenic bias in perinatal AIDS research
Authors: Bulterys Marc , Morgenstern Hal
Published: April 2008

Summary. Many epidemiological reports present estimates of exposure effect adjusted for a host of variables thought to be risk factors for the disease. The term iatrogenic bias is proposed to denote bias introduced by the analyst when inappropriately controlling for variables as though they were confounders. The focus of this commentary is iatrogenic bias resulting from the control of variables intermediate in the causal pathway between exposure and disease. Perinatal epidemiological studies are particularly vulnerable, and iatrogenic bias will typically mask or diminish the true effect of the exposure. The problem is illustrated with three examples from the field of perinatal AIDS epidemiology. It is recommended that researchers carefully scrutinise each variable considered for adjustment and use path diagrams to sort out causal pathways. In some instances, it may be most appropriate to present both adjusted and unadjusted estimates of effect.
‘Idiopathic’ jaundice in Sardinian full‐term newborn infants: a multivariate study
Authors: Corchia C. , Sanna M.C. , Serra C. , Balata A. , Orzalesi M.
Published: April 2008

Summary. ‘Idiopathic’ hyperbilirubinaemia in the first 4 days of life was studied in 431 unselected healthy full‐term (gestational age ≥37 weeks) singleton Sardinian infants with birthweight ≥2500 g. All infants were free from malformations or any disease requiring treatment other than jaundice, they were ABO and Rh compatible with their mothers and were not G6PD deficient. The serum bilirubin level was > 11.9 mg/dl (204 μmol/1) and > 14.9 mg/dl (256 μmol/1) in 37.1% and 15.3% of the study subjects. The vast majority of the infants (94%) were breast fed; no difference in the incidence of jaundice was found between breast‐fed and bottle‐fed infants. A logistic regression analysis indicated that high alpha‐fetoprotein concentrations in cord blood, history of neonatal jaundice in previous full‐term siblings, delayed first meconium passage and weight loss were associated with jaundice, defined as a serum bilirubin level > 11.9 mg/dl. These results suggest that the high rate of neonatal hyperbilirubinaemia in Sardinia is mostly related to constitutional and possibly hereditary factors.
Trends in weight‐for‐height and triceps skinfold thickness for English and Scottish children, 1972–1982 and 1982–1990
Authors: Chinn Susan , Rona Roberto J.
Published: April 2008

Summary. Data from the 1972, 1982 and 1990 surveys of the National Study of Health and Growth were used to calculate changes in height, weight, triceps skinfold thickness and weight‐for‐height index for children aged between 4.5 and 11.99 years. There were data for 7887, 6396 and 6420 white English children in the 3 years respectively, and data for 1586, 1191 and 1317 Scottish children. Increases in all measurements were found from 1972 to 1990, except for weight‐for‐height in English boys, and were generally greater from 1982 to 1990 than from 1972 to 1982. Approximately a third of the increases in weight‐for‐height and triceps skinfold thickness from 1972 to 1990 were associated with increases in parental body mass indices and decreases in family size. No consistent differences in trends were found between social groups. Greater trends were found for girls and for Scottish children, and Scottish boys are now heavier and fatter than their English counterparts. Trends in weight‐for‐height and fatness may have implications for future trends in coronary heart disease, and lessen the likelihood that the targets for reductions in obesity in the White Paper Health of the Nation1 will be met. Preventive measures should be directed at the entire population.
Exposure to passive smoking during pregnancy and childhood, and cancer risk: the epidemiological evidence
Authors: Trédaniel Jean , Boffetta Paolo , Little Julian , Saracci Rodolfo , Hirsch Albert
Published: April 2008

