Group Differences In Rates Research Articles

Metformin Administration and Laparoscopic Ovarian Drilling Improve Ovarian Response to Clomiphene Citrate (CC) in Oligo-anovulatory CC-resistant Women With Polycystic Ovary Syndrome

Clomiphene citrate (CC) is, at present, viewed as the agent of first choice for treating subfertile women with polycystic ovary syndrome (PCOS), but some are resistant to this medication. Laparoscopic ovarian drilling (LOD) has been proposed as a means of inducing ovulation in CC-resistant women with PCOS, and good reproductive outcomes have been reported. Metformin also appears to promote ovulation in CC-resistant women. This prospective study compared the efficacy of CC treatment in eight overweight women 22 to 34 years of age with PCOS, oligoamenorrhea, and primary infertility who remained anovulatory after receiving metformin (group A) and 20 others (group B) who had undergone LOD. The dose of metformin was 850 mg twice daily. Group B patients received placebo tablets after LOD. CC was given in a dose of 150 mg daily for 5 days, from days 3 to 7 of progesterone-induced uterine bleeding. The study continued for 6 months. Participants were advised to have intercourse four times every 2 days once a follicle 18 mm or more in diameter was evident sonographically. Women in groups A and B were clinically comparable and were studied over 36 and 74 cycles, respectively. There were no group differences in rates of ovulation, pregnancy, or live births at the end of the study. Nearly one third of women in each group ovulated, and approximately 17% became pregnant. Abortions were slightly more frequent in group B women, but live birth rates were similar: 67% in group A and 58% in group B. Treatment was, in general, well tolerated, and women in the two treatment groups had similar rates of adverse events. No adverse effects from CC were noted in either group. CC treatment is able to induce ovulation in overweight, infertile, CC-resistant women with PCOS who remain anovulatory after metformin therapy or LOD. Both these treatments apparently are able to make the ovaries more responsive to CC.

Neuropsychology/Language/Behavior: Adult

Neuropsychology/Language/Behavior: Adult

Impact of Ultrasound Cervical Length Assessment on Duration of Hospital Stay in the Clinical Management of Threatened Preterm Labor

Although women with symptoms of preterm labor usually are hospitalized, only 10% to 30% of those admitted to the hospital because of premature contractions deliver before term. Monitoring of contractions and digital examination do not have good predictive value. As a result, the hospital stay may be unnecessarily prolonged when the risk of preterm delivery is actually very low. This prospective study, enrolling 294 women with threatened preterm labor at 3 hospital units, was an attempt to learn whether ultrasound measurements of cervical length have greater predictive value. Patients in preterm labor reportedly are at very low risk when the cervical length is 15 mm or greater. In the initial phase of the study, cervical length was measured by transvaginal ultrasonography and the managing physicians were blinded to the results. In a second phase, physicians at 1 of the 3 units (group A) remained blinded, whereas those at the other 2 units (groups B and C) were able to incorporate the findings into their management plan. Early discharge was considered in group B women if the cervix measured 25 mm or more within 24 hours of admission. Group C women had a repeat scan after 24 to 48 hours and were considered for discharge when cervical length was unchanged. Women in all 3 groups were similar in age, Bishop scores, and ultrasonographic cervical length at admission. Nulliparous women were more frequent in group A than in the other groups. Hospital time averaged 6.1 days overall. In the interventional phase, women in groups B and C had significantly shorter hospital stays than did group A women. Within the same group, hospital time averaged 4.9 days for nulliparas and 5.2 days for parous women. Rates of delivery within 7 days and delivery before 37 weeks gestation were comparable in all units during both phases of the study. There were also no significant group differences in rates of readmission or the use of tocolytic agents. These findings suggest that ultrasound measurements of cervical length may substantially reduce time in the hospital for women with threatened preterm labor. The examination is noninvasive and the findings are reproducible.

