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Bump To Birth

The experience that a woman has during childbirth shapes how the rest of her child-raising experience goes, in many ways. A good birth can have a huge effect on how good you feel about your child, whereas a bad birth can often lead to feelings of sadness or PDST-type symptoms due to the pain and struggle of the birth experience. However, you don't need to worry about that now, because the information in this book gives you ALL of the experience and expert advice that you need in order to have a really amazing birth, that really marked that day as the truly special day that it is. This book teaches you how to use natural, holistic remedies to heal yourself during pregnancy in order to make sure that you feel your best during the whole birth experience. You can also learn everything you need to know about natural birth Everything you need to know to have a great pregnancy and birth is in this guide! Continue reading...

Bump To Birth Summary


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Birth Rates

Preterm birth is an example of a condition in which disparities among individuals of different races and ethnicities exist, with the largest and most persistent disparity occurring between Asian or Pacific Islanders and non-Hispanic black women, who have overall rates of preterm birth of 10.5 and 17.9 percent, respectively (Martin, 2005). As discussed in Chapter 4, some evidence suggests that genetic factors may play a role in the disparities in preterm birth rates by race-ethnicity. However, the evidence by no means proves that genetic factors contribute to these disparities. The most direct way to study whether genetic factors vary among racial-ethnic groups is to find variants that influence susceptibility to the risk of preterm birth and then to assess whether these variants differ in frequency or effect across populations.

Early Growth and Later Obesity Risk

Already in the 1950s, McCance and Widdowson showed that alterations in early growth by manipulating the feeding conditions of piglets during sensitive pre- and postnatal periods predetermined their ultimate weight in adulthood 16 . In humans high birth weight has been proposed as a risk factor for later overweight 17, 18 , which could reflect both the roles of genetics and early priming by intrauterine environment. Additionally recent studies pointed to further priming of childhood overweight in the first 2 years of life by a high postnatal weight gain 19-22 . In order to assess the best anthropometric predictor from birth to 2 years for later overweight, we performed a cohort study in Bavaria, southern Germany, on 4,235 German children aged 5-6 years Weight gain from birth to age 2 years is the best predictor of overweight at school age. Adapted from Toschke et al. 24 . participating in the obligatory school entry health examination in 1999 2000 23 . Overweight at school entry was...

Institutional records

Records generated by health facilities can provide much useful information about the demand for and utilization of health services and about the extent to which various target groups within the population are being served. For example, what proportion of eligible children have been immunized How many pregnant women received antenatal care and gave birth under the supervision of trained personnel Such information can be used to plan, monitor and modify the health services. By relating the performance of the institutions to their resources, one can monitor efficiency and guide health policy. For a discussion of the use of statistics in monitoring the performance of health services, see Chapter 10.

Newer cognitive approaches

Still other critics fault social-cognitive theory for oversimplifying cognition as well. In recent decades, cognitive psychology has been strongly influenced by technological advances in both computer science and neuroscience. This combination of cognitive psychology and neuroscience has given birth to a brand-new field cognitive neuroscience. The hybrid field attempts to unite the study of the mind with the study of the brain. It looks at both psychological and physiological aspects of memory, sensation, perception, problem solving, language, motor functions, and thought. There is even a subspecialty called social-cognitive neuroscience, which looks specifically at the mind brain processes involved in social learning and interpersonal communication.

Arteriovenous fistulae and malformations

H Presentation is variable, depending on the site and size of the AVM and symptoms may be due to local, peripheral or systemic effects (see below). Congenital AVMs involving the skin are often visible from birth (haemangiomas appear 4 weeks after birth). Malformations usually grow with age, often during puberty or pregnancy in women, and those within internal organs may only be detected once complications develop e.g. brain AVMs may cause haemorrhage, epilepsy or a neurological deficit. Other presentations include varicose veins, limb swelling or pain.

Data sources and collection methods

When censuses or vital registration systems are lacking or incomplete, population-based surveys provide the most reliable fertility data. Survey estimates may be derived from questions on births within a specified period prior to the survey or from birth histories. One advantage of using survey data is that, when complete birth histories are obtained from women, it is possible to examine trends using a single survey. This is especially important in countries where vital registration is incomplete or a series of population censuses does not exist. The main disadvantage with birth history data is that they depend on complete and accurate

Analysis and interpretation

The main strength of the TFR is that it is a single summary measure that is independent of age structure, unlike the general fertility rate that only partially controls for age structure and the crude birth rate that does not do so at all. It is thus useful for international comparisons and for monitoring trends over time. It should be emphasized, however, that the TFR is a hypothetical measure of completed fertility in cases of rapid fertility transition its value is primarily illustrative.

