Number Of Live-born Children Research Articles

Analysis of loss to follow-up status and influencing factors of children born to pregnant women with HIV infection in China in 2019

Objective: To understand the loss to follow-up of children born to pregnant women with HIV infection (HIV-exposed children) and analyze its influencing factors in China in 2019. Methods: The data were collected from the follow-up records of pregnant women with HIV infection and their children reported by the national "Management Information System for the Prevention of HIV, syphilis and Hepatitis B Mother-to-Child Transmission" in 2019. HIV-exposed children were defined as those who were not followed up after birth or who were not followed up at 18 months of age and who were not followed up at 21 months of age. The univariate and multivariate influencing factors of loss to follow-up of children born to HIV-infected pregnant women were analyzed by χ2 test and logistic regression model. SPSS 25.0 software was used for statistical analysis. Results: The number of HIV-infected pregnant women was 5 039, the number of live-born children was 5 035, the number of loss to follow-up children within 18 months of age was 283, and the loss to follow-up rate children was 5.62%(283/5 035). The results of multivariate logistic regression analysis showed that the rate of loss to follow-up of exposed children born to pregnant women who worked as farmers (animal husbandry and fishery) (aOR=0.34, 95%CI: 0.22-0.53), unmarried (aOR=0.47, 95%CI: 0.24-0.93), first marriage (aOR=0.38, 95%CI: 0.22-0.67), remarriage (aOR=0.36, 95%CI: 0.20-0.67) and cohabiting (aOR=0.47, 95%CI: 0.23-0.97), and knew they had HIV infection before this pregnancy (aOR=0.53, 95%CI: 0.40-0.70) was lower. Han nationality (aOR=1.52, 95%CI: 1.09-2.13), primary school (aOR=2.06, 95%CI: 1.10-3.89) and junior middle school (aOR=1.81, 95%CI: 1.03-3.17) educational level, non-use of antiviral drugs (aOR=6.21, 95%CI: 4.32-8.93) and delivery in township (street) level midwifery institutions (aOR=5.72, 95%CI: 1.61-20.27) had higher rates of loss to follow-up among infants born to HIV-infected pregnant women. Conclusions: HIV-exposed children still have a specific rate of loss to follow-up in China in 2019. In order to further reduce the rate of loss to follow-up, it is of great significance to improve the detection rate of HIV before pregnancy and the rate of antiviral drugs used in pregnant women with HIV infection, which is of great significance for the effective implementation of comprehensive intervention measures of prevention of mother-to-child transmission of HIV.

Quadruplet pregnancy outcome with and without fetal reduction: Danish national cohort study (2008-2018) and comparison with dichorionic twins.

To perform a nationwide study of quadrichorionic quadriamniotic (QCQA) quadruplet pregnancies and to compare the pregnancy outcome in those undergoing fetal reduction with non-reduced quadruplets and dichorionic diamniotic (DCDA) twin pregnancies from the same time period. This was a retrospective Danish national register-based study performed using data from the national Danish Fetal Medicine Database, which included all QCQA quadruplets and all non-reduced DCDA twin pregnancies with an estimated due date between 2008 and 2018. The primary outcome measure was a composite of adverse pregnancy outcomes, including pregnancy loss or intrauterine death of one or more fetuses. Secondary outcomes included gestational age at delivery, the number of liveborn children, preterm delivery before 28, 32 and 37 gestational weeks and birth weight. Data on pregnancy complications and baseline characteristics were also recorded. Outcomes were compared between reduced and non-reduced quadruplet pregnancies, and between DCDA pregnancies and quadruplet pregnancies reduced to twins. A systematic literature search was performed to describe and compare previous results with our findings. Included in the study were 33 QCQA quadruplet pregnancies, including three (9.1%) non-reduced pregnancies, 28 (84.8%) that were reduced to twin pregnancy and fewer than three (6.1%) that were reduced to singleton pregnancy, as well as 9563 DCDA twin pregnancies. Overall, the rate of adverse pregnancy outcome was highest in non-reduced quadruplets (66.7%); it was 50% in quadruplets reduced to singletons and 10.7% in quadruplets reduced to twins. The proportion of liveborn infants overall was 91.1% of the total number expected to be liveborn in quadruplet pregnancies reduced to twins. This was statistically significantly different from 97.6% in non-reduced dichorionic twins (P = 0.004), and considerably higher than 58.3% in non-reduced quadruplets. The rates of preterm delivery < 28, < 32 and < 37 weeks were decreased in quadruplets reduced to twins compared with those in non-reduced quadruplet pregnancies. Quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of DCDA twins. This national study of QCQA quadruplets has shown that multifetal pregnancy reduction improves pregnancy outcome, including a decreased rate of preterm delivery and higher proportion of liveborn children. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Maternal Magnesium Level Effect on Preterm Labor Treatment

