Leisure time physical activity and the risk of pre-eclampsia: a systematic review.

Today, pre-eclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality. It has been proposed that leisure time physical activity (LTPA) is associated with a decreased risk of PE. The objective of this study was to perform a systematic literature review examining the association between LTPA before and/or during pregnancy and the risk of PE. A systematic search of the EMBASE and PUBMED databases from inception to November 17, 2011 was conducted by two independent reviewers. Only studies describing the association between the intensity or amount of LTPA before and/or during pregnancy and the risk of PE were included. A narrative synthesis of the results was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A quality assessment was performed using the Newcastle Ottawa Scale. Eleven studies were included. None of the studies found light- or moderate-intensity LTPA to be associated with PE. Three studies reported that vigorous-intensity LTPA before and/or during pregnancy may reduce the risk of PE. One study reported a reduced risk among women who participated in LTPA at least 25 times per month or more than 4 h per week. However, one study found an elevated risk of severe PE with high amounts of LTPA, defined as 4.5 h per week or more. Results are mixed, but high intensity LTPA before and/or during pregnancy or more than 4 h per week of LTPA may reduce the risk of PE. However, an urgent need remains for high-quality studies including different ethnicities to further explore this relationship.

Distribution and predictors of exercise habits among pregnant women in the Danish National Birth Cohort.

Physical activity is recommended during pregnancy, although strong evidence on reproductive health is lacking. We present exercise habits and predictors of exercise during pregnancy. From the Danish National Birth Cohort (1996-2002), 88,200 singleton pregnancies were analyzed in logistic regression. About one-third of the women exercised in early/mid pregnancy and slightly less in late pregnancy. Bicycling, swimming, and low-impact activities were most common. Exercising more than three times per week was strongly correlated with older age, being a student or out of work, eating disorders, moderate alcohol consumption, and a healthy diet. Multiparity, a normal or less good self-rated health, smoking, and a less health conscious diet were the strongest predictors of not doing exercise. Women of 25 years or older, with metabolic or psychiatric disorders, or who had received subfecundity treatment were more likely to increase their activity level substantially from early to late pregnancy than comparison groups. In conclusion, exercising during pregnancy correlated with a number of maternal characteristics. The findings may be used to identify pregnant women not likely to exercise, to target activities that may fit their needs, and, for research purposes, to identify adjustment variables or guide sensitivity analyses when data on confounders are lacking.

Mechanical strength of ceramic scaffolds reinforced with biopolymers is comparable to that of human bone.

Eight groups of calcium-phosphate scaffolds for bone implantation were prepared of which seven were reinforced with biopolymers, poly lactic acid (PLA) or hyaluronic acid in different concentrations in order to increase the mechanical strength, without significantly impairing the microarchitecture. Controls were un-reinforced calcium-phosphate scaffolds. Microarchitectural properties were quantified using micro-CT scanning. Mechanical properties were evaluated by destructive compression testing. Results showed that adding 10 or 15% PLA to the scaffold significantly increased the mechanical strength. The increase in mechanical strength was seen as a result of increased scaffold thickness and changes to plate-like structure. However, the porosity was significantly lowered as a consequence of adding 15% PLA, whereas adding 10% PLA had no significant effect on porosity. Hyaluronic acid had no significant effect on mechanical strength. The novel composite scaffold is comparable to that of human bone which may be suitable for transplantation in specific weight-bearing situations, such as long bone repair.

Smoking and pregnancy-related pelvic pain.

OBJECTIVE: To investigate possible associations between smoking and pregnancy-related pelvic pain. DESIGN: Nested case-control study. SETTING: Denmark 2000-2001. POPULATION: The Danish National Birth Cohort. METHODS: The women were interviewed twice in pregnancy and twice after childbirth. The first pregnancy interview provided information on smoking and possible confounding factors,whereas the first interview after birth addressed case identification.Cases (n = 2302) were defined on the basis of self-reported pelvic pain, and controls were selected among women who did not report pelvic pain (n = 2692). Logistic regression analysis was used to estimate associations between smoking and pelvic pain. MAIN OUTCOME MEASURE: Pregnancy-related pelvic pain. RESULTS: Compared with non-smokers, women who smoked during pregnancy had an adjusted odds ratio of 1.2 (1.0-1.4) for overall pelvic pain, similar to women who stopped smoking in early pregnancy 1.3 (1.1-1.7). The equivalent adjusted odds ratio for severe pelvic pain was 1.2 (1.0-1.5) for smokers, and 1.5 (1.2-1.9)for women who stopped smoking. Smoking intensity, measured as number of cigarettes smoked per day, was associated with pelvic pain in a dose-response pattern. Information about smoking was collected prospectively, which makes it unlikely that differential recall alone explains the results. CONCLUSIONS: Smoking was associated with pregnancy-related pelvic pain, with a dose-response pattern between reported smoking intensity and pelvic pain. These findings suggest a possible new risk factor for a common ailment during pregnancy

Does leisure time physical activity in early pregnancy protect against pre-eclampsia? Prospective cohort in Danish women.