Public Health Databases

Fortunately, the change in gestational age determination from the use of LMP to ultrasound-based data has less of an effect on the preterm birth rate than it does on the birth rate for postterm infants born after 41 weeks gestation. Studies agree that this shift decreases the post-term birth rates, but the increase in the preterm birth rate is less (Goldenberg et al., 1989 Kramer et al., 1988 Savitz et al., 2005 Yang et al., 2002c). The timing of the ultrasound assessment is important ultrasounds early in pregnancy increases the number of births determined to be full term by LMP but reclassified as preterm by ultrasound assessment more than ultrasounds late in the pregnancy. Multiparous mothers and mothers with small stature, diabetes, and high prepregnancy BMIs and fetuses with chromosomal anomalies were more likely to have large ( 7-day) discrepancies between LMP- and early ultrasound-based gestational ages (Morin et al., 2005). Thus, a gradual shift toward the use of prenatal...

Clarifying Mortality Rates

If more infants are born alive at the limit of viability but die within days of delivery, thereby contributing to infant deaths, then a small rise in the infant mortality rate should not be viewed with alarm. It might generate a discussion of relative costs (emotional as well as financial) and how limited health care resources should be used, but it is not an indicator of worsening child health. Similarly, intensive prenatal care of high-risk mothers facilitates the detection of fetuses whose adaptive systems become overwhelmed by adverse intrauterine circumstances. An indicated preterm delivery that prevents a fetal death is not an indicator of worsening infant health, even if it does contribute to a higher preterm birth rate

Lan Zhao Francis Bahaa Martin Wilkins

Abstract The integrity of the pulmonary vascular endothelium plays a key role in pulmonary vascular homeostasis. In particular, reduced endothelial-derived nitric oxide (NO) bioavailability is implicated in the pathogenesis of pulmonary hypertension. Recent studies in complementary murine genetic models provide clear evidence that tetrahydrobiopterin (BH4), a cofactor for endothelial nitric oxide synthase (eNOS), is a key determinant of NO production in pulmonary vasculature and that lack of BH4 leads to increased superoxide production. Congenital deficiency of BH4 in the mouse is associated with structural changes in pulmonary vessels from birth and pulmonary hypertension in the adult. Conversely, increased local production in vascular endothelium protects against hypoxia-induced pulmonary hypertension. The data suggest a possible therapeutic role for BH4 in the management of pulmonary hypertension.

Marital Status And Cohabitation

Pregnancy in unmarried women has been associated with a higher risk of preterm birth (Blondel and Zuber, 1988 Holt et al., 1997 Luo et al., 2004 Olsen et al., 1995 Peacock et al., 1995 Raatikainen et al., 2005 Wen et al., 1990 Zeitlin et al., 2002). The rates of preterm birth for unmarried and married women were determined by using NCHS data for the 1998 to 2000 U.S. birth cohorts. As shown in Table 4-1, preterm birth rates are higher for unmarried women than for married women across all racial-ethnic and age groups. TABLE 4-1 Preterm Birth Rates (percent) for Married and Unmarried Women, by Maternal Age and Race-Ethnicity, 1998 to 2000_ TABLE 4-1 Preterm Birth Rates (percent) for Married and Unmarried Women, by Maternal Age and Race-Ethnicity, 1998 to 2000_ Approximately 40 percent of births that occur outside of marriage now occur to cohabiting couples (CDC, 2000), and the rates of cohabitation have been increasing in the United States within the last few decades. Several studies...

Homozygous or Double Heterozygous Recessive Conditions

PGD is of special value for dominant conditions and those couples with one homozygous or double heterozygous affected partner, when only a 50 chance of having an unaffected child may be expected. This was first applied for a couple with compound heterozygous male partner affected by phenylketonuria (PKU) and female partner carrying the third PKU mutation 30 . One in every 10,000 infants in the United States is born with PKU, an inherited metabolic disorder that causes mental retardation if untreated. When infants are fed a strict diet from birth, they have normal development and a normal lifespan. However, a strictly controlled diet must be maintained, especially during pregnancy in female patients to avoid potential detrimental effects on the fetus. Because of considerable progress in screening newborns for PKU and dietary modification treatment, PKU has not often been included in prenatal diagnosis. With the introduction of PGD, which enables couples to have a healthy pregnancy,...

Policy Leading to Increased Availability of Services

The 1990 RAMOS study that focused on maternal mortality helped galvanize the efforts behind these changes knowledge that the MMR was 182 gave the Ministry of Health a rude awakening (Danel 2000). Targeting regions of the country with the highest MMRs (regions 2, 5, and 6), the government, with donor assistance, built seven new rural area hospitals and, with community input, five maternity waiting homes attached to rural hospitals as well as eight new birthing centers. The number of urban medical health centers (CESAMO) and rural health centers (CESAR) also increased. While these health centers do not provide delivery care, they do offer prenatal care and referrals for hospital delivery for high-risk women. Throughout the country, an increase in the number of health personnel, especially auxiliary nurses, accompanied the rise in facilities. More training was offered. The training of the clinical staff, along with community health workers (including the TBAs), focused on recognizing...

