401
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Zwink N, Jenetzky E, Schmiedeke E, Schmidt D, Märzheuser S, Grasshoff-Derr S, Holland-Cunz S, Weih S, Hosie S, Reifferscheid P, Ameis H, Kujath C, Rißmann A, Obermayr F, Schwarzer N, Bartels E, Reutter H, Brenner H. Assisted reproductive techniques and the risk of anorectal malformations: a German case-control study. Orphanet J Rare Dis 2012; 7:65. [PMID: 22978793 PMCID: PMC3519554 DOI: 10.1186/1750-1172-7-65] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 09/04/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of assisted reproductive techniques (ART) for treatment of infertility is increasing rapidly worldwide. However, various health effects have been reported including a higher risk of congenital malformations. Therefore, we assessed the risk of anorectal malformations (ARM) after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). METHODS Data of the German Network for Congenital Uro-REctal malformations (CURE-Net) were compared to nationwide data of the German IVF register and the Federal Statistical Office (DESTATIS). Odds ratios (95% confidence intervals) were determined to quantify associations using multivariable logistic regression accounting for potential confounding or interaction by plurality of births. RESULTS In total, 295 ARM patients born between 1997 and 2011 in Germany, who were recruited through participating pediatric surgeries from all over Germany and the German self-help organisation SoMA, were included. Controls were all German live-births (n = 10,069,986) born between 1997 and 2010. Overall, 30 cases (10%) and 129,982 controls (1%) were born after IVF or ICSI, which translates to an odds ratio (95% confidence interval) of 8.7 (5.9-12.6) between ART and ARM in bivariate analyses. Separate analyses showed a significantly increased risk for ARM after IVF (OR, 10.9; 95% CI, 6.2-19.0; P < 0.0001) as well as after ICSI (OR, 7.5; 95% CI, 4.6-12.2; P < 0.0001). Furthermore, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed strong associations with ART (ORs 4.9, 11.9 and 7.9, respectively). After stratification for plurality of birth, the corresponding odds ratios (95% confidence intervals) were 7.7 (4.6-12.7) for singletons and 4.9 (2.4-10.1) for multiple births. CONCLUSIONS There is a strongly increased risk for ARM among children born after ART. Elevations of risk were seen after both IVF and ICSI. Further, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed increased risks in each group. An increased risk of ARM was also seen among both singletons and multiple births.
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Affiliation(s)
- Nadine Zwink
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ekkehart Jenetzky
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Centre for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Dominik Schmidt
- Department of Pediatric Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Märzheuser
- Department of Pediatric Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stefan Holland-Cunz
- Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sandra Weih
- Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
| | - Stuart Hosie
- Department of Pediatric Surgery, Klinikum Schwabing, Technical University Munich, Munich, Germany
| | - Peter Reifferscheid
- Department of Child and Adolescent Medicine, Westküstenklinikum Heide, Heide, Germany
| | - Helen Ameis
- Department of Pediatric Surgery, Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Christina Kujath
- Department of Pediatric Surgery, University Hospital Greifswald, Greifswald, Germany
| | - Anke Rißmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto-von-Guericke University, Magdeburg, Germany
| | - Florian Obermayr
- Department of Pediatric Surgery and Urology, University Hospital for Child and Adolescent Medicine Tübingen, Tübingen, Germany
| | - Nicole Schwarzer
- SoMA e.V.; Self-help organisation for people with anorectal malformation, Munich, Germany
| | - Enrika Bartels
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Neonatology, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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402
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Abstract
PURPOSE To ascertain the primary caregiver's postdischarge perceptions of infant care issues after neonatal heart surgery. STUDY DESIGN AND METHODS Fifteen primary caregivers of infants who had neonatal heart surgery for complex congenital heart disease (CHD) participated in this study. We conducted two focus groups and four individual phone interviews using a structured interview guide. The topics included parent feeding management, infant caloric intake, parental acceptance of nasogastric tube, infant feeding behaviors, and issues of parenting stress. We audio recorded focus group sessions, made detailed notes and key quotes were recorded verbatim by a certified impartial focus group facilitator. RESULTS Feeding problems were present in both infants who were on full oral feeds and infants who were dependent on supplemental feeding tubes. Mothers of infants with feeding problems expressed concern over infant weight gain and caregiver sleep deprivation, which largely contributed to parental stress. CLINICAL IMPLICATIONS In this small study of infants who experienced neonatal surgery for complex CHD, parental stress over feeding and weight gain were identified as important areas to be addressed during hospitalization. Future studies are needed to address increased at-home parental support.
