The influence of prenatal and postnatal fraternity size on reproduction in mice

Effects of prenatal and postnatal fraternity size (size of litter in which an individual is reared) on age at vaginal opening, growth, and subsequent litter production were examined by rearing mice in standardized prenatal and postnatal fraternities in a 3 X 3 factorial design. Prenatal fraternity size was standardized by reducing litters of 14 or more to either 14, 10, or 6 fetuses on Day 9 of gestation. Postnatal fraternity size was standardized by assigning pups randomly to nurse in litters of 5, 10, or 15 pups within 24 h of birth. Both prenatal and postnatal fraternity size affected growth of the mice (p = 0.02 and p less than 0.01, respectively) with mice reared in small fraternities attaining greater weights throughout the study. Prenatal fraternity size had a negative linear effect on litter size at second parity and tended to have a positive linear effect on age at vaginal opening. Postnatal fraternity size affected age at vaginal opening (p less than 0.01), litter size at first parity (p less than 0.01), and litter size at second parity (p = 0.03). These effects were positive and linear for age at vaginal opening (p less than 0.01; small fraternity size associated with younger age at vaginal opening) and negative and linear for litter size at first and second parity (p less than 0.01 and p = 0.10, respectively; smaller fraternity size associated with larger litter size). There was no interaction between prenatal and postnatal fraternity size effects on age at vaginal opening or litter size (p greater than 0.20).     

Cytolysis and karyopyknosis in postmenopausal vaginal smears as markers of endometrial cancer, diabetes and obesity. Studies based on a ten-year follow-up

The vaginal cytology of 507 postmenopausal women was followed prospectively for ten years. Of the subjects, the 207 with cytolytic or karyopyknotic vaginal smears constituted the study group and the 300 with atrophic smears (indicating an absence of estrogenic activity) constituted the control group at the beginning of the follow-up. A woman whose initial smear was cytolytic usually had a cytolytic smear ten years later, which implies that high postmenopausal estrogenic activity is constitutional. Both at the beginning of the study and ten years later, the mean body weights were higher in the study group than in the control group. The mean karyopyknotic index and the prevalence of cytolytic smears were significantly higher among women with impaired glucose tolerance than among subjects with a normal glucose tolerance test. During the follow-up period, 3.6% of the women in the study group and 0.7% of the women in the control group developed endometrial cancer (P less than .02). The incidence of 3.6% of endometrial cancer is significantly higher than the corresponding age-specific incidence (P less than .001). We conclude that obese and/or diabetic postmenopausal women with cytolytic or markedly karyopyknotic vaginal smears exhibit a high intrinsic estrogen activity and may thus be at risk for endometrial cancer.     

Goblet-like cells in atrophic vaginal smears and their histologic correlation. Possible confusion with endocervical cells.

The occurrence and origin of goblet-like cells seen between clusters of parabasal cells in atrophic vaginal smears were investigated. The goblet-like cells were cytologically identified in the vaginal smears from 23 (19.2%) of 120 patients whose smears showed an atrophic pattern, but without any inflammatory, dysplastic or malignant changes. Histologically, these cells were found in sections from 6 (18.8%) of 32 elderly women with atrophic vaginal epithelium. The goblet-like cells were situated among the squamous cells of the upper layer of the atrophic squamous epithelium from the vagina to the portio. These goblet-like cells in atrophic smears were initially misinterpreted as endocervical cells, which are regarded as a marker of smear adequacy in the cytologic screening for cancer of the uterine cervix. The correct interpretation of these goblet-like cells in smears from postmenopausal and elderly women is thus obviously important in assessing the adequacy of the sample for the detection of abnormal cells.     

Cytologic evidence of extensive keratotic reaction in women exposed to diethylstilbestrol in utero

Squamous mucous membranes and squamous metaplastic epithelium sometimes undergo hypermaturation with the production of a keratin layer. Anucleated keratotic squamous plaques in smears are generally recognized as cytologic evidence of this altered maturation. This keratotic reaction was quantified in cytologic smears from 191 women exposed in utero to diethylstilbestrol (DES). Keratotic reaction was observed in the vaginal smear in 40% of the cases, in the cervical smear in 26% and in the endocervical smear in 19%; overall, a keratotic reaction was observed in at least one specimen from 48% of the women. These frequencies are higher than those reported in other studies. The observed frequency was age related. The significance of the hyperkeratosis, including its possible relationship to a lower dysplasia rate among DES-exposed women, is unclear. No conclusions can be drawn until more is known about behavioral factors in DES-exposed women.     

