Late effects of cancer at a young age: Registry-based studies of the health of cancer patients and their off-spring

Modern cancer therapy has resulted in increased survival among patients diagnosed with cancer at a young age. These improvements have led to the investigation of late morbidity and mortality associated with cancer and its treatments. The aim of this study was to evaluate late effects of cancer treated at a young age on the health of patients and their offspring. Utilising the nationwide population-based registries in Finland, we evaluated the risk of hypothyroidism and the probability of parenthood in cancer survivors as well as preterm birth, neonatal outcomes, and the risk of cancer among offspring of patients. The survivor cohort, identified from the Finnish Cancer Registry, consisted of 25,784 cancer patients diag-nosed between ages 0 and 34 in 1953–2004. By linkage to the population register, siblings of these patients were identified for comparison. The prevalence of hypothyroidism was higher among former childhood cancer (aged 0–16) patients than in the general population. The probability of parenthood following early onset cancer was overall significantly reduced compared to siblings. Offspring of female cancer survivors were at an increased risk of preterm birth, this risk being highest among patients diagnosed in childhood and early adulthood (aged 20–34 years). The offspring were not, however, at a significantly increased risk of neonatal death or stillbirth, though they were more likely to need monitoring or intensive care in the neonatal period. The risk of sporadic cancer among offspring of male and female cancer survivors was not elevated in comparison to the general population. The study showed that former cancer patients are at risk of certain adverse endocrine and reproductive health outcomes and should be followed for timely intervention. The offspring of cancer survivors do not appear to be at risk for adverse health outcomes.

Depression with postpartum onset: a prospective cohort study in women undergoing elective cesarean section in Brasilia, Brazil

PURPOSE: It was to determine the prevalence of depressive symptoms in a sample of puerperal women from Brasília, Brazil, distinguishing cases with onset after delivery from those already present during pregnancy. METHODS: A prospective cohort study with convenience sampling of patients submitted to elective cesarean section at two private hospitals. As an instrument for assessing depressive symptoms, the Edinburgh Postnatal Depression Scale with cutoff >13 was applied shortly before delivery and four to eight weeks after childbirth. RESULTS: Among the 107 women who completed the study, 11 (10.3%) had significant depressive symptoms during pregnancy and 12 (11.2%) during the postpartum period. Among the 12 patients with postpartum symptoms, 6 had symptoms during pregnancy, so that 5.6% of the sample had postpartum onset of depression. The higher overall frequency of depression was significantly among single women than among married women (p=0.04), a fact mainly due to a higher frequency of single women experiencing persistent depressive symptoms both before and after delivery (p=0.002). The risk of depression was not influenced by age, parity or educational level. CONCLUSION: Women with depression identified during the postpartum period comprise a heterogeneous group, in which symptoms may have started before pregnancy, during pregnancy or after childbirth. In this sample, half of the postpartum depression cases already presented symptoms during late pregnancy. Since depression can arise before and after childbirth, it may have different etiologies and, therefore, a different response to treatment, a possibility that should be considered by clinicians and researchers.

Maternal age and adverse perinatal outcomes in a birth cohort (BRISA) from a Northeastern Brazilian city

PURPOSE:To verify the existence of associations between different maternal ages and the perinatal outcomes of preterm birth and intrauterine growth restriction in the city of São Luís, Maranhão, Northeastern Brazil.METHODS:A cross-sectional study using a sample of 5,063 hospital births was conducted in São Luís, from January to December 2010. The participants comprise the birth cohort for the study "Etiological factors of preterm birth and consequences of perinatal factors for infant health: birth cohorts from two Brazilian cities" (BRISA). Frequencies and 95% confidence intervals were used to describe the results. Multiple logistic regression models were applied to assess the adjusted odds ratio (OR) of maternal age associated with the following outcomes: preterm birth and intrauterine growth restriction.RESULTS:The percentage of early teenage pregnancy (12–15 years old) was 2.2%, and of late (16–19 years old) was 16.4%, while pregnancy at an advanced maternal age (>35 years) was 5.9%. Multivariate analyses showed a statistically significant increase in preterm births among females aged 12–15 years old (OR=1.6; p=0.04) compared with those aged 20–35 years. There was also a higher rate in preterm births among females aged 16–19 years old (OR=1.3; p=0.01). Among those with advanced maternal age (>35 years old), the increase in the prevalence of preterm birth had only borderline statistical significance (OR=1.4; p=0.05). There was no statistically significant association between maternal age and increased prevalence of intrauterine growth restriction.