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403
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Eggebø TM, Heien C, Berget M, Ellingsen CL. Routine use of color Doppler in fetal heart scanning in a low-risk population. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:496935. [PMID: 22685669 PMCID: PMC3363954 DOI: 10.5402/2012/496935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/19/2012] [Indexed: 11/23/2022]
Abstract
Objectives. To investigate the detection rate of major fetal heart defects in a low-risk population implementing routine use of color Doppler. Material and Methods. In a prospective observational study, all women undergoing fetal heart scanning (including 6781 routine examinations in the second trimester) during a three-year period were included. First a gray-scale scanning was performed including assessment of the four-chamber view and the great vessels. Thereafter three cross-sectional planes through the fetal thorax were assessed with color Doppler. Results. Thirty-nine fetuses had major heart defects, and 26 (67%) were prenatally detected. In 9/26 (35%) of cases the main ultrasound finding was related to the use of color Doppler. The survival rate of live born children was 91%. Conclusions. Routine use of color Doppler in fetal heart scanning in a low-risk population may be helpful in the detection of major heart defects; however, still severe malformations were missed prenatally.
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Affiliation(s)
- Torbjørn Moe Eggebø
- Department of Obstetrics and Gynecology, Stavanger University Hospital, N-4068 Stavanger, Norway
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404
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Boyd PA, Rounding C, Chamberlain P, Wellesley D, Kurinczuk JJ. The evolution of prenatal screening and diagnosis and its impact on an unselected population over an 18-year period. BJOG 2012; 119:1131-40. [PMID: 22676508 DOI: 10.1111/j.1471-0528.2012.03373.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To review changes in and impact of prenatal screening and diagnosis. DESIGN Population-based congenital anomaly register study. SETTING Oxfordshire. POPULATION Congenital anomalies confirmed and those suspected prenatally, delivered 1991-2008. METHODS Analysis of proportions of congenital anomalies confirmed and those suspected prenatally. MAIN OUTCOME MEASURES Birth prevalence, prenatal detection rates, pregnancy outcomes. RESULTS A total of 2651 (2.3%) infants/fetuses had a congenital anomaly diagnosed. There were 3839 suspected or confirmed cases, 2847 due to a prenatal suspicion, of which 1659 had an anomaly confirmed at delivery, and 1188 false-positive diagnoses, 91% due to reporting ultrasound normal variants. The percentage of prenatal notifications rose from 48% in 1991-93 to 83-88% from 1996 to 2003 and dropped to 61% in 2006-08, partly reflecting changes in the reporting of normal variants. Reporting these increased the prenatal diagnosis rate from 53 to 63% with an increase in false-positive rate from 0.09 to 1.04%. A total of 722 (44% of prenatally detected affected fetuses) resulted in termination; 48% of these had chromosome anomalies, 34% had isolated structural anomalies, 7% had multiple anomalies, 10% had familial disorders; 42% had lethal anomalies and 58% would probably have survived the neonatal period giving an estimated 20% reduction in birth prevalence of congenital anomalies compatible with survival because of terminations. CONCLUSION There has been an improvement in prenatal detection of congenital anomalies over the two decades studied. The recognition that reporting normal variants, although increasing prenatal detection rates, leads to an increase in false-positive diagnoses has had an impact on practice that has redressed the balance between these two effects.