Objectives: This study intended to compare the serum magnesium level in women with preterm labor, with its level in women with normal pregnancy of the same age, and assess the relationship between serum magnesium level and response to magnesium sulfate (MgSO4). Materials and Methods: Forty women aged 18-40, with gestational age of 26-32 weeks and signs of preterm labor, and 40 women in similar age and gestational age with normal pregnancy were included in this study. Case group received betamethasone 12 mg in 2 separate doses with 24-hour interval. MgSO4 was administrated (in dose of 4 mg), and continued by 2 mg/h. Once the tocolytic therapy goal was achieved, the administration of MgSO4 continued for an additional 12-hour. Results: The mean age, gestational age, gravidity, parity, number of live born children, number of dead children, miscarriage, and molar pregnancy were similar in 2 groups. The mean of serum magnesium level showed a significant difference between 2 groups. In the case group, 27 patients showed positive therapeutic response to MgSO4; the difference between the mean of serum magnesium level in these 27 patients and the other 13 patients who did not respond well was significant. The serum magnesium level < 1.85 mg/dL as a cut-off point had 85 sensitivity and 78 specificity with CI = 0.75-0.97 in predicting response to MgSO4 in the case group. Conclusion: Serum magnesium level can be used as a predictive tool for preterm labor. It can help in preterm labor in selecting patients who benefit from MgSO4 as a tocolytic agent. Magnesium supplementation may be helpful in patients with decreased serum magnesium level to prevent preterm labor. © 2018 The Author (s).

Resolution of infertility and number of children: 1386 couples followed for a median of 13 years.

How common were children among infertile couples? A total of 61.7% of infertile couples presenting for care subsequently had live born children 13.1 years after first being clinically assessed, with a mean of 1.7 children among those who had at least one. While the prognoses for infertile couples undertaking specific treatments have been well described, less is known about those not undergoing these treatments or the total number of children. This information is necessary for decision-making in many individual cases; not knowing this has been cited by patients and clinicians as impeding implementation of care. The sole provider of specialist fertility care for the two southern-most regions in New Zealand enroled 1386 infertile couples from 1998 to 2005 in a longitudinal study with follow-up on all births until the end of 2014. Couples were followed in care for a median of 1.1 years and median follow-up for births was 13.1 years. Clinic-collected data were linked to national maternity data to extend follow-up past the end of clinical contact. The primary outcome was the total number of live born children. Hurdle regression was used to investigate factors associated with resolving infertility and the total number of children. Infertility was resolved with a live birth by 61.7% (95% CI 59.1-64.2%) of couples; just over half of all first births were treatment-dependent. Among couples who resolved their infertility, 55.6% (52.2-58.9%) had at least one additional child and the mean number of children was 1.7. While female age strongly influenced outcomes, one-third of women aged 40-41 years had a child, not significantly less than those in their late 30s. The lowest levels of resolution occurred in women aged ≥42 years, couples who were infertile for >4 years and women with a BMI ≥ 35 kg/m2. Moderate obesity did not affect outcomes. The main limitation of this study was insufficient data to investigate male factor infertility outcomes. It is also possible that treatment-dependent resolution could be higher in more recent cohorts with the increased use of ART. Outcomes in these couples are comparable to those seen in other studies in high-income countries despite the relatively low contribution of ART. The prognosis for most infertile couples is positive and suggests many will not require treatment. Further research is needed to inform best practice for women in their early forties or with moderate obesity, and to develop prediction models that are more relevant for the initial management of infertility. This study was co-funded by a University of Otago PhD Scholarship and the Department of Women's and Children's Health, University of Otago. There were no competing interests to declare.

