Intergenerational teen pregnancy: a population-based cohort study.

OBJECTIVE: To estimate the intergenerational association in teenage pregnancy, and whether there is a coupling tendency between a mother and daughter in how their teen pregnancies end, such as a termination of pregnancy (TOP) versus a live birth. DESIGN: Population-based cohort study. SETTING: Ontario, Canada. POPULATION: A total of 15 097 mothers and their 16 177 daughters. METHODS: Generalised estimating equations generated adjusted odds ratios (aOR) of a daughter experiencing a teen pregnancy in relation to the number of teen pregnancies her mother had. Multinomial logistic regression estimated the odds that a teen pregnancy ended with TOP among both mother and daughter. All models were adjusted for maternal age and world region of origin, the daughter's socio-demographic characteristics and comorbidities, mother-daughter cohabitation, and neighbourhood-level teen pregnancy rate. MAIN OUTCOME MEASURES: Teen pregnancy in the daughter, between ages 15 and 19 years, and also the nature of the daughter's teen pregnancy, categorised as (1) no teen pregnancy, (2) at least one teen pregnancy, all exclusively ending with a live birth, and (3) at least one teen pregnancy, with at least one teen pregnancy ending with a TOP. RESULTS: The proportion of daughters having a teen pregnancy among those whose mother had zero, one, two, or at least three teen pregnancies was 16.3, 24.9, 33.5 and 36.3%, respectively. The aOR of a daughter having a teen pregnancy was 1.42 (95% CI 1.25-1.61) if her mother had one, 1.97 (95% CI 1.71-2.26) if she had two, and 2.17 (95% CI 1.84-2.56) if her mother had three or more teen pregnancies, relative to none. If a mother had at least one teen pregnancy ending with TOP, then her daughter had an aOR of 2.12 (95% CI 1.76-2.56) for having a teen pregnancy also ending with TOP; whereas, if a mother had at least one teen pregnancy, all ending with a live birth, then her daughter had an aOR of 1.73 (95% CI 1.46-2.05) for that same outcome. CONCLUSION: There is a strong intergenerational occurrence of teenage pregnancy between a mother and daughter, including a coupling tendency in how the pregnancy ends. TWEETABLE ABSTRACT: Strong intergenerational association for teenage pregnancy between mother and daughter.

Preterm preeclampsia in relation to country of birth.

OBJECTIVE: To examine the association between maternal country of birth and the risk of preeclampsia+preterm birth (PTB). STUDY DESIGN: We completed a population-based study in the entire province of Ontario, where there is universal access to obstetrical care. We included 881 700 singleton livebirths among Canadian-born mothers and 305 547 births among immigrant mothers. Adjusted risk ratios (aRRs) were adjusted for maternal age, parity and income quintile. RESULTS: Compared with a rate of preeclampsia+PTB of 4.0 per 1000 among Canadian-born mothers, the aRR of preeclampsia+PTB at 24 to 36 weeks was significantly higher for immigrant women from Nigeria (1.79, 95% confidence interval (CI) 1.12 to 2.84), the Philippines (1.54, 95% CI 1.30 to 1.86), Colombia (1.68, 95% CI 1.04 to 2.73), Jamaica (2.06, 95% CI 1.66 to 2.57) and Ghana (2.12, 95% CI 1.40 to 3.21). The aRRs generally followed a similar pattern for secondary outcomes. Specifically, women from Ghana were at highest risk of preeclampsia+very PTB (4.55, 95% CI 2.57 to 8.06), and women from Jamaica at the highest risk of preeclampsia+indicated PTB (1.89, 95% CI 1.43 to 2.50). CONCLUSION: The risk of preeclampsia+PTB is highest among women from a select number of countries. This information can enhance initiatives aimed at reducing the risk of PTB related to preeclampsia.

Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries.

OBJECTIVE: To assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries. DESIGN: Cross-country comparative study of linked population-based databases. SETTING: Provincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden. POPULATION: All immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995-2010). METHODS: Data was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI). MAIN OUTCOME MEASURES: Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries). RESULTS: There were 9,028,802 deliveries (3,031,399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest. CONCLUSION: Immigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.

