Biological control of nematode parasites of livestock in Fiji: screening of fresh dung of small ruminants for the presence of nematophagous fungi

OBJECTIVE: To assess risk factors and outcomes associated with nuchal cord at birth. STUDY DESIGN: A population-based, case-control study was conducted using linked birth and hospitalization records. Three thousand newborns were randomly selected from all singleton births with nuchal cord as noted on the birth record (n = 5,426) in King County, Washington, 1992-1993. For comparison, 3,000 controls were randomly selected from the 46,952 unaffected singleton births. RESULTS: An increased risk of nuchal cord was associated with induction of labor (odds ratio [OR] adjusted for maternal age and parity 2.0, 95% confidence interval [CI] 1.7-2.3), African American infant race (OR 1.3, 95% CI 1.0-1.6), primiparity (OR 1.2, 95% CI 1.0-1.5) and male sex (OR 1.2, 95% CI 1.0-1.3). After exclusion of selected obstetric complications, the risk of nuchal cord associated with induction of labor increased (OR 2.4, 95% CI 2.0-3.0). Nuchal cord was associated with increased risks of fetal distress (OR 2.7, 95% CI 2.1-3.4), meconium staining (OR 2.1, 95% CI 1.7-2.6), five-minute Apgar score < 7 (OR 1.6, 95% CI 1.1-2.4) and assisted ventilation < 30 minutes (OR 1.9, 95% CI 1.4-2.6). Although hospital charges for newborns with nuchal cord were slightly greater than for those without (P = .02), hospital lengths of stay did not differ significantly. CONCLUSION: Induction of labor was identified as an independent risk factor for nuchal cord. Certain adverse perinatal outcomes are increased in neonates with nuchal cord. However, neonates with nuchal cord do not have significantly longer neonatal hospital stays, and thus the adverse effects of nuchal cord may be transient.     

The spontaneous gating activity of OmpC porin is affected by mutations of a putative hydrogen bond network or of a salt bridge between the L3 loop and the barrel

Nineteen counties from San Francisco and Los Angeles, California and Seattle, Washington were the United States sites for a large population-based case-control study of childhood brain tumors (CBTs), sponsored by the National Cancer Institute. CBT patients who were < 20 years of age and were diagnosed between 1984 and 1991 were reported to each region's cancer registry. The 801 control subjects were obtained by random digit dial and were frequency-matched to the 540 CBT patients in San Francisco and Seattle (one patient to two controls) and in Los Angeles (one patient to one control). Data collected by in-person interview with subjects' mothers were analyzed to investigate an association between risk for CBTs and life on a farm, exposure to farm animals (dairy cattle, beef cattle, pigs, sheep/goats, poultry, and horses), and some cat and non-farm horse exposures. Elevated risks for CBTs were observed in association with mothers' exposure to pigs [odds ratio (OR) = 3.8, 95% confidence interval (CI) = 1.2-12] and horses (OR = 2.2, 95% CI = 1.0-4.8) on a farm during the index pregnancy. Children diagnosed with primitive neuroectodermal tumors showed elevated risks for CBTs with personal and maternal prenatal exposure to pigs (child, OR = 4.0, 95% CI = 1.2-13; mother, OR = 11.9, 95% CI = 2.8-51) and poultry (child, OR = 3.0, 95% CI = 1.1-8.0; mother, OR = 4.0, 95% CI = 1.2-14). No other animal exposures of children or mothers were found to be consistently related to CBTs. Children diagnosed with primitive neuroectodermal tumors who were on a farm for > 1 year and were first on a farm when they were < 6 months of age also had increased risk for CBTs (OR = 3.9, 95% CI = 1.2-13). A somewhat increased risk for CBTs was found for children of mothers who ever had worked on livestock farms compared with mothers who never had worked on a farm (OR = 7.4, 95% CI = 0.86-64, based on five case mothers and one control mother who worked on livestock farms during the 5 years preceding the birth of the index child). The associations are consistent with those of two previous studies in Norway (P. Kristensen et al., Int. J. Cancer, 65: 39-50, 1996) and the United States and Canada (G. R. Bunin et al., Cancer Epidemiol. Biomark. Prev., 3: 197-204, 1994) that investigated the role of farm-related exposures in the etiology of CBTs.     

