Epidemiological trends in multiple births in the United States, 1971-1998.

The astounding rise in multiple births in the United States continues. We analyzed live birth files from the U.S. National Center for Health Statistics. Twin, triplet, quadruplet, and quintuplet+ rates were calculated for the period 1971-1977 and for each year between 1990 and 1998. Triplet rates were also computed within categories of mother's education and age. The twin rate increased from 1.8% in 1971-77 to 2.8% in 1998. The rate of triplets increased 5.9-fold, quadruplets 11.9-fold, and quintuplets+ 5.3-fold between 1971-77 and 1998. Increases in triplet rates were much more marked among births to university-educated women and women 30 years and older. Among women 45 years and older, the triplet rate was approximately fifty times higher in 1998 than in 1971-77. This group of older women (> or = 45 years) had the highest multiple birth rate in 1998.     

Perinatal mortality in triplet births in Japan: time trends and factors influencing mortality.

Perinatal mortality rates (PMRs) in triplets were analyzed using Japanese Vital Statistics during the period of 1980-1998. The total number of perinatal deaths in triplets was 1051. The PMR significantly decreased from 214 per 1000 births in 1980 to 39 in 1998, a reduction of 82%. PMRs in triplets were 11.1-fold higher in 1980 and 6.9-fold higher in 1998 than in singletons, indicating that PMRs improved more in triplets than in singletons during the last two decades in Japan. The PMR was the highest in the third-born, followed by the second- and the first-born triplets in each period. As for maternal age, the PMR was 1.5-3.7 times higher in the < 25 years of age group than the other age groups. Additionally, the PMR was the lowest for birthweight (BW) >or= 2000 g during the entire period. In addition, the PMR decreased with gestational age (GA) of up to 38-39 weeks and increased thereafter. The effects of BW on the PMR were stronger than the effects of GA. The proportion of perinatal deaths in triplets with extremely low BW (< 1000 g) was 74% in 1980-1989 and increased to 82% in 1990-1998. The declining PMR was unlikely to be due to the improvement in BW in triplets. It is likely that it was related to the improved medical management of triplets during the perinatal period and the first week of life. Information obtained in the present study may be useful in counseling pregnant woman about triplet births.     

Why zygosity of multiple births is not always obvious: an examination of zygosity testing requests from twins or their parents.

This paper examines why parents of twins or adult twins themselves request zygosity testing. Of 405 multiples including 8 sets of triplets, the majority (93%) were monozygotic. Age of testing ranged from 0 days to 73 years. About 50% of requests came from parents or twins who were curious about, or expressed a need to be certain of, their zygosity. Other reasons included health concerns (current or future), other twins in the family, and misinformation about zygosity, frequently because of the erroneous assumption that all dichorionic twins are dizygotic. Parents of monozygotic twins may expect their twins to be 'identical' and believe their twins to be dizygotic because of minor phenotypic differences between them. Dizygotic twins like other siblings may share a phenotypic resemblance. Health professionals should be aware that zygosity of multiples may not always be obvious to parents and that accurate knowledge of zygosity may be justified.     

Trends in triplet stillbirth rates in Japan, 1975-1998.

Stillbirth rates of triplet births in the whole of Japan were analyzed using vital statistics from 1975 to 1998. Stillbirths were registered at 12 weeks gestation or later. The stillbirth rate was significantly higher in like- than in unlike-sex triplets for 1975-1998. During the 23-year period the stillbirth rate decreased from 342 to 49 per 1000 total births for like-sex and from 195 to 54 for unlike-sex triplets. The decrease in the stillbirth rate in the 23- year period was greater in both like- and unlike-sex triplets than in singleton and twin births. Risk factors for stillbirth in triplets were like-sex, youngest or oldest maternal age groups, shorter gestational age and lower birthweight. It is recommended that the optimum period to give birth for triplet pregnancies is 34-35 weeks of gestation for Japanese women.     

Netherlands Twin Register: a focus on longitudinal research.