Risk of stillbirth at extremes of birth weight between 20 to 41 weeks gestation.

OBJECTIVE: To determine the risk of stillbirth between 20 to 41 weeks gestation, at highly detailed weight percentiles, including extreme degrees of small (SGA) and large (LGA) for gestational age birth weight. STUDY DESIGN: We completed a population-based study of all births in Ontario, Canada between 2002 and 2007. We included 767, 016 liveborn and 4,697 stillborn singletons delivered between 20 and 41 weeks gestation. Smoothed birthweight percentile curves were generated for males and females, combining livebirths and stillbirths. Quantile regression was used to calculate sex-specific absolute birthweight differences and 95% confidence intervals (CI) between stillborns vs liveborns at various gestational ages. Logistic regression was used to calculate the odds ratios (OR) for stillbirth at various sex-specific birthweight percentiles, including <1st and ≥ 99th percentile. OR were adjusted for maternal age and parity. RESULT: At the 10th percentile, stillborns weighed significantly less than liveborns starting at 24 weeks gestation. By 32 weeks, this difference was 590 g (95% CI 430 to 750) for males and 551 g (95% CI 345 to 448) for females. A reverse J-shaped association was observed between birthweight percentile and risk of stillbirth across all gestational ages. Relative to the 40th to 60th percentile referent, the adjusted OR for stillbirth was 9.63 (95% CI 8.39 to 11.06) at a birth weight <1st percentile. At ≥ 99th percentile, the adjusted OR was 2.24 (95% CI 1.76 to 2.86). The risk of stillbirth at extreme birthweight percentiles was robustly observed across gestational ages. CONCLUSION: Substantial birthweight differences exist between stillborns and newborns. As a possible hallmark of impending intrauterine death, severe SGA and LGA may each be potential targets for future stillbirth prevention initiatives.

Declining sexually transmitted infections among female sex workers: the results of an HIV and sexually transmitted infection prevention strategy in Honduras, 2006-08.

In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.

Estimating gestational age at birth: a population-based derivation-validation study.

INTRODUCTION: Information on newborn gestational age (GA) is essential in research on perinatal and infant health, but it is not always available from administrative databases. We developed and validated a GA prediction model for singleton births for use in epidemiological studies. METHODS: Derivation of estimated GA was calculated based on 130 328 newborn infants born in Ontario hospitals between 2007 and 2009, using linear regression analysis, with several infant and maternal characteristics as the predictor (independent) variables. The model was validated in a separate sample of 130 329 newborns. RESULTS: The discriminative ability of the linear model based on infant birth weight and sex was reasonably approximate for infants born before the 37th week of gestation (r2 = 0.67; 95% CI: 0.65-0.68), but not for term births (37-42 weeks; r2 = 0.12; 95% CI: 0.12-0.13). Adding other infant and maternal characteristics did not improve the model discrimination. CONCLUSION: Newborn gestational age before 37 weeks can be reasonably approximated using locally available data on birth weight and sex.

Immigrants' duration of residence and adverse birth outcomes: a population-based study.

OBJECTIVE: This study aimed to examine preterm and small-for-gestational-age (SGA) births among immigrants, by duration of residence, and to compare them with the Canadian-born population. DESIGN: Population-based cross-sectional study with retrospective assessment of immigration. SETTING: Metropolitan areas of Ontario, Canada. POPULATION: A total of 83 233 singleton newborns born to immigrant mothers and 314 237 newborns born to non-immigrant mothers. METHODS: We linked a database of immigrants acquiring permanent residence in Ontario, Canada, in the period 1985-2000 with mother-infant hospital records (2002-2007). Duration of residence was measured as completed years from arrival to Canada to delivery/birth. Logistic regression models were used to estimate the effects of duration of residence with adjusted odds ratios and 95% confidence intervals. In analyses restricted to immigrants only, hierarchical models were used to account for the clustering of births into maternal countries of birth. MAIN OUTCOME MEASURES: Preterm birth (PTB) and SGA birth. RESULTS: Recent immigrants (<5 years) had a lower risk of PTB (4.7%) than non-immigrants (6.2%), but those with > or =15 years of stay were at higher risk (7.4%). Among immigrants, a 5-year increase in Canadian residence was associated with an increase in PTB (AOR 1.14, 95% CI 1.10-1.19), but not in SGA birth (AOR 0.99, 95% CI 0.96-1.02). CONCLUSIONS: Time since migration was associated with increases in the risk of PTB, but was not associated with an increase in SGA births. Ignoring duration of residence may mask important disparities in preterm delivery between immigrants and non-immigrants, and between immigrant subgroups categorised by their duration of residence.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries.

