Population policies and reproductive patterns in Vietnam

BACKGROUND: Vietnam's population policy since the 1980s had stipulated a limit on family size to two children, born 3-5 years apart, and recommends a minimum age of 19 for the mother of a first child. We analysed trends in the timing of marriages and births, and in fertility and abortion rates, among women born between 1945 and 1970, to assess the impact of these policies on reproductive patterns. METHODS: Reproductive histories were recorded in a random sample of 1432 married women aged 15-49 in a rural province in northern Vietnam. Mean age at marriage and at birth of the first child, birth intervals, fertility, and abortion rates were examined in relation to the woman's year of birth. FINDINGS: Later-born women married and had their first child at a younger age than women born earlier. Birth intervals had increased among later-born women but 25% still had only a 1-year interval between first and second child. Fertility had gradually decreased while abortion ratios had increased rapidly. Childbearing patterns had become "earlier, longer, and fewer" rather than "later, longer, and fewer" as stipulated by the policies. The results also show that women with more schooling married and had their first child later. Women involved in farming had shorter spacing between children. INTERPRETATION: There are signs that Vietnam's population policy has focused too strongly on contraception and abortion while ignoring the connection between fertility and women's opportunities for education and employment. In these respects, rural women are at particular risk.     

Childbearing and child development: Demographic and psychosocial trends.

A major trend in the US is the continuing decline in fertility. A steadily decreasing proportion of births are reported by married women as being unwanted at the time pregnancy was discovered. Currently marriage, 1st birth, and family formation are longer delayed. Preference for a smaller family is stronger. Increasing proportions of young wives are childless, while the birth rate for firstborn children is rising for women in their late 20's and early 30's. Improved control of family size is partly a function of effective contraceptive methods but probably is more closely related to higher levels of motivation. Births to women under age 20 now comprise a higher proportion of total births and are of increasing societal concern. International trends are discussed. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intraoperative patient care. Multiple injuries

Analysis of the shift in the marital structure of Nepal between 1961 and 1971 indicates that the marital structure of 1971 is more favorable to a higher CBR (crude birthrate). Although there has been a slight inc rease in the age at marriage, over 90% of Nepali women were married by the ages 20-24 years in 1971 and the decline in the incidence of widowho od has increased the proportions of potential child-bearing women and consequently the number of births. Thus shifts in the marital structure between 1961 and 1971 could have provided little impetus to a decline in the CBR of the country.     

Age, sex, marital status and suicide: an empirical study of east and west

The relationships among age, sex, marital status and suicidal behaviour in Australia and Hong Kong showed disparity in age-specific suicide rates among the four marital status groups, never married, married, widowed and divorced, for both sexes in the two locations. Examining the coefficients of preservation suggested the coefficient for never married to married in all cases was larger than 1, except for the groups of teenagers aged 15-19 years for both sexes and of elderly women aged 60 years or over in Hong Kong. The widowed or divorced groups have lower suicide rates than the married women among the elderly in Hong Kong. Hong Kong women seem not to have been benefited in marriage as much as men. Responsibility and workload in married life rather than low social status are the likely reasons for the relative high female suicide rate in Hong Kong. Possible cultural and environmental factors which are somewhat speculative (yet to be confirmed) are discussed.     

Regional and chronological differences of urogenital cancer deaths in Japan

PURPOSE: We investigated the changing patterns of urogenital cancer deaths during the past 22 years in Japan. METHODS: We analyzed patients that died from cancer of the prostate, bladder and kidney between 1973-1994. Age-adjusted death rates (adjusted to the world population), standardized mortality ratios (SMR) according to each prefectures and age-specific death rates for each types of cancer were calculated and changes in these patterns were analyzed. RESULTS: Age-adjusted death rates for cancer of the prostate increased from 2.29 in 1973 to 4.36 in 1994, a 1.9-fold increase. Death rates for cancer of the bladder were stable in males and declined in females. Death rates for cancer of the kidney (15 years or older) increased from 1.45 in 1973 to 2.72 in 1994, a 1.9-fold increase in males, and tended to increase in females as well. In the SMR analysis by prefecture, distribution in 1973-84 (former period) and that in 1985-94 (later period) were similar, and characteristic features were observed for each type of cancer. Age-specific death rates for cancer of the prostate and bladder rose by an index power of age, but that for cancer of the kidney reached a plateau or decreased after an index power increase to a certain age. The rate of increase in age-specific death rates (later period/former period) rose according to age, especially 70 years or older, in cancer of the prostate and kidney in both males and females. However, age-specific death rates in the later period from cancer of the bladder was higher only in patients 85 years or older, but was lower in other age groups. CONCLUSIONS: Death rates for cancer of the prostate and kidney (15 years or older) tended to increase, while that of the bladder remained stable or decreased. It is expected that detection and treatment of these disease can be improved by utilizing these epidemiologic information.     