In 1986 we began The Netherlands Twin Register (NTR) by recruiting young twins and multiples a few weeks or months after birth. Currently we register around 50% of all newborn multiples in The Netherlands. Their parents receive a questionnaire at registration and afterwards when the children are 2, 3, 5, 7, 10 and 12 years of age. Teachers are asked to rate the behavior of the children at ages 7, 10 and 12 years. Adolescent and young-adult twins were recruited through City Councils in the early 1990s. These twins, their parents and siblings participate in longitudinal survey studies that include items about health, fertility, lifestyle, addiction, personality and psychopathology, religion, socioeconomic status, and educational attainment. The total number of twins and multiples registered with the NTR is currently over 60,000. Subgroups of twins and siblings take part in studies of cognitive development, brain function and neuropsychological indices of attention processes, and molecular genetic studies of classical and behavioral cardiovascular risk factors. DNA samples are currently collected in selected twin families for two large linkage studies, which aim to find QTLs for anxious depression and for nicotine addiction. Sisters who are mothers of DZ twins contribute DNA samples for a linkage study of DZ twinning. Large cohorts of phenotyped family members from the general population are very valuable for genetic epidemiological studies and permit selection of informative families for gene finding studies.     

PUPPING PHENOLOGY AND DEMOGRAPHY OF HARBOR SEALS (PHOCA VITULINA RICHARDSI)ON TUGIDAK ISLAND, ALASKA

The number of seals on shore at Tugidak Island (Gulf of Alaska) declined 72%–85% between 1976 and 1988 and increased during the 1990s. We compared pupping phenology and the ratio of pupping-period counts to molting-period counts between declining (1976–1979) and increasing (1994–1998) years, and examined the sex/age structure of seals ashore during the 1990s. In the 1970s the onset and peak of pupping occurred 6–18 d later than in the 1990s. Rate of pup abandonment was higher in 1978 than in the 1990s. Between 1994 and 1995, the maximum and mean number of seals ashore increased >50%, largely due to an increase in non-pups. From 1995 to 1998, the sex/age structure of seals ashore was similar among years. We observed three to four times as many seals during the molting period than during the pupping period in the 1970s, whereas similar numbers were ashore during these periods in the 1990s, perhaps reflecting changes in demography and/or haul-out behavior. Changes in pupping phenology and demography may reflect environmental changes, such as food availability, and when monitored in conjunction with population counts, may help us better interpret changes in the number of seals ashore.     

High cancer mortality rates in the elderly in the UK

Introduction: Cancer is largely a disease of older individuals. We compared UK cancer mortality rates with those for other countries to assess progress. Methods: Death details were obtained from the WHO Mortality Database for the UK, the USA and 11 European countries. Mortality rates were calculated for the age groups 55–64, 65–74, 75–84 and ≥85 years. Trends between 1995–97 and 2003–05 were determined. The number of excess cancer deaths in the UK was calculated by applying the age-specific mortality rates observed in other regions to the UK. Results: For all cancers combined, UK rates for 2003–05 in those aged ≥75 years were 11–31% higher than in other regions. From 1995–97 to 2003–05, UK rates decreased by 16–17% in those aged <75 years, but increased by 2% in those ≥85 years compared with decreases of 4–16% for the other geographic areas. More than 14,000 cancer deaths in the UK in those aged ≥75 years would be avoided each year if UK mortality rates were identical to those in the USA. Conclusion: The UK is making poor progress in controlling cancer in older age groups. The gap in mortality rates between the UK and other countries and between old and young in the UK is widening.     

严格消毒注射器输液器械及针灸针以控制农村婴幼儿乙型肝炎病毒感染

在婴幼儿HBV高感染村,实施一人一针一管一用一消毒的严格措施后,使一岁儿童HBV感染率下降53.0％,HBsAg阳性率下降55.5％,使HBsAg阴性母亲的1～2岁儿童HBV感染率下降64.6％～76.4％,HBsAg阳性率降低78.6％～81.9％。     

Impact of war on central nervous system tumors incidence--a 15-year retrospective study in Istria County, Croatia