Estrogen-Dependent Proteolytic Cleavage of Semaphorin 4D and Plexin-B1 Enhances Semaphorin 4D-Induced Apoptosis during Postnatal Vaginal Remodeling in Pubescent Mice

Around the fifth week after birth, the vaginal cavity in female mouse pups opens to the overlaying skin. This postnatal tissue remodeling of the genital tract occurs during puberty, and it largely depends upon hormonally induced apoptosis that mainly occurs in the epithelium at the lower part of the mouse vaginal cavity. Previously, we showed that most BALB/c mice lacking the class IV Semaphorin (Sema4D) develop imperforate vagina and hydrometrocolpos; therefore, we reasoned that the absence of Sema4D-induced apoptosis in vaginal epithelial cells may cause the imperforate vagina. Sema4D signals via the Plexin-B1 receptor; nevertheless detailed mechanisms mediating this hormonally triggered apoptosis are not fully documented. To investigate the estrogen-dependent control of Sema4D signaling during the apoptosis responsible for mouse vaginal opening, we examined structural and functional modulation of Sema4D, Plexin-B1, and signaling molecules by analyzing both wild-type and Sema4D−/− mice with or without ovariectomy. Both the release of soluble Sema4D and the conversion of Plexin-B1 by proteolytic processing in vaginal tissue peaked 5 weeks after birth of wild-type BALB/c mice at the time of vaginal opening. Estrogen supplementation of ovariectomized wild-type mice revealed that both the release of soluble Sema4D and the conversion of Plexin-B1 into an active form were estrogen-dependent and concordant with apoptosis. Estrogen supplementation of ovariectomized Sema4D−/− mice did not induce massive vaginal apoptosis in 5-week-old mice; therefore, Sema4D may be an essential apoptosis-inducing ligand that acts downstream of estrogen action in vaginal epithelium during this postnatal tissue remodeling. Analysis of ovariectomized mice also indicated that Sema4D contributed to estrogen-dependent dephosphorylation of Akt and ERK at the time of vaginal opening. Based on our results, we propose that apoptosis in vaginal epithelium during postnatal vaginal opening is induced by enhanced Sema4D signaling that is caused by estrogen-dependent structural changes of Sema4D and Plexin-B1.     

Demographic, reproductive, medical, and environmental factors in relation to gastroschisis.

To identify risk factors for gastroschisis other than drug use in pregnancy, an analysis of data collected in a case-control surveillance program of birth defects (1976-1990) was conducted. Drug use is considered in Werler et al., Teratology, 45:361-367, 1992. Maternal demographic, reproductive, and medical factors, and first trimester environmental exposures, were compared between 76 gastroschisis cases and 2,581 malformed controls. A strong inverse association was found for maternal age: relative to women 30 years or older, relative risks for 25-29, 20-24, and less than 20-year-old women were 1.7, 5.4, and 16, respectively. Multivariate relative risks (and 95% confidence intervals) for alcohol use were as follows: for 1-5 drinks per week, 1.6 (0.7-3.4); for greater than or equal to 6 drinks per week, 2.5 (0.9-6.8); for a maximum of 1-4 drinks at any one time, 0.8 (0.4-1.6); and for a maximum of greater than or equal to 5 drinks, 2.8 (1.2-6.5). With the effect of age taken into account, no associations were identified for cigarette smoking, consumption of caffeinated or decaffeinated coffee, unplanned pregnancy, 12 or less years of education, or a parity of two or more. Other medical and reproductive factors, including weight gain, vaginal bleeding, nausea or vomiting, influenza, "other" infection, and history of spontaneous abortion or elective abortion did not increase the risk.     