Age at marriage and cervical cancer incidence

Cancer of the uterine cervix is the commonest cancer among Indian women accounting for 1/5 of the total cancer incidence. It is the estimated that by the turn of century 139,000 women in India would be developing cervical cancer. Age at marriage has been recognised as a major risk factor associated with cervical cancer. Over the past 8 decades there has been a rise in age at marriage varying from 14 years in 1901 to 18 years in 1981. Consequently the proportion of women married in the age group 15-19 years has fallen from 88% in 1941 to 45% in 1981. The present paper has attempted to study the effect of change in proportion married below 17 years on cervical cancer incidence for the year 1985 in India. The proportion of married women in the age group 15-19 years was constant around 88% from 1901-41 and from 1951 onwards the reduction in the proportion married has been observed. During the last 35 years, after the start of reduction in the proportion married in the age group (15-19) years, a reduction of 2097 cervical cancer cases or 6.3 percent reduction in the incidence of invasive cervical cancer is observed. It may be postulated that it will take a long time to expect a significant reduction in the incidence of cervical cancer if the primary prevention of rising the age at marriage above 18 years is adopted as a strategy for control of cervical cancer.     

Cytotoxicity of lindane and paraquat to human hepatoma cell lines

A serosurvey was conducted in a random sample of 259 women and 231 men in 12 rural communities in Mwanza Region, Tanzania, using a type-specific ELISA for Herpes simplex virus type 2 (HSV-2) infection. Seroprevalence rose steeply with age to approximately 75% in women >=25 years old and 60% in men >=30. After adjusting for age and residence, HSV-2 prevalence was higher in women who were married, in a polygamous marriage, Treponema pallidum hemagglutination assay (TPHA)-positive, had more lifetime sex partners, or who had not traveled. Prevalence was higher in men who were married, had lived elsewhere, had more lifetime partners, had used condoms, or were TPHA-positive. HSV-2 infection was significantly associated with recent history of genital ulcer. The association between HSV-2 infection and lifetime sex partners was strongest in those <25 years old in both sexes. This association supports the use of HSV-2 serology as a marker of risk behavior in this population, particularly among young people.     

Birth statistics: recent trends in England and Wales

This article summarises recent trends in birth statistics in England and Wales. Particular attention is given to the characteristics of conceptions in 1996 and births in 1997, the latest years for which figures are available. The article examines changes in the number of births outside marriage, the age women become mothers and the number of women expected to remain childless throughout their lives. It also analyses differences in the timing of childbearing between women from different social classes or living in different regions of the UK. Finally it describes changes in the overall and underage conception rates between 1995 and 1996.     

Number and timing failures among legitimate births in the United States: 1968, 1969 and 1972

More than one in 10 legitimate births that occurred in the United States during 1968, 1969, and 1972 were not wanted at all, and more than one-quarter of the births were timing failures. A substantial reduction in unwanted childbearing took place between 1968 and 1972. The proportion of legitimate births reported by their mothers to be unwanted ever declined from 13 percent in 1968 to eight percent in 1972. If, as reported in a number of cross-sectional surveys taken during this approximate period, there was a sharp reduction in wanted family size reported by married women, then these women would have remained at risk of having an unwanted birth for a longer period than when their wanted family size had been higher. Thus, these estimates of a decline in unwanted childbearing may be understated (although there was the countervailing trend of later age at marriage during these years). The decline in unwanted childbearing between 1968 and 1972 is only partially attributable to the shift toward lower birth orders that occurred. Declines in unwanted births occurred for almost all birth orders. There was no significant reduction in mistimed births. Because the decline in unwanted fertility during the study period was much greater for nonwhites than whites, the traditional racial differential in unwanted childbearing narrowed considerably between 1968 and 1972. In 1968, 12 percent of the white legitimate births were classified as not wanted, compared to 21 percent of the legitimate births to nonwhites. However, between 1968 and 1972, nonwhites experienced extremely sharp declines in unwanted childbearing. Thus, in 1972 only 9.5 percent of the legitimate births to nonwhites were reported as unwanted, compared to 8.1 percent of the white births. Mothers of higher parity were much more likely to report a birth as unwanted than those of lower parity. Mothers who had completed more schooling were less likely than poorly educated mothers to report births as unwanted. Income level seems unrelated to whether the birth is unwanted, but is inversely related to whether it is a timing failure. Births that resulted from premarital conceptions tended to be reported as timing failures. Viewed from the cross-sectional perspective of period rates of population change, the elimination of unwanted legitimate childbearing would have had a substantial effect on population growth in each of the study years even without decreasing marital mistimed births or illegitimate fertility. The data also suggest that eliminating unwanted marital childbearing could significantly reduce completed family size. However, this conclusion must be viewed with great caution, since we do not know the future variations in timing and spacing of births, and the extent to which the childbearing experience of the sampled mothers is representative of their birth cohorts.     