OBJECTIVE: This study aimed to investigate pregnancy outcomes in Somali-born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden. DESIGN: Meta-analyses of routinely collected data on confinements and births. SETTING: National or regional perinatal datasets spanning 3-6 years between 1997 and 2004 from six countries. SAMPLE: A total of 10 431 Somali-born women and 2 168 891 receiving country-born women. METHODS: Meta-analyses to compare outcomes for Somali-born and receiving country-born women across the six countries. MAIN OUTCOME MEASURES: Events of labour (induction, epidural use and proportion of women using no analgesia), mode of birth (spontaneous vaginal birth, operative vaginal birth and caesarean section) and infant outcomes (preterm birth, birthweight, Apgar at 5 minutes, stillbirths and neonatal deaths). RESULTS: Compared with receiving country-born women, Somali-born women were less likely to give birth preterm (pooled OR 0.72, 95% CI 0.64-0.81) or to have infants of low birthweight (pooled OR 0.89, 95% CI 0.82-0.98), but there was an excess of caesarean sections, particularly in first births (pooled OR 1.41, 95% CI 1.25-1.59) and an excess of stillbirths (pooled OR 1.86, 95% CI 1.38-2.51). CONCLUSIONS: This analysis has identified a number of disparities in outcomes between Somali-born women and their receiving country counterparts. The disparities are not readily explained and they raise concerns about the provision of maternity care for Somali women postmigration. Review of maternity care practices followed by implementation and careful evaluation of strategies to improve both care and outcomes for Somali women is needed.

Liberación de fluoruros de materiales utilizados como selladores (Un estudio in vitro) / Fluoride release from materials used as sealers (an in vitro study)

Este estudio de laboratorio evaluó el grado de liberación de fluoruro de diferentes materiales alternativos, utilizados como selladores de fisuras, en distintos periodos de tiempo. Dos selladores con base en resina, una resina compuesta fluida, dos compómeros y dos ionómeros vítreos convencionales fueron incluidos en este estudio. Se confeccionaron probetas en forma de disco que fueron sumergidas en 50 ml de agua destilada, a la cual se le agregaron 50 ml de solución buffer. Se usó un detector de ión flúor para leer la concentración de fluoruro en diferentes períodos de tiempo después de la inmersión. Los factores material y tiempo tuvieron influencia significativa sobre los resultados (p<0,0001). Las resinas compuestas mostraron la menor liberación de fluoruro con relación a los otros materiales experimentales. Se concluyó que el grado de liberación de fluoruro es variable en función del tiempo y las características particulares de cada material.

[Distinguishing pleural transudates and exudates through the quantification of biochemical parameters]. / Separación de trasudados y exudados pleurales mediante la cuantificación de parámetros bioquímicos.

