Relación entre los factores estímulo estrogénicos y subtipos biológicos de cáncer de mama luminal A, luminal B y HER2 / Relationship between estrogenic stimulating factors and biological subtypes of luminal A, luminal B and HER2 breast cancer

Resumen ANTECEDENTES: El cáncer de mama es la principal neoplasia en incidencia y mortalidad en mujeres. Los subtipos moleculares: luminal A, luminal B, HER2 y triple negativo tienen un pronóstico y tasas de supervivencia diferentes. En la bibliografía está demostrada la estrecha asociación entre los factores estímulo estrogénicos y el cáncer de mama en general, aunque las diferencias no son claras debido a los subtipos moleculares. OBJETIVO: Revisar la bibliografía reciente y describir la relación entre los subtipos moleculares del cáncer de mama y los factores reproductivos. METODOLOGÍA: Búsqueda en las bases de datos PubMed y LILACS con los términos MeSH y DeCS: neoplasias de la mama, subtipos moleculares, factores de riesgo, factores reproductivos. Se buscó la asociación entre los antecedentes de paridad, edad al primer embarazo y el antecedente de lactancia materna con los subtipos moleculares de cáncer de mama: luminal A, luminal B y HER2. RESULTADOS: Se obtuvieron 366 artículos y se eliminaron 352 por: duplicidad en títulos y resúmenes, sin pertinencia para el tema, protocolos de investigación que no estudiaran la asociación entre factores estímulo estrogénicos con los subtipos moleculares de cáncer de mama. Al final, el análisis se hizo con 14 artículos. CONCLUSIONES: Los tumores con receptores hormonales positivos se asociaron con: edad mayor al primer embarazo, mayor tiempo entre la menarquia y el primer embarazo a término y edad avanzada en el último embarazo. Factores protectores para tumores luminales y HER2 puro: lactancia materna y multiparidad.

Abstract BACKGROUND: Breast cancer represents the main neoplasia in incidence and mortality in women, it can be divided into molecular subtypes (luminal A, luminal B, HER2 and triple negative) having a differential prognosis and survival rates. There is literature that demonstrates the strong association between estrogenic stimulating factors and breast cancer, but the existing differences by molecular subtypes are not clear. OBJECTIVE: To review the recent literature and describe the relationship found between molecular subtypes of breast cancer and estrogenic stimulating factors. METHODOLOGY: Search in the PubMed and LILACS databases with the MeSH and DeCS terms: breast neoplasms, molecular subtypes, risk factors, reproductive factors, looking for the association between the antecedents of parity, age at first pregnancy and history of breastfeeding with molecular subtypes of breast cancer (luminal A, luminal B and HER2). RESULTS: A total of 366 results were obtained, excluding 352 articles when evaluating duplicity, titles and abstracts, articles without relevance to the topic, research protocols and articles that did not study the association of estrogenic stimulating factors with molecular subtypes of breast cancer, resulting in 14 articles. CONCLUSIONS: Hormone receptor-positive tumors were found to be associated with older age at first pregnancy, longer time between menarche and first term pregnancy and older age at last pregnancy. Breastfeeding and multiparity were found as protective factors for luminal tumors and pure Her2.

Recurrent preterm birth: data from the study "Birth in Brazil" / Prematuridade recorrente: dados do estudo "Nascer no Brasil"

ABSTRACT OBJECTIVE Describe and estimate the rate of recurrent preterm birth in Brazil according to the type of delivery, weighted by associated factors. METHODS We obtained data from the national hospital-based study "Birth in Brazil", conducted in 2011 and 2012, from interviews with 23,894 women. Initially, we used the chi-square test to verify the differences between newborns according to previous prematurity and type of recurrent prematurity. Sequentially, we applied the propensity score method to balance the groups according to the following covariates: maternal age, socio-economic status, smoking during pregnancy, parity, previous cesarean section, previous stillbirth or neonatal death, chronic hypertension and chronic diabetes. Finally, we performed multiple logistic regression to estimate the recorrence. RESULTS We analyzed 6,701 newborns. The rate of recurrence was 42.0%, considering all women with previous prematurity. Among the recurrent premature births, 62.2% were spontaneous and 37.8% were provider-initiated. After weighting by propensity score, we found that women with prematurity have 3.89 times the chance of having spontaneous recurrent preterm birth (ORaj = 3.89; 95%CI 3.01-5.03) and 3.47 times the chance of having provider-initiated recurrent preterm birth (ORaj = 3.47; 95%CI 2.59-4.66), compared to women who had full-term newborns. CONCLUSIONS Previous prematurity showed to be a strong predictor for its recurrence. Thus, expanding and improving the monitoring and management of pregnant women who had occurrence of prematurity strongly influence the reduction of rates and, consequently, the reduction of infant morbidity and mortality risks in the country.