Cost-effectiveness of different types of COH protocols for in vitro fertilization at national level

ABSTRACTThe aim of this study was to retrospectively analyse the cost-effectiveness of different types of controlled ovarian hyperstimulation (COH) protocols and regimes used in in vitro fertilization procedures at a national level. Information was gathered from the National Centre for Assisted Reproduction (Bulgaria). Out of 2849 patients, 2757 were included in the study. The patients were treated with three main protocols: gonadotrophin-releasing hormone (GnRH)-antagonist protocol, GnRH-agonist protocol and COH protocols without GnRH-analogues. In all main COH protocols, different types of gonadotrophins were combined in seven therapeutic schemes. A decision tree model was built for the cost-effectiveness analysis. Each decision node representing the three main COH protocols included seven possible chance nodes representing the COH therapeutic regimens. The results were evaluated based on the number of live-born children. The mean cost differed statistically significant between the three main types of protocols (p = 0.0001) and between all seven COH regimens. In terms of live birth, the GnRH agonist protocols were more effective, followed by GnRH-antagonist protocols and those without GnRH-analogues. The decision tree model confirmed that considering the probability of the therapeutic regimens being prescribed, the GnRH-agonist protocol is the cost-effective one with the smallest cost per live-born child (5033, 51 BGN). The other two protocols could also be considered cost-effective because the incremental cost effectiveness ratio is very low and is below the gross domestic product per capita for 2015. The Governmental Authorities, considering also the cost-effectiveness criteria, should carefully revise the trend towards a wider use of GnRH-antagonist protocols.

Live births, natural losses, and elective terminations with Down syndrome in Massachusetts.

No studies to date have reported an estimated number of live births, elective terminations, and natural losses (miscarriages and stillbirths) for Down syndrome (DS) in Massachusetts (MA). These numbers would be helpful to estimate how many expectant parents of children with DS need support and the number of live-born children with DS who require services. Combining robust data sets, including the Annual Reports of the MA Birth Defects Monitoring Program, we estimated the number of live births, elective terminations, and natural losses with Down syndrome from 1900 to 2010. The live birth prevalence for DS in MA for the most recent years for which data are available (2006-2010) was estimated at 12.4 per 10,000 live births, with a total of approximately 94 live births annually. During this period, an estimated 126 DS-related elective pregnancy terminations were performed in MA annually. As of 2008, the estimated rate at which live births with DS was reduced as a consequence of DS-related elective pregnancy terminations was 49%. The reduction of live births with DS is significantly higher in MA than in the rest of the United States as a whole. However, ethnic and racial differences in reduction rates were similar-highest for Asians/Pacific Islanders, followed by non-Hispanic whites, non-Hispanic blacks/Africans, and Hispanics.Genet Med 18 5, 459-466.

