Parental alcohol and drug abuse and offspring mortality by age 10: a population-based register study

BACKGROUND

Parental substance abuse (SA) of alcohol and drugs is associated with offspring mortality, including sudden infant death syndrome (SIDS), in infancy, but research on cause-specific mortality and mortality in later childhood is scarce.

METHODS

Using population-based register data on all births in Sweden in 1973-2013 (N = 4.2 million) and Cox regressions, we examined the associations of mother's and father's SA registered between 2 years before and 12 years after the child birth with offspring all-cause and cause-specific mortality in infancy and childhood.

RESULTS

Parental SA was associated with increased offspring all-cause and natural-cause mortality in infancy, but not in the neonatal period, and with external-cause mortality in ages 1-9. Risk of SIDS was 130-280% higher in infants with parental SA compared to infants with no parental SA. Adjusting for parental socioeconomic and immigrant status and severe psychiatric disorders, paternal SA was associated with 66% higher mortality due to communicable diseases and infections in infancy, and both maternal and paternal SA were associated with 40-174% higher mortality due to accidents in infancy and in ages 1-9. The associations between parental SA and offspring mortality were similar for male and female offspring.

CONCLUSIONS

Child mortality is rare in contemporary Sweden, and parental SA has variable associations with elevated offspring mortality throughout the first 10 years of life, excluding the neonatal period, which is indicative of insufficient recognition of children at risk. Preventive measures should be long-term and targeted to both parental and offspring behaviour.

Homophily in Personality Enhances Group Success Among Real-Life Friends

Personality affects dyadic relations and teamwork, yet its role among groups of friends has been little explored. We examine for the first time whether similarity in personality enhances the effectiveness of real-life friendship groups. Using data from a longitudinal study of a European fraternity (10 male and 15 female groups), we investigate how individual Big Five personality traits were associated with group formation and whether personality homophily related to how successful the groups were over 1 year (N = 147-196). Group success was measured as group performance/identification (adoption of group markers) and as group bonding (using the inclusion-of-other-in-self scale). Results show that individuals' similarity in neuroticism and conscientiousness predicted group formation. Furthermore, personality similarity was associated with group success, even after controlling for individual's own personality. Especially higher group-level similarity in conscientiousness was associated with group performance, and with bonding in male groups.

Shorter birth intervals between siblings are associated with increased risk of parental divorce

Birth intervals are a crucial component of fertility behaviour and family planning. Short birth intervals are associated—although not necessarily causally—with negative health-related outcomes, but less is known about their associations with family functioning. Here, the associations between birth intervals and marital stability were investigated by Cox regression using a nationally representative, register-based sample of individuals with two (N = 42,481) or three (N = 22,514) children from contemporary Finland (observation period 1972–2009). Shorter interbirth intervals were associated with an increased risk of parental divorce over a ten-year follow-up. Individuals with birth intervals of up to 1.5 years had 24–49 per cent higher divorce risk compared to individuals whose children were born more than 4 years apart. The pattern was similar in all socioeconomic groups and among individuals with earlier and later entry to parenthood. Our results add to the growing body of research showing associations between short birth intervals and negative outcomes in health and family functioning.

Financial opportunity costs and deaths among close kin are independently associated with reproductive timing in a contemporary high-income society

Evolutionary demography predicts that variation in reproductive timing stems from socio-ecologically contingent trade-offs between current and future reproduction. In contemporary high-income societies, the costs and benefits of current reproduction are likely to vary by socioeconomic status (SES). Two influential hypotheses, focusing on the parenthood 'wage penalty', and responses to local mortality have separately been proposed to influence the timing of parenthood. Economic costs of reproduction (i.e. income loss) are hypothesized to delay fertility, especially among high childhood SES individuals who experience greater opportunities to build capital through advantageous education and career opportunities. On the other hand, relatively low childhood SES individuals experience higher mortality risk, which may favour earlier reproduction. Here, we examine both hypotheses with a representative register-based, multigenerational dataset from contemporary Finland (N = 47 678). Consistent with each hypothesis, the predicted financial cost of early parenthood was smaller, and mortality among close kin was higher for individuals with lower childhood SES. Within the same dataset, lower predicted adulthood income and more kin deaths were also independently associated with earlier parenthood. Our results provide a robust demonstration of how economic costs and mortality relate to reproductive timing. We discuss the implications of our findings for demographic theory and public policy.