Is fecundability associated with month of birth? An analysis of 19th and early 20th century family reconstitution data from The Netherlands

The relationship between fecundability and month of birth was investigated in a cohort of 1526 women who married between 1802 and 1929, using only women whose first marriage occurred before the age of 35 years. On the basis of their time to pregnancy (TTP, calculated as time between wedding and first birth minus gestational length), women were categorized into two groups: fecunds (TTP up to 12 months or prenuptial conceptions, n = 1348) and subfecunds (TTP >18 months, n = 118). By use of logistic regression, cosinor functions with a period of 1 year or 6 months and variable shift and amplitude were fitted through the monthly odds of subfecunds versus fecunds. The best fitting curve was unimodal, with a zenith in September (P = 0.13 for H0: no differences). Exclusion of childless women (n = 36, minimum follow-up 5 years) from the subfecunds led to a similar curve (P < 0.01), while childless women, as compared with fecunds, showed a birth distribution that was best represented with a bimodal curve with zeniths in January and July (P = 0.06). This study provides evidence for the existence of differences in fecundability by month of birth. The cause of this relationship is unclear, but may lie in a melatonin-dependent circannual variability of the quality of the oocyte.     

A comparison of ever-married and never-married women with anorexia nervosa or bulimia nervosa

OBJECTIVE: The results of the scant research on anorexia nervosa and marriage suggest that married anorexics may exhibit more severely disordered eating. However, past research has not controlled for the greater age of married versus unmarried anorexics, and very little research has been conducted on marriage and women with bulimia nervosa. We investigated differences in disordered eating and clinical traits between ever-married and never-married women with anorexia nervosa or bulimia nervosa and statistically controlled for age. METHOD: Adult women ages 20-45, who were assessed in an outpatient eating disorders clinic and diagnosed with anorexia nervosa (n = 91) or bulimia nervosa (n = 223), completed several measures of disordered eating and related traits at the point of initial evaluation. RESULTS: In simple comparisons, ever-married women differed from their never-married peers with regard to several indices of symptom history and severity. However, after controlling for age, ever-married women differed only with regard to an earlier onset of menarche and, for women with bulimia nervosa, an earlier onset of sexual intercourse. DISCUSSION: Results are discussed with regard to possible explanation and directions for future research.     

Psychosexual development of women with congenital adrenal hyperplasia

Women with congenital adrenal hyperplasia (CAH) (N = 31) and their unaffected sisters or female cousins (N = 15) participated in a study of psychosexual development. All participants were > or = 18 years of age (mean age, 25 years; range, 18-40). Comparisons were also made between the CAH women with the salt-wasting (SW) form of the disorder and those with simple virilization (SV). A psychosexual assessment protocol examined six variables: (1) sex assignment at birth (probands only); (2) recalled sex-typed behavior during childhood; (3) gender identity and gender role identification in adulthood; (4) relationship status; (5) sexual orientation in fantasy; and (6) sexual orientation in behavior. Salt-wasting status and sex assignment at birth were also ascertained for the CAH women who either refused to participate in the study (N = 10) or could not be traced (N = 13). Compared to the controls, the women with CAH recalled more cross-gender role behavior and less comfort with their sense of "femininity" during childhood. The two groups did not differ in degree of gender dysphoria in adulthood, although the probands showed more cross-gender role identification. Three of the nonparticipant probands were living, as adults, in the male social role (2 reared from birth as boys and 1 who changed from the female to the male social role during adolescence). The CAH women and the controls did not differ in relationship status (married/cohabiting vs. single). The CAH women had lower rates of exclusive heterosexual fantasy and fewer sexual experiences with men than the controls; however, the CAH women did not have more sexual experiences with women than the controls. Comparisons between the SW and SV revealed several differences: the SW were less likely to be assigned to the female sex at birth, recalled more cross-gender role behavior during childhood, were less likely to be married or cohabiting, and had lower rates of sexual experiences with men. The results were discussed in relation to the effects of prenatal androgens on psychosexual differentiation.     

