The fitness of twin mothers: evidence from rural Gambia

We used a longitudinal database from a natural fertility population in rural Gambia to compare the overall fertility of mothers who had given birth to twins at some point in their reproductive history and mothers who had only ever given birth to singletons. We found that twin mothers had shorter birth intervals, higher age‐specific fertility and more surviving children than singleton mothers. This suggests that, despite the considerably higher mortality of twins found in this population, twin mothers have a fitness advantage over singleton mothers, even in the absence of modern medical care. We ran a simple simulation model to estimate the relative fitness of twin and singleton mothers, and found that the model also estimated higher fitness for twin mothers. Further, girls who went on to become twin mothers were of higher anthropometric status during their teenage years than those who became singleton mothers.     

Zygosity diagnosis in young twins by questionnaire for twins' mothers and twins' self-reports.

The present study deals with the determination of zygosity in twins of childhood age by simple questionnaire. The subjects were 224 twin pairs and their mothers, consisting of 159 monozygotic and 65 same-sex dizygotic pairs, identified by genetic markers including DNA samples. Mothers of twins responded to 19 questionnaire items dealing with twin similarity in 16 items about physical features and 3 items about the degree of similarity and frequency of being mistaken (confusion of identity) when twins were about 1 year of age. The twins themselves responded to three questionnaire items dealing with only confusion of identity items. The results of stepwise logistic regression analysis were as follows: the total accuracy of the mothers' questionnaire was 91.5% when using only the items dealing with confusion of identity. This accuracy was slightly lower than that obtained by twins' self-reports dealing with nearly the same question items of confusion of identity, answered by both twins separately with 93.3% accuracy. The total accuracy of mothers' questionnaire responses rose to 95.1% when we used all 19 items. In addition to "the frequency of being mistaken", two physical features, namely "shape of fingers" and "shape of eyebrow", were very informative. In conclusion, twin zygosity can be estimated by the use of the mothers' simple questionnaire with sufficient accuracy even in very young twins about 1 year of age.     

Twins are more different than commonly believed,but made less different by compensating behaviors

Twin studies are popular, because twins are believed to be the same/similar in genes and environmental exposures. It is well documented, however, that the firstborns are healthier at birth. We use the entire U.S. record of twin births during 1995–2000 to show that the survival duration parameters differ between twins depending on the birth order. We also find that wiser (i.e., older or educated) or married (i.e., resource-richer) mothers take more care of the weaker, which is a “compensating” behavior reducing the twin difference, as opposed to “reinforcing (the twin difference)” behavior. The systematic survival pattern difference and the mother's intervention against nature send cautions to twin studies that regard twins homogeneous to interpret their findings accordingly. Since the survival duration in our data is 97% right-censored in one year, we devise a quantile-based ‘fixed-effect’ semiparametric estimator that can handle heavy censoring, which is our methodological contribution.     

Professional unity to be a key focus for CMA in 1996

The need for professional unity in the face of growing government pressure is to be a key focus of the CMA''s 1996 activities, the Board of Directors decided at its December meeting. This will become clear as its future of health care campaign develops, with twin components of patient and physician advocacy. The board also learned that details about a major antismoking project have been finalized and of potential expansion within the Department of Publications.     

Interactions between parents and infants,and infants-father separation in the common marmoset (Callithrix jacchus)

The New World monkey,Callithrix jacchus, diversely from most Old World primates, shares infant care among all family members. This paper intends to describe a pattern of infant care in the common marmoset, and to verify if the infant-father separation induces a depression reaction, such as found in other separation studies. In Experiment 1, 11 families (mother, father, and twin newborn infants) ofCallithrix jacchus were observed from 1st to 36th days of infants' life. It was noted that infants were carried most of the time in the beginning of life, and that from the 4th day on this care came mostly from the father. In Experiment 2, nine families were divided in three separation groups (15, 30, and 45 days of infants' life). Each group had a control and two experimental families. Removal of the father was done for three days, beginning at the indicated infants' ages. Results showed that upon removal of the father, the mother assumes the infants' care, and no depression reaction appeared.     

The outcome of twin pregnancies complicated by single fetal death after 20 weeks of gestation.