RESUMO OBJETIVO Descrever e estimar a taxa de prematuridade recorrente no Brasil segundo o tipo de parto, ponderado pelos fatores associados. MÉTODOS Os dados foram obtidos do estudo nacional de base hospitalar "Nascer no Brasil", realizado em 2011 e 2012, a partir de entrevistas com 23.894 mulheres. Inicialmente foi utilizado o teste qui-quadrado para verificar as diferenças entre os recém-nascidos, segundo a prematuridade prévia e o tipo de prematuridade recorrente. Sequencialmente, aplicou-se o método de ponderação pelo escore de propensão para equilibrar os grupos de acordo com as seguintes covariáveis: idade materna, classificação socioeconômica, tabagismo durante a gravidez, paridade, cesárea anterior, natimorto ou óbito neonatal anterior, hipertensão crônica e diabetes crônica. Por último, foi realizada regressão logística múltipla para estimar a prematuridade recorrente. RESULTADOS Foram analisados 6.701 recém-nascidos. A taxa de prematuridade recorrente foi de 42,0%, considerando todas as mulheres com prematuridade prévia. Dentre os prematuros recorrentes, 62,2% foram espontâneos e 37,8% ocorreram por intervenção-obstétrica. Após a ponderação pelo escore de propensão, verificou-se que mulheres com prematuridade prévia têm 3,89 vezes a chance de terem prematuridade recorrente espontânea (ORaj = 3,89; IC95% 3,01-5,03) e 3,47 vezes a chance de terem prematuridade recorrente por intervenção obstétrica (ORaj = 3,47; IC95% 2,59-4,66), em comparação às mulheres que tiveram recém-nascidos termo completo. CONCLUSÕES A prematuridade prévia revelou-se um forte preditor para sua recorrência. Assim, ampliar e melhorar o monitoramento e manejo de gestantes com história de prematuridade impacta fortemente na redução das taxas e, consequentemente, na redução dos riscos de morbimortalidade infantil no país.

Influencing factors of platelet antibody screening in pregnant women / 中国输血杂志

【Objective】 To investigate the positive rate of platelet antibody in pregnant women and analyze the related factors. 【Methods】 A total of 620 pregnant women who underwent antenatal examination from March 2017 to July 2018 were screened for platelet antibodies by solid phase agglutination method. The relationship between platelet antibody positive rate and blood transfusion history, reproductive history and ABO blood group were analyzed, and the profile of disease were alsodiscussed. 【Results】 55 out of 620 pregnant women presented positive platelet antibody, with a positive rate of 8.87%.The platelet antibody positive rate of pregnant women with ahistory of blood transfusion (14.13%) was higher than those never transfused before(6.65%), and the platelet antibody positive rate of pregnant women with a childbirth history (10.46%) was higher than those didn′t bear before(3.52%), showing statistically significant differences (P0.05). Pregnant women with positive platelet antibodies mainly suffered from diseases such as placenta pravia, scarred uterus, placental implantation and thrombocytopenia. 【Conclusion】 Blood transfusion history, reproductive history and disease type have certain effects on the positive rate of platelet antibody in pregnant women.Screening platelet antibody in pregnant women is of great significance to prevente and reduce miscarriage during pregnancy and the occurrence of neonatal alloimmune thrombocytopenic purpura(NAITP).

Women's obstetric history and midtrimester cervical length measurements by 2d/3d and doppler ultrasound / História obstétrica e medida do comprimento do colo uterino de mulheres no segundo trimestre gestacional por ultrassonografia bi/tridimensional e Doppler

Abstract Objective The aim of the present study was to compare the obstetric history and both two- and tri-dimensional ultrasound parameters according to different cervical lengths. Methods The present cross-sectional study analyzed 248 midtrimester pregnant women according to cervical length and compared the data with the obstetric history and 2D/3D ultrasound parameters. Patients were divided into 3 groups according to cervical length: The Short Cervix group for cervical lengths ≥ 15mm and< 25mm(n= 68), the Very Short Cervix group for cervical lengths< 15mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25mm. Results When analyzing the obstetric history of only non-nulliparous patients, a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth was reported (p = 0.021). Cervical length and volume were positively correlated (Pearson coefficient = 0.587, p < 0.0001). The flow index (FI) parameter of cervical vascularization was significantly different between the Control and Very Short Cervix groups. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. Uterine artery Doppler was also not related to cervical shortening. Conclusion The present study showed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth. None of the vascularization indexes correlate with cervical length as an independent parameter. Uterine artery Doppler findings do not correlate with cervical length.

Resumo Objetivo O objetivo do presente estudo foi comparar a história obstétrica e os parâmetros bi- e tridimensionais ultrassonográficos de acordo com os diferentes comprimentos cervicais. Métodos O presente estudo transversal analisou 248 gestantes no segundo trimestre de acordo com o comprimento cervical e comparou os dados com a história obstétrica e os parâmetros ultrassonográficos 2D/3D. As pacientes foram divididas em 3 grupos de acordo com o comprimento do colo uterino: grupo Colo Curto para comprimentos cervicais ≥ 15mm e < 25mm (n = 68), grupo Colo Muito Curto para comprimentos cervicais < 15mm (n = 18) e grupo Controle, composto por 162 gestantes com comprimento cervical uterino ≥ 25 mm. Resultados Ao analisar a história obstétrica apenas de pacientes não nulíparas, foi relatadauma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior (p = 0,021). Comprimento e volume do colo uterino foram correlacionados positivamente (coeficiente de Pearson = 0,587, p < 0,0001). O parâmetro índice de fluxo (IF) da vascularização cervical foi significativamente diferente entre os grupos Controle e Colo Muito Curto. Entretanto, após regressão linear, na presença de informações de volume, não encontramos associação entre os grupos e o parâmetro IF. Também não foi encontrada relação entre o Doppler da artéria uterina e o encurtamento cervical. Conclusão O presente estudo mostrou uma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior. Nenhum dos índices de vascularização se correlaciona com o comprimento cervical como parâmetro independente, assim como o Doppler da artéria uterina também não está relacionado ao comprimento do colo uterino.