Twenty-year dynamics of serum cholesterol levels in the middle-aged population of eastern Finland

BACKGROUND: In cross-sectional analyses, serum cholesterol levels differ among different age groups. However, secular time trends in cholesterol levels can be seen across age groups in a population. A birth cohort analysis provides useful information on the combined effect of age and time on changes in serum cholesterol levels. OBJECTIVE: To analyze the 20-year dynamics of serum total cholesterol levels in relation to age, sex, birth cohort, time period, mortality rate, and changes in the intake of saturated fats. DESIGN: Cross-sectional measurements of serum total cholesterol levels in five independent population surveys done in 1972, 1977, 1982, 1987, and 1992. SETTING: Kuopio and North Karelia provinces in eastern Finland. PATIENTS: Random sample of 16,711 men and 17,542 women 25 to 64 years of age. Persons in the oldest birth cohort were born in 1913; persons in the youngest birth cohort were born in 1967. MEASUREMENTS: Total serum cholesterol levels and daily intake of dietary fat. RESULTS: Between 1972 and 1992, mean cholesterol levels decreased with time in each age group and for both sexes. According to the cross-sectional data, cholesterol levels increased with age and increased more steeply in women than in men. Contrary to these data, cholesterol levels in birth cohorts did not increase with age. Cholesterol levels did not change at all within birth cohorts of women and started to decrease after 45 years of age in birth cohorts of men. Cholesterol levels in the youngest birth cohorts (persons 25 to 29 years of age) entering the study each study year were markedly lower than levels in the same age group in the previous survey of risk factors. Daily intake of saturated fat decreased markedly between 1972 and 1992. Most of this decrease could be explained by change in intake of liquid dairy products and spreadable fats. In both sexes, changes in saturated fat intake were correlated with the time period, whereas the association with age was weak. CONCLUSIONS: In this Finnish population, total serum cholesterol levels are more closely associated with birth cohort than with age. Changes in dietary intake of saturated fat over time may account for changes in cholesterol levels. This finding suggests that community-based strategies for preventing cardiovascular disease can affect most of the population.     

Frequency of pap and pil operons in Escherichia coli strains associated with urinary infections

The influence of reproductive variables on cervical cancer incidence, controlling for other sociodemographic factors, was estimated in Norwegian register and census data, using Poisson regression models. Among the 1.3 million women under observation, a total of 2,870 cases of cervical cancer were diagnosed. According to models restricted to parous women, parity level had no independent impact on cervical cancer incidence, but a clear effect of age at first birth was noted. It was most pronounced in the squamous cell carcinomas, where the incidence was reduced by 48 percent from age at first birth < 21 years to age at first birth 27+ years. Women without children had the same cervical cancer incidence as parous women with a first birth after age 24. The sociodemographic variables controlled for exerted a strong net effect on the cervical cancer incidence. Educational level was related inversely to the cancer risk. Moreover, an increased risk was seen for women who had given birth when they were still single (never married) and for those who were divorced/separated at the time of the last previous census. A fairly small excess risk was found to be associated with living in non-rural compared with rural areas.     

In vitro fertilization versus tubal surgery: is pelvic reconstructive surgery obsolete?

OBJECTIVE: To compare the results of pelvic reconstructive surgery with cumulative success rates of IVF for couples with tubal factor infertility. DATA RESOURCES: Outcomes of pelvic surgery were obtained from a review of articles from the literature identified by directed Medline searches. Cumulative pregnancy rates of 771 couples with tubal factor infertility treated at the Cornell IVF program between December 1989 and December 1992 were calculated by life-table analysis. RESULTS: Overall delivery rate per transfer for patients with tubal factor was 28.9% (303 deliveries per 1,048 transfers) and did not appear to be affected significantly by the presence of a secondary diagnosis. A significant decline in pregnancy rates was observed with advancing age: age < 30 years, 48.4%; 30 to 34 years, 44%; 35 to 38 years, 28%; 39 to 40 years, 20%; 41 to 42 years, 9%; and > 42 years, 4.3%. Cumulative pregnancy rates for cycles 1 to 4 were 32%, 59%, 70%, and 77%, respectively, in patients with only tubal factor, and 28%, 55%, 62%, and 75% in patients with tubal combined with other associated infertility factors. CONCLUSIONS: Our experience suggest that > 70% of women with tubal factor infertility will have a live birth within four cycles of treatment with IVF. These results compare favorably with the best outcomes after tubal reconstructive surgery. In older women, because of the rapid decline of fertility potential with advancing age, efforts should be directed toward the treatment method that provides the highest likelihood of success within the shortest time interval.     