A retrospective study involving 972 twin births was conducted to evaluate the maternal and fetal outcomes of twin pregnancies complicated by single fetal death. The incidence of single fetal death in twin pregnancies after 20 weeks was 3.3%. Preterm birth rates for 37 and 32 gestational weeks were 81.3% and 41.6% respectively. The median interval between the diagnosis of fetal death and the delivery was 11 days (range 1-27 days). Eighteen (56%) infants were delivered by cesarean and 14 (43%) vaginally. Twin-twin transfusion syndrome (TTTS) was the cause of single fetal death in 8 of 32 twin pregnancies (25%). Ten of the surviving co-twins were lost in the neonatal period (31.3%) and half of those neonatal deaths were due to TTTS. TTTS is the major contributor for perinatal mortality in same-sex twins complicated by single fetal death. The death of one twin in utero should not be the only indication for preterm delivery, and in case of severe prematurity with a stable intrauterine environment; expectant management may be advisable until fetal lung maturation ensues.     

Why are clinical problems difficult? General practitioners' opinions concerning 24 clinical problems.

This study was conducted to describe the difficulties perceived by general practitioners concerning 24 common clinical problems and to compare their perceptions with those of faculty members in family medicine. A random sample of 467 general practitioners and all 182 faculty members in family medicine in Quebec were sent one of four open-ended questionnaires, each of which dealt with six clinical problems; 214 general practitioners and 114 faculty members participated. A total of 5111 difficulties were reported; the number reported by each subject varied from 0 to 13 (mean 2.6 [standard deviation 2.09]) per problem. The problems that generated the most difficulties were depression, confusion in the elderly, chronic back pain, loss of autonomy in the elderly and sexually transmitted disease. The most frequent difficulties were with the patient''s noncompliance with treatment, clinical diagnosis, failure of a specific treatment, inadequate health care resources and the physician''s own emotional reactions. The difficulties for each problem were the same in the two groups 70% of the time. Physician''s perceptions of their difficulties can be useful in the planning of initial training and continuing medical education.     

HLA and genomewide allele sharing in dizygotic twins

Gametic selection during fertilization or the effects of specific genotypes on the viability of embryos may cause a skewed transmission of chromosomes to surviving offspring. A recent analysis of transmission distortion in humans reported significant excess sharing among full siblings. Dizygotic (DZ) twin pairs are a special case of the simultaneous survival of two genotypes, and there have been reports of DZ pairs with excess allele sharing around the HLA locus, a candidate locus for embryo survival. We performed an allele-sharing study of 1,592 DZ twin pairs from two independent Australian cohorts, of which 1,561 pairs were informative for linkage on chromosome 6. We also analyzed allele sharing in 336 DZ twin pairs from The Netherlands. We found no evidence of excess allele sharing, either at the HLA locus or in the rest of the genome. In contrast, we found evidence of a small but significant (P=.003 for the Australian sample) genomewide deficit in the proportion of two alleles shared identical by descent among DZ twin pairs. We reconciled conflicting evidence in the literature for excess genomewide allele sharing by performing a simulation study that shows how undetected genotyping errors can lead to an apparent deficit or excess of allele sharing among sibling pairs, dependent on whether parental genotypes are known. Our results imply that gene-mapping studies based on affected sibling pairs that include DZ pairs will not suffer from false-positive results due to loci involved in embryo survival.     

Diagnosis of twin zygosity by mailed questionnaire

A deterministic questionnaire method for zygosity determination is developed for use in epidemiological studies of adult twins. It is based on the answers of both members of a twin pair to two questions on similarity and confusion in childhood. The algorithm of the method is used to determine the zygosity status of a twin pair at two different levels of certainty. The validity of the method is tested by making blood marker determinations of 11 polymorphic marker systems fro a random sample of 104 twin pairs. The agreement between questionnaire and blood marker diagnosis was 100%, but the stricter level of certainty left 8.7% in the nonclassified group. The genetical representativeness of the sample is tested by the allele distribution of the markers as compared to the Finnish population data as well as by the distribution of the number of intra-pair differences in blood markers.     