Effects of allocation of attention on habituation to olfactory and visual food stimuli in children

Responding to food cues may be disrupted by allocating attention to other tasks. We report two experiments examining the effects of allocation of attention on salivary habituation to olfactory plus visual food cues in 8–12-year-old children. In Experiment 1, 42 children were presented with a series of 8 hamburger food stimulus presentations. During each intertrial interval, participants completed a controlled (hard), or automatic (easy) visual memory task, or no task (control). In Experiment 2, 22 children were presented with 10 presentations of a pizza food stimulus and either listened to an audiobook or no audiobook control. Results of Experiment 1 showed group differences in rate of change in salivation ( p=0.014). Children in the controlled task did not habituate to repeated food cues, while children in the automatic ( p<0.005) or no task ( p<0.001) groups decreased responding over time. In Experiment 2, groups differed in the rate of change in salivation ( p=0.004). Children in the no audiobook group habituated ( p<0.001), while children in the audiobook group did not habituate. Changes in the rate of habituation when attending to non-food stimuli while eating may be a mechanism for increasing energy intake.

Episiotomy and Perineal Tears Presumed to be Imminent: A Randomized, Controlled Trial

Several randomized, controlled trials have suggested that routine episiotomy should be avoided to lower the risk of injuring the posterior perineum, place fewer sutures, and minimize complications of healing. Restricted use of episiotomy, however, has been associated with more anterior perineal trauma. The present prospective, randomized, controlled trial compared the use of episiotomy only for fetal indications (group A, the restrictive group) with a policy of also doing an episiotomy when a tear appeared to be imminent (group B, the liberal group). Participants were 146 primiparous women with uncompleted singleton pregnancies past 34 weeks gestation. The final study group included 109 women who vaginally delivered a live, full-term infant. Forty-nine of these women were in group A and 60 in group B. A tear was considered imminent when the perineum was extremely thin and pale and the head was visible during a contraction to a diameter of approximately 4 to 5 cm. Episiotomy was done in 41% of the restrictive policy group and 77% of the liberal policy group (Table 1). The perineum was intact in 29% and 10% of these groups, respectively. Group A women had more minor perineal trauma (39% vs. 13%). There were no significant group differences in rates of third-degree tears or anterior perineal trauma. Nevertheless, 5 of 7 third-degree tears occurred in the liberal policy group. Women following the restrictive policy had significantly lower pain scores. There were no differences in mean time to hospital discharge or pre- or postnatal maternal hemoglobin levels. Neonatal outcomes also were comparable in the 2 groups. These findings strongly suggest that when a mediolateral episiotomy is done because of a presumed imminent tear, perineal pain results but there is no apparent benefit for the mother or child.TABLE I: Perineal outcome

Effect of Magnesium Sulfate Given for Neuroprotection Before Preterm Birth: A Randomized, Controlled Trial

Some observational studies show that, in very preterm births, magnesium sulfate treatment is associated with a lower risk of intraventricular hemorrhage (IVH), which predisposes to cerebral palsy (CP), but no large randomized trials have been reported. The present randomized, controlled study examined the efficacy of magnesium sulfate in 1062 women having fetuses younger than 30 weeks for whom birth was expected (or planned) within 24 hours. They were assigned to receive a loading infusion of 8 mL of a 0.5-g/mL solution of magnesium sulfate (4 g) or isotonic saline solution in 20 minutes followed by a maintenance infusion of 2 mL/hour for up to 24 hours or until birth. Surviving children were followed up at a corrected age of 2 years by developmental pediatricians and psychologists who did not know the treatment assignment. Baseline maternal characteristics were similar for the treatment and control groups and typical of a high-risk population. The median gestational age at the outset was 27 weeks. The most common primary reason for preterm birth was preterm labor, followed by preeclampsia, antepartum hemorrhage, and chorioamnionitis. Pregnancy outcomes were comparable in the 2 groups, and there was no substantial difference in mean birth weights. Primary outcomes, including death, CP in a surviving infant, and CP in an infant who died were all less frequent in actively treated women but the differences were not statistically significant. Causes of infant death were similar in the 2 groups. No major adverse maternal side effects were noted in either group. In particular, respiratory depression was not more frequent in actively treated women. Significantly more of these women had a decrease of more than 15 mm Hg in diastolic blood pressure. Minor maternal adverse effects, including tachycardia, nausea, discomfort, dizziness, and blurred vision, were more frequent after magnesium infusion. There were no substantial group differences in rates of major IVH, cystic periventricular leukomalacia, chronic lung disease, necrotizing enterocolitis, the need for mechanical ventilation, or time in the hospital. There was, however, a higher rate of substantial motor dysfunction in the magnesium-treated group. No major differences were found in rates of blindness, deafness, or developmental delay. Adverse outcomes were less frequent in magnesium-treated patients than in control subjects in this study. Although not statistically significant, the differences are viewed as potentially being clinically important. The present findings do not, however, warrant routine prenatal magnesium sulfate as a neuroprotective measure in very preterm infants.