Historia reproductiva y fecundidad en pacientes con proteinopatías del Sistema Nervioso / Reproductive history and fertility in patients affected by Proteinopathies of the nervous system

RESUMEN Introducción: Se conoce que varias proteinopatías del sistema nervioso se asocian a la ocurrencia de cambios significativos en la historia reproductiva y la fecundidad. Objetivo: Reflejar el comportamiento de la historia reproductiva y de la fecundidad en pacientes con proteinopatías del sistema nervioso. Material y Métodos: Se realizó una revisión bibliográfica entre los meses de enero de 2018 a diciembre de 2018. Se consultaron las bases de datos PubMed, EBSCO, Google Scholar y HighWire. Se empleó la estrategia de búsqueda avanzada para la selección de los artículos. Desarrollo: Se identificaron evidencias de ocurrencia de cambios significativos en la historia reproductiva y la fecundidad en pacientes con proteinopatías del sistema nervioso. Mientras que las mujeres con enfermedad de Parkinson y los pacientes con Esclerosis lateral amiotrófica tienden a tener una menor fecundidad que individuos de la población general, los pacientes con la enfermedad de Huntington o con Ataxias espinocerebelosas tienden a tener una mayor fecundidad que individuos de la población general, con un importante rol para la nupcialidad. Las mujeres con enfermedad de Alzheimer tienden a presentar la menopausia a edades más tardías, mientras que las pacientes con enfermedad de Parkinson tienden a tener una menarquía más tardía y un menor número de abortos. Conclusiones: Las evidencias disponibles con respecto a cambios significativos en la historia reproductiva y la fecundidad en pacientes con proteinopatías del sistema nervioso son frecuentemente contradictorias y se caracterizan por un énfasis en factores biológicos y la consecuente desestimación de factores de tipo socioeconómico y cultural.

ABSTRACT Introduction: It is known that several proteinopathies of the nervous system are associated with significant changes in reproductive history and fertility. Objective: To show the behavior of reproductive history and fertility in patients with proteinopathies of the nervous system. Material and Methods: A literature review was carried out from January, 2018 to December, 2018. Search was carried out in databases like PubMed, EBSCO, Google Scholar and HighWire. An advanced search strategy was used in the selection of the articles. Results: Evidence on the occurrence of significant changes in reproductive history and fertility in patients with proteinopathies of the nervous system were identified. Women with Parkinson´s disease and patients with Amyotrophic Lateral Sclerosis tend to show lower fertility than individuals in the general population. On the contrary, patients with Huntington´s disease or Spinocerebellar Ataxias tend to show higher fertility than individuals in the general population, with a significant role for nuptiality. On the other hand, women with Alzheimer´s disease usually show menopause at older ages whereas women with Parkinson´s disease usually show delayed menarche and a more reduced number of abortions than women in the general population. Conclusions: Available evidence regarding significant changes in the reproductive history and fertility in patients with proteinopathies of the nervous system are frequently contradictory and focused on biological factors with underestimation of socio-economic and cultural factors.

Characterization of women with cervical cancer assisted at Inca by histological type / Caracterização de mulheres com câncer cervical atendidas no Inca por tipo histológico

ABSTRACT OBJECTIVE To determine the distribution of sociodemographic, reproductive, clinical and lifestyle habits in the cohort of women diagnosed with cervical cancer, assisted at Inca between 2012 and 2014, according to the histological type. METHODS Retrospective observational study of a hospital cohort of 1,004 women diagnosed with cervical cancer. Data were obtained from the Inca hospital cancer registry, physical and electronic records. RESULTS The most frequent histological type was squamous cell carcinoma (83.9%). Approximately 70% of the women aged more than 40 years. The study includes non-white women (67.4%), with less than 8 years of education (51.9%), with onset of sexual activity up to 16 years of age (40.7%), who were pregnant before (95.5%), with more than one pregnancy (82.9%), and more than two children (52.7%); 45.8% of the women were smokers or former smokers. Cervical adenocarcinoma was positively associated with earlier staging (IA-IIA) (OR = 1.79; 95%CI 1.03-3.13), as well as women with ≥ 12 years of education (OR = 6.30; 95%CI 1.97-20,13), who had no children (OR = 3.81; 95%CI 1.20 - 12,08) or who had up to two children (OR = 1.74; 95%CI 1.05 - 2,87). CONCLUSIONS The difference between histological types is highlighted, suggesting that women with cervical adenocarcinoma may represent a distinct clinical entity of cervical neoplasia, which may require different approaches from those used in squamous cell carcinoma.

RESUMO OBJETIVO Determinar a distribuição das características sociodemográficas, reprodutivas, clínicas e de hábitos de vida na coorte de mulheres diagnosticadas com câncer cervical, atendidas no Inca entre 2012 e 2014, segundo o tipo histológico. MÉTODOS Estudo observacional retrospectivo de uma coorte hospitalar de 1.004 mulheres diagnosticadas com câncer cervical. Os dados foram obtidos pelo Registro Hospitalar de Câncer do Inca, prontuários físicos e eletrônicos. RESULTADOS O tipo histológico mais frequente foi o carcinoma de células escamosas (83,9%). Aproximadamente 70% das mulheres foram diagnosticadas com mais de 40 anos de idade. Houve a predominância de mulheres não brancas (67,4%), com menos de 8 anos de escolaridade (51,9%), com início da atividade sexual até 16 anos de idade (40,7%), que já engravidaram alguma vez na vida (95,5%), com mais de uma gestação (82,9%) e mais de dois filhos (52,7%); 45,8% das mulheres eram tabagistas ou ex-tabagistas. O adenocarcinoma cervical esteve positivamente associado ao estadiamento mais precoce (IA-IIA) (OR = 1,79; IC95% 1,03-3,13), assim como a mulheres com ≥ 12 anos de estudo (OR = 6,30; IC95% 1,97-20,13), que não tiveram filhos (OR = 3,81; IC95% 1,20-12,08) ou que tiveram até dois filhos (OR = 1,74; IC95% 1,05-2,87). CONCLUSÕES Destaca-se a diferença entre os tipos histológicos, sugerindo que as mulheres com adenocarcinoma cervical possam representar uma entidade clínica distinta de neoplasia cervical, podendo demandar abordagens diferentes das utilizadas no carcinoma de células escamosas.