OBJECTIVES: 1) to evaluate the possibility of distinguishing pleural transudates and exudates through the joint determination of 26 biochemical parameters in pleural effusion and in plasma (including the determination of high molecular weight proteins, acute phase reactants, and proinflammatory citokines), and 2) to formulate a logistic regression equation for optimizing the classification efficiency, comparing the equation obtained with Light's criteria. PATIENTS AND METHODS: All diagnostic thoracocentesis carried out in La Rioja Autonomous Community during a 22-month period were evaluated. The 245 clinical records were evaluated periodically along a minimum of 2 years, after the discharge of the patients. In pleural effusion and in plasma the following were quantified: total proteins, LDH, glucose, amylase, cholesterol, albumin, cholinesterase, phosphatase alkaline, urea, beta2-microglobulin, IgG, IgM, alpha2-macroglobulin, C reactive protein, transferrin, alpha1-antitrypsin, serum amyloid A protein, interleukin 1-beta, interleukin 6, tumoral necrosis factor-alpha, and lysozyme. In addition, the cellularity, polymorphonuclear elastase and adenosine deaminase were evaluated in pleural fluid. RESULTS: The LDH pleural effusion/plasma ratio was the individual parameter that showed higher area under the receiver operating characteristic curve for the separation of pleural transudates and exudates. Interleukin 6 and tumoral necrosis factor-alpha showed pleural effusion/plasma ratios higher than the unit, which suggests an in situ citokines production. An predictive logistic regression equation was obtained that incorporates only LDH and cholesterol ratios, including the diuretic treatment of the patient at the time of thoracocentesis, which did not modify the protein concentrations in pleural effusion. Except for LDH ratio, the logistic regression equation showed an area under the receiver operating characteristic curve higher than that of all the evaluated individual parameters, with a sensitivity of 95% and a specificity of 85% (70% for the Light's criteria). CONCLUSIONS: LDH ratio is the best individual parameter for distinguishing pleural transudates and exudates. The additional evaluation of cholesterol ratio and of the diuretic state of the patient make possible to improve the clinical efficiency of this classification. The quantification of high molecular weight proteins, acute phase reactants and citokines does not contribute additional significant information.

Produccion de Beta-endorfinas por poblaciones leucocitarias estimuladas con diferentes mitógenos / Production of beta-endorphins by hamatic leucocyte population stimulated by different mitogens

Se acepta generalmente que los péptidos opioides endógenos juegan un papel fundamental en la modulación de la respuesta inmune en procesos dolorosos. Durante tres años, nuestro Departamento ha investigado una técnica capaz de realizar estudios semi-cuantitativos de las Beta-endorfinas presentes en fa superficie de células leucocitarias hemáticas. Los trabajos previos, indican que la cantidad de Beta-endorfina presente en la superficie de estas células leucocitarias no depende exclusivamente de fa cantidad de Beta-endorfina existente en el plasma de los pacientes. Existiría una tracción de la misma que sería sintetizada por las propias células inmunocompetentes. El objetivo es conocer la capacidad de producción de Beta-endorfinas por células leucocitarias hemáticas cultivadas in vitro y estimuladas con diferentes mitógenos ( Fitohematoglutinina y Concanavalina A). La población de estudio estuvo formada por 16 sujetos sanos. A todos, se les extrajo una muestra de sangre, en la que se separaron fas células de fa serie blanca mediante una técnica de gradiente de densidad. Con las células leucocitarias obtenidas de cada sujeto se hicieron tres alicuotas ajustándose fa suspensión a 2.5 millones de células/250 microlitros en medio de PBS. Una de las muestras quedó como muestra control, la segunda se estimuló con PHA y la tercera muestra con Con A. Todas las muestras se incubaron durante 24 horas y se determinó la cantidad de Beta-endorfina existente en el sobrenadante celular mediante la técnica comercial de Nichols Institute. Se observaron concentraciones de Beta-endorfinas significativamente superiores en las muestras estimuladas con PHA en relación a las muestras controles y a las muestras estimuladas con ConA (AU)

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Terminación superficial y pulido de resinas compuestas microhibridas y compómeros / Superficial finishing and polishing of microhibrid composite resins and compomers