The interplay of nature, nurture, and developmental influences: the challenge ahead for mental health.

This article succinctly reviews research achievements in the fields of psychiatric genetics, psychosocial influences on mental disorder, and developmental processes. The challenges for the future are discussed in relation to finding and understanding the following: (1) susceptibility genes; (2) environmentally mediated causal risk processes; (3) nature-nurture interplay; (4) the effects of psychosocial adversity on the organism; (5) the causal processes responsible for group differences in rates of disorder; and (6) age-related changes in psychopathological characteristics.

Harrdiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation.

This study assessed the effects of social support and hardiness on the level of stress in mothers of typical children and children with developmental disabilities. One hundred and twenty mothers participated (40 mothers of children with autism, 40 mothers of children with mental retardation, and 40 mothers of typically developing children). Results indicated significant group differences in ratings of depression, anxiety, somatic complaints and burnout. Regression analyses were conducted to determine the best predictors of the dependent measures. Both hardiness and social support were predictive of successful adaptation. The relationships among hardiness, support and coping are discussed.

The Contribution of Social Epidemiology: Ten New Books

In the last several years a spirited debate has devel? oped in the epidemiologic literature about the ap? propriate focus for epidemiologic research and prac? tice.1-8 Some have argued for a focus on the distribution and determinants of disease at the population level while others have emphasized the importance of identi? fying disease risk factors at the individual level. Proponents of the population approach argue that, while risk factors and risky behaviors are observed in individuals, they are generated and reinforced in social contexts. Therefore, interventions should take account of these contexts. Those in support of a risk factor approach agree with this idea in general, but feel that interven? tions are more realistically directed at changing individ? ual behavior, rather than social structures. Social epidemiologists have struggled with these same issues. These debates have been strongly influenced by the work of three seminal thinkers: Emile Durkheim, Geoffrey Rose, and John Cassel. Durkheim studied one of the most intimate behaviors imaginable: suicide.9 He argued that although the causes of suicide must be found in the individual life histories of individuals, there was a patterned regularity in suicide rates among population groups, over time, even as individuals moved in and out of these groups. He suggested that there must be something about the social environment that promoted a characteristic suicide rate for the group. While these population characteristics do not determine which indi? viduals in the group commit suicide, they do help ex? plain the group differences in rates over time. Geoffrey Rose laid out two fundamental principles not entirely dissimilar from the points made by Durkheim.10 First, groups of individuals function collectively and are affected by the average functioning of those around them. Second, due to this first principle, we should examine entire population distributions

Predicting infant temperament from neonatal reactivity for AGA/SGA twin pairs.

The predictive relation between neonatal reactivity and 12-, 18-, and 24-month temperament was assessed for 22 appropriate-for-gestational-age (AGA)/small-for-gestational-age (SGA) twin pairs. Neonatal reactivity included ratings of visual and auditory orienting responses to a bull's-eye, rattle, bell, voice, and face plus voice combined, as well as alertness. Infant temperament ratings were made of emotional tone, activity, attentiveness, and social orientation to staff during age-appropriate activities in the laboratory. There were no group differences in the neonatal or infant ratings. For AGA twins, a pattern of predictive correlations was obtained between neonatal reactivity and temperament at each age. A similar predictive pattern was not observed for the SGA twins. Group differences in rates of maturation related to stresses associated with intrauterine growth retardation influenced the significance of the neonatal variables for later temperament development.

Predicting infant temperament from neonatal reactivity for AGA/SGA twin pairs

AbstractThe predictive relation between neonatal reactivity and 12-, 18-, and 24-month temperament was assessed for 22 appropriate-for-gestational-age (AGA)/small-for-gestational-age (SGA) twin pairs. Neonatal reactivity included ratings of visual and auditory orienting responses to a bull's-eye, rattle, bell, voice, and face plus voice combined, as well as alertness. Infant temperament ratings were made of emotional tone, activity, attentiveness, and social orientation to staff during ageappropriate activities in the laboratory. There were no group differences in the neonatal or infant ratings. For AGA twins, a pattern of predictive correlations was obtained between neonatal reactivity and temperament at each age. A similar predictive pattern was not observed for the SGA twins. Group differences in rates of maturation related to stresses associated with intrauterine growth retardation influenced the significance of the neonatal variables for later temperament development.