Parity-Associated Body Weight: Modification by Sociodemographic and Behavioral Factors

This research examines the association between parity and body weight and how this relationship is modified by sociodemographic and behavioral factors. Using multiple linear regression analysis, the study assessed the relationship between parity and relative body weight (as Body Mass Index, BMI) and how this relationship interacts with seven sociodemographic and seven behavioral factors in a national sample of 5,707 women from the Second National Health and Nutrition Examination (NHANES II) survey. After adjusting for sociodemographic factors, the amount of weight associated with parity averaged about 0.5 kg per child. However, parity-associated weight differed by sociodemographic and behavioral factors, and was much larger in some subgroups. Among 18–45 year olds, the amount of weight associated with parity was greater in blacks than in whites, less in employed than unemployed white women but greater in employed than unemployed black women, less in smokers than nonsmokers, less in those with a high level of recreational exercise, and differed with the level of nonrecreational physical activity depending on race. Among 46–74 year olds, the amount of weight associated with parity was greater in married than unmarried women, and less in those who were active outside of recreation versus those who were less active. These results suggest that sociodemographic and behavioral variables modify the relationship between parity and body weight, and provide insight for identifying women who are at risk for having greater BMI with higher parity. This information may be applicable to the targeting and design of interventions to prevent postpartum weight retention.     

Use of magnetic resonance imaging in the study of goat mammary glands in vivo

A technique is described for the in-vivo determination of mammary gland size and gross composition in goats by using nuclear magnetic resonance imaging (MRI). The volume of test objects determined with MRI had an error of +0.4 +/- 1.6% of the actual volume. In lactating goats the in-vivo MRI estimate of mammary parenchymal volume was significantly greater than, but highly significantly correlated with, the weight of parenchyma determined post mortem (for the whole udder, r = 0.88, P less than 0.001; for individual glands, r = 0.85, P less than 0.001). MRI-determined estimates of the volume of fluid within the mammary gland were within 1.2% of the volume of milk removed from the udders after imaging. The spin-lattice (T1) relaxation time of the whole udder correlated closely with the volume of fluid within the udder. The T1 relaxation time of parenchymal tissue measured in vivo did not differ significantly from that determined immediately after post-mortem excision.     

Vaginal cytology in endocrinopathies

In order to evaluate the diagnostic significance of vaginal smears in endocrinopathies associated with menstrual disorders, the cytologic pattern of vaginal smears was examined in 703 patients who had a well-established diagnosis of the disorder's origin. The patients were classified into four groups according to their menstrual disorders: primary amenorrhea (159 patients), secondary amenorrhea (116 patients), primary oligomenorrhea (214 patients) and secondary oligomenorrhea (214 patients). Using the maturation index and the maturation value, three cytologic patterns of vaginal smears were distinguished: parabasal cell pattern, intermediate cell pattern and superficial cell pattern. The frequency with which the cytologic patterns occurred in the groups of patients and their subdivisions are presented. As a whole, the 703 patients showed 25.2% with a parabasal cell pattern, 58.3% with an intermediate cell pattern and 16.5% with a superficial cell pattern. Although the cytohormonal pattern of vaginal smears in endocrinopathies with associated menstrual disorders is not diagnostic of a specific endocrinopathy, the cellular patterns may prove helpful in suggesting a range of diagnoses or in excluding some possibilities.     

Influence of body size and gender on control of ventilation

Hypoxic (HVR) and hypercapnic (HCVR) ventilatory responses are influenced by both metabolic activity and hormonal factors. By studying 67 subjects of both sexes, including those at the extremes of stature, we examined the influence of gender, CO2 production (VCO2), O2 consumption (VO2), body surface area (BSA), and vital capacity (VC) on resting ventilation (VE), HVR, and HCVR. We measured resting VE, VO2, and VCO2 and then performed isocapnic progressive hypoxic and hypercapnic ventilatory responses. The effect of stature was reflected in higher VE and metabolic rate (both P less than 0.001) in tall men compared with short men that was ablated by correction for BSA. Perhaps because their heights vary less than those of the men, tall women were not statistically distinguishable from short women in any of these measured parameters. Tall men tended to have greater hypoxic chemosensitivity than short men but this was not significantly different (P = 0.07). Gender affected the control of ventilation in a number of ways. Men had higher VE (P less than 0.05) and metabolic rate (P less than 0.001) than women. Even after correction for BSA men still had higher metabolic rates. Women had higher VE/VCO2 than men (P less than 0.05) and lower resting end-tidal Pco2 (PETCO2) values (P less than 0.05). Both A, the shape parameter of the hyperbolic HVR curve, and HVR determined from mouth occlusion pressure (AP) were greater in women than in men, although only AP reached statistical significance. However, corrections of A for BSA (P less than 0.05), VCO2 (P less than 0.01), and VC (P less than 0.001) amplified these differences.(ABSTRACT TRUNCATED AT 250 WORDS)     