Reducing Rates of Multiple Gestation

A recent study examined the results of approximately 200 IVF cycles in which patients had either one or two embryos transferred. Results revealed similar implantation and live birth rates and a significant reduction in the number of twins conceived with single embryo transfer (Criniti et al., 2005).

Body Composition during the First Year of Life

However, the Fomon model, which provided data from birth to 10 years of age, was presented as preliminary and crude because it was based on quite a limited data set. Since that time, several studies have evaluated whole body composition during infancy using different techniques. TOBEC reference values were provided by de Bruin et al. 13 . DEXA reference values were determined by Koo et al. 25 as well by our group 23 . More recently Olhager et al. 2 evaluated MRI data during the first 4 months of life, and a longitudinal study of human body composition during the first 2 years of life was reported by Butte et al. 7 using a multi-compartmental system.

The Biopsychosocial Development of Individuals

The neuroanatomically manifested developmental changes described above are accompanied by changes in cortical functioning as manifested in the EEG. More than 60 years of work using EEG have demonstrated a systematic increase in EEG wave frequency, in EEG coherence between regions, between hemispheres, and between anterior and posterior areas, and in dimensional complexity during wakefulness, from birth to adulthood 14-16 .

Detecting Stability and Causes of Change in Population Density

The concept of a balance of nature goes back to the very early days of ecology. It is obvious that unlimited capacity of all animals to increase in population size or density is inevitably checked by competition for resources or the action of natural enemies. If any of these factors cause systematic changes in survival or fecundity of a population as the density increases, they are said to be density dependent. If fecundity or survival decreases sufficiently as the population increases, then the per capita birth rate will decline to a value equal to or less than the per capita death rate and population growth will stop. In this manner, density-dependent processes constitute negative feedbacks on population growth that can maintain densities at or near an equilibrium value indefinitely.

Supporting indicators

Births attended by skilled health personnel and proportion of institutional deliveries (deliveries occuring in medical facilities among all deliveries) are important supporting indicators. Where skilled care for pregnancy, childbirth and early postnatal care is lacking, perinatal mortality is expected to be high. When no data are available, historical and current experience shows that early neonatal deaths represent half of infant deaths, and one can estimate by assuming that the perinatal mortality rate is as high as the infant mortality rate. Probably just under half of deaths occur before or during birth and the remainder in the first week of life.

InsulinIGF1 Signaling

Among the most extensively studied mouse models of delayed aging are the Ames and Snell dwarf mice, which harbor mutations in transcription factors that regulate pituitary development. Such mice are among the longest lived of all the delayed-aging mouse models, showing life span increases of 50 to 70 and postponement of all major age-related pathologies. Both models are deficient from birth in several

Life Span Patterns Humans and Primates

Estimates based on regressions of anthropoid primate subfamilies or limited to extant apes indicate a major increase in longevity between Homo habilis (52-56 years) to Homo erectus (60-63 years) occurring roughly 1.7 to 2 million years ago. The predicted life span for small-bodied Homo sapiens is 66 to 72 years (14). From a catarrhine (Old World monkeys and apes) comparison group, a life span of 91 years is predicted when contemporary human data are excluded from the predictive equation. For early hominids (family of bipedal primate animals comprising recent man, his ancestors, and related forms) to live as long or longer than predicted was probably extremely rare the important point is that the basic Old World primate design resulted in an organism with the potential to survive long beyond a contemporary mother's ability to give birth. This suggests that postmenopausal survival (Chapter 10) is not an artifact of modern life style but may have originated between 1 and 2 million years...

Metals And Metalloids

Contradictory results were obtained in pairs of studies on exposures to cadmium and arsenic in drinking water. Cadmium concentrations at the time of delivery were significantly higher in maternal blood but not in the myometriums or the placentas of women who delivered preterm (n 13) than in those of women who delivered at term (n 11) (Fagher et al., 1993). In a study of women (n 44) living in a cadmium-contaminated region of China in which the median concentrations were used to form the comparison groups, there were no significant differences in preterm birth rates between women with higher cadmium concentrations and women with lower cadmium concentrations in maternal blood, umbilical cord blood, or the placenta (Zhang et al., 2004).