Spina bifida cystica and severe congenital bilateral talipes equinovarus in one twin of a monoamniotic pair: a case report

Background

Spina bifida and congenital talipes equinovarus (CTEV) are common congenital malformations which may occur together and increase morbidity. Monozygous twins are particularly at risk of these malformations and discordance in one type of malformation is typical. The occurrence of both spina bifida and CTEV in one twin of a monozygotic pair is rare.

Case presentation

A 22 year-old Cameroonian primigravida at 36 weeks of a twin gestation was received in our district hospital at the expulsive phase of labour on a background of sub-optimal antenatal care. A caesarean section indicated for cephalo-pelvic disproportion was performed and life monoamniotic male twins were extracted. The first twin was normal. The second twin had spina bifida cystica and severe bilateral CTEV. Routine postnatal care was ensured and at day 2 of life, the affected twin was evacuated to a tertiary hospital for proper management. He was later on reported dead from complications of hydrocephalus.

Conclusions

Spina bifida cystica with severe bilateral CTEV in one twin of a monoamniotic pair illustrates the complexity in the interplay of causal factors of these malformations even among monozygotic twins who are assumed to share similar genetic and environmental features. The occurrence and poor outcome of the malformations was probably potentiated by poor antenatal care. With postnatal diagnoses, a better outcome was difficult to secure even with prompt referral. Early prenatal diagnoses and appropriate counseling of parents are cardinal.

     

Ethnonationalism,ethnic nationalism,and mini‐nationalism: A comparison of Connor,Smith and Snyder

Some terms have been coined to highlight the important relation between nationalism and ethnicity. However, there has been much confusion as to the meaning of such concepts as ‘ethnonationalism’, ‘ethnic nationalism’ and ‘mini‐nationalism’. This article compares the three terms, as used respectively in the works of Walker Connor, Anthony Smith and Louis Snyder. These scholars are selected not only because of their well‐respected position in the study of nationalism but also because their works are representative of each of the three concepts. The comparison finds that since both Connor and Smith emphasized the ethnic dimension of nationalism, their ideas can be presented in one analytical framework. In fact, Connor's ‘ethnonationalism’ and Smith's ‘ethnic nationalism’ overlap with each other. However, Smith's theory of nationalism is comprehensive enough to take care of the fact that the nationalisms of many new states of today's world have no ethnic base at all, whereas Connor's analysis makes no mention of this. In this respect, Smith's model is preferred to that of Connor. Finally, Snyder's ‘mini‐nationalism’ is seen as the least useful concept, since the use of size rather than ethnicity to classify nationalisms does not increase our understanding of the concept.     

Evaluating and preventing illness associated with indoor air pollution.

Homicides have been on the rise in California in recent years, almost entirely as a result of increased firearm activity, resulting in one of the highest homicide rates in the country. With increasing morbidity and mortality from guns, health care professionals have called the situation an epidemic. In the past decade, attention from the health care profession has resulted in a new focus on the public health issues surrounding firearms. There is considerable confusion among policy makers regarding what should be done to stem firearm violence. I discuss morbidity and mortality trends, academic research, and legal issues surrounding firearm violence, affording insight into the seriousness and complexity of this rapidly growing problem and providing policy ideas for addressing the role of firearms. Such policy ideas include removal of the California Legislature''s preemptive authority on firearms licensing and registration; the formation of an information and advisory body within the California Department of Health; increased liability for manufacturers, distributors, dealers, and owners; and a statewide registration system.     

Addison,pernicious anemia and adrenal insufficiency

In 1849 Thomas Addison described the clinical entity now known as pernicious anemia. In 1855 he reported several cases of adrenal insufficiency, or Addison''s disease. Considering the importance of these works, there remains a great deal of confusion about them. Contrary to what many historians have written, a review of Addison''s original publications demonstrates a firm appreciation of the distinction between pernicious anemia and adrenal insufficiency, based particularly on the discoloration of the skin in these conditions. Three major sources of possible confusion for historians who are attempting to understand Addison''s views include Addison''s early attempts to link pernicious anemia with disease of the supra-renal capsules, Addison''s redefinition of pernicious anemia in his monograph on adrenal disease, and several confusing statements made by Wilks and Daldy in the first reprint of Addison''s monograph.     