The Company You Keep

Studies on personality and friendship have focused on similarities between friends, while differences in friendship patterns have received less attention. We used data from the British Household Panel Survey data ( N = 12,098) to investigate how people’s personalities are related to various characteristics of their three closest friends. All personality traits of the five-factor model were associated with several friendship characteristics with effect sizes corresponding to correlations between −.06 and .09. Openness was especially prominent and idiosyncratic; individuals with high (vs. low) openness were about 3% more likely to have friends who live further away, are of the opposite sex and another ethnicity, and whom they meet less often. Agreeableness and extroversion were related to more traditional friendship ties. Individuals with high agreeableness had known their friends for a longer time, lived close to them, and had more “stay-at-homes” among their friends.

Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?

BACKGROUND

We aimed to investigate whether fluid therapy with a goal of near-maximal stroke volume (SV) guided by oesophageal Doppler (ED) monitoring result in a better outcome than that with a goal of maintaining bodyweight (BW) and zero fluid balance in patients undergoing colorectal surgery.

METHODS

In a double-blinded clinical multicentre trial, 150 patients undergoing elective colorectal surgery were randomized to receive fluid therapy after either the goal of near-maximal SV guided by ED (Doppler, D group) or the goal of zero balance and normal BW (Zero balance, Z group). Stratification for laparoscopic and open surgery was performed. The postoperative fluid therapy was similar in the two groups. The primary endpoint was postoperative complications defined and divided into subgroups by protocol. Analysis was performed by intention-to-treat. The follow-up was 30 days. The trial had 85% power to show a difference between the groups.

RESULTS

The number of patients undergoing laparoscopic or open surgery and the patient characteristics were similar between the groups. No significant differences between the groups were found for overall, major, minor, cardiopulmonary, or tissue-healing complications (P-values: 0.79; 0.62; 0.97; 0.48; and 0.48, respectively). One patient died in each group. No significant difference was found for the length of hospital stay [median (range) Z: 5.00 (1-61) vs D: 5.00 (2-41); P=0.206].

CONCLUSIONS

Goal-directed fluid therapy to near-maximal SV guided by ED adds no extra value to the fluid therapy using zero balance and normal BW in patients undergoing elective colorectal surgery.

Effects of mixtures of persistent organic pollutants (POPs) derived from cod liver oil on H295R steroidogenesis

Crude cod liver oil and liver oil supplements are consumed as a source of vitamin A, D and polyunsaturated fatty acids; during winter and early pregnancy. Crude cod liver oil however constitutes a considerable source of persistent organic pollutants (POPs). This paper aimed at characterizing and quantifying the influence of POP mixtures extracted from three different steps in the cod liver oil industrial process on hormone production and the expression of steroidogenesis-related genes in H295R cells. Exposure to extracts from crude cod liver oil and from its industrial waste increased progesterone (P4), cortisol (Cort), testosterone (T) and estradiol (E2) production; and among others, the expression of MC2R, CYP11B1 and HSD3B2 genes. Observed effects after exposure to pharmaceutical cod liver oil extract were considerably lower. The type of effects on gene expression and hormone production were similar to those induced by forskolin and PCBs, the latter being the major contaminants within the extracts. Additional research is required to further unveil the mechanisms behind the observed steroidogenic effects and to assess whether the potential risk might outweigh the potential benefits of crude and processed cod liver oil consumption.