Protein Intake and Growth

Raiha et al. 9, 10 published studies in which normal term infants were fed either human milk, a standard formula (protein 15g l, 2.2g 100kcal), or a formula with reduced protein content of 12 g l (18g 100kcal). Growth was adequate in all feeding groups from birth to 3 months of age. At 8 and 12 weeks the protein intake was significantly higher in infants fed standard formula when compared to breast-fed infants or the infants fed the reduced protein formula 2.7 vs. 1.6 and 1.7g kg day, respectively. Other studies confirm that formulas with protein concentrations of 11-12 g l or 1.6-1.8g 100kcal result in adequate growth rates 13, 15, 19 .

Intranational and International Comparisons

Large variations in infant mortality rates exist among different geographical regions as well as among racial and ethnic groups (Alexander et al., 1999 Allen et al., 2000 Carmichael and Iyasu, 1998 Joseph et al., 1998) (Chapters 1 and 2 and Appendix B). The United States ranked 28th of 37 industrialized nations in infant mortality in 2001 and has a higher rate of low birth weight. Although increasing preterm birth rates and racial and ethnic disparities in the rates of preterm birth have been implicated, methodological factors are contributors to these differences (Chapter 2 and Appendix B). For example, efforts at resuscitating infants born at the lower limit of viability, thereby classifying them as live births (not stillbirths), increases the rate of infant mortality because so many infants born before 24 weeks of gestation die (Alexander et al., 2003 Martin et al., 2005 MacDorman et al., 2005). The dearth of international comparisons of preterm birth rates is due to similar...

Policy Guiding Action

The policy approach to dayas (traditional birth attendants) has also varied. In 1912 Egypt's first daya school was opened by the 1930s, health centers had daya schools attached. However, in 1954 the government issued a decree to gradually abolish these schools, and by 1962 all had been closed (Hefni and Kassas 1991). Etman and colleagues (1984) note that in 1969, the Egyptian Ministry of Health, confident that sufficient numbers of trained nurses and nurse-midwives were available, revoked the licensure of indigenous dayas. Despite these legal restrictions, dayas at that time attended over 90 percent of deliveries in Egypt. Since the early 1980s, however, activities aimed at training dayas, rather than excluding them, have been undertaken, including programs under the auspices of UNICEF and the Child Spacing Program of the Egypt Ministry of Health (Ricter 1992 UNICEF 1985). These have emphasized avoiding harmful practices and the early detection and referral of women with obstetric...

Demographic Variation

Other considerations affect persistence. The value of R (the birth rate minus the death rate) is critical. R can be negative (death rate exceeds birth rate) and the population can still persist for 100 years, which may seem counterintuitive. Furthermore, R can be positive (birth rate exceeds death rate) and the population can still go extinct. For example, suppose R is increased to 0.02 by making the birth rate 0.51 and the death rate 0.49. The persistence for A0 20 increases

Oxytocin And Argininevasopressin

AVP has prominent roles in controlling fluid balance via its effects on the kidney and regulating blood pressure via its vasoconstrictive effects on blood vessels, and can directly promote the sensation of thirst. AVP also promotes the release of ACTH from the anterior pituitary in the presence of CRF, and is released following stressful stimuli 116 . In humans, oxytocin is predominantly involved in controlling smooth muscle contraction during both breast-feeding and parturition (myometrium). In rodents, oxytocin promotes a number of reproductive (grooming, arousal, lordosis, orgasm, nesting, birthing) and maternal behaviours. Although there are marked species differences in the effects of oxytocin, central infusion of this peptide in females of a monogamous prairie vole species promotes lifelong pair bonding in the absence of mating. Furthermore, pair bonding in this species, which normally accompanies mating, can be blocked by oxytocin antagonists, thus implying a key role for...

High Protein Intakes High PER and Obesity

Rolland-Cachera et al. 18 were the first to propose an early adiposity rebound as a first predictor of later obesity in infants. They speculated that the age at body mass index rebound may be influenced by the amount of protein supplied in the 10- to 24-month period 19 . They investigated 112 French children who were measured for weight and length and skin-fold thickness (two sites) at 10 months, 2, 4, 6 and 8 years of age. At 2 years of age, protein intake as percent of energy was

Population Differences

Wu et al. (1983) 40 presented a comparative study performed in the Qingnan area and Aljin Mountains at altitudes between 3050 m and 5188 m. Four different ethnic pediatric populations (from birth to 14 years of age) who have been at altitude for varying lengths of time but reside at equal altitudes were studied. It is interesting to note that there is a relationship between population prevalence of PHAHD and duration of altitude residence. The prevalence of PHAHD is markedly lower among native Tibetan children than in Han, Kazakhi or Mongolian children at comparable altitudes in Tibet (Table 1).