Single vitrified blastocyst transfer maximizes liveborn children per embryo while minimizing preterm birth

To compare live-birth rates, blastocyst to live-birth efficiency, gestational age, and birth weights in a large cohort of patients undergoing single versus double thawed blastocyst transfer. Retrospective cohort study. Assisted reproduction technology (ART) practice. All autologous frozen blastocyst transfers (FBT) of one or two vitrified-warmed blastocysts from January 2009 through April 2012. Single or double FBT. Live birth, blastocyst to live-birth efficiency, preterm birth, low birth weight. Only supernumerary blastocysts with good morphology (grade BB or better) were vitrified, and 1,696 FBTs were analyzed. No differences were observed in patient age, rate of embryo progression, or postthaw blastomere survival. Double FBT yielded a higher live birth per transfer, but 33% of births from double FBT were twins versus only 0.6% of single FBT. Double FBT was associated with statistically significant increases in preterm birth and low birth weight, the latter of which was statistically significant even when the analysis was limited to singletons. Of the blastocysts transferred via single FBT, 38% resulted in a liveborn child versus only 34% with double FBT. This suggests that two single FBTs would result in more liveborn children with significantly fewer preterm births when compared with double FBT. Single FBT greatly decreased multiple and preterm birth risk while providing excellent live-birth rates. Patients should be counseled that a greater overall number of live born children per couple can be expected when thawed blastocysts are transferred one at a time.

Gonadotropin Therapy versus Laparoscopic Ovarian Drilling in Clomiphene Citrate-Resistant Polycystic Ovary Syndrome Patients: A Retrospective Cost-Effectiveness Analysis

Background: Gonadotropin therapy and laparoscopic ovarian drilling (LOD) are treatment options for ovulation induction (OI) in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives. Methods: A retrospective health-economic evaluation was performed from a societal perspective in which human menopausal gonadotropin (hMG) therapy (n = 43) was compared with LOD (n = 35), followed by OI with CC and/or hMG if spontaneous ovulation did not occur within 2 months. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy rate and number of live-born children. Results: The ongoing pregnancy rate was 21/35 (60%) after LOD and 30/43 (69.8%) after hMG treatment (relative risk 0.85, 95% CI 0.61-1.19). The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1,073, 95% CI 180-1,967). Conclusion: This economic evaluation based on real-life data shows that the societal cost up to an ongoing pregnancy is less after hMG treatment when compared with LOD surgery in CC-resistant PCOS patients.

Regresión Logística Ordinal Aplicada a la Identificación de Factores de Riesgo para Cáncer de Cuello Uterino

La identificación de factores de riesgo para cáncer de cuello uterino es determinante a la hora de establecer diagnósticos efectivos que, en un momento dado, pueden ser determinantes para salvar vidas. Desde esta perspectiva se realizó este estudio en una muestra constituida por 105 pacientes, que circunscribió a todas las mujeres que concurrieron a la consulta ginecológica en una campaña desarrollada por la Secretaría de Salud del Departamento del Atlántico. Se utilizaron dos instrumentos para la recolección de los datos: aquellos vinculados a cáncer de cuello uterino se registraron en un formulario elaborado para tales efectos. En el estudio fue considerada como variable dependiente el Cáncer de cuello uterino (CCU) y como variables independientes los factores relacionados con la paridad (Edad (ED), Número de Hijos Nacidos Vivos (NHV), Número de Hijos Nacidos Muertos (NHM), tipo de parto (TP) y tipo de embarazo (TE)). Finalmente, también se incluyeron las características de la conducta sexual [Enfermedades venéreas (EV): sífilis, herpes, gonorrea u otras]. De manera general se observa que el riesgo de tener cáncer de cuello uterino es mayor cuando aumenta el número de hijos en partos por cesárea y se ha perdido un hijo.

Risk factors for 'small for gestational age babies'.

To identify the risk factors for small for gestational age (SGA) babies. The present study was a nested case control study which was carried out by two Medical Officers of Health areas (The field level administrative unit responsible for provision of preventive and promotive health services) in Colombo district. SGA babies were identified using 'weight for gestational age' curves developed for Sri Lankan babies. Newborns of 1,200 pregnant women, who were identified within the first 8 wk of amenorrhea and who delivered in selected hospitals were included in the study. Sample size was calculated as n=167 cases and 4 n=668 controls, with four controls for each case. A case was defined as a newborn whose birth weight was less than the 10th percentile of the weight for gestational age, the control being a newborn whose birth weight was between the 10th and the 90th percentile of the weight for gestational age. Multivariate analysis identified 7 significant risk factors as, number of live born children=0, inadequate weight gain during pregnancy according to initial BMI, maximum and minimum physical work, mother's pre-pregnant weight less than 38 kg, high level of stress at second trimester, presence of pregnancy induced hypertension (PIH) and inadequate support from husband. The risk factors indicate the directions for planning intervention programs.