Are birth weight and maternal smoking during pregnancy associated with malnutrition and excess weight among school age children?

In the late 1980's child malnutrition was still prevalent in Brazil, and child obesity was beginning to rise in the richest regions of the country. To assess the extent of the nutritional transition during the period and the influence of birth weight and maternal smoking on the nutritional condition of schoolchildren, we estimated the prevalence of excess weight and malnutrition in a cohort of Brazilian schoolchildren from 1987 to 1989. We calculated the body mass index (BMI) of 8- to 10-year-old schoolchildren born in Ribeirão Preto in 1978/79. We considered children with a BMI <5th percentile (P5) to be malnourished, children with P5³BMI

Depression in men in the postnatal period and later child psychopathology: a population cohort study

Objective: Postnatal depression in women is associated with adverse effects on both maternal health and children's development. It is unclear whether depression in men at this time poses comparable risks. The present study set out to assess the association between depression in men in the postnatal period and later psychiatric disorders in their children and to investigate predisposing factors for depression in men following childbirth. Method: A population-based cohort of 10,975 fathers and their children from the Avon Longitudinal Study of Parents and Children (ALSPAC) was recruited in the prenatal period and followed for 7 years. Paternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale and later child psychiatric disorder (DSM-IV) with the Development and Well-Being Assessment. Results: Depression in fathers in the postnatal period was significantly associated with psychiatric disorder in their children 7 years later (adjusted OR 1.72, 95% CI 1.07-2.77), most notably oppositional defiant/conduct disorders (adjusted OR 1.94, 95% CI 1.04-3.61), after adjusting for maternal depression and paternal educational level. A history of severe depression and high prenatal symptom scores for depression and anxiety were the strongest predictors of paternal depression in the postnatal period. Conclusions: Depression in fathers in the postnatal period is associated with later psychiatric disorders in their children, independently of maternal postnatal depression. Further research into the risks associated with paternal psychopathology is required because this could represent an important opportunity for public health intervention.

Cognitive follow up of a small cohort of Huntington's disease patients over a 5 year period

A small group of patients with manifest Huntington's disease (HD) were followed longitudinally to assess cognitive decline in relation to time from disease diagnosis. This article looks at performance on a range of computerised and pencil and paper cognitive tasks in patients 5 years post diagnosis, who were assessed annually for a 5 year follow up period. The almost universal cognitive decline reported in other longitudinal studies of HD was not replicated in this study. It was proposed that longitudinal follow up in HD is complicated by the varying degree to which different tasks are able to withstand repeated administration; a finding which would have significant implications on study design in future trials of cognitive enhansing interventions.

Effects of age at first calving, gestation length and dry period on milk yield in a Gyr herd

Relationships of several reproductve traits and milk yield were studied in 716 Gyr cows at Sant'Ana da Serra farm, Mococa, State of São Paulo, a humid tropical climate region. Mean age at first calving was 49.8 +/- 0.4 months, with a coeficient of cariation (C. V.) of 20.8%. Only year of parturition significantly affected age at first calving (P < 0.01). Heritability, estimated from paternal half-sib correlations, was 0.91 +/- 0.20, a value considered unrealistically high. Overall mean gestation length was 287.7 +/- 0.5 days (C. V. = 3.3%) for 419 observations, with month and year of parturition having significant effects. Heritability estimate was 0.30 +/- 0.14. Overall mean dry period for 1.276 observations was 238 +/- 3 days (C. V. = 48%); repeatability estimate was 0.19 +/- 0.06. Estimated annual genetic trend for dry period was -0.6 days, phenotypic trend was 11.5 days, and environmental trend, 12.1 days. Month and year of parturition and cow age had no significant effect on dry period. Highest milk yield was obtained at fourth lactation. The gross correlation between milk yield and gestation period was 0.11, and between previous dry period and subsequent milk yield, 0.16. Normal gestations of 285 to 290 days were associated with higher milk yields. Milk yield increased as dry period advanced from 30 to 390 days, and declined as dry period continued beyond 390 days. Delays in first mating and a more extensive dry period decreased reproductive efficiency in the herd studied.