Combined estrogen-progestin pill is a safe and effective option for endometrial hyperplasia without atypia: a three-year single center experience / 부인종양

OBJECTIVE: To evaluate the effectiveness of oral contraceptive pill (OCP) as therapy for endometrial hyperplasia (EH) without atypia in reproductive-aged women compared with oral progestin. METHODS: A retrospective cohort study was carried out in our reproductive center. Consecutive patients diagnosed with infertility and non-atypical EH identified through electronic database who met inclusion criteria (n=309). Patients were assigned to two treatment groups: OCP (n=216) and oral progestin (n=93); clinical and reproductive outcomes were recorded. RESULTS: Reversal of EH to normal endometrium, clinical pregnancy, live birth and miscarriage rate. Women in OCP group were younger, had higher prevalence of Polycystic Ovary Syndrome and other uterine pathology and longer duration of infertility than women in progestin group. Reversal of EH was observed in 93.52% women on OCP and in 86.02% women on progestin (p=0.032; adjusted odds ratio [aOR]= 2.35; 95% confidence interval [CI]=1.06-5.21) after the initial course of treatment for 2 to 6 months. Cyclic OCP (n=184) resulted in better response to treatment compared to continuous OCP (n=32) (95.11% vs. 84.38%; p=0.039; aOR =3.60; 95% CI =1.12-11.55). Clinical pregnancy rate in OCP group was marginally higher than progestin group (87/208, 41.83% vs. 27/90, 30.00%; p=0.054). Miscarriage (25.29% vs. 29.63%; p=0.654) and live birth rate (31.25% vs. 21.11%; p=0.074) were comparable between the groups. CONCLUSION: For the first time we demonstrate that OCP is an effective therapy for non-atypical EH and is associated with higher remission rate compared with oral progestin. Reproductive outcomes are reassuring and comparable between the two groups.

Interaction Effect Between Breast Density and Reproductive Factors on Breast Cancer Risk in Korean Population

BACKGROUND: This study was conducted to explore the effect of known risk factors, focusing on risk factors including age at menarche, age at menopause, number of children, family history of breast cancer, and age at first birth according to breast density, in consideration of interaction among East-Asian women. METHODS: Case-control study with 2,123 cases and 2,121 controls with mammographic density was conducted. Using the mammographic film, breast density was measured using Breast Imaging-Reporting and Data System. To identify the association of selected reproductive factors including age at menarche, age at menopause, number of children, family history of breast cancer, and age at first birth according to breast density, stratified analysis was conducted according to breast density groups and interaction effects was assessed. The results were presented with adjusted OR and 95% CIs. RESULTS: Significant interaction effect between age at first birth and breast density on breast cancer (P = 0.048) was observed. Women with age at first birth ≥ 28 years old showed increased breast cancer risk in extremely dense breast group (≥ 75%) (OR = 1.627, 95% CI = 1.190–2.226). However, women with fatty breast (< 50%) and heterogeneously dense breast (50%–75%) did not show an increased association. Age at menarche, age at menopause, number of children, and family history of breast cancer did not show significant interaction with breast cancer and similar risk patterns were observed. CONCLUSIONS: Age at first birth showed significant interaction with breast density on breast cancer risk. Further studies considering biologically plausable model between exposure, intermediate outcomes and breast cancer risk with prospective design need to be undertaken in East Asian women.

Aspectos sociodemográficos, história sexual reprodutiva e conhecimento contraceptivo de puérperas adolescentes e adultas / Características sociodemográficas, historia reproductiva sexual y el conocimiento de anticonceptivos de adolescentes y adultos / Socio-demographic aspects, sexual reproductive history and contraceptive knowledge of puerperal teenagers and adults

OBJETIVO: descrever e comparar os aspectos sociodemográficos, a história sexual e reprodutiva e o conhecimento contraceptivo de puérperas adolescentes e adultas que tiveram seus partos numa maternidade de referência para a macrorregião de saúde. MÉTODOS: foi realizada entrevista individual com um instrumento semi estruturado contendo questões relativas aos aspectos estudados. RESULTADOS: a média de idade das puérperas foi de 26,74 anos. Dentre os métodos contraceptivos, a pílula foi apontada como mais conhecido. Houve associação estatisticamente significante entre o período fértil e a idade da puérpera e a renda. A mediana de idade em que as puérperas tiveram sua primeira relação sexual foi de 17 anos. A associação idade da puérpera e idade da primeira relação sexual (p<0,001) identificou início mais cedo da atividade sexual entre as adolescentes. CONCLUSÃO: as puérperas, em geral, possuem conhecimento inadequado do período fértil, além do conhecimento limitado acercados métodos contraceptivos. Há necessidade de maior atenção à assistência e ao planejamento familiar.