Completude da informação nas Declarações de Nascido Vivo e nas Declarações de Óbito, neonatal precoce e fetal, da região de Ribeirão Preto, São Paulo, Brasil, 2000-2007

This study aimed to evaluate the completeness of data on nine items included in both the certificate of live birth (CLB) and death certificate (DC), as well as the retrieval of data on early neonatal deaths. The study assessed live birth and early neonatal and fetal death records in municipalities in the Ribeirão Preto Region, São Paulo State, Brazil, from 2000 to 2007. Database matching for live births and deaths allowed retrieving data on early neonatal deaths. Data completion was good on the CLB and poor on the DC. Retrieval of data related to mortality was satisfactory, except for maternal schooling, number of live born children, and stillbirths. The findings highlight the need to improve completion of the DC and showed that the retrieval process improved the completeness of data from the database on early neonatal deaths. The use of reports on local investigation of deaths is recommended as a strategy to make mortality databases more complete.

The Italian National ART Register

On February 19th 2004 in Italy was promulgate a law that regulates all assisted reproduction techniques (ART) ( * ). In this law is established the creation of the National ART Register (Registro Nazionale della Procreazione Medicalmente Assistita) at the National Institute of Health (Istituto Superiore di Sanita, ISS). The National Health Institute prepares an annual report to the Ministry of Health, with all the data from the ART clinics operating in Italy. Sending data to the Register is mandatory. The aims of the Register are: list all the authorized structures that apply ART techniques in Italy, collect and diffuse transparent information of these techniques and the results of their application. Diffuse the correct information to all citizens and infertile couples in particular on reproductive health, prevention of infertility and possible therapeutic interventions. The Register data collection is made on a specific web site ( www.iss.it/rpma ) create to allow ART clinics to complete and send out the annual summary data reports “on-line”. Each clinic has an username and a password that consent them the access to a private zone in this web site where they can communicate with the Italian National ART register. Actual law requires The Register to collect information also on children born after ART procedures. Actually all the ART clinics have big problems to recruit such kind of data, because not all the couples let them know if their treatments have been successfully. The data covering treatments and births starts during a specific year. The data are usually available two years after the end of the treatment period. The summaries of each clinic contain data regarding: number of ART procedures, pregnancies and deliveries by ART procedure including standard IVF, ICSI, FIVET, GIFT and FER; the number of cycles started, number of oocyte aspirations and of embryo transfers; abortions an ectopic pregnancies; the number of live born children; the number of IVF treatments, reported per ART procedure, the indications for treatment and women's age (in five year intervals); the number of embryo replaced per procedure. Data collection take place twice a year: the first data collection regards ART treatments results and the other one for data regarding surveillance of children born after ART procedures. The Italian Register cooperate with other 29 countries sending data to the eim European IVF Monitoring. The European data collection is made once a year from all the participating countries and the results are published after two years. In addition, the Italian ART Register is trying to build up a report system of individual cycle data. As a matter of fact it was created a specific software freely distribute among ART clinics to consent them the collection of individual cycle data and to administrate their own patients flow. Unfortunately the national privacy protection authorities (“Garante della Privacy”) until today has not gave the permission to collect this kind of data.