Women’s Longitudinal Patterns of Smoking during the Pre-Conception,Pregnancy and Postnatal Period: Evidence from the UK Infant Feeding Survey

BackgroundAn understanding of women’s longitudinal patterns of smoking during the pre-conception, pregnancy and postnatal period and the factors associated with these patterns could help better inform smoking cessation services and interventions.MethodsLatent class analysis (LCA) was used to empirically identify women’s smoking patterns in a sample of 10,768 mothers from the 2010 UK Infant Feeding Survey. Multinomial logistic regression was used to identify characteristics associated with these patterns.ResultsLCA identified five distinct smoking patterns during the pre-conception, pregnancy and postnatal period: “non-smokers” (74.1% of women); “pregnancy-inspired quitters” (10.2%); “persistent smokers” (10.1%); “temporary quitters” (4.4%); and postnatal quitters (1.1%). Smoking patterns varied markedly according to socio-demographic variables and parity. After adjusting for these variables, mothers who lived during pregnancy with a partner who smoked were more likely to be temporary quitters (aOR 2.64, 95% CI 1.74–3.99) or persistent smokers (aOR 3.32, 95% CI 2.34–4.72) than pregnancy-inspired quitters. Mothers who lived during pregnancy with someone else other than a partner who smoked were more likely to be persistent smokers (aOR 2.34, 95% CI 1.38–3.97) or postnatal quitters (aOR 2.97, 95% CI 1.07–8.24) than pregnancy-inspired quitters. Mothers given information on how their partner could stop smoking if they lived during pregnancy with a smoking partner were less likely to be persistent smokers (aOR 0.42, 95% CI 0.27–0.65) than pregnancy-inspired quitters.ConclusionHealth professionals should ask about smoking at every opportunity, and refer women who self-report as current smokers to an evidence based smoking cessation service.     

Thyroid function before and after induced abortion in normal pregnant women.

We assessed thyroid function before and after induced abortion in 25 normal pregnant women. Serum TSH was significantly increased (P less than 0.02), and serum hCG-beta was significantly reduced (P less than 0.001) 1 week after induced abortion, compared with the levels before induced abortion. There was a significant negative correlation between hCG-beta and TSH, and a positive one between hCG-beta and FT4 before induced abortion (P less than 0.02). No difference was observed in thyroid hormones before and 1 week after induced abortion. The results suggest that hCG stimulates the thyroid gland, gaining an advantage over TSH, in normal pregnant women.     

Effect of one-legged exercise on the strength, power and endurance of the contralateral leg. A randomized, controlled study using isometric and concentric isokinetic training.