Expectancy profiles generated by major scales: Group differences in ratings and reaction time.

Expectancy profiles generated by major scales: Group differences in ratings and reaction time.

The use of infertility services among fertility-impaired couples

In 1982, 8.4 percent of all currently married American couples had childbearing impairments for reasons other than surgical sterilization (Mosher and Pratt, 1985). This suggests that more than 2.5 million couples were candidates for infertility services, that is, medical advice and assistance in conceiving or successfully carrying a baby to term. Some couples with nonsurgical childbearing impairments, however, may not seek infertility services because they have no desire for children (or for additional children) or because of financial considerations. We know little beyond anecdotal data about which couples with fertility impairments seek infertility services and which do not. Research on infertility has not adequately examined the determinants of the use of infertility services. The clinical literature has focused on the medical and psychological roots of infertility (Kleinman and Senanayake, 1979; Mozley, 1985) as well as on the diagnosis and treatment of the condition (Atlas and Martinelli, 1979; Menning, 1976; Ollivier, Lesser, and Bell, 1984; Rosenfeld and Mitchell, 1979). The demographic literature has focused on rates of childbearing impairments, trends in infertility over time, and the sociodemographic characteristics of couples with fertility impairments (Mosher, 1985; Mosher and Pratt, 1982). A recent study by Horn and Mosher (1984) examined the use of infertility services among ever-married women 15-44 years of age. They found higher utilization rates among older and white women. It is unclear, however, whether these subgroup differences in utilization reflect group differences in rates of infertility or in the use of services among couples with fertility problems. To clarify this issue, it is necessary to hold fertility status constant by focusing on couples with childbearing impairments in analyses of the sociodemographic predictors of the use of infertility services. Understanding the determinants of help-seeking behavior among couples with impaired fertility is important for several reasons. First, infertility affects fertility rates, family size, and potentially, satisfaction with marital and family roles. As such, the utilization of infertility services is an important though neglected aspect of family and fertility behavior. In addition, information about the likelihood that different groups of couples with impaired childbearing capacity will seek help would enable us to identify underserved groups. These efforts will be aided by assessing whether group differences are due to differential motivation to use infertility services or to differential access to such services. Two key sets of factors may affect the use of infertility services. The first set relates to a couple's motivations to seek services and includes desire for children, parity, age, and fertility history prior to the current marriage. The second set relates to informational and economic access to these services. Socioeconomic variables are key here, as they affect a couple's access to knowledge about the availability of services as well as their ability to afford them.

A Longitudinal Study of Ethnicity and Disease Incidence

Ethnic differences in the distribution of disease and injury have been attributed to a constellation of genetic, social, and cultural factors associated with ethnicity. In this paper I describe the results of a prospective study of ethnic group differences in rates of first hospitalization for all diseases and injuries among a cohort of U.S. Navy men who enlisted in 1974 and were followed for a six‐year period. Eight groups were defined on the basis of the self‐designated ethnic identity of each cohort member. Incidence rates were derived from all first hospitalizations during the follow‐up period and then grouped into 16 ICDA‐8 diagnostic categories. Results indicated that ethnic groups were not uniformly at risk for first hospitalizations in all disease categories, even when social environment, socioeconomic status, and access to medical care were held constant, and that the relationship between ethnicity and disease incidence differed with respect to each diagnostic category.

Effects of Experience and Ethnicity on Ratings of Life Events as Stressors

This study was designed to determine whether experience with life events affects ratings of the amount of readjustment they require and to testfor certain group differences in ratings with experience controlled. Ten events were selected to represent variability in social desirability and in the extent of an individual's probable control over the event. Ratings were done by a sample of convenience of college students. Analyses of variance showed that none of the events was rated significantly differently by judges who had versusjudges who had not experienced the event or by judges who differed in age or sex but judges of different ethnicity gave significantly different ratings to some events. Ethnicity and experience interacted to effect ratings of one event, marriage.