Risk factors for amenorrhea in juvenile systemic lupus erythematosus (JSLE): a Brazilian multicentre cohort study

We evaluated the prevalence and clinical associations of amenorrhea in 298 female juvenile systemic lupus erythematosus (JSLE) patients (ACR criteria) followed in 12 Brazilian Paediatric Rheumatology centres. Amenorrhea was observed in 35 patients (11.7%) with a mean duration of 7.2 +/- 3.6 months. The hormones were performed in 32/35 patients and none of them had FSH and LH levels above and estradiol below the normal range according to pubertal changes. JSLE patients with amenorrhea were younger (15.04 +/- 2.5 versus 17.8 +/- 3.1 years; P = 0.001), and had a shorter period of time between menarche and current age (3.4 +/- 2.9 versus 6.7 +/- 5.4 years; P = 0.001). Interestingly, the frequency, cumulative dose, number of pulses and duration of intravenous cyclophosphamide treatment were alike in patients with and without amenorrhea (P > 0.05). In contrast, patients with amenorrhea had significantly higher SLEDAI (P = 0.01) and SLICC/ACR-DI (P = 0.024) scores compared to those without this condition. Independent risk factors identified by multivariate analysis were higher SLEDAI (OR=1.059; CI=1.004-1.116; P=0.034) and SLICC/ACR-DI (OR=2.125; IC = 1.373-3.291; P = 0.001) scores. Our data suggest that in spite of imummosuppressive therapy, JSLE patients have an adequate ovarian follicular reserve and amenorrhea is particularly associated with disease activity and damage.

Influence of Dietary Lysine Levels and Arginine:Lysine Ratios on Performance of Broilers Exposed to Heat or Cold Stress during the Period of Three to Six Weeks of Age

Four trials of identical experimental design were conducted to determine the effects of temperature, dietary Lys level, and dietary Arg:Lys ratios on performance and carcass yield of male broilers. Birds of a commercial strain were grown from 21 to 42 d of age in wire-floored finishing batteries placed in environmental chambers. The chambers were programmed to provide either a constant thermoneutral temperature (21.1 C), a constant cold temperature (15.5 C), or a cycling hot diurnal temperature (25.5 to 33.3 C). Within each environment there was a factorial arrangement of three Lys levels (1.0, 1.1, and 1.2%) with four Arg:Lys ratios (1.1:1, 1.2:1, 1.3:1, and 1.4:1). Environmental temperature significantly influenced virtually every characteristic examined. Hot cyclic temperatures reduced weight gain, feed intake, and breast meat yield, and increased feed conversion, dressing percentage, leg quarter yield, and abdominal fat content. The cold environment promoted increased feed intake and mortality. Ascites and cardiomyopathy were the leading causes of death under cold exposure and thermoneutral conditions, whereas complications arising from heat exposure were the main cause of death under hot cyclic conditions. Levels of Lys affected leg quarter yield and abdominal fat content over all environments but increased breast meat yield only under cold conditions. Increasing Arg: Lys ratios improved feed conversion and dressing percentage and reduced abdominal fat content; it could not be determined whether these responses were consistent with Arg per se or were due to a nonspecific N response. As increasing Lys levels or Arg:Lys ratios did not improve weight gain, increase breast meat yield, or attenuate adverse effects due to heat or cold exposure, it is concluded that the levels of Lys and Arg suggested for 21 to 42 d by the NRC are adequate for birds of this age under the environmental conditions encountered.