Total blubber burden of organochlorine pollutants in phocid seals; methods and suggested standardization

The purpose of the present paper was to investigate methods for calculating the total blubber burden of organochlorine pollutants (OCs) in phocid seals. Harp seals (Phoca groenlandica) were used as the model species. A sample of fat pre-breeding adult females (N = 9) and a sample of thin moulting adult females (N = 7) were collected. From each animal blubber samples from five different body sites (complete blubber columns and samples from different blubber layers), in addition to a sample from a homogenate derived from the entire blubber mass, were analyzed for selected OCs. Significant differences in the concentrations of major OC contaminants were found between inner and outer blubber layer. Within each seal group, no significant difference in OC concentrations was found between homogenates from whole blubber columns from the five different sites of the animals or when comparing these with the OC concentrations found in the blubber sample deriving from a homogenate of the entire blubber mass. When comparing the two seal groups, the mean OC concentrations were significantly higher in the thin seals. However, blubber burden of OCs measured directly and calculated indirectly were not significantly different, and did not vary between the two groups of seals. Since these seals are of the same age and sex group and from the same population, this is not an unexpected result. The present results suggest that comparison of blubber concentrations of OCs in phocid seals should be avoided, especially when comparing differences between geographical areas or for time-trend analyses. For this type of study, we suggest that the blubber burden of OCs is applied as standard in the future. Furthermore, since blubber depth at a specific sampling site is required when using the estimator for calculation of the percent blubber content in phocid seals (the LMD-index), we suggest that this sampling site (central dorsally) is introduced as a standard when sampling blubber for OC analyses in phocid seals.

Sentinel node localization in breast cancer patients using intradermal dye injection

In a series of 161 consecutive breast cancer operations, intradermal injection of Patent Blue was used to localize the sentinel node (SN). The surgical localization rate was 60%. Including the blue lymph nodes found by the pathologist, localization rate was 70%. After the first 103 operations, the surgical procedure was changed, resulting in a localization rate of 83%. Ten surgeons participated, but only one had previous experience with SN dissection. The others experienced a steep learning curve. Metastasis was found in 42 of 97 SNs (43%). In 15 cases (36%) metastasis was recognized only after step-sectioning and immunohistochemical staining for cytokeratin. In one case a benign epithelial inclusion was found. The sentinel node was false negative in 9.1% of cases. The consensus from the literature is that the best results are achieved using a combination of dye and isotopic techniques.

Mercury, cadmium, lead, and selenium in fish from a Norwegian fjord and off the coast, the importance of sampling locality

Hepatic levels of mercury, cadmium, lead, and selenium and levels of mercury and selenium in muscle tissue were analysed in tusk from the Nordfjord in Norway. With the exception of selenium in the muscle tissue, the metal levels were significantly higher in the fjord fish than in fish caught off the coast. No local source is known to explain the difference in levels, and this indicates that the fjord efficiently accumulates atmospheric contaminants. The present results demonstrate the importance of sampling area when determining levels of metals in marine organisms far from point sources. The liver was increasingly used as a storage compartment for mercury and selenium with increasing exposure.

Organochlorines in deep-sea fish from the Nordfjord

Hepatic levels of OCs (Organochlorines) were analysed in deep-sea fish from the Nordfjord in Norway. Levels of PCBs in the present study exceed background levels in fish from Norwegian water by a factor of 1.5 to 50, and DDTs by one to two orders of magnitude. DDTs in fish from the Nordfjord have previously been attributed to DDT use in fruit orchards. The present levels of DDTs show that the decline usually found in biota in Scandinavia since the 1970s is not found in the deep-sea fish in Nordfjord. There is no known local PCB source that can explain the elevated levels in the present study. This indicates that the fjord efficiently accumulates atmospheric contaminants. Chlordanes and HCB were less important, and HCHs were not detected.