Early discharge. Risks, benefits, and who decides

Over the last several decades, there has been a significant decrease in the length of hospital stays for mothers and their newborns, ranging from the average of 7 to 10 days before World War II to approximately 2 days in recent years. Many women saw the benefit of early discharge as a means to demedicalize the birth process, to be home with their families sooner, and to have their deliveries be a more positive experience. Although the trend toward shorter hospital stays was originally initiated by consumer interest, the recent further shortening of maternity stays has escalated as a result of insurance and managed care plans attempting to contain health care costs. With this trend toward earlier discharge, a litany of problems have been reported, including missed newborn screening, jaundice, feeding problems, missed congenital anomalies, and readmissions. Although cost-efficient use of health care is vital, the ultimate goal should not only be the prevention of unnecessary morbidity and mortality, but the promotion of health and well being for the child and family.     

Knowledge base and use in the management of pressure sores

OBJECTIVE: To determine whether early discharge (< 72 hours) after childbirth increased the risk for women developing postnatal depression. DESIGN: Prospective cohort design consisting of an initial interview, and six-weekly assessments for 24 weeks using a self-report questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Women discharged within 72 hours were compared with the remaining women. SETTING: Tertiary referral hospital in western Sydney, New South Wales, 1993. PARTICIPANTS: All 749 women delivering over a three-month period were recruited. Of the 522 participants, 425 women completed the study. MAIN OUTCOME MEASURES: Women scoring > 13 on the EPDS on two or more occasions were considered potential "cases" of postnatal depression. The diagnosis was confirmed using the Structured Clinical Interview for DSM-III-R disorders (SCID). RESULTS: Of the 153 women (36%) discharged early, 22 women (14.4%) developed postnatal depression over the study period compared with 20 of the 272 women (7.4%) who had standard length of stay. Women who were discharged within 72 hours had a significantly increased risk for developing postnatal depression (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.07-4.21). This risk persisted when other sociodemographic, obstetric and psychosocial risk factors were controlled for in a logistic regression analysis (OR, 3.06; 95% CI, 1.22-7.69). CONCLUSION: Women planning early discharge after childbirth should be carefully assessed before discharge and follow-up should be rigorous. The potential to develop postnatal depression should be considered in all women choosing early discharge from hospital.     

Testicular cancer and cryptorchidism in relation to prenatal factors: case-control studies in Denmark

To explore prenatal risk factors that are common to testicular cancer and cryptorchidism, two parallel case-control studies were conducted in Denmark. Information about characteristics of the mother, the pregnancy, and the birth were obtained from the mothers of cases and controls, using a mailed self-administered questionnaire. A maternal age above 30 years was associated with odds ratios (OR) of 1.9 (95 percent confidence interval [CI] = 1.2-3.0) for cryptorchidism and 2.0 (CI = 1.2-3.6) for testicular seminoma; the latter effect was particularly high when the boy was the first child of the mother (OR = 4.1, CI = 1.1-14.6). Birthweights below 3,000 g or above 4,000 g were associated with increased risks of testicular cancer, with ORs up to 2.6 (CI = 1.1-5.9) for birthweight below 2,500 g. For cryptorchidism, there was a monotonous trend in the OR from 0.4 in birthweights above 4,500 g to 2.3 in birthweights below 2,500 g. The association between cryptorchidism and testicular cancer was not attenuated by adjustment for maternal age and birthweight, indicating that all three variables are independent risk factors for testicular cancer. With the exception of high maternal age, which consistently is associated more strongly with seminoma than with non-seminoma, it remains most likely that seminoma and non-seminoma have similar causes.     

Pleural effusions in the medical ICU: prevalence, causes, and clinical implications