The aim of study was to analyze epidemiological features of central nervous system (CNS) tumors diagnosed in Istria County, Croatia, with a particular emphasis on incidence dynamics during the wartime (1991-1995). The data were extracted from the medical records of patients with CNS tumors admitted to the Department of Neurology of Pula General Hospital in the period from the 1st January 1986 to the 31st December 2000, N = 364. For calculation of rates, we used data from the 2001 Croatian consensus http://www.dzs.hr/Eng/Census/census2001.htm. Data are presented as counts and incidence rates (IRs) per 100,000 persons-years in the case of annual rates. Annual incidence rates are shown as "raw" incidence rates and smoothed 5-year rolling average rates. The examined patient-related variables were: sex, age, occupation, premorbidity and comorbidity, with a particular emphasis on psychosomatic disorders and negative habits. The analyzed tumor-related variables included clinical manifestation, localization, and applied diagnostic and therapeutic methods. Primary tumors were separated from the metastatic, and the latter were analysed with respect to their site of origin. The lowest incidence of CNS tumors (10 patients) was reported in 1990, and the highest (42 patients) in 1993. The incidence dynamics of CNS tumors showed a rapidly progressive increase over the 1991-1995 period, followed by the return to average values. The access to a better and more readily available diagnostics may only partially explain this phenomenon. Therefore, we analyzed other factors that may have contributed towards the rapid increase in the number of CNS tumors, such as its coincidence with the war or psychotrauma. The results confirm the observational clinical hypothesis of an extreme increase in the number of CNS tumors during the period under consideration.     

Controversial issues in the management of multiple pregnancies.

The management of multiple pregnancies represents a true challenge for all sub-specialties concerned with perinatal medicine. Many issues were neglected over the years merely because they were rare and therefore considered not sufficiently important to merit clinical trials. This paper discusses a personal selection of controversial issues, such as multifetal pregnancy reduction of triplets and twins, special cases in multifetal pregnancy reduction, need for invasive genetic studies, management of twin-twin transfusion, discordant fetal conditions, the definition of "term" in multiples, and the controversy about the mode of delivery.     

The context and long-term impacts of multiple birth loss: a peer support network perspective.

Following my own experience with the death of a twin baby, I founded the Center for Loss in Multiple Birth (CLIMB) Inc. During the last 13 years I have worked with nearly 7000 bereaved parents of twins, triplets or other high multiples throughout the US and worldwide. The role of a peer support organisation and the range of families with multiples who have contacted it is described. They come from diverse backgrounds with many forms of bereavement: death during pregnancy, at birth or after of both or all babies, of one twin, of one or more higher order multiples; multifetal pregnancy reduction or selective fetocide; the death of one or more multiples in childhood. Some have had more than one multiple pregnancy and loss. Many are concerned for the surviving children. A peer support organisation has an important role to play in increasing public awareness of the needs of these families as well as influencing policy on infertility treatments that carry a high risk of producing multiple pregnancies with the associated risk of death and disability for one or more of the babies.     

The phytoplankton of S'Ena Arrubia Lagoon (Centre-Western Sardinia) between 1990 and 1995

Abstract

The phytoplankton study on the S'Ena Arrubia Lagoon started in 1990, after dystrophic events, leading to high fish mortality and consequently great economic losses. This study presents a general picture of the conditions of the lagoon between 1990 and 1995, and reports on the quali-quantitative changes in the phytoplanktonic populations, as well as the trends of temperature, salinity, pH, dissolved oxygen, algal nutrients and chlorophyll a. The lagoon was characterized by great changes in salinity between years and within the same year, by high nutrient contents and by a phytoplankton trend characterized by sudden intense blooms mostly due to the Chlorophyceae and the Bacillariophyceae. The number of species found, decreased from 1990 to 1994, followed by a slight increase in 1995. The same trend was also found for total density and chlorophyll a.     