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Affiliation(s)
- P A Boyd
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
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405
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Bedard T, Lowry RB, Sibbald B, Harder JR, Trevenen C, Horobec V, Dyck JD. Congenital heart defect case ascertainment by the Alberta Congenital Anomalies Surveillance System. ACTA ACUST UNITED AC 2012; 94:449-58. [DOI: 10.1002/bdra.23007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/09/2012] [Accepted: 02/10/2012] [Indexed: 11/09/2022]
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406
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Klausen SH, Mikkelsen UR, Hirth A, Wetterslev J, Kjærgaard H, Søndergaard L, Andersen LL. Design and rationale for the PREVAIL study: effect of e-Health individually tailored encouragements to physical exercise on aerobic fitness among adolescents with congenital heart disease--a randomized clinical trial. Am Heart J 2012; 163:549-56. [PMID: 22520519 DOI: 10.1016/j.ahj.2012.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
Abstract
Intensive exercise may be an important part of rehabilitation in patients with congenital heart disease (CHD). However, performing regular physical exercise is challenging for many adolescent patients. Consequently, effective exercise encouragements may be needed. Little is known on the effect of e-Health encouragements on physical fitness, physical activity, and health-related quality of life in adolescents. This trial is a nationwide interactive e-Health rehabilitation study lasting 1 year, centered on interactive use of mobile phone and Internet technology. We hypothesize that e-Health encouragements and interactive monitoring of intensive exercise for 1 year can improve physical fitness, physical activity, and health-related quality of life. Two hundred sixteen adolescents (age, 13-16 years) with surgically corrected complex CHD but without significant hemodynamic residual defects and no restrictions to participate in physical activity are in the process of being enrolled by invitation after informed consent. Physical fitness is measured as the maximal oxygen uptake (Vo(2)) at baseline and after 12 months by an assessor blinded to the randomization group. After baseline testing, the patients are 1:1 randomized to an intervention group or a control group. Individually fully automated tailored e-Health encouragements--SMS, Internet, and mobile applications--aimed at increasing physical activity are delivered to the participants in the intervention group once a week. The Bandura's Social Cognitive Theory inspires the behavioral theoretical background. The e-Health intervention and the Godfrey cycle ergometer protocol have been feasibility tested and seem applicable to adolescents with CHD. The trial is expected to contribute with new knowledge regarding how physical activity in adolescents with CHD can be increased and, possibly, comorbidity be reduced.
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407
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Sharland G. Fetal cardiac screening and variation in prenatal detection rates of congenital heart disease: why bother with screening at all? Future Cardiol 2012; 8:189-202. [DOI: 10.2217/fca.12.15] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Antenatal screening for fetal cardiac abnormalities was introduced over 25 years ago, yet detection of congenital heart disease before birth remains a challenge. While experienced tertiary centers report a high level of diagnostic accuracy, with most major forms of congenital heart disease being detectable before birth, the overall detection rate remains low. Pregnancies at increased risk of having an affected baby are referred to tertiary centers for fetal ECG, but most cases of congenital heart disease will occur in low-risk pregnancies. These cases will only be detected by screening the low-risk population at the time of routine obstetric scanning. Many obstetric ultrasound units have learnt to successfully obtain, and correctly interpret, views of the heart, including the four-chamber view and outflow tract views. However, standards for doing this are not uniform, nationally or internationally, so there is a significant variation in detection rates across individual countries and between different countries. Early diagnosis of babies with lesions that can result in cardiovascular collapse and death, could improve their survival as well as reducing morbidity. In addition, detection of a cardiac abnormality during pregnancy allows time to prepare parents for the likely course of events after birth. It also facilitates detection of other abnormalities in the baby and gives parents a choice, even if the choice is difficult and unwelcome. As well as providing parents with accurate and up-to-date information regarding the their baby’s abnormality, it is vital to provide continuing support to help them deal with the problem, regardless of what decisions they make. Much work remains to establish a uniform standard for antenatal detection of cardiac abnormalities. More recent national guidelines for examining the fetal heart along with formalized auditing processes should help to achieve this, although considerable time and effort will be required, particularly with regard to the teaching and training required.
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Affiliation(s)
- Gurleen Sharland
- Fetal Cardiology Unit, Evelina Children’s Hospital, Westminster Bridge Road, London SE1 7EH, UK
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408
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Snijder CA, Vlot IJ, Burdorf A, Obermann-Borst SA, Helbing WA, Wildhagen MF, Steegers EAP, Steegers-Theunissen RPM. Congenital heart defects and parental occupational exposure to chemicals. Hum Reprod 2012; 27:1510-7. [DOI: 10.1093/humrep/des043] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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409
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Subirana MT, Oliver JM, Sáez JM, Zunzunegui JL. [Pediatric cardiology and congenital heart disease: from fetus to adult]. Rev Esp Cardiol 2012; 65 Suppl 1:50-8. [PMID: 22269840 DOI: 10.1016/j.recesp.2011.10.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/17/2011] [Indexed: 11/29/2022]
Abstract
This article contains a review of some of the most important publications on congenital heart disease and pediatric cardiology that appeared in 2010 and up until September 2011. Of particular interest were studies on demographic changes reported in this patient population and on the need to manage the patients' transition from the pediatric to the adult cardiology department. This transition has given rise to the appearance of new areas of interest: for example, pregnancy in women with congenital heart disease, and the effect of genetic factors on the etiology and transmission of particular anomalies. In addition, this review considers some publications on fetal cardiology from the perspective of early diagnosis and, if possible, treatment. There follows a discussion on new contributions to Eisenmenger's syndrome and arrhythmias, as well as on imaging techniques, interventional catheterization and heart transplantation. Finally, there is an overview of the new version of clinical practice guidelines on the management of adult patients with congenital heart disease and of recently published guidelines on pregnancy in women with heart disease, both produced by the European Society of Cardiology.