The purpose of this investigation was to study the effect of one-legged exercise on the strength, power and endurance of the contralateral leg. The performance of the knee extensor and flexor muscle of 20 healthy young adults (10 men and 10 women) was first tested by Cybex II+ and 340 dynamometers. Then 10 subjects were chosen at random to train using one leg three times a week for 7 weeks whilst the other 10 served as controls. During the 8th week, the tests were repeated. Both quadriceps and hamstring muscles of the trained subjects showed a cross-transfer effect from the trained limb to the untrained side. This concerned the strength and power, as well as endurance characteristics of these muscles. The average change in peak torque of the quadriceps muscle was +19% (P less than 0.001) in the trained limb, +11% (P less than 0.01) in the untrained limb and 0% in the control limbs. In hamstring muscles the changes were +14% (P less than 0.01), +5% and -1%, respectively. Concerning muscle endurance (work performed during the last 5 contractions in the 25-repetition test) the corresponding changes were +15% (P less than 0.01), +7% (P less than 0.01), and -1% in quadriceps muscle, and +17% (P less than 0.05), +7%, and -3% in hamstring muscles. The average strength benefit in the untrained limb was +36% (hamstring muscles) and +58% (quadriceps muscle) of that achieved in the trained limb. Untrained hamstring muscle showed better benefits in the endurance parameters than in strength or power parameters, while in the quadriceps muscle this effect was reversed. A positive relationship was observed between the changes (greater improvement in the trained limb resulted in greater improvement in the untrained limb) (hamstring muscles: r = 0.83, P less than 0.001, quadriceps muscle: r = 0.53, P less than 0.001). In endurance parameters, this relationship was almost linear while in the strength and power parameters the results were more in favour of a curvilinear relationship with limited benefit.     

Postnatal disappearance of the pregnancy-associated reduced sensitivity of plasma cortisol to feedback inhibition

We recently observed that the characteristic insensitivity of the pituitary-adrenal system in women to feedback inhibition during pregnancy persists for at least four days postnatally. We therefore examined women during the first five weeks after delivery to assess when the sensitivity of plasma cortisol to glucocorticoid inhibition returns to normal. Dexamethasone (DEXA, 1 mg) was ingested at 11 pm by normal healthy women, once between the 3rd and 27th postnatal days, and again on day 35. Blood plasma was collected at 4 pm on the following day for cortisol assay. Plasma cortisol levels (nmol/L, mean +/- sem [n]) after DEXA in the first two weeks (216 +/- 28, [47]) were higher (p less than 0.001) than in nonmedicated nonpregnant women (47.4 +/- 8.9 [12]) and were normal by the 35th day after delivery (41.7 +/- 4.8 [74]). A negative association was found between post-DEXA cortisol and time after delivery in the first 4 post-partum weeks (r = -0.46, p less than 0.001). The study confirms that insensitivity of plasma cortisol to feedback inhibition persists beyond normal pregnancy in a significant proportion of healthy women for two to three weeks, and is absent by the 5th postnatal week.     

Behavioral and physiological changes in early-weaned multiparous and primiparous beef cows

Early weaning is used to advance postpartum ovulation in beef cows, but triggers a stress response, affecting cows' and calves' welfare. Our aim was to compare the response to early weaning in multiparous and primiparous cows. Seventy-one days after birth, calves from 14 primiparous and 11 multiparous cows were weaned. Since birth, cow's body weight (BW), body condition (BC), milk yield and calves' BW were recorded. Basophil/neutrophil relationship, total protein and albumin concentrations were measured before and after weaning. The distance between each cow and its calf before weaning, as well as main behaviors of the cows before and after weaning were recorded using 10 min scan sampling. BW and BC were greater in multiparous than in primiparous cows (P < 0.0001 for both). There was an interaction between parity (P = 0.004) and gender of the calf (P = 0.007): both BW and BC were greater in multiparous than primiparous cows, but multiparous cows with male calves had lower BW and BC than those with females (P < 0.001 for both variables). Milk yield was greater in multiparous than in primiparous cows (P = 0.02), and there was an interaction, with greatest milk yield in multiparous cows that calved males (P = 0.02). Total protein blood concentration increased with time (P < 0.0001), similarly in both groups. Albumin concentration profiles were similar despite parity, and decreased since 10 days after weaning (P < 0.0001). Basophil/neutrophil ratio was not affected by parity, and increased the day of weaning, remaining high until day 10 (P < 0.05). Frequency of standing decreased during the 2 days after weaning, with a greater decrease in multiparous than in primiparous cows (P < 0.0001). Pacing increased after weaning (P = 0.001), but increased significantly more in multiparous cows (P = 0.006), with a significant time after weaning by parity interaction (P = 0.01) reflected in greater frequencies in multiparous cows in the 2 days. Walking increased with time (P < 0.0001), and was more frequent in primiparous cows (P = 0.008). Ruminating, which was less frequent in multiparous cows (P = 0.014), decreased and remained low during the 3 days following weaning (P < 0.0001), but there was a significant time by parity interaction (P < 0.0001). The frequency of vocalizations increased dramatically after weaning (P < 0.0001), and was greater in multiparous cows (P = 0.006), and decreased more slowly during the 2nd and 3rd days after weaning (P = 0.005) in these animals. In conclusion, behavioral changes induced by weaning were greater in multiparous than primiparous cows, indicating a more intense response to cow-calf separation in the multiparous animals.     