La reciente introducción de Resinas Compuestas Microhíbridas y Compómeros y la diversidad de métodos e instrumental preconizados para la terminación superficial motivaron este trabajo. El propósito fue evaluar la rugosidad de superficie de estos materiales, en función de la técnica de pulido. Se utilizaron 35 muestras de resina epoxi con cavidades cilindricas de 10 mm de diámetro por 3 mm de profundidad que fueron obturadas, por técnica incremental en 2 capas con los siguientes materiales: Arabesk (A); Degufill (D); Dyract (DD); Herculite (XRV (H); Pertac hybrid (P);Tetric (T) y Z1OO (Z). Sobre cada grupo se realizaron 5 procedimientos de terminado y pulido con diferentes instrumentos, subgrupo l, fresas de carburo de tungsteno de 40 filos, con refrigeración acuosa; subgrupo 2, piedras de diamante de grano extrafino, con refrigeración acuosa; subgrupo 3, discos de óxido de aluminio de granulometría decreciente, en seco; subgrupo 4, igual que el subgrupo 3 seguido de puntas de goma siliconadas con alúmina, en seco; subgrupo 5, igual que el subgrupo 3 seguido de pasta de pulir, en húmedo. Posteriormente mediante un Profilometer se realizaron mediciones de la rugosidad, ondulación y perfil de la superficie. Del análisis de los datos se deduce que ambos factores (técnicas de pulido y materiales) son significativos. Mediante la prueba detuckey pudo determinarse que con los procedimientos de pulido correspondientes a los subgrupos 3 y 5 se obtuvo la menor rugosidad, mientras que los subgrupos 1 y 2 revelaron la mayor rugosidad, no encontrándose diferencias significativas entre el subgrupo 2 y 4. Los valores medios más bajos de Ra, se obtuvieron en el grupo Z. En general, el sistema de discos Soflex produjo las superficies más lisas en todos los materiales

[Endogenous opioid peptides and the immune system]. / Péptidos opioides endógenos y sistema inmunitario.

Several studies have demonstrated that endogenous opioid peptides produced by the neuroendocrine system can modulate several immunological functions. Immune system cells have also been shown to have the ability to synthesize and release such peptides. This would mean that the neuroendocrine and immunological systems share molecules and opioid receptors and it may be that peptides produced by the neuroendocrine system modify immunocompetence and that these same substances released by macrophages that infiltrate inflamed tissue also act on the pain response in the zone of lesions. We aimed to investigate the immunoregulatory function of endogenous opioid peptides and their effects on the complement system's natural "killer" cell activity, chemotaxis, phagocytosis and oat cell activity.

Denture stomatitis: quantification of interleukin-2 production by mononuclear blood cells cultured with Candida albicans.

Denture stomatitis is usually associated with the presence of yeast, particularly Candida albicans, and several bacteria. In this study mononuclear blood cells were grown in the presence of Candida albicans from a single colony, and interleukin-2 production induced in T lymphocytes was measured. Blood cells were from a population of patients with denture stomatitis and a control group of denture wearers without stomatitis. Induction of interleukin-2 production was correlated with factors that condition denture stomatitis, namely, isolation of Candida albicans in selective medium, age of the denture, and diabetes. Concentrations of interleukin-2 in supernatant and serum were also compared. Significant differences in interleukin-2 production were found between patients with denture stomatitis and controls. Statistical analysis demonstrated a significant association between isolation of Candida albicans and elevated interleukin-2 production in cultures from patients with and without denture stomatitis.

Induction of interleukin-1 alpha production by Porphyromonas gingivalis in mononuclear blood cell cultures from periodontitis patients.

The capacity of mononuclear blood cells to produce interleukin-1 alpha (IL-1 alpha) after stimulation with Porphyromonas gingivalis in cell culture was studied. The results obtained with cells from periodontitis patients were compared with those from a control population. The concentration of IL-1 alpha in serum and saliva was also determined and compared with the concentration in mononuclear blood cell cultures. No significant relationship was found between the incidence of periodontitis or severity of the lesions and IL-1 alpha production in the presence of P. gingivalis. Nevertheless, 11 of 30 periodontitis patients, showed levels > 30 pg/ml of IL-1 alpha in mononuclear blood cell cultures stimulated by P. gingivalis, whereas only three healthy control showed these titers of IL-1 alpha.

Some histopathological and clinical correlations in oral squamous cell carcinoma.

Oral squamous cell carcinoma (SCC) is an important health problem that causes high mortality and morbidity. Correlations between some clinical and histopathological parameters were studied in 37 oral SCC. Some interesting aspects in oral SCC arising from precancerous lesions were found such as smaller size and a lower TNM stage at the moment of diagnosis. Histological and clinical differences were also found between tumors invading deep tissues by little groups of dissociated malignant cells and those invading by big masses of malignant cells. The possible significance of the intensity of peritumoral eosinophilic infiltrate was also studied.