OBJECTIVE: to describe and to compare the sociodemographic aspects, the sexual and reproductive history and contraceptiveknowledge of postpartum teenagers and adults who had their births in a reference maternity for the health macro-region.METHODS: we used individual interview with a semi-structured instrument containing questions related to the previously studiedaspects. RESULTS: the average of the mothers’ age was 26.74 years old. Among the methods of contraception, the pill was the mostknown by the mothers. There was a statistically significant association between the fertile phase, the age of puerperal woman andincome. The median age at which the mothers had their first sexual intercourse was 17 years old. The association of postpartumage and her first sexual intercourse age (p <0.001) identified earlier onset of sexual activity among adolescents. CONCLUSION: ingeneral, they have inadequate knowledge of the fertile period, in addition to limited knowledge about contraceptive methods.There is a need for greater attention to family planning and care.

OBJETIVO: describir y comparar los aspectos socio-demográficos, la historia sexual y reproductiva y el conocimiento anticonceptivode las madres adolescentes y adultos que tenían sus entregas en una maternidad de referencia en la macro-región de salud. MÉTODOS: fueron realizadas entrevistas individuales con instrumentos semi-estructurados con las cuestiones relativas a losaspectos estudiados. RESULTADOS: La edad media de las madres fue de 26,74 años. Entre los métodos anticonceptivos, la píldora hasido nombrado el más conocido. Se observó una asociación estadísticamente significativa entre el período fértil y la edad puerperaly los ingresos. La edad media a la que las madres tuvieron su primera relación sexual fue a los 17 años. La asociación edadpuerperal y la edad de la primera relación sexual (p <0,001) identificó inicio más temprano de la actividad sexual entre losadolescentes. CONCLUSIÓN: las madres, generalmente, tienen un conocimiento inadecuado del período fértil, además de unconocimiento limitado acerca de los métodos anticonceptivos. Existe la necesidad de una mayor atención a la ayuda y a laplanificación familiar.

Preterm Labor and Birth: Definition, Assessment, and Management

No abstract available.

The Effect of Reproductive Factors on Breast Cancer Presentation in Women Who Are BRCA Mutation Carrier / 한국유방암학회지

PURPOSE: Germline mutations in the BRCA1 and BRCA2 genes confer increased risks for breast cancers. However, the clinical presentation of breast cancer among women who are carriers of the BRCA1 or BRCA2 (BRCA1/2 carriers) mutations is heterogenous. We aimed to identify the effects of the reproductive histories of women with the BRCA1/2 mutations on the clinical presentation of breast cancer. METHODS: We retrospectively analyzed clinical data on women with proven BRCA1 and BRCA2 mutations who were recruited to the Korean Hereditary Breast Cancer study, from 2007 to 2014. RESULTS: Among the 736 women who were BRCA1/2 mutation carriers, a total of 483 women had breast cancers. Breast cancer diagnosis occurred at significantly younger ages in women who experienced menarche at ≤14 years of age, compared to those who experienced menarche at >14 years of age (37.38±7.60 and 43.30±10.11, respectively, p<0.001). Additionally, the number of full-term pregnancies was significantly associated with the age of diagnosis, especially in women with the BRCA2 mutation. The prevalence of advanced stages (stage II or III vs. stage I) of disease in parous women was higher than in nulliparous women (68.5% vs. 55.2%, p=0.043). This association was more pronounced in women with the BRCA2 mutation (hazard ratio, 2.67; p=0.014). CONCLUSION: Our results suggest that reproductive factors, such as the age of onset of menarche and the presence of parity, are associated with the clinical presentation patterns of breast cancer in BRCA1/2 mutation carriers.

Relationship between reproductive history and preterm births in the last pregnancy, in Shaanxi province / 中华流行病学杂志

Objective To analyze the incidence of preterm delivery among single live neonates and the association between maternal reproductive history and preterm birth.Methods A questionnaire survey was conducted on reproductive history among women at childbearing age who were selected through multi-stage stratified random sampling method in Shaanxi,during 2010-2013.Samples would include women at childbearing age and in pregnancy or having had definite pregnancy outcomes.Results A total of 29 608 women at childbearing age with their infants,were studied.The overall incidence of premature delivery among the single live birth neonates under this study,was 2.7％ during 2010-2013.Results from the logistic regression model showed that factors as:having had history with preterm delivery (OR=7.99,95％CI:5.59-11.43),age of the mothers,older than 35 (OR=2.03,95％CI:1.59-2.59) and with history of birth defects (OR=1.54,95％CI:1.01-2.34) were at higher risks for premature delivery in neonates.Intervals on pregnancies between 3-4 years (compared with ≤2 years,OR=0.74,95％CI:0.58-0.93),between 5-6 years (compared with ≤2 years,OR=0.66,95％CI:0.52-0.82),or ＞6 years (compared with ≤2 years,OR=0.48,95％CI:0.37-0.61)together with numbers of parity as 1 (compared with primiparas,OR=0.80;95％CI:0.67-0.95),as ≥2 (compared with primiparas,OR=0.62,95％ CI:0.39-0.97) etc.were protective factors to preterm delivery.Factors as:history of preterm delivery,mothers age (older than 35 years) and intervals of pregnancy,appeared influential to the age of gestation,under the ordinal polytomous logistic regression analysis.Conclusion The incidence of preterm births among single live birth neonates in Shaanxi was lower than the average national level.Programs related to health care services prior to conception and during pregnancy,together with increasing the self-care consciousness of childbearing aged women etc,should all be strengthened in order to reduce the occurrence of preterm birth,in Shaanxi province.