A zinc-dependent DNA-binding activity co-operates with cAMP-responsive-element-binding protein to activate the human thyroglobulin enhancer

Footprinting experiments involving the human thyroglobulin gene enhancer and thyroid nuclear extracts revealed a protected region called X2, containing an incomplete cAMP-responsive element (CRE). Band-shift experiments identified two binding activities recognizing the X2 element: a CRE-binding protein (CREB)/activating transcription factor (ATF) relative that binds the half CRE motif and a second factor that interacts with a G-rich motif located just upstream from the CRE. The first factor appears to be CREB itself, as indicated by the supershifting when using an antibody directed against CREB, and the second DNA-binding activity involved was shown to be zinc-dependent and exhibited an apparent molecular mass of 42-44 kDa in South-Western blotting experiments. This factor may represent a novel entity, which we named CAF, for 'CREB Associated Factor'. Three copies of X2 sequence conferred a strong cAMP-dependent transcriptional activation to a heterologous promoter in transient transfection assay in cAMP-stimulated primary thyrocytes and HeLa cells. Transfection experiments of constructs containing the X2 element mutated in either the CRE or the G-rich site showed that both motifs were required for this transcription activating function. Moreover, the combination of several individual X2 elements mutated in either the CRE or the G-rich motif did not exhibit full transcriptional activity. This suggests that, in the context of the X2 element, CREB requires a close interaction with CAF to achieve both basal and cAMP-dependent transcriptional activation.

Identification of a thyroid-specific and cAMP-responsive enhancer in the upstream sequences of the human thyroglobulin promoter

Functional analysis of remote 5'-flanking sequences from the human thyroglobulin gene in primary cultured dog thyrocytes led to the identification of a partly cAMP-responsive enhancer, located between -3.6 to -2.2 kb from the transcriptional start site. Deletion analysis of the 1.4 kb-long region localised the enhancer activity in a 0.5 kb-long fragment (located between -3.2 and -2.7 kb relative to transcription start), which could be divided into two functional sub-fragments of 0.2 and 0.3 kb. A potential binding site for the CREB/ATF transcription factors was found in the 0.3 kb element. The complete enhancer region had no detectable activity when assayed in Hela cells, suggesting that it constituted a thyroid-specific regulatory element. Accordingly, footprinting experiments revealed the presence of several binding sites for Thyroid Transcription Factor-1 (TTF-1) in both the 0.2 and 0.3 kb elements.

[Ultrasound screening of hip joints in newborn infants]

The aim of the present study was to assess the efficiency of ultrasonography in the screening of hip joints in newborn babies. In 1987, 2,531 newborns (92.4% of all liveborn babies) were examined clinically and with ultrasound. The coverage of the femoral head by the bony acetabular roof was measured on a longitudinal, coronal scan. The mean head coverage was 57% in boys and 55% in girls (p = 0.0001). Unstable hips, shown by both ultrasound and clinical examination, were found in 27 newborns (1.1%). The mean head coverage of unstable hips was 41%, significantly lower than for stable hips. No late hip dislocations were diagnosed in children with normal findings who were not included in the follow-up routines. In conclusion, the study indicated that ultrasonography measuring the femoral head coverage is an appropriate method of screening in newborns. It is useful for differentiating between a true and a false positive Ortolani sign. Moreover, ultrasound can show hip dysplasia that is not clinically demonstrable at birth.

[Self-regulated intake of food and drinks after abdominal surgery]

106 consecutive patients who had undergone laparotomy were allowed to drink freely from the first and to eat from the second day after operation. Only patients with an operated oesophagus were excluded. Nasogastric suction was not used. Our study shows that if patients are allowed to choose, they like to drink and to eat soon after the operation. They prefer water, juice and soup during the early days. Most of them soon drank more than 1,500 ml of liquids per day. They often start to drink and to eat before the passage of first flatus. Only five patients (4.7%) needed to have a nasogastric tube inserted. We found no major complications associated with our regimen. All our patients are now allowed to drink and eat according to their own wishes.