OBJECTIVE: To examine the association between physical activity in early pregnancy and risk of pre-eclampsia. DESIGN: Prospective cohort. SETTING: Denmark. POPULATION: A total of 85,139 pregnant Danish women, recruited between 1996 and 2002. METHODS: The authors assessed leisure time physical activity in first trimester by a telephone interview and categorised women a priori into seven groups: 0 (reference), 1-44, 45-74, 75-149, 150-269, 270-419 and 420+ minutes/week. Pre-eclampsia diagnoses were extracted from the Danish National Patient Registry. A number of potential confounders were adjusted for by logistic regression. MAIN OUTCOME MEASURES: Pre-eclampsia and severe pre-eclampsia. RESULTS: The two highest physical activity levels were associated with increased risk of severe pre-eclampsia compared with the nonexercising group, with adjusted odds ratios of 1.65 (95% CI: 1.11-2.43) and 1.78 (95% CI: 1.07-2.95), whereas more moderate levels of physical activity (1-270 minutes/week) had no statistically significant association with risk of pre-eclampsia (total n = 85,139). CONCLUSIONS: We were unable to document a protective effect of leisure time physical activity against pre-eclampsia. Our data even suggest that leisure time physical activity exceeding 270 minutes/week in first trimester may increase risk of severe pre-eclampsia.

Leisure time physical exercise during pregnancy and the risk of miscarriage: a study within the Danish National Birth Cohort.

OBJECTIVE: To examine the association between leisure time physical exercise during pregnancy and the risk of miscarriage. DESIGN: Prospective study with elements of retrospective data collection. SETTING: Denmark 1996-2002. POPULATION: A total of 92,671 pregnant women enrolled in the Danish National Birth Cohort and interviewed subsequently. METHODS: Data on exercise during pregnancy and potential confounders were obtained through computer-assisted telephone interviews either during pregnancy or after an early miscarriage. Outcome of pregnancy was identified by register linkage. Using Cox regression analysis, we estimated the hazard ratio (HR) of miscarriage according to weekly amount of exercise and the type of exercise. The HR was estimated for <11, 11-14, 15-18, and 19-22 weeks of gestation, respectively. MAIN OUTCOME MEASURES: Miscarriage, defined as fetal loss before 22 completed weeks of gestation. RESULTS: A stepwise increasing relation was found between amount of exercise and risk of miscarriage, where risk of miscarriage increased by amount of exercise up to HR = 3.7 (95% CI 2.9-4.7) for women who exercised more than 7 hours per week compared with nonexercisers. Particularly 'high-impact exercise' was associated with an increased risk of miscarriage. No association was seen between exercise and risk of miscarriage after 18 weeks of gestation. CONCLUSIONS: This study suggests that exercise early in pregnancy is associated with an increased risk of miscarriage. The results should, however, be interpreted cautiously as potential bias arising from retrospective data collection may explain part of the association.

Moderate alcohol consumption and waiting time to pregnancy.

BACKGROUND: Recent research indicates that even a moderate consumption of alcohol in women trying to become pregnant is associated with longer waiting time to pregnancy. The findings, though, are based upon few observations. METHODS: Self-reported data on alcohol intake and waiting time to pregnancy (0-2, 3-5, 6-12 and >12 months) was used for 39 612 pregnant women, recruited to the Danish National Birth Cohort within the first 24 weeks of pregnancy from 1997 to 2000. Main outcome measures were odds ratios (OR) for a prolonged waiting time to pregnancy according to alcohol intake. RESULTS: In nulliparous women neither moderate nor high alcohol intake was related with longer waiting time to pregnancy compared with a low intake. In parous women, a modest association was seen only among those with an intake of >14 drinks per week (subfecundity OR 1.3; 95% confidence interval 1.0-1.7). Women who reported no alcohol intake had a slightly longer waiting time (subfecundity OR 1.2; 95% confidence interval 1.1-1.3) than women with a moderate intake of alcohol. CONCLUSIONS: Our findings do not corroborate recent results suggesting a marked reduction in fecundity associated with a moderate intake of alcohol.