Congenital heart disease in live-born children: incidence, distribution, and yearly changes in the Campania Region

Congenital heart disease (CHD), the most common cardiac malformation in the fetal and neonatal period, represents a heterogeneous group of defects with little known cause. The aim of this study was to investigate the incidence rate (IR) of CHD without spontaneous resolution in the first year of life, the age at diagnosis, the most common type of CHD, and the IR changes in severe and nonsevere CHD during the study period. From January 1997 to December 2002, 4559 live births with CHD (diagnosed until December 2004) were enrolled in the Campania Region. Number of live-born children by month was derived from national registries. About 70% of CHD patients were diagnosed within the first year of life. The overall mean regional IR of CHD was 11.1 (confidence interval 10.8-11.4) patients per 1000 live-born children. The overall mean IR of CHD was significantly different in the five provinces of the Campania Region, but the annual IR remained stable in each of them throughout the study period. The relative risk in live-born children and residents in the areas with an elevated IR of CHD was higher for nonsevere CHD, but of low significance for severe CHD. At least one-third of CHD patients had atrial septal defects. We described the highest IR of CHD from one of the largest samples used up to now for this purpose (410 181 live-born children), but we think that this value could be higher (poor surveillance in some areas). Moreover, this study increases the awareness that CHD patients with a few symptoms are frequently underdiagnosed in areas with inadequate health services and that by an improved availability of pediatric echocardiographic assesments seem warranted. Eight years of surveillance and an increasing attention of both pediatricians and cardiologists to mild CHD in some provinces allowed us to demonstrate that, despite previous reports, the most common CHD in our region was atrial septal defect.

Reproductive History and Endometriosis Among Premenopausal Women

To clarify the temporal complexities of the relation between reproductive factors and endometriosis. We analyzed 10 years of prospective data from the Nurses' Health Study II cohort. Information was obtained through questionnaires sent every 2 years to 116,678 women aged 25-42 years when enrolled in 1989. Cox proportional hazards models were used to adjust for age, calendar time, and confounding variables. During 726,205 woman-years of follow-up, 1,721 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. Greater incidence was observed among women with an earlier age at menarche (rate ratio of 1.3 comparing menarche at age < 10 to age 12 years; 95% confidence interval [CI] 1.0-1.8; P value, test for trend < .001) and shorter cycle length during late adolescence (rate ratio of 1.3 comparing < 26 days to 26-31 days; 95% CI 1.1-1.5). Time to cycle regularity was not associated with risk. Among parous women, a linear decrease in risk was observed with number of liveborn children (rate ratio of 0.5 comparing > 3 with 2 children; 95% CI 0.4-0.7; P value, test for trend < .001) and lifetime duration of lactation if time since last birth was less than 5 years (rate ratio of 0.2 comparing > 23 months with never; 95% CI 0.1-0.4; P value, test for trend < .001). Hormonal and anatomical changes associated with menstruation and pregnancy may affect the rate of laparoscopically confirmed endometriosis. Within this cohort, risk was greatest among nulliparous women with earlier age at menarche and shorter menstrual cycles. Among parous women, parity and lifetime duration of lactation were associated with decreased risk.

Brief communication: birth month influences reproductive performance in contemporary women.

Season of birth has been reported to affect later reproduction in samples of pre-modern women and contemporary men. To examine whether the effect of birth date is also valid in contemporary women, we investigated the association between birth month and measures of reproductive performance (number of live-born children, % childless individuals) in a representative sample of contemporary Austrian women. Among reproducing women, birth month is significantly associated with the number of live-born children (n = 2839, P = 0.032). On average, women born in summer months have fewer children than women born during the remainder of the year. No association between birth month and the percentage of childless individuals was found. As has been reported in pre-modern women, month of birth also appears to affect later reproduction in contemporary women.