[Plasma estradiol levels and duration of lactation amenorrhea]

In Temuco, Chile, 114 women in fully nursing, were studied, according to their length of lactational amenorrhea and their relation with estradiol levels at 3th postpartum month. Sixty six (58%) recovery their menses before the 6th postpartum month. The length of lactational amenorrhea was 100.7-5.2 and 277 +/- 10.6 days, for those mothers who were with menses and amenorrhea, respectively. The estradiol levels were 88 pmol/l higher in the woman with short length of lactational amenorrhea. This study corroborate, that short length of lactational amenorrhea is a condition highly frequent in Chilean population. The difference in the estradiol levels may be a indicators of the early recovery of the postpartum fertility.

Linen in the hospital bed: effects on patients' well-being

The aim of the study was to determine if using linen in hospital beds affects patients' well-being. An experimental group consisting of 52 patients (mean age: 64.4 years) at a medical ward used linen in the bottom sheet, the protective sheet, the pillow-case and the patient gown for 4 weeks. A control group consisting of 40 patients (mean age: 67.5 years) at the same ward was observed for 4 weeks using the conventional material (cotton, cotton/polyester). Marginal positive effects on patients' well-being were noted when linen was used. It was discussed that the relative importance of the bed material to patients' well-being may be low, compared to medical treatment, nursing, etc. Given the high cost of linen, about 15 times more than the conventional material, it was suggested that the health care system should refrain from large-scale use of linen in hospital beds.

Hip rotation and in-toeing gait. A study of normal subjects from four years until adult age

In a selected population, from four years old up to adult age, the function of 1522 hips of 761 apparently normal subjects of both genders were studied to define: (1) the lower and upper limits of normal hip rotation; and (2) the frequency of in-toeing gait related to age and gender. Internal and external rotation were measured with the subject lying prone with flexed knees. Presence of in-toeing gait was noted. A significant reduction of internal rotation with age was found in both females and males. In all age groups, females had significantly higher range of internal rotation than males. External rotation did not show the same age and gender dependency. Sixteen percent of all subjects had an in-toeing gait. The frequency decreased from 30% in the four-year-old group to 4% in adults. The subjects with in-toeing had a significantly increased internal rotation and decreased external rotation.

Ultrasound for hip assessment in the newborn

The hips of 1000 newborn babies were examined clinically and by ultrasonography. The ultrasound assessment was based on measurements of the coverage of the femoral head by the bony acetabular roof, and this parameter was called the Bony Rim Percentage (BRP). The mean BRP was 55.3% in girls and 57.2% in boys, a significant difference. Clinical instability occurred in 0.7% of the newborn babies, and all of the unstable hips had a BRP below the lower limit of normal. All infants with normal clinical findings and suspected abnormal hips based on ultrasound were followed up; in all but two the hips became normal spontaneously. We conclude that ultrasonography, using the measurements of femoral head coverage, is appropriate for screening the newborn, is reliable in differentiating between a true and a false positive Ortolani sign, and that hip dysplasia which is not clinically demonstrable at birth can be detected by ultrasound. Ultrasound should replace radiography as the routine method of following up high-risk infants and those with suspicious signs.

Hip motion related to age and sex

In a selected population 4 years old to adult age, 1,522 hips in 761 healthy subjects of both sexes were studied. Arcs of passive motion of the hip were measured by the technique recommended by the American Academy of Orthopaedic Surgeons. The lower and upper limits of normal range of hip motion in all the planes were established for both sexes in the different age groups. We found that the amplitude of most hip motions decreased with age. Females had higher ranges of total hip motion, total rotation, internal rotation, and abduction compared with males.