The Minnesota Twin Registry: current status and future directions.

The Minnesota Twin Registry is a birth-record-based twin registry. Begun in 1983, it includes data for 4307 surviving intact pairs born in Minnesota between 1936 and 1955. In addition, the Registry includes 901 twin pairs born in Minnesota from 1904 to 1934, as well as 391 male pairs born in Minnesota from 1961 to 1964. The research focus is primarily on human individual differences assessed by self-report. Questionnaires completed by the participants include measures of personality, occupational interests, demographics, and leisure-time activities. We outline major contributions that have resulted from Registry research, as well as current and future research directions.     

The Danish Twin Registry: 127 birth cohorts of twins.

The Danish Twin Registry is the oldest national twin register in the world, initiated in 1954 by ascertainment of twins born from 1870 to 1910. During a number of studies birth cohorts have been added to the register, and by the recent addition of birth cohorts from 1931 to 1952 the Registry now comprizes 127 birth cohorts of twins from 1870 to 1996, with a total of more than 65,000 twin pairs included. In all cohorts the ascertainment has been population-based and independent of the traits studied, although different procedures of ascertainment have been employed. In the oldest cohorts only twin pairs with both twins surviving to age 6 have been included while from 1931 all ascertained twins are included. The completeness of the ascertainment after adjustment for infant mortality is high, with approximately 90% ascertained up to 1968, and complete ascertainment of all liveborn twin pairs since 1968. The Danish Twin Registry is used as a source for large studies on genetic influence on aging and age-related health problems, normal variation in clinical parameters associated with the metabolic syndrome and cardiovascular diseases, and clinical studies of specific diseases. The combination of survey data with data obtained by linkage to national health related registers enables follow-up studies both of the general twin population and of twins from clinical studies.     

Early changes in vascular dynamics in relation to twin-twin transfusion syndrome.

A clearer understanding of the early determinants of normal and abnormal vascular development is pivotal in order to identify those at increased risk of later vascular disease, and perhaps to prevent it by early intervention. Measurement of pulse wave velocity(PWV) has been used in the postnatal evaluation of the monochorionic(MC) twins. They are genetically identical and those with twin-twin transfusion syndrome(TTTS) provide an ideal natural model in whom to study the influence of differing haemodynamic stresses on the developing vascular tree. We investigated firstly whether surviving twin pairs with TTTS have altered arterial distensibility in childhood by comparing PWV in the radial arteries of surviving MC twin pairs with TTTS and in two control groups, one cohort of MC twins without TTTS and another dichorionic group (DC) Secondly, we tested a cohort of TTTS twin pair survivors treated with laser photocoagulation. The co-twin pairs in the group managed palliatively with amnioreduction showed increased PWV in the donor and reduced PWV in the recipient twins. This was neither seen in the laser-treated, nor in the control groups. Our studies suggest that a period of haemodynamic imbalance gives rise to changes in a muscular conduit artery that persist at least into infancy and it seems that by correcting the abnormal haemodynamics relatively soon after the disease process had begun, the alterations in elasticity are prevented. These studies are the first to demonstrate fetal programming of the vascular bed in humans, and prevention or reversal of this programming by an intervention in mid-gestation.     