Treatment and Prevention

To avoid the disease, it is common practice for Han mothers to descend to their lowland homes to give birth and then entrust their child to the care of elderly relatives, because the Han mother must return to altitude and work. The child is then not brought to high altitude until is it over a year old or more. If some Han mothers must to give birth at high altitude for economic or personal reasons, the newborns should be under the care of the hospital. Establishing an oxygen enrichment room for infants is extremely necessary in Tibet. Nutritional supplements such as carbohydrates, proteins, iron and vitamins are necessary both for pregnant women and for infants. Prevention of respiratory infections is more important in children at high altitude.

Medical Care Costs Due To Preterm Birth Birth to Early Childhood

Less research has been conducted on the medical care expenses of preterm birth beyond early hospitalization. Comprehensive data on medical care delivery and cost for the cohort of infants born between 1998 and 2000 who were covered by Intermountain Healthcare (IHC) Health Plans and who were monitored from birth through 2004 afforded the opportunity to analyze inpatient and outpatient medical care costs associated with preterm birth from birth to age 7 years, well beyond the term covered by any previous study in the United States. In making national estimates, it would have been preferable to have data from several rather than from a single health plan. Resource constraints faced by the committee precluded the incorporation of data from additional plans. As noted below, however, substantial effort was undertaken to stratify the sample and adjust estimates so as to make valid approximation of costs for the nation as a whole.

The Magnitude of the Problem

Fortunately, well-defined preventive and curative interventions exist for a large series of identified causes of death 18 . Those interventions can be delivered through the health sector with maternal education or birth control. In addition to immunization and specific treatments, nutritional interventions include appropriate use of breastfeeding and complementary feeding, and supplementation such as a pharmacological dosage of zinc and vitamin A. It is of note that other nutritional interventions are not considered in the analysis, and for this reason they will be discussed below. As a result of extensive analysis, 23 interventions were proven to be effective in a context of middle or low income countries identified. They were then put into an economic model where 18 contacts between the child or mother and a health care provider were incorporated into a delivery timetable from birth to 5 years of age 19 . The conclusion was that approximately USD 5 billion in new resources is...

Disability Specific Costs Beyond Early Childhood

The net effect was to reduce the total lifetime medical costs associated with these conditions by less than 5 percent. Because the age categories used in the developmental disability cost study made it difficult to accurately carve out medical care costs for 6- and 7-year-olds separately, cost estimates for those 6- and 7-year-olds were subtracted from the overall medical care costs for preterm birth provided above to avoid double counting. Estimates of the costs at each age were discounted at a rate of 3 percent to the year of birth. Adjustment for the prevalence differences between term and preterm birth by condition and application of the algorithm for multiple disabilities discussed above yielded a total of 976 million in lifetime incremental medical care costs associated with preterm birth after age 5 years, or nearly 2,000 per preterm birth. The addition of these costs to the national costs of preterm birth from birth to age 5 years yielded a total national cost...

Countries With Legislation That Specifically Addresses

France has adopted two laws covering human embryo research and the practice of PGD (Viville & Nisand, 1997). French law permits human embryo research in exceptional cases and only if the study represents a direct benefit to the embryo under study, especially in terms of improving its chance of implantation, or if knowledge concerning the physiology and pathology of human reproduction is enhanced. Embryo research cannot be performed to modify the embryo's genome or alter embryonic development. A second law specifically concerns the practice of PGD. This act differs from other nations' laws by linking the practice of PGD to prenatal diagnosis and not to research on human embryos. The conditions under which PGD may be practised are strict (1) centres must be licensed for PGD and ART-IVF and their activity is subject to an annual evaluation (2) the couple seeking PGD must have a high probability of giving birth to a genetically affected child (3) the genetic defect must be of a particular...

Induction of labor and intrapartum fetal distress

Many cases also arose in the context of induction of labor for pre-eclampsia with the subsequent development of intrapartum ''fetal distress.'' The alleged ''fetal distress'' resulted in a brain-damaged infant or an intrapartum fetal death. When a decision is made to intervene by induction of labor for pre-eclampsia, each pregnancy should be assessed for the prospects of safe vaginal birth. If, for example, there is clinical evidence of intrauterine growth impairment and or oligohydramnios, Cesarean may be the preferred route of delivery to avoid the downstream consequences of abruption and or intrapartum fetal distress.

Stateofthe Art Psychiatric Rehabilitation Day Programming

The development of a nationwide network of clubhouse programs helped give birth to the psychosocial rehabilitation movement. The clubhouse network was also instrumental in the creation of the International Association of Psychosocial Rehabilitation Services (IAPSRS), now USPRA. Today, some clubhouses belong to both USPRA as organizational members and to the national clubhouse movement, the ICCD.