Recent emergence of serogroup C meningococcal disease in Greece

The number of cases of meningococcal disease reported to the Meningitis Reference Laboratory in Athens rose dramatically in 1996-1997. The aims were (1) to determine if the increase was due to introduction of new strains, (2) to assess the geographic and age distribution of the cases, (3) to compare antibiotic sensitivity patterns of the current isolates with strains from the early 1990s. In 1993-1994, 15/19 (74%) of the cases for which information on age was available were in children < or = 5 years; in 1995-1997, 80/179 (45%) of cases were in children < or = 5 years and 99 (55%) in the older age range (P < 0.02). From 593 cases in 1993 1997, 214 (36%) isolates were available for characterisation. Serogroup B was predominant in the early 1990s, but by 1997, serogroup C accounted for 46/72 (64%) of isolates and serogroup B for 25/72 (35%). Serogroup B was predominant in children < or = 5 years (44/78, 56%) but only 19/99 (18%) of older children and adults (P=0.0000005). Sulfonamide resistance decreased from 10/22 (45%) in 1993-1994 to 27/192 (14%) in 1995-1997 (P<0.01). Multilocus enzyme electrophoresis of 70 strains obtained during this period identified the epidemic ET-15 clone in 24 (34.3)%. The profiles of the Greek ET-15 isolates were identical to C:2a:P1.2(P1.5) strains responsible for the epidemic in the Czech Republic which began in 1993. This genotype was not found in Greek strains isolated prior to 1993. We conclude that the increase in meningococcal disease is due to introduction of the epidemic serogroup C:2a:P1.2(P1.5) strain responsible for disease in the Czech Republic and Canada.     

Historical changes in juvenile southern bluefin tuna Thunnus maccoyii growth rates based on otolith measurements

Suspected historic changes in juvenile southern bluefin tuna Thunnus maccoyii growth rates were investigated using otolith increment width data. Four hundred and ninety otoliths were selected from fish estimated to be between 1 and 41 years-old. The distance between the first five annuli were measured on the otoliths, giving estimates of otolith growth for age classes 1+ to 4+ years for fish spawned from the early 1960s to mid 1990s. The data showed that growth rates of juveniles (age 1+ and 2+ years) started to increase at around 1979–1980, and that growth continued to increase throughout the 1980s and early 1990s. Lee's phenomenon was not observed in the data. Correlation tests did not reveal clear relationships between annual otolith growth and regional environmental variables such as sea surface temperature or Southern Oscillation Index. The increase in otolith growth, however, was consistent with juvenile growth estimates obtained from other sources, and correlated with large-scale trends in population size and environmental conditions.     

Seasonality of triplet births in the United States

Birth data on 1050 sets of triplets delivered in the United States from 1985 to 1988 were analyzed to establish whether seasonal variations in the number of triplet births occur. These data were compared to live birth data from the entire United States population over a similar period; the US data exhibit a seasonal variation with a peak in late summer. Seasonality in the number of triplet births was noted, and it differed significantly (p = 0.01) from that of the entire US population. A large peak in triplet births was seen in the spring (April-May) and a smaller peak in late summer (August-September). Only minor differences in these trends could be observed when triplet data were stratified by cause of pregnancy (spontaneous versus drug-induced ovulation) or corrected for the shorter gestations of triplet pregnancies.     

Spot overlapping in two-dimensional maps: a serious problem ignored for much too long

In the analysis of a neuroblastoma xenograft implanted in mice using two-dimensional maps, some 85 proteins were found to be up- or down-regulated (out of a total of 264 detected by a medium-sensitivity colloidal Coomassie stain). When these spots were eluted and analysed by mass spectrometry in a quadrupole time of flight mass spectrometer, a number of spots were found to be envelopes of different polypeptide chains. Out of a total of 74 proteins identified, 52 (71%) were found to be singlets, 14 (19%) were doublets, 6 (8%) were triplets, 1 was a quadruplet and 1 a quintuplet. Analysis of the DeltapI and DeltaMr of all species contained in a single gel segment eluted helped point out potential errors in protein identification. This was a unique case, in that very minute bioptic sample loads were applied to the gel. In normal cases, where sample loads of ca. 1 mg of total protein are applied and typically at least 1000 spots are visualised, the singlets will be the minority, rarely exceeding 30% of all spots analysed. The experimental data on the abundance of overlapping spots were in excellent agreement with theoretical data calculated on the basis of the statistical theory of spot overlapping, originally proposed by Davis and further developed by some of the authors. Ways and means for minimizing spot overlap and visualising a greater number of spots in a two-dimensional map are discussed.     