The Danish National Birth Cohort--its background, structure and aim.

BACKGROUND: It is well known that the time from conception to early childhood has importance for health conditions that reach into later stages of life. Recent research supports this view, and diseases such as cardiovascular morbidity, cancer, mental illnesses, asthma, and allergy may all have component causes that act early in life. Exposures in this period, which influence fetal growth, cell divisions, and organ functioning, may have long-lasting impact on health and disease susceptibility. METHODS: To investigate these issues the Danish National Birth Cohort (Better health for mother and child) was established. A large cohort of pregnant women with long-term follow-up of the offspring was the obvious choice because many of the exposures of interest cannot be reconstructed with sufficient validity back in time. The study needs to be large, and it is aimed to recruit 100,000 women early in pregnancy, and to continue follow-up for decades. The Nordic countries are better suited for this kind of research than most other countries because of their population-based registers on diseases, demography and social conditions, linkable at the individual level by means of the unique ID-number given to all citizens. Exposure information is mainly collected by computer-assisted telephone interviews with the women twice during pregnancy and when their children are six and 18 months old. Participants are also asked to fill in a self-administered food frequency questionnaire in mid-pregnancy. Furthermore, a biological bank has been set up with blood taken from the mother twice during pregnancy and blood from the umbilical cord taken shortly after birth. Data collection started in 1996 and the project covered all regions in Denmark in 1999. By August 2000. a total of 60,000 pregnant women had been recruited to the study. It is expected that a large number of gene-environmental hypotheses need to be based on case-control analyses within a cohort like this.

Odontological identification of fire victims--potentialities and limitations.

A retrospective study was performed to analyse the power of odontological evidence in burn victims. The material comprised 292 single fire cases registered at 4 centers of forensic odontology in Scandinavia (DK: Aarhus, Copenhagen; N: Oslo; S: Goteborg) covering a 10-year period. Filed antemortem (am) and postmortem (pm) data were critically reviewed and registered. New systems for classification of the degree of injuries to the teeth and jaws and of the quality of dental records were developed. Matching dental am-pm units/features were recorded using the tooth as unit. Units were scored as either ordinary or extraordinary if the frequency of occurrence in a Danish reference population was > or = 10% or < 10%, respectively. The ID conclusion of a single case was classified into one of the categories: no conclusion, ID possible, ID probable or ID established, depending on the number of ordinary/extraordinary matching units. All age groups were represented. Most fatal burns occurred in house fires (62%) and there was a preponderance of males (71%). Detailed written records supplied by single or by systematic radiographs were available in 71% of cases. About 50% of burn victims were classified into the no-injury group and approximately 25% of cases showed injuries to the anterior teeth only. The number and complexity of dental restorations increased with age. The dental examination was a powerful tool in identification of burn victims. Thus, dental identity (ID) was established in 61% of burn victims and dental evidence assisted the identification in another 31% (ID possible 19%; ID probable 12%).(ABSTRACT TRUNCATED AT 250 WORDS)

Ligature-induced marginal inflammation around osseointegrated implants and ankylosed teeth: stereologic and histologic observations in cynomolgus monkeys (Macaca fascicularis).

The aim of the investigation was to provide quantitative and qualitative histologic data on marginal inflammation around osseointegrated implants. The significance of the lack of a periodontal ligament in the initial breakdown phase of supporting tissues in implants was examined by comparing stereologic and histologic manifestations of ligature-induced marginal inflammation around osseointegrated implants with those around ankylosed and normal control teeth in 8 cynomolgus monkeys (Macaca fascicularis). Clinical and radiographic findings have been reported elsewhere. The marginal connective tissue around ligated implants was infiltrated by a significantly increased total number of lymphocytes, plasma cells, and neutrophils compared to non-ligated implants and teeth. The total number of lymphocytes around ligated implants was significantly higher than around ligated ankylosed and normal control teeth. There were, however, no significant differences in the total number of plasma cells and neutrophils within the ligated group. Osteoclasts were exclusively observed around ligated implants and ankylosed teeth. Although variations in microbiota and susceptibility of different jaw positions to periodontal break-down may influence the results of the present study, the results seem to substantiate the theory that marginal inflammation around implants and ankylosed teeth may have more serious implications than does marginal inflammation around teeth with a periodontal ligament. Since presence of osteoclasts was not related to the absence of cervical cementum with inserting gingival fibers around ligated ankylosed teeth, the increased susceptibility of bone loss of implants is probably not caused by the absence of these tissue components. In contrast, the histologic observations seem to support that the increased susceptibility for bone loss around implants may be related to the absence of a periodontal ligament.