Surgical Treatment of Female Infertility

Periadnexal Adhesions

Fimbrioplasty is performed for the treatment of fimbrial phimosis, which is a partial obstruction of the distal end of the fallopian tube. The tube is patent, but there are adhesive bands surrounding its terminal end. The procedure involves dividing the peritoneal adhesive bands that surround the fimbria releasing fimbrial agglutination. In one series, treatment of severe fimbrial phimosis with laparoscopic fimbrioplasty resulted in 51 intrauterine pregnancy rate, 37 live birth rate and 23 ectopic pregnancy rate at two years of follow-up. In general, salpingostomy is recommended only for young women with mild distal tubal disease. Tubal surgery has the advantages of allowing for several pregnancies from a single procedure with no increase in multiple birth rate. In vitro fertilization is a better alternative for older patients, patients with severely damaged tubes and those with infertility due to multiple etiologies. The presence of hydrosalpinx reduces the probability of achieving a...

[44 Insulysin and Pitrilysin Insulin Degrading Enzymes of Mammals and Bacteria

Thymus, and uterus.26'27 Studies using in situ hybridization revealed high levels of IDE mRNA in the liver and kidney of rats.28 There was also a high level of message in the adrenal cortex from birth to adulthood in the rat and in the brown fat of rat pups. On a per cell basis, the highest levels of IDE mRNA were found in germ cells, in the egg cell in females and spermatocytes in males.

The Impact of Insurance on Use of Services

The analysis by quintile shows that the poorest segment of the population has increased use of skilled birth attendants and of health facilities for birthing. However, the poorest segment has the longest way to go to be covered by a skilled provider in birth as of 1998, approximately 80 percent of the poorest were still outside of services. Most of the insurance funds are covering the costs of those better off, nearly all of them using skilled care for birthing.

Medical Interventions

Early diagnosis of preterm labor has been pursued with the expectation that the use of to-colytic drugs to stop labor would be more effective if they are given early, before significant cervical changes occur. The results of an initial experience that used a program of preterm labor risk assessment and education of at-risk women about preterm labor were favorable (Herron et al., 1982), but larger trials of similar interventions with diverse populations found no benefit (CWGP, 1993 Mueller-Heubach and Guzick, 1989). This approach was expanded by using sensitive electronic monitoring of uterine contractions at home accompanied by daily nursing contact, but the intervention had no effect on eligibility for tocolysis, the rate of preterm birth, or neonatal outcomes in large randomized controlled trials conducted with women at risk (CHUMS, 1995 Dyson et al., 1998 Hueston et al., 1995). The largest such trial (Dyson et al., 1998) enrolled 2,422 women with an increased risk of preterm birth,...

Cognitive Behavioral Therapies for PTSD

A patient's daughter was born premature and suffered severe complications during the birth process. The child nearly died but was saved by aggressive intervention by hospital staff. She was eventually discharged and scheduled for a follow-up appointment in a couple of weeks. The patient was unable to take the child to the appointment, and after several reschedules the treating pediatrician consulted with a psychologist. The mother agreed to see the psychologist and, after several sessions, was finally able to take her daughter to the hospital for her follow-up visits. Here is an excerpt from the treatment

Womens Perspective on Use of Services

In focus groups, women listed several factors that prevent them from giving birth in hospitals. They include feelings of embarrassment and fear of the hospital's negative image, the lack of money to pay for transportation and hospital services, bad roads, lack of transport or fear of crime at night, no one to care for their children, and short duration of labor. Facilitators for accessing birth at a hospital include referral by a TBA or health personnel, concerns for safety, complications, and the ability to meet their need for surgical sterilization.

Comparison of pregnancy in rodents and humans

Many of the features of pregnancy in rodents are different than in humans, such as a gestation length of 3 weeks versus 9 months and the fact that rodents usually give birth to litters rather than singletons. Despite these obvious differences, however, the fact that rodents can develop pre-eclampsia shows that there is more in common between rodents and humans than is widely appreciated. A number of anatomical and physiological features of pregnancy are similar in humans and rodents (Table 14.1). At a structural level, the conceptus in rodents, as in humans, invades into the uterine wall after implantation and promotes increased maternal blood flow to the implantation site by promoting both increased blood vessel formation (angiogenesis) and vasodilation (Cross et al., 2002). The outermost cells of the rodent placenta (trophoblast giant cells) are analogous to extravillous cytotrophoblast cells in humans invade

Your Environment Your Fertility Is There a Link

Changes in fecundity and impaired fecundity in the US have been examined by comparing responses to the National Survey for Family Growth (NSFG) in 1982, 1988 and 1995. This analysis found increases in impaired fecundity over that time period, and the authors suggested that this change was due to more couples voluntarily delaying child-bearing. We questioned that interpretation, however, since the greatest increase in impaired fecundity was seen in women under 25, precisely the age group in which subfecundity, because of delayed childbearing, would be least likely. These data suggest that, at least in the US, fecundity declined between 1982 and 1995. Limited data have recently become available from the sixth cycle of the NSFG. However, data on live birth rates between 1990 and 2000 suggest a reversal of the decline seen in previous reports. This reversal is seen across race ethnic groups and for most age groups. Data on impaired fecundity, perhaps the most relevant statistics for...