Orthogonal Relations and Color Constancy in Dichromatic Colorblindness

This paper employs uniform color space to analyze relations in dichromacy (protanopia, deuteranopia, tritanopia). Fifty percent or less of dichromats represent the classical reduction form of trichromacy, where one of three cones is inoperative but normal trichromatic color mixture such as complementary colors (pairs that mix white) are accepted by the dichromat, whose data can thus be plotted to CIE chromaticity spaces. The remaining dichromats comprise many and varied more-complex gene arrays from mutations, recombinations, etc. Though perhaps a minority, the three reductionist types provide a simple standard, in genotype and phenotype, to which the more complex remainder may be compared. Here, previously published data on dichromacy are plotted and analyzed in CIELUV uniform color space to find spatial relations in terms of color appearance space (e.g., hue angle). Traditional residual (seen) hues for protanopia and deuteranopia (both red–green colorblindness) are yellow and blue, but analysis indicates the protanopic residual hues are more greenish yellow and reddish blue than in tradition. Results for three illuminants (D65, D50, B) imply four principles in the spatial structure of dichromacy: (1) complementarity of confusion hue pairs and of residual hue pairs; (2) orthogonality of confusion locus and residual hues locus at their intersection with the white point, in each dichromatic type; (3) orthogonality of protanopic and tritanopic confusion loci; and (4) inverse relations between protanopic and tritanopic systems generally, such that one''s confusion hues are the other''s residual hues. Two of the three dichromatic systems do not represent components of normal trichromatic vision as sometimes thought but are quite different. Wavelength shifts between illuminants demonstrate chromatic adaptation correlates exactly with that in trichromatic vision. In theory these results clarify relations in and between types of dichromacy. They also apply in Munsell and CIELAB color spaces but inexactly to the degree they employ inexact complementarity.     

A critique of 'countryside biogeography' as a guide to research in human‐dominated landscapes

Proliferation of redundant terms in ecology and conservation slows progress and creates confusion. ‘Countryside biogeography’ has been promoted as a new framework for conservation in production landscapes, so may offer a replacement for other concepts used by landscape ecologists. We conducted a systematic review to assess whether the 'countryside biogeography' concept provides a distinctive framing for conservation in human‐dominated landscapes relative to existing concepts. We reviewed 147 papers referring to countryside biogeography and 81 papers that did not. These papers were divided into categories representing three levels of use of countryside biogeography concepts (strong, weak, cited only) and two categories that did not use countryside biogeography at all but used similar concepts including fragmentation and matrix. We revealed few distinctions among groups of papers. Countryside biogeography papers made more frequent use of the terms 'ecosystem services', 'intensification' and 'land sparing' compared with non‐countryside biogeography papers. Papers that did not refer to countryside biogeography sampled production areas (e.g. farms) less often, and this related to their focus on habitat specialist species for which patch‐matrix assumptions were reasonable. Countryside biogeography offers a conceptual wrapper rather than a distinctive framework for advancing research in human‐modified landscapes. This and similar wrappers such as ‘conservation biogeography’ and ‘agricultural biogeography’ risk creating confusion among new researchers, and can prevent clear communication about research. To improve communication, we recommend using the suite of well‐established terms already applied to conservation in human‐modified landscapes rather than through an interceding conceptual wrapper.     

Infant care in a family of siamangs (Hylobates syndactylus) with twin offspring at Berlin Zoo

Infant-carrying in a family group of siamangs with twin offspring was observed during a 2-week period. The twins were about 11 months old at the time of the study. One or both twins were usually carried by their father, but hardly ever by their mother. A considerable amount of infant-carrying was also contributed by the twins' juvenile brother. Helping behavior (defined as the care of offspring by individuals who are not their parents) is not normally known to occur in siamangs or other hylobatids. We suggest that the presence of multiple offspring may have facilitated the occurrence of infant-carrying exhibited by a nonparental family member. This finding may point to one of the mechanisms influencing the occurrence of helping behavior in general.     

Liver transplantation in 100 children: Cambridge and King's College Hospital series.

To review the results of the Addenbrooke''s and King''s College Hospital children''s liver transplantation programme.Retrospective analysis of the first 100 children to receive liver grafts at Addenbrooke''s Hospital, Cambridge, from December 1983 to March 1990.Addenbrooke''s Hospital, Cambridge, and King''s College Hospital, London.153 children assessed for liver transplantation, of whom 22 died before a donor became available and 31 were considered unsuitable. 100 children received grafts, of whom 27 had second grafts.One year actuarial patient survival was 71%, with 57% one year graft survival. In the last two years survival rates had improved considerably, with 86% of patients and 63% of grafts surviving for at least one year. Sixty five children were alive 12 to 86 months after transplantation; 63 were well and leading normal active lives and 56 had entirely normal liver function. Children''s growth and development were essentially normal, with many showing remarkable catch up growth.Liver transplantation offers children with terminal liver disease a high chance of a return to full quality life and normal development. Improved surgical and medical care have progressively improved survival. The timing of transplantation is critical but has been constrained particularly by the availability of donors and resources.