Possible mechanism of hemostasis effected by electrocoagulation

Forty acute gastric ulcers were created in 10 rabbits. The bleeding was controlled by monopolar electrocoagulation in 20 ulcers, the remaining ulcers were left untreated as controls. Spontaneous intravascular thrombosis was precluded by heparinization. A histological assessment in the acute stage revealed significant morphological alterations in electrocoagulated ulcers, with fibrin deposition, decreased tissue stainability and swelling of the vessel walls, indicating heat-induced damage including cells of the vessel walls. An intravascular occlusive fibrin thrombosis demonstrated in all coagulated ulcers is suggested to be the probable mechanism of hemostasis.

The strain on sutured Achilles tendons in walking cast. An EMG analysis

To evaluate the strain on a sutured Achilles tendon during walking in a short leg cast the EMG activity of the triceps surae muscles was studied. The regression line of the EMG/torque relationship of the triceps surae in the noninjured leg was investigated during isometric contractions with the foot in the same plantarflexed position as the injured foot immobilized in plaster cast. A linear relationship was found between EMG activity (EMG signals converted to rectified mean square values) and torque, measured with Cybex II. The torque provided by the triceps surae of the injured leg was calculated from the registered EMG activity during walking and the regression line. The strain acting on the sutured Achilles tendon was calculated after measurement of the lever arm. There was no significant difference in calculated strain on the sutured Achilles tendon during nonweight bearing in a short leg cast and full weight bearing without external rotation movement of the leg. External rotation movement of the leg during full weight bearing gave increased strain on the sutured Achilles tendon. The actual strain is considered somewhat lower than the calculated one since other muscles than the triceps surae contribute to plantar flexion of the ankle joint. The results indicate that the strain during weight bearing in a short leg cast is unlikely to exceed the strength of a sutured Achilles tendon.

Factors influencing mortality in patients with bleeding ulcer. Review of 7 years' experience preceding therapeutic endoscopy

Over a seven-year period 369 patients with a median age of 67 years were admitted with bleeding peptic ulcer and 41% of the patients required emergency surgery. In 37 low risk patients (24%), defined as patients younger than 70 years without a complicating disease, the mortality rate following emergency surgery was 11% compared to 36% in 118 poor-risk patients (p less than 0.005). A preexisting complicating illness, postoperative complications, and absent history of dyspepsia were calculated to be the three most important factors determining fatal outcome. Age, onset of hemorrhage during hospitalization or prior to admission, previous ulcer surgery, previous bleeds, preoperative endoscopy, site of the ulcer, timing of surgery, and transfusion requirements had comparatively less bearing on the outcome. Hematocrit exceeding 37 in the postoperative period, however, was associated with a significantly increased risk of cardiopulmonary insufficiency. Though surgery controls life-threatening hemorrhage, it is badly tolerated in the many poor-risk patients, and an evaluation of other efficient methods carrying a lower risk of lethal complications seems justified.

Proximal fecal diversion: review of ten years' experience

In a retrospective study, the clinical course of 250 patients subjected to 257 transverse colostomies was reviewed in an effort to evaluate the problems associated with proximal fecal diversion. Morbidity following stomal construction was 28 per cent, with a significant increase when performed in infants or as an emergency. Two-thirds of the colostomies were emergencies, chiefly due to obstruction and free perforation which was associated with a mortality rate of 12 and 48 per cent respectively. In 102 patients undergoing definite colorectal resection with a previous or simultaneous transverse colostomy, the overall morbidity rate was 58 per cent including a leakage rate of 22.5 per cent. Despite a proximal defunctioning colostomy, surgical intervention was required in 12.7 per cent with a fatal outcome due to peritonitis in 3.9 per cent. Colostomy closure was associated with a morbidity rate of 57 per cent, comprising a leakage rate of 10 per cent and a mortality rate of 1.7 per cent. Apart from incurable cancer and deaths prior to closure every third patient kept the transverse colostomy permanently. Advanced age and poor condition of patients not proceeding to a definite treatment, or an underlying benign lesion were the three most determining factors. The present results indicate a too extensive use of transverse colostomy, emphasizing the need for a circumspect initial selection of patients for diversionary procedures.