Summary. There are relatively few studies on the association between environmental tobacco smoke (ETS) during pregnancy and childhood, and cancer in childhood, adolescence or adulthood. The associations between maternal smoking during pregnancy and childhood cancer have been studied intensively, but there is no clear association overall, or for specific sites. The association between childhood cancer and smoking by the father in the preconceptional period, and by either parent during the child's lifetime, has been little studied. Again, no clear associations have been identified. However, evidence from studies of exposure to known carcinogens from ETS, and of genotoxic effects indicates that any effect, if present, is expected to be weak, and therefore could not have been detected by most of the studies which have been performed, due to the small number of cases included. There is some consistency of association between ETS exposure in childhood and the risk of lung cancers in adulthood. There is therefore a need for further epidemiological studies on ETS exposure during pregnancy and childhood and the occurrence of cancers.
Secular trends of sudden infant death syndrome in Norway 1967–1988: application of a method of case identification to Norwegian registry data
Authors: Oyen Nina , Irgens Lorentz M. , Skjærven Rolv , Morild Inge , Markestad Trond , Rognum Torleiv Ole
Published: April 2008

Summary. In Norway, towards the end of the 1980s, sudden infant death syndrome (SIDS) was the most frequent cause of infant death. Both SIDS and the total post‐perinatal mortality rates had increased. This paper presents a procedure for identifying SIDS from death certificates. Supplemented with additional information, a database was established to evaluate secular trends of SIDS and for further analytical research. The Medical Birth Registry of Norway comprises 1.3 million births from 1967 to 1988. Of these, 5447 infants died in the post‐perinatal period. The cause of death was reviewed by an expert panel and 1984 cases of SIDS were retrieved.

Low maternal age, higher birth order, male gender, and lower birthweight were confirmed as risk factors for SIDS. In 1988, the rate for SIDS and for total post‐perinatal deaths reached 2.69 and 5.02 per 1000 infants at risk. The incidence of SIDS increased 2.2 times from the period 1967–1971 to the period 1987–1988. Adjusted for maternal age, birth order, and birthweight, the odds ratio was 3.1. The increase is due to factors not yet accounted for. Adjusted mortality rates for the other post‐perinatal deaths were not different from the crude rates.
Total bilirubin level in relation to excipients in parenteral morphine sulfate administered to seriously ill newborn infants
Authors: Lesko Samuel M. , Mitchell Allen A.
Published: April 2008

Summary. We examined exposure to excipients in different morphine sulfate preparations in relation to maximum total bilirubin level during the first 5 days of life among 155 infants admitted to a newborn intensive care unit. Sixty‐six (43%), 47 (30%), and 42 (27%) newborns were exposed to chlorobutanol, phenol and neither excipient, respectively. Mean maximum total bilirubin in the first 5 days of life among newborns not exposed to chlorobutanol or phenol was 10.8 mg/dL (184 μmol/L). After adjusting for birthweight, race, sex, and use of phototherapy, the maximum total bilirubin level among newborns exposed to phenol was 1.4 mg/dL (24 μmol/L) higher than the maximum level among newborns exposed to neither excipient (P < 0.05); the corresponding difference associated with chlorobutanol exposure was 1.6 mg/dL (27 μmol/L) (P < 0.02). Further adjustment for potential confounding by the major risk factors for hyperbilirubinaemia did not materially change the results. While unconfirmed, these findings support the growing concern that excipients added to parenteral medications may not be ‘inactive’ as is often assumed, and that the safety of such exposures in seriously ill newborn infants needs to be studied further.
A population database for maternal and child health research in Western Australia using record linkage
Authors: Stanley Fiona J. , Croft Maxine L. , Gibbins John , Read Anne W.
Published: April 2008

Summary. This paper describes a linked total population database established in Western Australia for monitoring and evaluating maternal and child health and for conducting epidemiological studies. Good vital statistics data including all Western Australian hospitalisations and excellent birth defects and cerebral palsy registers have ensured that complete data are available. Examples of studies which have been conducted using the database are given.
Does maternal behaviour influence the risk of perinatal death in Jamaica?
Authors: Greenwood Rosemary , McCaw‐Binns Affette
Published: April 2008

Summary. Features of behaviour of mothers of singleton perinatal deaths collected over the 12‐month period from 1 September 1986 to 31 August 1987 were compared with 9919 mothers of singleton infants born in September and October 1986 and surviving the first week of life, as part of the Jamaican Perinatal Mortality Survey.