Persistent vaginal cornification in mice treated with estrogen prenatally.

Twelve of 14 female mice of the ICR strain which had received a single injection of 50 mug estradiol-17beta on day 17 of fetal life exhibited irreversible cornification or stratification of the vaginal epithelium which persisted after ovariectomy until sacrifice performed 42-48 days later. Eight of the 12 mice had corpora lutea in their ovaries removed at 3-5 months of age. A similar injection of estradiol on day 15 of fetal life induced irreversible cornification or stratification of the vaginal epithelium in 6 of 12 females and only one of the 6 had corpora lutea in its ovaries when removed at 3-5 months. Mice given the same dose of estradiol on the day of birth or at 3 days of postnatal age invariably had ovaries bearing follicles of varying sizes and hypertrophied interstitial tissue but no corpora lutea. Changes in the vaginal epithelium in these animals were less remarkable as compared to that in prenatally treated mice.     

Effect of milk production on the incidence of double ovulation in dairy cows

To determine the effect of parity and milk production on the incidence of double ovulation, the synchronization of ovulation, using GnRH and prostaglandin F2 alpha followed by timed AI (Ovsynch), was initiated at a random stage of the estrous cycle in lactating Holstein cows (n = 237). Ovulatory response at 48 h after the second GnRH injection and conception rate at 28 d post AI were determined by transrectal ultrasonography. Ovulation was synchronized in 84% of cows receiving the Ovsynch protocol. Of the synchronized cows, 14.1% exhibited a double ovulation and 47.6% conceived. Conception rate tended to be greater (P = 0.08) for cows exhibiting double (64.0%) rather than single ovulation (45.2%). To determine the effect of milk production on the incidence of double ovulation, cows were classified into low (< or = 40 kg/d) or high (> 40 kg/d) milk production groups based on the average milk production of 40.5 +/- 0.8 kg/d collected 2 d before AI. Although the incidence of double ovulation tended to increase linearly (P = 0.09) with increasing parity, the incidence of double ovulation was nearly 3-fold greater (P < 0.05) for cows in the high (20.2%) than the low (6.9%) milk production group. Furthermore, the increase in the incidence of double ovulation with parity apparently occurred because, within a parity group, the proportion of cows with high milk production was greater for the older cows. Twinning rate of cows that calved (n = 58) was 5.2%. In a secondary objective, cows were retrospectively classified as cystic or normal based on ultrasonographic ovarian morphology at the time of the second GnRH injection. Incidence of ovarian cysts was 11%, and the synchronization and conception rate of cows classified as cystic was 73.1 and 36.8%, respectively, which did not differ from that of normal cows. We conclude that milk production is the primary factor affecting the incidence of double ovulation in lactating dairy cows and may explain the effect of parity on twinning rate. In addition, Ovsynch appears to be an effective method for establishing pregnancy in lactating dairy cows with ovarian cysts.     

Weights and hematology of wild black bears during hibernation.

We compared weights and hematological profiles of adult (greater than 3-yr-old) female black bears (Ursus americanus) during hibernation (after 8 January). We handled 28 bears one to four times (total of 47) over 4 yr of varying mast and berry production. Mean weight of lactating bears was greater (P less than 0.0001) than that of non-lactating females. White blood cells (P less than 0.05) and mean corpuscular volume (P = 0.005) also differed between lactating and non-lactating bears. Hemoglobin (P = 0.006) and mean corpuscular hemoglobin concentration (P = 0.02) varied among years; values were lowest during 1975, following decreased precipitation and the occurrence of a second year of mast and berry crop shortages in a three-year period. Significant (P less than 0.05) interaction between reproductive status (lactating versus non-lactating) and study year for hemoglobin, red blood cells, and packed cell volume, and increased mean corpuscular volume, suggested a greater nutritional challenge for lactating females compared to non-lactating females during the 1975 denning season. Our data suggest that hematological characteristics of denning bears may be more sensitive than weights as indicators of annual changes in nutritional status; however, other influential factors, in addition to mast and berry crop production, remain to be examined.     