Success rates with gamete intrafallopian transfer and in vitro fertilization in women of advanced maternal age

OBJECTIVE: To evaluate the effect of maternal age on outcomes for IVF and GIFT in women 40 to 45 years of age. DESIGN: Retrospective. SETTING: Boston IVF, a free-standing university-affiliated IVF and GIFT unit. PATIENTS: A total of 2,931 cycles of IVF and 1,826 cycles of GIFT were analyzed in women undergoing assisted reproductive technologies (IVF or GIFT) using autologous eggs. INTERVENTIONS: Medical records of patient outcomes were reviewed. RESULTS: For patients undergoing IVF, the cancellation rate for initiated cycles showed significant differences in women aged 25 to 39 (38.3%), women aged 40 to 43 (49.5%), and women aged 44 to 45 years (69.5%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 years when compared with women aged 25 to 39 years. No deliveries occurred in 59 cycles in women aged 44 to 45 years, thereby representing a significant difference when compared with both women aged 25 to 39 years and women aged 40 to 43 years. For patients undergoing GIFT, the cancellation rate for initiated cycles was significantly higher in women aged 40 to 43 (25.0%) and 44 to 45 years (31.0%) when compared with women aged 25 to 39 years (15.1%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 and 44 to 45 years when compared with women aged 25 to 39 years. CONCLUSIONS: Success rates for IVF and GIFT decline significantly in women > 40 years old. Women aged > or = 44 years are unlikely to benefit from the use of IVF and GIFT.     

Anti-hepatitis A virus antibody response elicited in mice by different forms of a synthetic VP1 peptide

To explore factors associated with longevity, we studied geographic distribution of centenarians in Japan, based on 1990 the population census. We calculated the proportion of centenarians from ratio of number of centenarian to that of population aged 65 years or older. Centenarians in Japan consisted of number 4,152 persons. By prefecture, Tokyo had the most centenarians (383), followed by Okinawa (193) and Fukuoka (151) prefectures. Fukui had the least (24), followed by Akita (26) and Ishikawa (29) prefectures. The proportion of centenarians in Japan was 21.6 (per 100,000 populations) in 1990. By prefecture, the highest proportion lived in Okinawa (133.8), whereas the fewest were found in Akita (8.9). The relationship between geographic distribution of centenarians and environmental factors and nutritional factors were analyzed. Correlation coefficients between proportion of centenarians and mean temperature, high quality of welfare work and of medical services, and having much leisure time were positively significant. As for nutritional factor, correlation coefficients between proportion of centenarians and protein (% of energy) was positively significant, while intake of total energy was negatively significant.     

Teenage sex talk

Although an international study recently revealed that 87% of the UK's teenage mothers are unmarried, the highest figure in the world according to Alan Guttmacher Institute data of 1998, the teen conception rate in the country has declined considerably over the past 25 years and the number of teen mothers has been almost halved. Teens, as well as couples in other age groups, are increasingly cohabiting outside of marriage rather than getting married; more than two-thirds of babies born to teenagers are jointly registered by both parents. However, despite the decline in teenage conceptions since 1970, the UK still has one of the highest rates in Europe. The UK's real scandal is its failure to give young people the information they need to manage their sexual health. International research has proven that sexual health can be improved if societies are open about sex, accept teenage sexuality, and permit discussion about sex without embarrassment. Moreover, sex and relationships education should start at an early age, and young people should have easy access to free and confidential sex advice. Individuals under age 16 years have the right to the same degree of confidentiality as that afforded to adults. Vast potential exists for nurses to increase teenagers' use of services by removing the key obstacles which deter them from seeking advice: fears about confidentiality, lack of service publicity, and inappropriate opening times.     

Age of mother at last birth in two historical populations

This study uses sets of historical family reconstitutions from all of Quebec and from four villages of the Haut-Jura, France--first marriages of 2226 and 994 women, respectively--to investigate the physiological and social factors affecting age of mother at last birth before and during fertility transition. Age remained high throughout the period covered in Quebec, under 'natural' conditions, but showed a steady decline in the French material which extends to late 19th century generations practising family limitation. Age at marriage had no influence in Quebec; in France, however, women with the most surviving children at age 35 continued childbearing the latest. There was no link between biological ability to achieve a live birth, or in health status or aging rhythm, and age at last birth. Behaviour of mothers and daughters showed no relation. The variability in age at last birth thus appears to be random under natural conditions; with the onset of controls, social differences seem to influence not only the end of childbearing, but all aspects of behaviour governing final family size and child survival.