Epithelial alpha-naphthyl acetate esterases in the green vervet monkey gingiva before and after periodontal surgery and during tooth eruption.

To provide enzymatic information on de novo formed junctional (JE) and sulcular epithelium (SE), we performed periodontal surgery on 24 teeth. Ten to 14 days postoperatively, all experimental and 16 control teeth were extracted with adjacent buccal gingiva. In addition, specimens from unerupted and partly erupted teeth containing enamel epithelium (EE) were examined. Fixed cryostat sections were cut in series, stained with HE, or incubated with and without substrate for demonstration of alpha-naphthyl acetate esterase activity and for control purposes, respectively. The distribution and intensity of the alpha-naphthyl acetate esterase activity of newly reformed JE and SE was identical to that of the original JE and SE, i.e. suprabasal and very strong. In contrast, both the oral gingival epithelium (OGE) and the EE displayed a very weak enzyme reaction. These observations indicate that the presence of alpha-naphthyl acetate activity of original and reformed JE and SE is probably site specific and of nondevelopmental origin. Heavy inflammation after healing was associated with enhanced epithelial proliferation of OGE and, in addition, marked esterase activity of these proliferations and corresponding OGE. This points at a possible inflammatory induction of the marked esterase activity seen in JE and SE as well as site-specific, connective tissue influences. Further investigation is needed to elucidate the effect of inflammation on the esterase activity.

Immunohistochemical distribution of keratin proteins in human gingival heterotransplants in nude mice.

Clinically healthy human gingivae from deciduous molar regions were transplanted to subcutaneous sites of nude mice (nu/nu NC). Transplants were harvested after posttransplantation periods of 5, 6, 7, 8.5, 10.5 and 12 weeks and examined histologically after staining with hematoxylin-eosin (H.E.), bisbenzimide, and a panel of mouse monoclonal anti-keratin antibodies in an indirect fluorescence technique. Central parts of transplants contained human connective tissue covered by human stratified squamous epithelium which were unkeratinized in 5- to 7-wk-old transplants and most frequently (75%) parakeratinized in 8.5-wk to 12-wk transplants. Comparison of keratin expression before and after transplantation revealed a progressive keratin reconstitution, i.e., keratin markers of basal/suprabasal cells preceded those of suprabasal/spinous cell layers and immunohistochemical markers of keratinization preceded routine histologically observed parakeratinization. Original keratin staining and essential features of histodifferentiation were reconstituted and maintained after 8.5 wk but graft recovery rate decreased drastically 12 wk after transplantation. This study shows that the human gingiva/nude mouse model is useful in experimental studies of the gingival keratin profile in the period 8.5 to 10.5 wk after transplantation.

Thiophene-degrading Escherichia coli mutants possess sulfone oxidase activity and show altered resistance to sulfur-containing antibiotics.

We have previously isolated mutants of Escherichia coli which show increased oxidation of heterocyclic furan and thiophene substrates. We have now found that strains carrying the thdA mutation express a novel enzyme activity which oxidizes a variety of substrates containing a sulfone (SO2) moiety. Both heterocyclic sulfones (e.g., tetramethylene sulfone) and simple aliphatic sulfones (e.g., ethyl sulfone) were oxidized. The thdA mutants were more resistant than wild-type strains to aromatic sulfone antibiotics such as dapsone. In contrast they showed increased susceptibility to thiolutin, a cyclic antibiotic containing sulfur at the sulfide level of oxidation. Several new thdA mutant alleles were isolated by selecting for increased oxidation of various aliphatic sulfur compounds. These new thdA mutants showed similar sulfone oxidase activity and the same map location (at 10.7 min) as the original thdA1 mutation. The constitutive fadR mutation was required for the phenotypic expression of thdA-mediated oxidation of sulfur compounds. However, the thdA-directed expression of sulfone oxidase activity was not fadR dependent. The thdC and thdD mutations probably protect against the toxicity of thiophene derivatives rather than conferring improved metabolic capability.

Presence of alpha-naphthyl acetate esterase enzymes in dental and oral epithelium of guinea pig embryos.