OBJECTIVE: To determine the prevalence and causes of pleural effusions in patients admitted to a medical ICU (MICU). DESIGN: Prospective. SETTING: MICU in a tertiary care hospital. PATIENTS: One hundred consecutive patients admitted to the MICU at the Medical University of South Carolina whose length of stay exceeded 24 h had chest radiographs reviewed daily and chest sonograms performed within 10 h of their latest chest radiograph. RESULTS: The prevalence of pleural effusions in 100 consecutive MICU patients was 62%, with 41% of effusions detected at admission. Fifty-seven of 62 (92%) pleural effusions were small. Causes of pleural effusions were as follows: heart failure, 22 of 62 (35%); atelectasis, 14 of 62 (23%); uncomplicated parapneumonic effusions, seven of 62 (11%); hepatic hydrothorax, five of 62 (8%); hypoalbuminemia, five of 62 (8%); malignancy, two of 62 (3%); and unknown, three of 62 (5%). Pancreatitis, extravascular catheter migration, uremic pleurisy, and empyema caused an effusion in one instance each. Heart failure was the most frequent cause of bilateral effusions (13/34 [38%]). When compared with patients who never had effusions during their MICU stay, patients with pleural effusions were older (54+/-2 years, mean+/-SEM, vs 47+/-2 years [p=0.04]), had lower serum albumin concentration (2.4+/-0.1 vs 3.0+/-0.01 g/dL [p=0.002]), higher acute physiology and chronic health evaluation II scores during the initial 24 h of MICU stay (17.2+/-1.1 vs 12+/-1.2 [p=0.010]), longer MICU stays (9.8+/-1.0 vs 4.6+/-0.7 days [p=0.0002]), and longer mechanical ventilation (7.0+/-1.3 vs 1.9+/-0.7 days [p=0.004]). No patient died as a direct result of his or her pleural effusion. Chest radiograph readings had good correlation with chest sonograms (p<0.0001). CONCLUSION: Pleural effusions in MICU patients are common, and most are detected by careful review of chest radiographs taken with the patient in erect or semierect position. When clinical suspicion for infection is low, observation of these effusions is warranted initially, because most are caused by noninfectious processes that should improve with treatment of the underlying disease.     

Early postpartum discharge in the postpartum

OBJECTIVE: To assess a policy of early discharge from hospital after a vaginal birth. DATA SOURCES: Reports of studies on this topic were identified in Medline and Cochrane Collaboration database (from 1985 to the beginning of 1995, in english or latin publications). This search was supplemented by referenced studies in book chapters and in other published bibliographies. Key words were: early discharge or ambulatory care and mother or infant or post-partum or obstetrics. STUDY SELECTION: One hundred and ten articles have been retrieved. We have included in the meta-analyse the randomized clinical trials comparing a group of women discharged early (less than 48-72 hours after delivery) with a control group leaving hospital after an usual stay (more than 48-72 hours). Quality of the studies was analysed through the Chalmers et al. recommendations. DATA EXTRACTION: Data were retrieved independently by two authors, and results were compared. Selected outcomes were: hyperbilirubinemia, infant feeding problems and skin rashes; breast feeding; maternal satisfaction on the hospital stay; readmission and non-routine clinics for both the mother and her child. DATA SYNTHESIS: Data from five included studies were pooled by the Peto method. There are no significant modifications of the risks of re-admission to hospital. The frequency of non-routine clinics and the risk of skin rash are not different in the two groups. The risk of hyperbilirubinemia and infant food problems are not different. The frequency of breastfeeding one month after delivery was higher in the early discharge group (OR = 1.88; 95% CI: 1.09-3.23), but this difference decreased over time. Women satisfaction on hospital stay was lower in case of early discharge (OR = 0.56; 95% IC: 0.44-0.72). CONCLUSION: The meta-analysis suggests an advantage of early discharge policy on breastfeeding at one month after the delivery, but mothers seem to prefer longer hospital stays. These results must be cautiously interpreted as included studies are of small sample size or rather old. This policy remains to be evaluated more thoroughly before recommendations could be made.     

Optimization of energy-dependent processes in mitochondria from rat liver and brain after inhalation of negative air ions

BACKGROUND: Bone cancers in children are serious and highly fatal conditions, yet relatively little is known about their causes or methods of prevention. METHODS: The relationship between parental occupation and bone cancer in offspring was explored in a case-control study. Cases were identified from the Ontario Cancer Registry; population-based controls were matched on sex and age. Data were collected from their parents through the use of a mailed self-administered questionnaire. RESULTS: The odds ratio estimates (OR) for bone cancer were elevated for fathers in the social sciences (OR = 2.5, 95% confidence interval [CI]: 0.7-8.4). Risk of Ewing's sarcoma was significantly high among children with fathers in social sciences (OR = 6.2, 95% CI: 1.6-24.5) and mothers in teaching (OR = 3.1, 95% CI: 1.1-8.7) or farming (OR = 7.8, 95% CI: 1.9-31.7). Osteosarcoma risk was increased for fathers in farming (OR = 2.1, 95% CI: 0.8-5.7), and mothers in managerial and administrative work (OR = 2.3, 95% CI: 0.6-8.1), and product fabricating, assembling, and repairing (OR = 2.0, 95% CI: 0.6-7.2). CONCLUSIONS: Certain methodological problems plague studies of bone cancer in children (e.g. small studies, low statistical power, analysis of multiple occupational categories, difficulty in identifying specific carcinogenic agents). These associations require further investigation, especially as elevated risks have been reported previously for agricultural occupations.     