Relationship between reproductive history and preterm births in the last pregnancy, in Shaanxi province / 中华流行病学杂志

Objective To analyze the incidence of preterm delivery among single live neonates and the association between maternal reproductive history and preterm birth.Methods A questionnaire survey was conducted on reproductive history among women at childbearing age who were selected through multi-stage stratified random sampling method in Shaanxi,during 2010-2013.Samples would include women at childbearing age and in pregnancy or having had definite pregnancy outcomes.Results A total of 29 608 women at childbearing age with their infants,were studied.The overall incidence of premature delivery among the single live birth neonates under this study,was 2.7％ during 2010-2013.Results from the logistic regression model showed that factors as:having had history with preterm delivery (OR=7.99,95％CI:5.59-11.43),age of the mothers,older than 35 (OR=2.03,95％CI:1.59-2.59) and with history of birth defects (OR=1.54,95％CI:1.01-2.34) were at higher risks for premature delivery in neonates.Intervals on pregnancies between 3-4 years (compared with ≤2 years,OR=0.74,95％CI:0.58-0.93),between 5-6 years (compared with ≤2 years,OR=0.66,95％CI:0.52-0.82),or ＞6 years (compared with ≤2 years,OR=0.48,95％CI:0.37-0.61)together with numbers of parity as 1 (compared with primiparas,OR=0.80;95％CI:0.67-0.95),as ≥2 (compared with primiparas,OR=0.62,95％ CI:0.39-0.97) etc.were protective factors to preterm delivery.Factors as:history of preterm delivery,mothers age (older than 35 years) and intervals of pregnancy,appeared influential to the age of gestation,under the ordinal polytomous logistic regression analysis.Conclusion The incidence of preterm births among single live birth neonates in Shaanxi was lower than the average national level.Programs related to health care services prior to conception and during pregnancy,together with increasing the self-care consciousness of childbearing aged women etc,should all be strengthened in order to reduce the occurrence of preterm birth,in Shaanxi province.

Role of reproductive factors in female patients with primary biliary cholangitis / 临床肝胆病杂志

ObjectiveTo investigate the role of productive factors in the development of primary biliary cholangitis (PBC). MethodsA total of 273 female patients with a definite diagnosis of PBC who visited Xijing Hospital from October 2013 to August 2015 were enrolled. The patients with autoimmune hepatitis, primary sclerosing cholangitis overlap syndrome, and hepatic encephalopathy and those with incomplete data after telephone follow-up were excluded, and 54 female PBC patients who had female relatives were finally enrolled (PBC group). The female relatives who were less than 10 years older or younger than the patients were collected, and those with severe systemic diseases and incomplete data after telephone follow-up were excluded; finally 88 relatives were enrolled (relative group). The questionnaire for female reproductive factors in PBC was used to survey all these enrolled patients and collect data. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and a multivariate logistic regression analysis was used for the analysis of dose-response relationship. ResultsThe PBC group had a significantly higher number of births than the relative group (2.55±1.84 vs 1.84±0.95, t=2.708, P=0.009). Furthermore, there was a significant dose-response pattern between the number of births and the development of PBC (P=0.002). ConclusionThe number of births may be associated with the development of PBC in a dose-response manner. As for the female population susceptible to PBC, a reduction in the number of births may reduce the possibility of PBC.

Magnetic Resonance Imaging Evaluation of L5-S1 Intervertebral Disc Degeneration in Japanese Women

STUDY DESIGN: Retrospective case series. PURPOSE: To calculate the prevalence of L5-S1 intervertebral disc degeneration (IDD) by evaluating gynecological disease findings, obtained by pelvic magnetic resonance imaging (MRI), and reveal the risk factors for IDD by analyzing its relationship with age, sacral structure, body mass index (BMI), number of deliveries, and intrapelvic space-occupying lesions. OVERVIEW OF LITERATURE: Age, obesity, height, smoking history, occupation, and lumbosacral structure are reportedly the main factors of lumbar IDD. However, in women, the relationship of IDD with obstetric and gynecological history is unclear. METHODS: The presence of L5-S1 IDD was evaluated on sagittal T2-weighted pelvic MRI during gynecological evaluations in 660 Japanese women. We measured the sacral table angle (STA), sacral kyphosis angle (SKA), and intrapelvic space-occupying lesion size. Age, height, weight, BMI, number of deliveries, lumbosacral structure, size of space-occupying lesions, and presence of uterine leiomyoma based on medical records were compared between the IDD-positive and IDD-negative groups. RESULTS: Lumbosacral IDD was observed in 405 cases (61.4%), and its prevalence increased with age. Differences in age, height, weight, BMI, and number of deliveries between the IDD-positive and -negative groups were significant, but differences in STA, SKA, and presence of uterine leiomyoma and space-occupying lesion size were not. Logistic regression analysis indicated that age, BMI, and STA were risk factors for lumbosacral IDD. CONCLUSIONS: Age is the biggest risk factor for lumbosacral IDD in Japanese women, with BMI and STA also contributing to its development. However, SKA and obstetric and gynecological history were not significantly involved.