Other Social Programs

Singleton pregnancies) has been reported over the past 30 years. The proportion decreased from 8.3 percent in 1972 to 6.8 percent in 1976, to 5.6 percent in 1982, to 4.9 percent in 1988. This decrease was more notable for preterm births less than 34 weeks. In addition, spontaneous pre-term births decreased, while indicated preterm births increased. As discussed in the Introduction, it is difficult to draw comparisons of preterm birth rates among various countries because of differences in measurement of gestational age, reporting of fetal deaths and live births which affect preterm birth rates, and variations in maternal characteristics and behaviors, social environment, and health services. Pregnancy in unmarried women has been associated with a higher risk of preterm birth. Public policies can influence family formation. For example, the marriage penalty under current Earned Income Tax Credits (EITC) or TANF programs and state child support policies may discourage family formation...

Unique Features of Plants

Historically, the demography of plants was considered to be relatively intractable because of this variation in growth forms, specifically because an individual is sometimes difficult to delineate. For unitary species, identification of an individual is not difficult and age- or size-specific mortality and reproduction are relatively easy to follow. For species with clonal growth, Harper (1977) introduced the term genet to refer to all individuals that were derived from the same zygote, and ramet as the modules of a genet, which may in some cases become severed from the parent plant and grow as independent individuals. As long as the birth rate of ramets exceeds the death rate, a genet will survive in the population. Ramet demography may, in some cases, act as a buffer for the dynamics of a genet. In a computer simulation based on several years of data from populations of Ranunculus repens, it was found that the decay rate of the genet can be buffered by the decay rate of the ramets,...

Complications of Radioiodine Treatment

Order Thyroid Cancer Severity

There is no significant difference in observed fertility rates, birth rates, or premature delivery among women treated with radioiodine compared with those who have not received 131I. In our series of 496 patients, temporary amenor-rhea and minor menstrual irregularities were seen in 20 427 normal children were born to 276 women and only one patient was unable to conceive 99 . On the basis of these data there is no reason for patients who are treated with radioiodine to avoid subsequent pregnancy.

Women of Freudian psychology

Sigmund Freud's words, written to his friend Wilhelm Fleiss (also his cocaine-supplier) in 1895 upon the birth of his daughter Anna show the bias encountered by early female psychologists. From birth, Anna had a poor relationship with her mother and siblings, describing herself as not part of them, but not her famous father. Early in life, Anna became her father's favored child and showed herself to be brilliant. She was self-taught for the most part as she hated school, but availed herself of the many members of the intelligentsia that frequented the Freud household. (In her teens she spoke five languages.) At 14, she wrote to her father I have read some of your books, but you should not be horrified by that, for I am already grown up and so it is no surprise that I am interested. Her father's possessiveness and her total loyalty to him kept her tied to him, and she never strayed very far from his rigid beliefs. Anna taught in England, wrote several books, and together with Melanie...

Other defects of the enzymes of the glycolytic system

Triose phosphate isomerase deficiency produces a severe syndrome present from birth, consisting of CNSHA, a progressive neurological disorder with spasticity and CNS degeneration. Cardiac failure and sudden death due to arrhythmias are also features. Death occurs usually about 5 years of age. There is, as usual, some variation, and haemolysis without neurological degeneration, and the opposite, have been described. Splenec-tomy does not appear to be effective in modifying the haemolysis and does not influence the neurological complications. The diagnosis is made based on clinical suspicion, together with the appropriate enzyme assay. A number of point mutations that lead to the syndrome have been identified, but far and away the most predominant is Glu104Asp, a mutation linked by common haplotypes, suggesting descent from a common ancestor.

Evolutionary Approaches A Theories of Senescence

Evolutionary theorists have alternatively suggested that senescence may be a non-adaptive trait which has evolved indirectly as a consequence of a selective premium on genes with favorable effects on survival or fecundity early in the life history. The key element to allow the evolution of senescence is the fact that the force of natural selection on survival and fertility necessarily decreases with age because organisms have a nonzero chance of dying from external causes such as predation and accidents. Medawar (1952) provided the foundation for the major theoretical progress on the evolution of senescence. He suggested that, even in the hypothetical complete absence of senescence, if constant fertility is assumed, the reproductive output of each age class declines with age, because survivorship from birth is a decreasing function of age. As a result, the relative importance of traits expressed at late ages, to the lifetime fitness of an individual, is less than the importance of...