Maternal flu, fever, and the risk of neural tube defects: a population-based case-control study

Results of clinical and epidemiologic studies have shown an increased risk for neural tube defects (NTD) in infants whose mothers were exposed to heat during pregnancy. However, the risk for NTD in infants whose mothers had influenza during pregnancy has not been well studied. This population-based case-control study of infants born in metropolitan Atlanta, Georgia, from 1968 through 1980 included 385 infants with NTD, 3,647 infants with other birth defects, and 2,676 infants without birth defects. Of the 385 mothers of case infants, 31 reported having a 2-day or longer episode of flu with fever from 1 month before through 3 months after conception (odds ratio (OR) = 3.0; 95% confidence interval (CI) 1.9-4.7). Infants of mothers who took medications for their episodes of flu with fever had an even higher risk for NTD (OR = 4.3, 95% CI 2.6-7.1). When mothers of infants with birth defects other than NTD were used as controls, an increased risk of NTD remained for flu with fever (OR = 1.7, 95% CI 1.1-2.5). There was no increased risk for NTD among the infants of mothers who reported fever from causes other than flu. Because of the heterogeneity of maternal flu, the individual contributions of infection, fever, and medications remain difficult to disentangle.     

Laparoscopically assisted abdominal aortic aneurysm repair. A report of 10 cases

BACKGROUND: Laparoscopic surgery decreases postoperative pain and length of hospital stay. Whether laparoscopically assisted abdominal aortic aneurysm (AAA) repair can be safely and reliably performed is unknown. This prospective study was designed to establish the feasibility of laparoscopically assisted AAA repair and its effects on intraoperative and postoperative variables. METHODS: With IRB approval, 10 patients with infrarenal AAA requiring a tube graft underwent laparoscopically assisted AAA repair. The procedure consisted of laparoscopic dissection of the aneurysm neck and iliac vessels. Then, through an 8-11-cm minilaparotomy, a standard endoaneurysmorrhaphy was performed. Data included laparoscopic and total operative times, blood loss, fluid requirements, duration of nasogastric suction (NGT), and lengths of intensive care unit (ICU) and postoperative hospital stays. RESULTS: Laparoscopically assisted AAA was completed in nine of 10 patients. The first patient was converted to a standard incision because the aneurysm neck could not be adequately dissected. Laparoscopic and total operative times were 1.8 +/- 0.4 and 4.5 +/- 0.7 h, respectively. Mean blood loss was 1 +/- 0.6 l. Intraoperative fluid requirement was 6.6 +/- 1.3 l. The duration of NGT suction was 1.8 +/- 1.0 days. The ICU stay was 2.1 +/- 0.8 days and hospital stay was 6.7 +/- 2.5 days. There were two minor complications and no deaths. CONCLUSIONS: Laparoscopically assisted AAA repair is technically feasible with acceptable blood loss, operative time, morbidity, and mortality. Potential advantages may be early removal of the NGT and shorter ICU and hospital stays. Prospective randomized trials are needed to determine if laparoscopically assisted AAA repair is advantageous.     

Prenatal vitamin supplementation and pediatric brain tumors: huge international variation in use and possible reduction in risk