Breastfeeding and subsequent maternal visceral adiposity

Women gain visceral fat during pregnancy. Studies examining the impact of breastfeeding on maternal body composition are inconclusive. We examined the extent to which breastfeeding was associated with visceral adiposity in a sample of US women. This was a cross-sectional analysis of 351 women aged 45-58 years, who were free of clinical cardiovascular disease and had not used oral contraceptives or hormone replacement therapy in the 3 months prior to enrollment in the Study of Women's Health Across the Nation (SWAN)-Heart Study (2001-2003). History of breastfeeding was self-reported. Computed tomography was used to assess abdominal adiposity. Among premenopausal/early-peri-menopausal mothers, those who never breastfed had 28% greater visceral adiposity (95% confidence interval (CI): 11-49, P = 0.001), 4.7% greater waist-hip ratio (95% CI: 1.9-7.4, P < 0.001), and 6.49 cm greater waist circumference (95% CI: 3.71-9.26, P < 0.001) than mothers who breastfed all of their children for ≥3 months in models adjusting for study site; age; parity; years since last birth; socioeconomic, lifestyle, and family history variables; early adult BMI; and current BMI. In comparison to women who were nulliparous, mothers who breastfed all of their children for ≥3 months had similar amounts of visceral fat (P > 0.05). In contrast, premenopausal/early-peri-menopausal mothers who had never breastfed had significantly greater visceral adiposity (42% (95% CI: 17-70), P < 0.001), waist circumference (6.15 cm (95% CI: 2.75-9.56), P < 0.001), and waist-hip ratio (3.7% (95% CI: 0.69-6.8), P = 0.02) than nulliparous women. No significant relationships were observed among late peri-menopausal/postmenopausal women. In conclusion, until menopause, mothers who did not breastfeed all of their children for ≥3 months exhibit significantly greater amounts of metabolically active visceral fat than mothers who had breastfed all of their children for ≥3 months.     

Cervical cytology in the Vale of Trent faculty of the Royal College of General Practitioners, 1985-8.

OBJECTIVE--To assess changes in the organisation and performance of cervical cytology programmes in the practices of members of the Vale of Trent faculty of the Royal College of General Practitioners. DESIGN--Retrospective audits completed in 1985 and 1988 by general practitioners on a sequential sample of 100 records of women aged 35-64 in their practice. SETTING--General practices in which one or more partners were members or associates of the Vale of Trent faculty of the college, of which 76 participated in the first audit and 55 (82% of 67 eligible practices) in the second. SUBJECTS--Sequential samples of 100 women born between 1 January 1920 and 31 December 1949 (first audit) and between 1 January 1923 and 31 December 1952 (second audit) whose surnames began with P or B respectively. MAIN OUTCOME MEASURES--Percentage of women in each practice with a record of cervical cytology performed in the previous five years and percentage with no recorded smear. RESULTS--Of the 76 practices completing the audit in 1985, 55 (82% of those eligible) repeated the exercise in 1988. Performance was not significantly different in practices that did and did not respond. The median percentage of women who had had a smear in the previous five years was 49% and 69% in 1985 and 1988 respectively (p less than 0.001) and that of women with no record of a cervical smear was 28% and 16% respectively (p less than 0.001). All but six practices showed improvement in both outcome measures. In both audits an active call system was associated with a significantly increased performance (p less than 0.05). In nine practices (16%) 80% or more of the samples of women had had a smear in the previous five years. CONCLUSION--Organisation and performance of practices audited improved between 1985 and 1988. Although this might result from participation in the first audit, it probably represents a more general trend within primary care. ACTION--Between the two audits more practices (87% v 67%) had developed a policy on screening, and this was more likely to include the aim of performing regular smears on all sexually active women (98% v 80%).