Anthropometric changes in the brazilian cohort of older adults: SABE survey (Health, Well-Being, and Aging)

The aim of the present study was to analyze the anthropometric changes in a home-based cohort of Brazilian older adults who participated in the SABE Survey, conducted in 2000 and 2006. A total of 1030 men and women were examined by age group: 60-69, 70-79, and ≥80 years. This representative sample consists of the survivors of the 2000 cohort. The following anthropometric variables were assessed: body mass, arm muscle, waist and calf circumferences, triceps skinfold thickness, body mass index, waist-hip ratio, and arm muscle area according to mean values and percentile distribution. Except for body mass and body mass index, a significant difference (P<0.05) was observed among the assessed anthropometric variables during the follow-up period. The older adults ≥80 years presented the lowest values. The reduction in the mean values of triceps skinfold thickness was greater (30%) than that of waist circumference (9%) and was more pronounced in women (21%) than in men (9%). Arm muscle circumference and area reduced by 8% and 19%, respectively, in men and 1% and 3%, correspondingly, in women. Our findings revealed reductions in the mean values for all anthropometric variables in the follow-up period from 2000 to 2006 among older adults. © 2013 Manuela Ferreira de Almeida et al.

Internal migration in Guatemala during the period 1976-1981 by ethnicity, sex and age

El analisis forma parte del proyecto IMIN, orientado a realizar investigaciones en profundidad sobre la migracion interna a partir de los ultimos censos de poblacion. El enfasis se situa en la descripcion del fenomeno en Guatemala, durante 1976-1981 y la poblacion bajo estudio es aquella nacida en Guatemala que vivio en el pais hasta la fecha del censo y 5 anos antes. Los migrantes son personas cuya residencia habitual en 1981 era distinta de aquella en 1976. Guatemala, Esquintla y El Peten son los departamentos de inmigracion por excelencia por ser la sede de la capital, y por su desarrollo agrario. Las mujeres se dirigen hacia el departamento de Guatemala, independiente del grupo etnico; la migracion es selectiva por edad y los grupos en que se producen los desplazamientos mayores se situan entre 15 y 24 anos. Las migrantes son algo menores que los hombres migrantes y los no indios migran mas que los indios; entre estos ultimos, predominan los hombres.

CHARACTERIZATION OF THE BRAZPD II COHORT AND DESCRIPTION OF TRENDS IN PERITONEAL DIALYSIS OUTCOME ACROSS TIME PERIODS

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study

Background: Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis. Methods: Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form. Results: Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:≥32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer. Conclusion: Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.

Reproducibility and day time bias correction of optoelectronic leg volumetry: a prospective cohort study

Background Leg edema is a common manifestation of various underlying pathologies. Reliable measurement tools are required to quantify edema and monitor therapeutic interventions. Aim of the present work was to investigate the reproducibility of optoelectronic leg volumetry over 3 weeks' time period and to eliminate daytime related within-individual variability. Methods Optoelectronic leg volumetry was performed in 63 hairdressers (mean age 45 ± 16 years, 85.7% female) in standing position twice within a minute for each leg and repeated after 3 weeks. Both lower leg (legBD) and whole limb (limbBF) volumetry were analysed. Reproducibility was expressed as analytical and within-individual coefficients of variance (CVA, CVW), and as intra-class correlation coefficients (ICC). Results A total of 492 leg volume measurements were analysed. Both legBD and limbBF volumetry were highly reproducible with CVA of 0.5% and 0.7%, respectively. Within-individual reproducibility of legBD and limbBF volumetry over a three weeks' period was high (CVW 1.3% for both; ICC 0.99 for both). At both visits, the second measurement revealed a significantly higher volume compared to the first measurement with a mean increase of 7.3 ml ± 14.1 (0.33% ± 0.58%) for legBD and 30.1 ml ± 48.5 ml (0.52% ± 0.79%) for limbBF volume. A significant linear correlation between absolute and relative leg volume differences and the difference of exact day time of measurement between the two study visits was found (P < .001). A therefore determined time-correction formula permitted further improvement of CVW. Conclusions Leg volume changes can be reliably assessed by optoelectronic leg volumetry at a single time point and over a 3 weeks' time period. However, volumetry results are biased by orthostatic and daytime-related volume changes. The bias for day-time related volume changes can be minimized by a time-correction formula.