An international case-control study of primary pediatric brain tumors included interviews with mothers of cases diagnosed from 1976-1994 and mothers of population controls. Data are available on maternal vitamin use during pregnancy for 1051 cases and for 1919 controls in eight geographic areas of North America, Europe and Israel. While risk estimates varied by study center, combined results suggest that maternal supplementation for two trimesters may decrease risk of brain tumor [odds ratio (OR)=0.7; 95% confidence interval (CI)=0.5-0.9], with a trend toward less risk with longer duration of use (P trend= 0.0007). The greatest risk reduction was among children diagnosed under 5 years of age whose mothers used supplements during all three trimesters (OR=0.5; CI=0.3- 0.8). This effect did not vary by histology and was seen for supplementation during pregnancy rather than during the month before pregnancy or while breast feeding. These findings are largely driven by data from the US, where most mothers took vitamins. The proportion of control mothers who took vitamins during pregnancy varied tremendously, from 3% in Israel and in France through 21% in Italy, 33% in Canada, 52% in Spain to 86-92% at the three US centers. The composition of the various multivitamin compounds taken also varied: daily dose of vitamin C ranged from 0 up to 600 mg; vitamin E from 0 to 70 mg; vitamin A from 0 to 30,000 IU and folate from 0 to 2000 mg. Mothers also took individual micronutrient supplements (e.g., vitamin C tablets), but most mothers who took these also took multivitamins, making it impossible to determine potential independent effects of these micronutrients.     

Change in anaesthesia practice and postoperative sedation shortens ICU and hospital length of stay following coronary artery bypass surgery

We randomized prospectively 144 patients, undergoing elective coronary artery bypass surgery, to either early or to routine extubation [mechanical ventilatory support for 4-7 h (Group A), or 8-14 h (Group B)]. Anaesthesia was modified for both groups. The groups were well matched in terms of sex, age, NYHA class, preoperative left ventricular ejection fraction, bypass time and aortic cross-clamp time, number of grafts used, and blood units transfused. All patients had normal preoperative respiratory, renal, hepatic and cerebral functions. Mechanical ventilatory support (mean +/- SD) was 6.3 +/- 0.7 h for Group A and 11.6 +/- 1.3 h for Group B. Mean ICU stay was 17 +/- 1.3 h for Group A and 22 +/- 1.2 h for Group B, while the mean hospital stay was 7.3 +/- 0.8 days and 8.4 +/- 0.9, respectively. There were no statistically significant differences in the frequency of all postoperative complications among the two groups. There were no reintubation, readmission to the ICU or death in either group. We concluded that change in anaesthesia practice and early postoperative sedation in patients undergoing elective coronary artery bypass graft (CABG) surgery resulted in earlier tracheal extubation, shorter ICU and hospital length of stay without organ dysfunction or postoperative complications. Early extubation was only possible due to the modification of anaesthesia and ICU sedation regime.     

Factors associated with the use of episiotomy during vaginal delivery

OBJECTIVE: To examine factors associated with the performance of episiotomy. METHODS: A retrospective review was performed on 8647 deliveries during 1991 and 1992 at five medical centers. Episiotomy rates were compared based on variables involving patient demographics, obstetric condition, and physician factors for the 6458 vaginal deliveries in the sample. Logistic regression modeling using variables associated in bivariate analysis was performed to examine independent effects of each variable. RESULTS: Several characteristics of the patient, her clinical status, and physician factors were all associated with episiotomy use. The strongest independent predictors of episiotomy were nulliparity (odds ratio [OR] 4.10, 95% confidence interval [CI] 3.59-4.68) and the use of forceps (OR 5.03, 95% CI 3.39-7.46) or vacuum extraction (OR 3.78, 95% CI 2.36-6.04). Provider specialty and the site of care were also associated independently with episiotomy. Episiotomy use was also associated with major perineal lacerations and an increased length of hospital stay. CONCLUSION: Although differences in episiotomy rates mainly reflect clinical circumstances, important site-to-site variations and interspecialty differences point to potential areas where physician behaviors influence the performance of episiotomy.     

Infants conceived using in-vitro fertilization do not over-utilize health care resources after the neonatal period

Health outcomes during the first year for 95 infants born following in-vitro fertilization (IVF) were compared with those of 79 naturally conceived controls whose mothers were of identical parity and similar age. Primigravid women were enrolled prospectively at 30 weeks gestation, perinatal and neonatal data were collected during pregnancy and following birth, and details of health care resource use were obtained from mothers at 4 and 12 months. Median (range) number of medical problems during the first year tended to be less for IVF infants, 4 (0-41) versus 5 (0-12) (P = 0.07), whilst total number of visits to health care workers was similar for IVF and control infants, 19 (2-47) versus 19 (1-47). IVF infants were more likely to have an excessive number of visits to Early Childhood Health Care Centres [odds ratio (OR; 95% confidence interval, CI) = 2.44 (1.11-5.56)], but less likely to have an excessive number of visits to general medical practitioners [OR = 0.45 (0.22-0.93)] and other health care workers [OR = 0.48 (0.23-0.99)]. These data provide some degree of reassurance about medium-term health outcomes for children conceived using IVF. Although they are more likely to utilize the resources of neonatal intensive care units, IVF infants do not appear to have an increased number of medical problems or to over-utilize health care resources during the remainder of their first year of life.     