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Affiliation(s)
- M Teresa Subirana
- Unidad de Cardiopatías Congénitas del Adolescente y Adulto Vall d'Hebron-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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410
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Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2012; 58:2241-7. [PMID: 22078432 DOI: 10.1016/j.jacc.2011.08.025] [Citation(s) in RCA: 1998] [Impact Index Per Article: 166.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/26/2011] [Accepted: 08/08/2011] [Indexed: 11/23/2022]
Abstract
Congenital heart disease (CHD) accounts for nearly one-third of all major congenital anomalies. CHD birth prevalence worldwide and over time is suggested to vary; however, a complete overview is missing. This systematic review included 114 papers, comprising a total study population of 24,091,867 live births with CHD identified in 164,396 individuals. Birth prevalence of total CHD and the 8 most common subtypes were pooled in 5-year time periods since 1930 and in continent and income groups since 1970 using the inverse variance method. Reported total CHD birth prevalence increased substantially over time, from 0.6 per 1,000 live births (95% confidence interval [CI]: 0.4 to 0.8) in 1930 to 1934 to 9.1 per 1,000 live births (95% CI: 9.0 to 9.2) after 1995. Over the last 15 years, stabilization occurred, corresponding to 1.35 million newborns with CHD every year. Significant geographical differences were found. Asia reported the highest CHD birth prevalence, with 9.3 per 1,000 live births (95% CI: 8.9 to 9.7), with relatively more pulmonary outflow obstructions and fewer left ventricular outflow tract obstructions. Reported total CHD birth prevalence in Europe was significantly higher than in North America (8.2 per 1,000 live births [95% CI: 8.1 to 8.3] vs. 6.9 per 1,000 live births [95% CI: 6.7 to 7.1]; p < 0.001). Access to health care is still limited in many parts of the world, as are diagnostic facilities, probably accounting for differences in reported birth prevalence between high- and low-income countries. Observed differences may also be of genetic, environmental, socioeconomical, or ethnic origin, and there needs to be further investigation to tailor the management of this global health problem.
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411
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Jouannic JM, Thieulin AC, Bonnet D, Houyel L, Lelong N, Goffinet F, Khoshnood B. Measurement of nuchal translucency for prenatal screening of congenital heart defects: a population-based evaluation. Prenat Diagn 2011; 31:1264-9. [DOI: 10.1002/pd.2883] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 08/27/2011] [Accepted: 09/01/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Jean-Marie Jouannic
- Service de Gynécologie-Obstétrique et Centre Pluridisciplinaire de Diagnostic Prénatal de l'Est Parisien; Hôpital Armand Trousseau; APHP, Paris 6, 26 Avenue A. Netter 75012 Paris France
| | - Anne-Claire Thieulin
- Unité INSERM UMR S953, Recherches épidémiologiques sur la santé périnatale et la santé des femmes et des enfants; Université Pierre et marie Curie; Paris 6, 82 Avenue Denfert Rochereau 75679 Paris France
| | - Damien Bonnet
- Service de cardiopédiatrie; Hôpital Necker-Enfants Malades; APHP, Paris 5, 149 rue de Sèvres 75015 Paris France
| | - Lucile Houyel
- Service de cardiopédiatrie; Centre Chirurgical Marie Lannelongue; 149 Avenue de la Résistance 92350 Le Plessis Robinson France
| | - Nathalie Lelong
- Unité INSERM UMR S953, Recherches épidémiologiques sur la santé périnatale et la santé des femmes et des enfants; Université Pierre et marie Curie; Paris 6, 82 Avenue Denfert Rochereau 75679 Paris France
| | - François Goffinet
- Unité INSERM UMR S953, Recherches épidémiologiques sur la santé périnatale et la santé des femmes et des enfants; Université Pierre et marie Curie; Paris 6, 82 Avenue Denfert Rochereau 75679 Paris France
| | - Babak Khoshnood
- Unité INSERM UMR S953, Recherches épidémiologiques sur la santé périnatale et la santé des femmes et des enfants; Université Pierre et marie Curie; Paris 6, 82 Avenue Denfert Rochereau 75679 Paris France
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412
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Riley JP, Habibi H, Banya W, Gatzoulis MA, Lau-Walker M, Cowie MR. Education and support needs of the older adult with congenital heart disease. J Adv Nurs 2011; 68:1050-60. [PMID: 21848858 DOI: 10.1111/j.1365-2648.2011.05809.