For perinatal deaths as a whole, and in the presence of maternal age and social and environmental features, logistic regression analyses showed that the following were independently related with higher risk of mortality: (1) deliberately trying to get pregnant; (2) ever having used Depo Provera; (3) not drinking alcohol in pregnancy; and (4) smoking cigarettes in pregnancy. There were no associations with coital frequency, ever using the contraceptive pill or smoking ganja (cannabis).

Deaths were classified using the Wigglesworth scheme, and separate analyses carried out for the three major groups ‐ antepartum fetal deaths, deaths from immaturity and deaths from intrapartum asphyxia. Antepartum fetal deaths were at increased risk if (1) mothers were deliberately trying to get pregnant or (2) they had ever used Depo Provera. Deaths from immaturity were not associated with any health behaviour variables. Deaths from intrapartum asphyxia were more likely if (1) the mother was deliberately trying to get pregnant or (2) she had never used an intrauterine contraceptive device.
Antenatal and perinatal care in Jamaica: do they reduce perinatal death rates?
Authors: McCaw‐Binns Affette , Greenwood Rosemary , Ashley Deanna , Golding Jean
Published: April 2008

Summary. Information concerning 9919 singleton pregnancies delivered in Jamaica in the 2‐month period of September and October 1986 and surviving the early neonatal period were compared with 1847 singleton perinatal deaths occurring in the 12‐month period from 1 September 1986 to 31 August 1987, classified according to the Wigglesworth schema.

Logistic regression was used to assess features of antenatal and intrapartum care that were associated with the different groups of perinatal death after taking account of environmental, maternal and medical factors.

In Jamaica, 67% of all mothers took iron during pregnancy. These mothers appeared to have a lower risk of perinatal death. This does not appear to be an artefact related to the gestation at which the mother delivers, and was particularly associated with antepartum fetal deaths.

Commencement of antenatal care in the first trimester appeared to reduce the risk of all perinatal deaths, and for intrapartum asphyxia in particular. It is speculated that the mechanism may involve early detection and treatment of anaemia and syphilis.

Quality of perinatal care available in the area of residence, as measured by the presence of consultant obstetricians and a paediatric consultant unit, is shown to be significantly related to a reduction in deaths from intrapartum asphyxia, but it appeared not to be related to antepartum fetal deaths.
The contribution of twins to perinatal mortality in Jamaica
Authors: Ashley Deanna , Samms‐Vaughan Maureen , Greenwood Rosemary , Golding Jean
Published: April 2008

Summary. The Jamaican Perinatal Mortality Survey collected data that have been used in this paper to estimate: (1) the rate of multiple deliveries on the island; (2) the way in which this varies with demographic features; and (3) the causes of perinatal mortality among twins on the island.

The survey consisted of two phases: a study of all births in the months of September and October 1986 (the cohort months) and a study of all perinatal deaths in the 12 months from 1 September 1986 to 31 August 1987.

Among the 10408 pregnancies in the cohort months, 99(1.0%) were multiple pregnancies. The twinning rate showed statistically significant trends with maternal age and parity but no association with social factors.

Among the 2020 perinatal deaths occurring in the 12‐month period, 173 (8.6%) were twins, with particularly high contribution to the Wigglesworth group ‘deaths from immaturity’. Mortality rate of twins was significantly lower if mothers resided in areas where there were good obstetric and paediatric facilities.
Assessment of risk of perinatal death in Jamaica
Authors: Greenwood Rosemary , Ashley Deanna
Published: April 2008

Summary. Data from the Jamaican Perinatal Mortality Survey had been used to create a statistical model using logistic regression.1 From this a simple additive scoring system to predict perinatal death was devised and tested on the 2 cohort months of the study.

The score had a theoretical range of 0–28 points, with the higher the score, the greater the likelihood of a perinatal death. For a cut‐point of 7, sensitivity was 43% and specificity 84%. A cut‐point of 8 resulted in 27% sensitivity and 94% specificity. Higher cut‐points resulted in much reduced sensitivity but enhanced specificity (e.g. cut‐point 10: 11% sensitivity, 99% specificity).