Delayed childbearing--are there any risks?

OBJECTIVE: To determine whether women delivering their first child at age 35 years or older are at increased risk of adverse (non-genetic) pregnancy outcomes. DESIGN AND SETTING: A cross-sectional analytic study of singleton deliveries in Northern Sydney Area Health Service (NSAHS) hospitals. PARTICIPANTS: All women aged > or = 20 years delivering their first child between 1 January 1990 and 31 December 1991. MAIN OUTCOME MEASURES: Obstetric complications and procedures, type of delivery and neonatal outcomes. RESULTS: Compared with women aged 20-29 years, women delivering their first child at > or = 35 years were at increased risk of pre-existing maternal hypertension (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.0), antepartum haemorrhage (adjusted OR, 2.4; 95% CI, 1.6-3.7), preterm delivery (33-36 weeks) (adjusted OR, 2.0; 95% CI, 1.5-2.8) and breech presentation (adjusted OR, 1.8; 95% CI, 1.3-2.4). Women aged > or = 35 years were also substantially more likely to have an operative delivery, induced labour and/or epidural anaesthesia. Neither these women nor their infants were at increased risk of pregnancy-induced hypertension, gestational diabetes, threatened premature labour, postpartum haemorrhage, very preterm delivery (< or = 32 weeks), perinatal death, low Apgar scores or the need for neonatal resuscitation. CONCLUSIONS: Women who delay the birth of their first child face some increased risks, but these risks, for the most part, are manageable in the context of modern obstetric care.     

Parapartum mental illness: a long-term follow-Up study

All mothers (n = 79) in the county of Stockholm who gave birth to a child during 1976-77 and were also hospitalised for the first time in a psychiatric clinic were followed up after a mean interval of 15 years. The sample was classified according to the Research Diagnostic Criteria. Comparisons were made with matched obstetric controls. Five patients had died. The recurrence rate was 51% and 7. 3% relapsed after a subsequent childbirth. No difference was found between psychotic and non-psychotic mothers regarding mean sick-leave days per year. The majority of the women with a depressive disorder at index admission suffered from a minor depressive disorder. The women in the group with an unspecified functional psychosis showed a less severe course of illness than the women in the schizophrenia group.     

Symptom-related self-care of Mexican Americans with type 2 diabetes: preliminary findings of the Starr County Diabetes Education Study

OBJECTIVES: Late age at first birth and nulliparity are established risk factors for breast cancer, yet the extent to which fertility problems contribute to these associations remains largely unexplored. Here, we examine self-reported fertility problems as a risk factor for breast cancer in young women. METHODS: We used a population-based case-control study of 2,173 cases and 1,990 controls aged 20 to 54 years in the United States. Structured in-person interviews were used to elicit detailed information on established and potential breast cancer risk factors. Information was collected on pregnancy details, including difficulties becoming pregnant or maintaining a pregnancy. RESULTS: Self-reported difficulty in becoming pregnant or maintaining a pregnancy was reported by 450 cases and 377 controls. Overall, there was little association between these fertility problems and risk of breast cancer (odds ratio [OR] = 1.05). Parity was associated with a decreased risk of breast cancer in women both with (OR = 0.71) and without (OR = 0.79) fertility problems. There was little evidence of an increased risk of breast cancer with later age at first full-term birth among women without fertility problems (ORage 35+ :age <20 = 1.13, 95 percent confidence interval [CI] = 0.7-1.9), but a relatively strong association among women with fertility problems (ORage 35+ :age <20 = 2.96, CI = 1.3-7.0). Among women with a first full-term birth at age 35 or older, fertility problems were associated with a twofold risk of breast cancer. Analyses of duration of unprotected sexual intercourse prior to first pregnancy as an alternative estimate of infertility produced similar results. CONCLUSIONS: Our study suggests that the association between late age at first birth and breast cancer is stronger among women with self-reported fertility problems than among women with no fertility problems.     