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM This article is a report of a study exploring health-related quality of life in adults with congenital heart disease and the extent to which it is associated with patients' illness beliefs and emotional health. BACKGROUND A reduction in mortality in patients with congenital heart disease has led to an increasingly older population that faces new challenges. Studies in a younger adult population have reported inconsistent findings regarding health-related quality of life. Factors such as, the complexity of the congenital heart defect, have not been found to be associated with quality of life. The association between illness beliefs and health-related quality of life has not previously been reported. METHOD A cross-sectional questionnaire study of adults with congenital heart disease attending an outpatient clinic in a specialist centre in the United Kingdom between October 2007 and May 2008. RESULTS The mean age of the study population was 37·2 years. Participants reported poorer physical functioning, role functioning and general health than a general population. High levels of anxiety were reported in 38% and high levels of depression in 17%. In multivariate analysis, higher levels of anxiety and depression were associated with poorer mental functioning and higher levels of depression with poorer physical quality of life. CONCLUSION We have reported that high levels of anxiety and depression in an older population of patients with congenital heart disease are associated with poorer quality of life. This highlights the need to routinely assess anxiety and depression in this patient group and to provide psychological support appropriately.
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Affiliation(s)
- Jillian P Riley
- Royal Brompton & Harefield NHS Foundation Trust, London, UK.
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413
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Mastroiacovo P, Leoncini E. More folic acid, the five questions: why, who, when, how much, and how. Biofactors 2011; 37:272-9. [PMID: 21674648 DOI: 10.1002/biof.172] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 04/28/2011] [Indexed: 12/31/2022]
Abstract
In recent years, a number of studies have been performed to evaluate the possible health benefits of an increased intake of folic acid (FA) on human health. However, the only well-documented benefit emerging from randomized controlled trials, nonrandomized interventions trials, and observational studies is the risk reduction of neural tube defects (NTDs). NTDs are congenital malformations that include anencephaly, encephalocele, and spina bifida caused by the failure of fusion of the neural tube that normally closes between 22nd and 28th day since conception (on an average 40-42th day after the first day of last menstrual period). The occurrence of NTDs varies among population between 0.8 and 3 per 1,000, and it is estimated that 324,000 pregnancies are affected every year worldwide. More FA can decrease the NTDs risk up to 0.6 per 1,000 births. Other malformations as congenital heart defects, cleft lip, and limb deficiencies can be most probably also reduced. To decrease the NTDs risk, it is recommended that all women capable of becoming pregnant should have more FA. The goal is that every woman could start her pregnancy with an optimal folate status, estimated today to be as more than 906 nmol/L of red blood cell folate concentration. More FA can be obtained through a strict Mediterranean pattern of nutrition and healthy life style, fortified food, supplements. Women and health authorities can choose the most appropriate strategy. Monitoring folate status of women during the periconceptional period is an essential way to evaluate the success of the preferred strategy.
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Affiliation(s)
- Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity, Via Carlo Mirabello 14, Roma, Italy.
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414
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Brand S, Kirov R. Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions. Int J Gen Med 2011; 4:425-42. [PMID: 21731894 PMCID: PMC3119585 DOI: 10.2147/ijgm.s11557] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Indexed: 02/05/2023] Open
Abstract
Restoring sleep is strongly associated with a better physical, cognitive, and psychological well-being. By contrast, poor or disordered sleep is related to impairment of cognitive and psychological functioning and worsened physical health. These associations are well documented not only in adults but also in children and adolescents. Importantly, adolescence is hallmarked by dramatic maturational changes in sleep and its neurobiological regulation, hormonal status, and many psychosocial and physical processes. Thus, the role of sleep in mental and physical health during adolescence and in adolescent patients is complex. However, it has so far received little attention. This review first presents contemporary views about the complex neurobiology of sleep and its functions with important implications for adolescence. Second, existing complex relationships between common adolescent somatic/organic, sleep-related, and psychiatric disorders and certain sleep alterations are discussed. It is concluded that poor or altered sleep in adolescent patients may trigger and maintain many psychiatric and physical disorders or combinations of these conditions, which presumably hinder recovery and may cross into later stages of life. Therefore, timely diagnosis and management of sleep problems appear critical for growth and development in adolescent patients.