Changes in survival among elderly patients initiating dialysis from 1990 to 1999

Background

Over the past decade, there has been a steep rise in the number of people with complex medical problems who require dialysis. We sought to determine the life expectancy of elderly patients after starting dialysis and to identify changes in survival rates over time.

Methods

All patients aged 65 years or older who began dialysis in Canada between 1990 and 1999 were identified from the Canadian Organ Replacement Register. We used Cox proportional hazards models to examine the effect that the period during which dialysis was initiated (era 1, 1990–1994; era 2, 1995–1999) had on patient survival, after adjusting for diabetes, sex and comorbidity. Patients were followed from initiation of dialysis until death, transplantation, loss to follow-up or study end (Dec. 31, 2004).

Results

A total of 14 512 patients aged 65 years or older started dialysis between 1990 and 1999. The proportion of these patients who were 75 years or older at the start of dialysis increased from 32.7% in era 1 (1990–1994) to 40.0% in era 2 (1995–1999). Despite increased comorbidity over the 2 study periods, the unadjusted 1-, 3- and 5-year survival rates among patients aged 65–74 years at dialysis initiation rose from 74.4%, 44.9% and 25.8% in era 1 to 78.1%, 51.5% and 33.5% in era 2. The respective survival rates among those aged 75 or more at dialysis initiation increased from 67.2%, 32.3% and 14.2% in era 1 to 69.0%, 36.7% and 20.3% in era 2. This survival advantage persisted after adjustment for diabetes, sex and comorbidity in both age groups (65–74 years: hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.72–0.81; 75 years or more: HR 0.86, 95% CI 0.80–0.92).

Interpretation

Survival after dialysis initiation among elderly patients has improved from 1990 to 1999, despite an increasing burden of comorbidity. Physicians may find these data useful when discussing prognosis with elderly patients who are initiating dialysis.Within general medical and subspecialty areas, chronic kidney disease is increasingly recognized as an important comorbid condition that is often associated with prolonged hospital stays and increased morbidity and mortality.^1–3 As a result, internists and other specialists are more likely than before to be involved with the care of patients for whom dialysis needs to be started because of end-stage kidney disease. The majority of patients starting dialysis are 65 years or older at the time of their first treatment, and many are over 75 years.⁴ Given the heightened awareness of chronic kidney disease, its high prevalence, the association with multiple comorbidity, and the impact of dialysis on survival and quality of life, we sought to calculate the mean life expectancy of elderly patients who began dialysis at either 65–74 years of age or at 75 years or more, and to identify whether there was any change in survival probability, or in the effect of comorbidity characteristics, on dialysis over the past decade.     

The effects of implementing a feral cat spay/neuter program in a Florida county animal control service

In 1995, a county animal control service implemented a feral cat sterilization program with the goal of reducing the number of healthy cats euthanized, complaints, and the county's costs. The service collected data from a 6-year period both before and after the program's implementation. The service totaled the numbers of both cat and dog impoundments, surgeries, adoptions, euthanasias, and complaints for each year; standardized both sets of numbers on a per- 10,000-person basis to compare trends between dogs and cats; and calculated estimated costs for neutering versus impounding and euthanizing the feral cats. Changing from a policy of euthanasia of feral cats to support for trap-neuter-return did not result in an increase in the number of complaints or cat impoundments. The percentage of impounded cats euthanized decreased between the periods before and after the program began, and the percentage adopted increased. The ratio of complaints to impounds decreased between the 2 periods, and the ratio of surgeries to impounds increased. Impoundments of cats were relatively steady in spite of the continually increasing human population. Euthanasias decreased for both cats and dogs since 1997. Since 1996, complaints decreased for both. Surgeries for both cats and dogs increased over the 12 years. Adoptions for cats and dogs increased greatly in fiscal year 1998/1999.