Comparison of two methods for enumerating malaria parasites in thick blood films

We evaluated the risk of brain tumor occurrence in relation to previous head injury in a population-based case-control study of 540 children with a primary brain tumor and 801 control children. The risk of a brain tumor among children with a previous head injury that resulted in medical attention was slightly elevated when compared with children with no reported head injury [odds ratio (OR) = 1.4; 95% confidence limits (CL) = 1.0, 1.9]. This effect was stronger when we restricted the head-injured group to the few children with loss of consciousness (OR = 1.6; 95% CL = 0.6, 3.9) or an overnight admission to a hospital (OR = 1.7; 95% CL 0.7, 4.6), relative to those with no head injury. We observed no appreciable association between brain tumor occurrence and birth injury involving the head or a forceps delivery. Among the few children with either a birth injury or forceps delivery and a subsequent head injury, we observed approximately twofold elevations in risk. The OR was 2.6 (95% CL = 1.1, 6.9) for those with a birth injury and subsequent head injury, relative to those with neither a birth injury nor head injury. Our results provide only weak evidence in support of head injury as an etiologic agent for brain tumor occurrence in children, although most of our exposed group had only mild head injury.     

Sterility of anesthetic and resuscitative drug syringes used in the obstetric operating room

Because of the constant threat of emergent cesarean delivery, anesthetic induction and resuscitation drugs are often drawn into syringes and stored in the obstetric operating room (OR). This study investigated the potential for bacterial and fungal contamination of six drugs (thiopental, succinylcholine, ephedrine, atropine, lidocaine, and oxytocin) often prepared in the obstetric OR. A total of 756 drug syringes were prepared and stored in the obstetric OR for 8 days using normal clinical practices. Starting on Day 0, and subsequently on Days 4 and 8 of the experiment, 42 syringes of each drug were randomly selected from the pool, filtered through a 0.45-microm porosity sterile cellulose filter, and cultured on 5% sheep blood agar. Of the 756 syringes tested, none grew organisms of any type, which indicates a probability of drug sterility of > or = 0.9961 (95% confidence interval [CI]). The data from the cultures performed on syringes on Day 0 indicate a probability of initial contamination of < or = 0.018 (95% CI). This study demonstrates a high probability of sterility in drugs drawn into sterile syringes and stored at room temperature in an OR environment for up to 8 days. Implications: Drug syringes stored in emergency operating rooms are discarded after 24 h because of possible contamination. We searched for microorganisms in drug syringes stored in the operating room for up to 8 days. No microbes were detected using standard sterility testing techniques. Adopting longer storage periods could result in significant cost savings.     

Infant respiratory function after RSV-proven bronchiolitis

The mechanisms underlying the increased risk of wheezing in early childhood following acute bronchiolitis in infancy remain unclear. Previous studies have reported significant abnormalities in infant respiratory function after clinical recovery from bronchiolitis, but are difficult to interpret because of the frequent omission of a concurrent comparison group. Respiratory function was compared within pairs of previously healthy full-term caucasian infants admitted with a first episode of acute bronchiolitis to an inner London hospital, and age- and sex-matched control infants without prior wheezing, asthma, or lower respiratory illness who were recruited from local general practices. Respiratory function was measured in 29 control and 29 asymptomatic index infants, with measurements in the latter done at a median interval of 36 wk (range: 16 to 49 wk) after admission, when 16 (55%) had experienced subsequent wheezing. Index infants tended to be autumn-born and of shorter gestation than control infants, to have younger mothers, and to have been exposed to tobacco smoke. There were no statistically significant differences in plethysmographic FRC, initial inspiratory airway resistance (Raw), or respiratory system compliance (mean [index minus control] within-pair difference [95% confidence interval]: -11 ml [-29, 7 ml]; -0.2 kPa/L/s [-0.7, 0.4 kPa/L/s]; -8 ml/kPa [-21, 4 ml/kPa], respectively), but respiratory rate and time to peak tidal flow as a proportion of total expiratory time (tPTEF:tE) were significantly diminished in index as compared with control infants (-4.0 breaths/min [-7.6, -0.4 breaths/min], versus -0.035 [-0.066, -0.005], respectively). These findings suggest a better prognosis for infant lung function after acute bronchiolitis than reported previously. Longitudinal studies are needed to clarify whether subclinical alterations in airway function precede acute bronchiolitis.