Ovarian cancer mortality among women aged 40-79 years in relation to reproductive factors and body mass index: latest evidence from the Japan Collaborative Cohort study / 부인종양

OBJECTIVE: This study mainly aimed to investigate the association of ovarian cancer mortality with reproductive factors and body mass index among Japanese women aged 40-79 years. METHODS: The source of the data was the Japan Collaborative Cohort (JACC) study which covered the period of 1988 to 2009. A representative sample of 64,185 women was used. Cox model was used to estimate the relative risk (RR) and 95% confidence interval (CI). RESULTS: The total number of ovarian cancer deaths was 98, with a mortality rate of 9.30 per 100,000 person-years. Women with single marital status revealed significantly higher age-adjusted RR (RR, 4.11; 95% CI, 1.66 to 10.23; p=0.005) as compared to married women. The effect of single marital status was stronger among older women aged 50+ years (RR, 4.58; 95% CI, 1.65 to 12.72; p=0.003) than younger women. An elevated risk was found for both nulliparous and nullipregnant women. Similarly, an increased risk of ovarian cancer mortality was estimated among overweight among aged 50 years or less. CONCLUSION: Out of many factors only single marital status indicated a higher risk for ovarian cancer mortality. All other factors provided inconclusive results, which imply further epidemiological investigations.

¿Fracasaron la consejería preconcepcional y el control prenatal?: una mirada desde las estadísticas vitalesen Bogotá (Colombia), 2009-2010 / Did the preconception counseling and prenatal control fail?: a look from the vital statistics in Bogota (Colombia), 2009-2010

Introducción: la Política de Salud Sexual y Reproductiva ha sido objeto decuestionamiento por los medios de comunicación y diversas organizacionesgubernamentales en tres sentidos: la consejería preconcepcional, el controlprenatal y el número de partos por cesárea. Se propone un ejercicio teóricoanalítico utilizando el módulo de Nacidos Vivos y Defunciones del Registro Únicode Afiliación en Salud para comprobar estos hechos.Métodos: estudio de tipo cohorte única, con los registros de nacidos vivos en Bogotá entre 2009 y 2010 disponibles en el portal electrónico del registro, compilados en Microsoft Excel® 2007, filtrados con criterios de inclusión y analizados en EpiINFO 3.5.2Resultados: se totalizaron 123.068 registros de nacidos vivos, de los cuales el 82,5 porciento fueron incluidos para análisis. Nacimientos: 37 porciento fueron por cesárea en 2009, y 38,6 porciento en 2010. 21,3 porciento de los nacimientos en 2009 y 17,7 porciento en 2010 fueron de madres adolescentes. El OR para parto distótico en adolescentes fue de 1,69 (χ2 = 944,96; p=0,0); el OR para Apgar bajo al minuto en neonatos de adolescentesfue 1,31 (χ2=31,27, p=0,001).Conclusión: del registro se configura una realidad sugestiva de una falla específicade la actual política de salud sexual y reproductiva, y la necesidad de su evaluación y reformulación en el marco del futuro Plan Decenal de Salud.

Introduction: the policy for Sexual and Reproductive Health has been questioned by the communication media and by diverse government organizations in three ways: the preconception counseling, prenatal control and the number of births bycesarean section. An analytical theoretical exercise is proposed through the usage of the module of Born Alive and Deaths from the Exclusive Registry of Health affiliation in order to corroborate these facts. Methods: a quantitative study of the sole cohort type, with the registry of the born alive in Bogota between 2009 and 2010 available in the electronic portal ofrecords compiled in Microsoft Excel® 2007, filtered with inclusion criteria andanalyzed by EpiINFO 3.5.2 Results: a total of 123,068 records of born alive children of which 82.5% were included in the analysis. Births: 37% were through cesarean section in 2009 and38.6% in 2010. 21.3% of the births in 2009 and 17.7% in 2010 were from adolescent birth in adolescents was 1.69 (X2 = 944.96% p= 0, 0); the OR for low Apgar after one minute in neonate babies from adolescents was 1.31 (X2=31.27, p=0.001) Conclusion: from the records we can form an interesting reality of a specific faultand the need to evaluate it and reformulate it, in the framework of a future Decennial Health Plan.

Diferenças no investimento materno em função de variáveis socioambientais / Differences in maternal investment as a function of socio-environmental variables

A partir da Teoria do Investimento Parental prevê-se diminuição no investimento com a diminuição da relação benefício/custos. Investigou-se a variação no investimento materno em função de variáveis socioambientais que podem apresentar impacto na relação benefício/custo do investimento materno. Os fatores investigados apresentaram, de forma geral, efeito sobre o investimento materno no sentido esperado de acordo com a teoria: quanto maiores os custos representados pela ausência de coabitação com pai, pouca disponibilidade de renda e início precoce da vida reprodutiva, menor o investimento materno. Conclui-se que os fatores socioambientais podem promover ou inibir o investimento materno indicando a importância de políticas públicas no sentido da promoção da estabilidade destes fatores.

The Theory of Parental Investment predicts a decrement in parental investment as the benefit/cost ratio decreases. Differences in maternal investment were investigated in relation to socio-environmental variables that may have an impact on the benefit/cost ratio. The factors investigated showed, in general, effects on maternal investment in the expected direction according to the theory: as costs increased, represented by the absence of cohabitation with the father, diminished income and early reproductive age, lower levels of investment were observed. It is concluded that socio-environmental factors may promote or inhibit maternal investment, indicating the importance of public policies in promoting the stability of these variables.