However, it is likely that these estimates are optimistically high, and to achieve unbiased estimates of sensitivity and specificity the score needs to be tested on a sample of the population from which it was not derived before implementation takes place. Meanwhile, the cut‐off level for implementation will depend on appropriate resources available.
The changing pattern of cerebral palsy in Avon
Authors: MacGillivray Ian , Campbell Doris M.
Published: April 2008

Summary. The overall rate of cerebral palsy excluding post‐neonatal cases, has remained relatively constant, varying between 1.93 and 2.27 per 1000 births over the 20‐year period between 1969 and 1988 in Avon. The rate of the subgroup of spastic cerebral palsy varied from 1.40 to 1.78 per 1000 births over the same time period.

In singletons the corresponding figures were 1.80‐2.17 per 1000 births and 1.28‐1.67 per 1000 births, and in multiple births the figures were 7.12‐8.80 per 1000 births and 7.12‐8.44 per 1000 births. Although the overall rates have remained fairly constant there was an increase in incidence in the later years among children with low birthweight and short gestation.
Antenatal antecedents of moderate and severe cerebral palsy
Authors: Palmer Lyle , Blairt Eve , Petterson Beverly , Burton Paul
Published: April 2008

Summary. Aetiological relationships between cerebral palsy, preterm birth, small‐for‐gestational‐age (SGA) birth and selected feto‐maternal factors were investigated in a case‐control study of all moderate and severe cerebral palsy cases born in Western Australia between 1980 and 1986 (n= 215). Cases were individually matched to three controls of the same gender and plurality born in the same year. Two of the controls were matched to the index cases for gestational age, one of which was also matched for birthweight.

Pre‐eclampsia and urinary tract infections were not significantly associated with cerebral palsy. The significant association of antepartum haemorrhage with cerebral palsy was accounted for by its associations with preterm birth. Congenital malformations and non‐cerebral palsy neurological disorder were significantly associated with cerebral palsy; these associations were only partially accounted for by adjusting for preterm birth and small‐for‐gestational‐age birth.

This study shows that some of the risk of cerebral palsy associated with the antenatal antecedents of some common feto‐maternal factors is mediated through preterm birth, confirming the importance of interrelationships between antenatal antecedents in the aetiology of some cerebral palsy.

Perinatal and post‐neonatal causes now account for only around 20% of all cerebral palsy. Future reductions in cerebral palsy incidence may therefore depend on acquiring greater knowledge of inter‐relationships between antenatal antecedents.
Method for cohort and nested case‐control studies: the prevalence, timing and effectiveness of obstetric ultrasound, Victoria 1991–1992
Authors: Yates Judith M. , Lumley Judith , Bell Robin J. , Bettio Janita
Published: April 2008

Summary. The study was designed to assess the effectiveness of obstetric ultrasound in the diagnosis of congenital malformations and to establish its prevalence of use and timing. Statewide data were collected in 138 of the 141 obstetric hospitals in Victoria over a 12‐month period during 1991–1992. Within the final cohort of 55 226 mothers providing responses, a nested case‐control study group was formed. This group comprised 719 cases (infants born with one or more malformations potentially diagnosable at 16–20 weeks) and 703 controls (non‐malformed infants). The cases for the group were extracted from the Victorian Congenital Malformations Register; controls were randomly selected from the Victorian Perinatal Data Collection Unit's database. Of the 1422 in the study group, 1328 medical records were validated in 100 hospitals. The design, method, procedure, sample and outcome are described for the cohort and nested case‐control studies. At the conclusion of the study it was established that major variations between the cohort and missing data were confined to mothers less likely to have had a spontaneous vaginal delivery or to those with poor perinatal outcome. There was no significant selective loss of cases or controls in the nested case‐control study group.
From our own correspondents
Authors: Thomas Lewis
Published: April 2008

Each time we learn something new and surprising, the astonishment comes with the realization that we were wrong before. In truth, whenever we discover a new fact it involves the elimination of old ones. We are always, as it turns out, fundamentally in error.
The Tasmanian SIDS Case‐Control Study: univariable and multivariable risk factor analysis
Authors: Ponsonby Anne‐Louise , Dwyer Terence , Kasl Stan V. , Cochrane Jennifer A.
Published: April 2008