Natural change of the rural population of Yugoslavia with an emphasis on fertility in the early 1990s

The process of intensive deruralization or decline in total rural population of the FR of Yugoslavia in the second half of the 20th century ??m? exclusively as ? result of migration from rural to urban areas. Though constantly positive at the level of the country as ? whole, the downward tendency in rural population growth was observed throughout the period. The author analyzes components and dynamics of natural change in rural population with emphasis on the period from 1981 to 1997, regional specifics up to the republican and provincial levels, and the main differences from the specifics of natural change in urban population. The author highlights that in analyzing natural change b? type of settlement, particular attention should b? paid to the very pronounced interdependency between the components of population dynamics and the age-sex structure, the more so as the latter is becoming the most significant direct determinant of the natural population growth. Namely, crude birth rate of rural population in Yugoslavia has tor several decades now been lower th?n the corresponding measure for urban population, while the crude death rate has, however, been higher. At the same time, in age-specific terms, fertility was higher and mortality lower in rural relative to urban populations. Such discrepancy evolved primarily from the unfavorable age-specific structure of rural population and its notably disturbed sex-specific structure (pronounced surplus in male, particularly younger middle-aged population). The author goes on to analyze the main features of fertility and reproduction in rural population based on demographic statistics. ?? argues that the general and total fertility rates represent more adequate indicators of fertility in rural population, as the impact of age structure has been partially or even fully eliminated. Thus, in 1990-1992, both indicators are higher for rural relative to urban population, and sufficiently high relative to the mortality level to assure integral replacement (net reproduction was 1.0 in rural relative to 0.9 in urban population). In all m???r regions of the country, fertility was higher in rural relative to urb?n population. Such differences were minimal in low fertility regions, while remaining significant in Kosovo and Metohia. The analysis of fertility was supplemented b? the 1991 census data, which, for the first time, included the number of live born children b? age of mother and type of settlement. Despite the fact that such data on female population illustrate the situation at the moment of census taking only, and not at the moment of birth, the author thinks that the cohort analysis based on the census data provide ? much more realistic account of fertility in rural population than the period analysis based on vital statistics, primarily as it resolves the problem of ???ur?t? registration 0f vital events b? type of settlement. Thus, cohort fertility rates show that fertility of rural female population is notably higher than the effective fertility in urban areas. This is true for all five-year age groups without exception, and equally true for all major regions Finally, the author analyzes cohort fertility of the autochthon versus migrant populations, as well as fertility b? ethnic origin. ?? draws ? general conclusion that fertility is higher in migrant relative to autochthon female population, and that th? differences are much more pronounced in rural relative to urban populations. This phenomenon is explained b? the so-called marriage-motivated migration, which the author assumes to b? dominant in migrant female population. As for fertility rates b? ethnic origin, the well-known differences are also evident in rural population. Namely, all ethnic groups can b? classified b? level fertility into three categories. The highest rate is recorded for ethnic Albanian, Roma and Muslim women. Montenegrin women record moderately high fertility rates, while the rate recorded for women of Croatian descent is generally sufficient for generation replacement. The third category is made u? of Serb, Yugoslav, and ethnic Hungarian women as well as the great majority of women of other ethnic origin (?unj?va?, Romanian and Slovak). ?ll these nationalities record very low fertility levels, which have for years been insufficient to enable generation replacement.

Gypsies in the Czech Republic and the Slovak Republic: Geographic and demographic characteristics

Geographic and demographic characteristics of Gypsies were elaborated on the basis of population census' results in 1970 and 1980. In 1980, there were about 300 000 of Gypsies in Czechoslovakia (2% of the total population). The fast numerical growth of Gypsies becomes a subject of increasing interest of both specialists and large public. According to the prognosis till 2005, in the Czech Republic and the Slovak Republic will be about 495 000 of Gypsies (3% of the total population). The spatial structure of Gypsies is very uneven, they are concentrated mainly in the East Slovakian districts. The differences between Gypsies and other inhabitants in the demographic behaviour are evident from the age structure. Gypsies are demographically young population with the progressive type of the age structure (high proportion of children and low proportion of the aged). Gypsy women have a high level of fertility during the whole childbearing period. The number of live born children per one Gypsy woman was 6,0 in the age group 45–49 (total population 2,3) in 1980. The effort has been made to estimate the expectation of life of Gypsies on the basis of results from population census 1970 and 1980. The probability of death was derived from the probability of survival between 1970 and 1980. In the period 1971–1980 the expectation of life at birth of Gypsy men was 55,3 years and 59,5 years for Gypsy women. The level of life expectancy like this we can find in developing countries of the Third World. Changes in the demographic behaviour occur as permanent changes only on the basis of the overall social and economic development. The consequences of this development appear usually after a certain delay, measured by the length of generation, not by calendar years.