Aborto no Brasil: uma pesquisa domiciliar com técnica de urna / Abortion in Brazil: a household survey using the ballot box technique

O artigo apresenta os primeiros resultados da Pesquisa Nacional de Aborto (PNA), um levantamento por amostragem aleatória de domicílios, realizado em 2010, cuja cobertura abrangeu as mulheres com idades entre 18 e 39 anos em todo o Brasil urbano. A PNA combinou duas técnicas de sondagem: a técnica de urna e questionários preenchidos por entrevistadoras. Seus resultados indicam que, ao final da vida reprodutiva, mais de uma em cada cinco mulheres já fez aborto, ocorrendo os abortos em geral nas idades que compõem o centro do período reprodutivo das mulheres, isto é, entre 18 e 29 anos. Não se observou diferenciação relevante na prática em função de crença religiosa, mas o aborto se mostrou mais comum entre mulheres de menor escolaridade. O uso de medicamentos para a indução do último aborto ocorreu em metade dos casos e a internação pós-aborto foi observada em cerca de metade dos abortos. Tais resultados levam a concluir que o aborto deve ser prioridade na agenda de saúde pública nacional.

This study presents the first results of the National Abortion Survey (PNA, Pesquisa Nacional de Aborto), a household random sample survey fielded in 2010 covering urban women in Brazil aged 18 to 39 years. The PNA combined two techniques, interviewer-administered questionnaires and self-administered ballot box questionnaires. The results of PNA show that at the end of their reproductive health one in five women has performed an abortion, with abortions being more frequent in the main reproductive ages, that is, from 18 to 29 years old. No relevant differentiation was observed in the practice of abortion among religious groups, but abortion was found to be more common among people with lower education. The use of medical drugs to induce abortion occurred in half of the abortions, and post-abortion hospitalization was observed among approximately half of the women who aborted. Such results lead to conclude that abortion is a priority in the Brazilian public health agenda.

Influência da paridade sobre o índice de massa corpórea de mulheres brasileiras / Influence of parity on body mass index of Brazilian women

No Brasil a obesidade é um importante problema de saúde pública com prevalência mais elevada em mulheres do que em homens. A gestação e o período pós­ parto são momentos críticos devido à ocorrência de ganho ponderal excessivo na gravidez e retenção de peso pós-parto. Objetivos - Estudar a influência da paridade sobre o IMC em mulheres brasileiras com idade entre 20 e 49 anos .Investigar o possível efeito de modificação do poder aquisitivo,escolaridade e utilização do SUS sobre a associação entre paridade e IMC. Métodos - Foram analisados dados da Pesquisa Nacional de Demografia e Saúde 2006, inquérito que utilizou amostragem complexa representativa de todo o território brasileiro. A associação entre o fator de estudo (paridade: O, I ,2, 3 e + ) e o desfecho (IMC) foi testada mediante análise de regressão linear. O efeito ajustado do fator de estudo sobre o IMC foi avaliado em modelo múltiplo contendo como variáveis de controle: idade, classes de poder aquisitivo ABEP (A+Bl, B2+C+D e E), e escolaridade (menos de 8 e mais de 8 anos de estudo completo). Para testar as interações de interesse foram realizados modelos múltiplos, em separado,incluindo três variáveis que combinam paridade dicotômica (nulíparas e demais) com poder aquisitivo,escolaridade e utilização do SUS.Foram considerados significativos valores de p inferiores a 0,05. Resultados - Das 13.087 mulheres investigadas foram excluídas do estudo 14,4 por cento (gestantes, mulheres com filhos menores de 6 meses e aquelas com dados incompletos para peso e altura). A análise foi conduzida em uma amostra de I 1.96 I mulheres, levando-se em consideração a estrutura complexa da amostra. A média de IMC para o conjunto das mulheres brasileiras foi de 25,6 Kg-m2 (IC95 por cento: 25,4 - 25,8). O IMC médio foi maior entre as pertencentes à classe de poder aquisitivo intermediária (B2,C,D) e baixa (E). Observou-se elevação do IMC com o aumento do número de filhos e idade. Na análise ajustada, confirmou-se...

In Brazil, obesity is a public health problem and its prevalence is higher among women. Pregnancy and the postpartum period are critical moments for the occurrence of excessive weight gain and weight retention. Objectives - To study the influence of parity on BMI in Brazilian women aged between 20 and 49 years. To investigate the possible modifying effect of the purchasing power, schooling and the use of public health system in the relation between parity and BMI. Methods - We used data from the National Demographic and Health Survey 2006, a survey with a complex sample, nationally representative of the Brazilian territory. The association between the study factor (parity: 0,1,2, and 3 +) and the outcome (BMI) was tested by linear regression analysis. The effect of parity on BMI was evaluated by a multivariate model adjusted by control variables: age, score ABEP (A + B1, B2 + C + D and E) and education (<8 and 8 years of study). To test the interactions, multivariate models were performed in separate with three different variables combining parity (nulliparous and others) with purchasing power, education and use of the public health system. The level of significance adopted was p < 0,05. Results - From the 13.087 women screened, 14,4% were excluded (pregnant women, women with children under 6 months and those with incomplete data for height and weight). The analysis was conducted on a sample of 11.961 women, adjusted by the complex structure. The mean BMI of the Brazilian women was 25,6 kg/m2 (95% CI: 25,4 to 25,8). It was higher among women in the middle class purchasing power (B2, C, D) and in the lower class (E). The BMI was elevated with the increase...