This study examines the distribution of alpha-naphthyl acetate esterase enzymes in reduced enamel epithelium, i.e., post secretory ameloblasts (PSA) and external cells of reduced enamel epithelium (ERE) of continuously growing incisor and molar tooth germs and in the covering oral epithelium (OE). Jaws of guinea pig embryos, 25-50 days of gestation age, were pretreated, frozen, serially cut, and incubated with alpha-naphthyl acetate as substrate and hexazotized pararosaniline as capture agent for demonstration of enzyme activity. In addition, sections were preincubated with various inhibitors of enzyme activity. A strong enzyme reaction, essentially unaffected by pretreatment procedures, was demonstrated in all cells of PSA and ERE, and in suprabasal cells of OE. Preliminary characterization of the alpha-naphthyl acetate esterase enzymes by means of inhibitors suggests a prevailing presence of B-esterase enzymes in both oral and dental epithelia. PSA were selectively stained when 2 x 10(-3) M arsanilic acid was used as inhibitor, ERE were selectively inhibited by 10(-5) M eserine, and cells of OE were selectively stained when 2 x 10(-3) M HgCl2 was used as inhibitor. We therefore conclude that the alpha-naphthyl acetate esterase enzymes in combination with inhibitors may serve as histochemical markers for discrimination of dental and oral epithelium in the guinea pig prior to eruption of teeth.

Missed injuries in an orthopaedic department.

In a prospective study lasting 6 months, all missed injuries in patients visiting the casualty department or admitted to the orthopaedic department of Aarhus Amtssygehus were registered and analysed. A total of 15,806 patients attended the casualty department and 783 patients were admitted to the orthopaedic department. Eighty-four injuries were missed in 83 patients in the casualty department, making a missed injury rate of 0.5 per cent. Twenty-three injuries were missed in 17 patients in the orthopaedic department making a missed injury rate of 2.2 per cent. Re-examination of all patients and matching radiographs reduced the number of missed injuries significantly.

[Delayed diagnosis of epiphysiolysis capitis femoris]. / Forsinket diagnose af epiphysiolysis capitis femoris.

The prognosis in epiphysiolysis of the head of the femur (ECF) depends on immediate treatment in the earliest stage of the disease. The reasons for and the extent of delayed diagnosis of slipping of the epiphysis in the hip were analysed in 56 children (72 hips) with ECF. The median total delay was six months with a delay of one month due to the patient and delay of three months due to the doctor. Pain in the lower limbs not related to the hip, including pain in the knee, occurred in 1/3 of the patients and resulted in more extensive delays due to the doctor (median four months). Other reasons for delay due to the doctor were erroneous interpretation of the x-ray films (14 patients). The most characteristic clinical finding was limited internal rotation of the affected hip. Comparison with the literature revealed that delay in the diagnosis of ECF has not been reduced during the past 35 years. Clinical examination of the hips should be undertaken in any child who complains of pain in the knee or thigh. If internal rotation is limited, x-ray examination including Lauenstein's projection should be carried out or the child should be referred to a department of orthopaedic surgery on account of suspected hip disease.

Immunohistochemical distribution of keratin proteins in clinically healthy human gingival epithelia.

In clinically healthy/subclinically inflamed biopsies of marginal gingiva, the immunohistochemical distribution of keratin proteins was studied in junctional (JE), sulcular (SE), oral gingival (OGE) and in a few samples of alveolar mucosal epithelium (AE) by means of various mouse monoclonal anti-keratin antibodies in an indirect fluorescence technique. All regions stained in a nearly similar way with AE3 (keratins 1-8, all cells) and BE14 (keratin 5, basal and supra/parabasal cells). AE8-staining (keratin 13, supra/parabasal and spinous cells) was primarily confined to the stratified, nonkeratinized epithelia SE and AE, but also a variable part of JE and less frequently OGE were positive. The parakeratinized OGE was distinct in showing a homogeneous staining with AE2 (keratins 1/2, 10) and AE5 (keratin 3) throughout spinous cell layers. These antibodies did not stain JE and AE whereas SE stained in a scattered way with AE5 and sometimes also with AE2. The latter finding might indicate initial keratinization at molecular level. The JE was distinct in retaining basal characteristics throughout the epithelium with PKK2 (keratin 7, 16, 17, 19) and BE14 (keratin 5) although some initial suprabasal maturation, as observed with AE8, cannot be excluded. Differences in keratin staining of gingival epithelia and the AE was found with respect to AE1-reactivity (keratins 10, 14-16, 19) which was suprabasal in JE, SE and OGE but basal in AE.