Summary. A population‐based retrospective case‐control study has been conducted in Tasmania since October 1988. Study measurements pertained to the scene of death of last sleep, as well as a verbal questionnaire on relevant exposures. From 1 October 1988 to 1 October 1991, 62 cases of sudden infant death syndrome (SIDS) occurred. Case response rate for retrospective interviews was 94% (58/62). The initial control response rate was 84% (101/121). After stratification for maternal age and birthweight, there was no increase in risk associated with the usual side position (odds ratio [OR] 1.05 [0.27, 5.02]), compared with the supine position (OR 1.00, reference). The prone position was associated with increased risk [OR 5.70 (1.67,25.58)], relative to the supine position. In the final multivariable model, predictors of SIDS in this study were usual prone position (P < 0.001), maternal smoking (P = 0.008), a family history of asthma (P = 0.045) and bedroom heating during last sleep (P = 0.039). Protective factors were maternal age over 25 years (P = 0.013) and more than one child health clinic attendance (P = 0.003). The results provide further support for current health education activities which aim to inform parents of modifiable risk factors for SIDS, including the prone sleeping position, thermal stress and infant exposure to tobacco smoke.
Racial differences in the patterns of preterm delivery in central North Carolina, USA
Authors: Blackmore Cheryl A. , Savitz David A. , Edwards Lloyd J. , Harlow Sioban D. , Jr. Watson A. Bowes
Published: April 2008

Summary. In order to assess racial differences in rates of idiopathic preterm labour, preterm premature rupture of membranes, and medically indicated preterm delivery, the authors analysed data on 388 preterm (< 37 completed weeks of gestation) births (7.9% of all births) occurring between 1 September 1988 and 31 August 1989, in three central North Carolina counties. The crude relative risk (RR) of preterm birth among black women compared with white women was 2.6 [95% confidence interval (CI) 2.1, 3.1]. With adjustment for age, gravidity, marital status, education, and county of residence, the estimated relative risk for black women compared with white women was 2.1 (95% CI 1.1,4.1) for medically indicated preterm delivery, 1.6 (95% CI 1.1,2.3) for preterm birth as a result of preterm labour, and 1.9 (95% CI 1.2,3.1) for preterm premature rupture of membranes. Compared with white women, black women were at the highest risk of a preterm birth before 34 weeks of gestation (RR = 2.9; 95% CI 1.8, 4.7). The risk of medically indicated preterm delivery at 36 weeks was considerably higher for black women than for white women (RR = 3.4; 95% CI 1.1,10.2). For a better understanding and ultimately a reduction of the risk for preterm delivery among black women, investigation of specific aetiological pathways and gestational age groups may be required.
Do pregnant smokers eat differently from pregnant non‐smokers?
Authors: Trygg Kerstin , Lund‐Larsen Kari , Sandstad Berit , Hoffman Howard J. , Jacobsen Geir , Bakketeig Leiv S.
Published: April 2008

Summary. This article describes a study of the relationship between diet and smoking in a group of 821 Norwegian pregnant women. The study is part of a multi‐centre project, examining risk factors for intrauterine growth retardation. Two 3‐day dietary records were collected during the 17th and 33rd week of pregnancy. Information on smoking habits and other relevant parameters were collected through an extensive questionnaire. The results showed that the smokers consumed significantly less than the non‐smokers of bread, cakes and cookies, vegetables, fruits and berries, cheese, yoghurt, low fat milk, juice and tea. The smokers also consumed significantly more meat, margarine, whole milk, soft drinks and coffee than the non‐smokers on both occasions. The diet of the smokers contained significantly less protein, carbohydrate, dietary fibre, thiamin, riboflavin, vitamin C, calcium and iron as compared with the non‐smokers. Fat contributed significantly more to the energy content of the diet of the smokers and it is concluded that their diet was less nutritious than that of the non‐smokers throughout pregnancy.