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Affiliation(s)
- Serge Brand
- Depression and Sleep Research Unit, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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415
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Zwink N, Jenetzky E, Brenner H. Parental risk factors and anorectal malformations: systematic review and meta-analysis. Orphanet J Rare Dis 2011; 6:25. [PMID: 21586115 PMCID: PMC3121580 DOI: 10.1186/1750-1172-6-25] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/17/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anorectal malformations (ARM) are rare forms of congenital uro-rectal anomalies with largely unknown causes. Besides genetic factors, prenatal exposures of the parents to nicotine, alcohol, caffeine, illicit drugs, occupational hazards, overweight/obesity and diabetes mellitus are suspected as environmental risk factors. METHODS Relevant studies published until August 2010 were identified through systematic search in PubMed, EMBASE, ISI Web of Knowledge and the Cochrane Library databases. Furthermore, related and cross-referencing publications were reviewed. Pooled odds ratios (95% confidence intervals) were determined to quantify associations of maternal and paternal smoking, maternal alcohol consumption, underweight (body mass index [BMI] < 18.5), overweight (BMI 25-29.9), obesity (BMI ≥30) and maternal diabetes mellitus with ARM using meta-analyses. RESULTS 22 studies that reported on the association between prenatal environmental risk factors and infants born with ARM were included in this review. These were conducted in the United States of America (n = 12), Spain (n = 2), Sweden (n = 2), the Netherlands (n = 2), Japan (n = 1), France (n = 1), Germany (n = 1) and Hungary (n = 1). However, only few of these studies reported on the same risk factors. Studies were heterogeneous with respect to case numbers, control types and adjustment for covariates. Consistently increased risks were observed for paternal smoking and maternal overweight, obesity and diabetes, but not for maternal smoking and alcohol consumption. In meta-analyses, pooled odds ratios (95% confidence intervals) for paternal smoking, maternal overweight, obesity, pre-gestational and gestational diabetes were 1.53 (1.04-2.26), 1.25 (1.07-1.47), 1.64 (1.35-2.00), 4.51 (2.55-7.97) and 1.81 (1.23-2.65), respectively. CONCLUSION Evidence on risk factors for ARM from epidemiological studies is still very limited. Nevertheless, the few available studies indicate paternal smoking and maternal overweight, obesity and diabetes to be associated with increased risks. Further, ideally large-scale multicentre and register-based studies are needed to clarify the role of key risk factors for the development of ARM.
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Affiliation(s)
- Nadine Zwink
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ekkehart Jenetzky
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Gissler M, Klemetti R, Sevón T, Hemminki E. Monitoring of IVF birth outcomes in Finland: a data quality study. BMC Med Inform Decis Mak 2004; 4:3. [PMID: 15070411 PMCID: PMC385243 DOI: 10.1186/1472-6947-4-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2003] [Accepted: 03/10/2004] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The collection of information on infertility treatments is important for the surveillance of potential health consequences and to monitor service provision. STUDY DESIGN We compared the coverage and outcomes of IVF children reported in aggregated IVF statistics, the Medical Birth Register (subsequently: MBR) and research data based on reimbursements for IVF treatments in Finland in 1996-1998. RESULTS The number of newborns were nearly equal in the three data sources (N = 4331-4384), but the linkage between the MBR and the research data revealed that almost 40% of the reported IVF children were not the same individuals. The perinatal outcomes in the three data sources were similar, excluding the much lower incidence of major congenital anomalies in the IVF statistics (157/10 000 newborns) compared to other sources (409-422/10 000 newborns). CONCLUSION The differences in perinatal outcomes in the three data sets were in general minor, which suggests that the observed non-recording in the MBR is most likely unbiased.
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Affiliation(s)
- Mika Gissler
- STAKES National Research and Development Centre for Welfare and Health, Information Division. Helsinki, Finland
| | - Reija Klemetti
- STAKES National Research and Development Centre for Welfare and Health. Division for Social and Health Care Services, Helsinki, Finland
| | - Tiina Sevón
- STAKES National Research and Development Centre for Welfare and Health. Division for Social and Health Care Services, Helsinki, Finland
| | - Elina Hemminki
- STAKES National Research and Development Centre for Welfare and Health. Division for Social and Health Care Services, Helsinki, Finland
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