Effect of family history, body-fat distribution, and reproductive factors on the risk of postmenopausal breast cancer.

A family history of breast cancer reflects shared cultural factors, genetic predisposition, or both. There is evidence that the estimated risk associated with a family history of breast cancer increases multiplicatively in combination with other risk factors. We examined the combined effect of family history and anthropometric and reproductive factors on the risk of breast cancer in postmenopausal women. Using data from a prospective cohort study, we studied 37,105 women 55 to 69 years of age to determine whether known risk factors for breast cancer are modified by a reported family history at the time of entry into the study. During the first 4 years of follow-up, 493 new breast cancers were diagnosed. The association of the waist-to-hip ratio (the circumference of the waist divided by that of the hips) with the risk of breast cancer was limited predominantly to women with a family history of breast cancer; the age-adjusted relative risk of breast cancer for the women above the fourth quintile for waist-to-hip ratio as compared with those below the first quintile was 3.2 in women with a family history of breast cancer and 1.2 for women without such a family history. An interaction was observed between a family history of breast cancer and the number of live-born children; the protective effect of higher parity was observed primarily among women with a family history of breast cancer. Similarly, the age-adjusted relative risk of breast cancer associated with a late age at first pregnancy (i.e., greater than or equal to 30 years) was 5.8 for women with a family history of breast cancer and 2.0 for women without such a family history. The increase in the risk of breast cancer associated with a high waist-to-hip ratio, low parity, or greater age at first pregnancy is more pronounced among women with a family history of breast cancer. These findings suggest etiologic differences between familial breast cancer and the sporadic form.

Liveborn children and risk of hepatocellular carcinoma.

Clinical, animal, and epidemiologic evidence indicates that exogenous steroids influence the risk of hepatocellular carcinoma (HCC) and a recent study suggested that parity also may increase the risk of this tumor in women. The latter hypothesis was evaluated in the data from a case-control study which was carried out in Athens and covered 166 male and 19 female cases of HCC, and 381 male and 51 female hospital controls. Among males, there was no association between the number of liveborn children and risk of HCC, whereas among women, there was a suggestive positive association. Compared with women with one or two children, the relative risk for HCC was 0.6 among nulliparous women, 1.3 among those with three or four children and 1.7 among those with five or more children. The association of parity with risk of HCC was limited to women who were positive for hepatitis-B surface antigen (HBsAg) and was not confounded by hepatitis-C virus infection or tobacco smoking. The small number of HCC cases does not permit firm conclusions. If confirmed, however, these results would provide the foundation for a practical preventive advice that could be given to women who are positive for HBsAg.

Spontaneous abortions and work in day nurseries.

420 pregnancies were recorded between 1962 and 1987 among 202 women working for at least one month in day nurseries during 1984. During that time 230 pregnant mothers had worked as childminders in day nurseries ('exposed' pregnancies). The remaining 190 pregnancies were classified as 'unexposed'. 27 spontaneous abortions were exposed and 7 unexposed corresponding to abortion rates of 11.7% and 3.9%, respectively, which is a significant difference. Also 'threatened' abortions during the first trimester of pregnancies ending up in live-born children were accumulated in exposed pregnancies, and the miscarriage rate was possibly increased in unexposed pregnancies of women with their own children in day nurseries. Significant differences were not observed with regard to premature birth, congenital malformations, number of live-born children and sex ratio of live-born children. The cause of the increased frequency of spontaneous and 'threatened' abortions in exposed pregnancies could be a contagious agent.