Systemic lupus erythematosus and antiphospholipid syndrome

The management of APS in pregnancy includes low-dose aspirin and unfractionated or low molecular weight heparin (LMWH) (Nelson-Piercy and Khamashta, 2003), although the additional benefit of LMWH over and above aspirin is controversial. The randomized studies examining the efficacy of such strategies have used fetal loss rates and live birth rates as outcome measures (Farquharson et al., 2002 Kutteh, 1996 Rai et al., 1997). Data relating to incidence of pre-eclampsia come predominantly from retrospective cohort studies.

Early Infant and Childhood Interventions

A three-stage stratified sampling procedure was used to identify the original sample for the study. Twenty states were selected on the basis of the number of children served in early intervention and the region of the country. These states represented considerable variation with regard to the lead agency and whether or not the agencies served children at risk. The second stage involved the selection of counties on the basis of the estimated number of children served in Part C programs.1, Three to seven counties were selected within each state, for a total of 93 counties. The children ranged in age from birth to 30 months when they began receiving early intervention services (between 1997 and 1998).

Use of Date of Last Menstrual Period

In addition to biological variations in menstrual cycles, ovulation, and implantation, many other factors contribute to difficulties with the use of LMP for pregnancy dating. Irregular menses, first-trimester vaginal bleeding, unrecognized spontaneous abortions, oral contraceptive use, and recall errors contribute to errors in calculating the duration of a pregnancy from LMP. Mothers who are socioeconomically disadvantaged are more likely to receive late or no prenatal care and to have a poor recall of LMP (Campbell et al., 1985 Dubowitz and Goldberg, 1981 Buekens et al., 1984). As many as 25 to 50 percent of the women in some samples have had difficulty recalling LMP (Campbell et al., 1985). Determination of gestational age by the use of LMP or by the use of clinical estimates thus causes significant differences in the gestational age distributions and in the preterm and postterm birth rates for large populations (Alexander et al., 1995 Mustafa and David, 2001). LMP data are missing...

Summary And Future Directions For Research

The results of more than two decades of observational studies on naturally occurring social support do not confirm a hypothesized link between maternal social support and preterm delivery however, the studies do provide fairly consistent evidence for a direct association between social support and infant birth weight. Similarly, the provision of additional support to pregnant women during controlled intervention studies has not reduced the likelihood that the mother will give birth too early, although it does appear to have other benefits for women's health care and psychosocial adjustment. The few available studies on maternal self-esteem, mastery, and optimism provide little evidence for associations with preterm birth specifically, although the concept of perceived control may be a risk factor. Finally, preliminary research on the association of the intendedness of the pregnancy and preterm delivery suggests that women with unintended pregnancies are more likely to deliver their...

Racial and Ethnic Disparities

Although controversy exists over inclusion criteria for racial and ethnic subgroups, racial and ethnic disparities in preterm birth rates, birth weight distributions for gestational age, neonatal and infant mortality rates, and gestational age- and birth weight-specific neonatal mortality rates have been consistently reported (see Appendix B). In the United States in 2003, preterm birth rates were 10.5 for Asian and Pacific Islanders, 11.3 percent for whites, and 17.8 percent for African Americans (Chapter 1). In 1997, the birth rates for white, Hispanic, and African-American infants with gestational ages less than 28 weeks were 0.35, 0.45, and 1.39 percent, respectively (Alexander et al., 2003). Racial, ethnic, and gender differences in birth weight for gestational age become increasingly prominent as pregnancies approach term (Alexander et al., 1999). At 40 weeks of gestation, birth weight for African-American infants tends to be lower than those for white, Hispanic, and...

Prevention Strategies

33 percent reduction in preterm birth rates Most interventions are based on the traditional medical model of identifying and correcting each potential cause or risk factor for preterm birth, with the expectation that the rate of pre-term births would decline in accordance with the contribution of that factor to the prematurity rate. Intervention trials have thus addressed the early identification of preterm labor through patient education, pharmacologic suppression of uterine contractions, antimicrobial therapy of vaginal microorganisms, the use of cerclage sutures to bolster the cervix, reduction of maternal stress, improved nutrition and improved access to prenatal care, and reduced physical activity. Some trials enrolled women with the risk factor in question without regard to obstetric history (e.g., antibiotics for women with a positive culture for a genital microorganism), whereas others were limited to women with a prior preterm delivery (e.g., the European cerclage trials or...

Neurodevelopmental Disabilities

Early studies focused primarily on cognitive impairment, as measured by intelligence quotient (IQ) and by the detection of motor abnormalities on standardized neurological examinations. A landmark study, the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, monitored 35,000 children born before neonatal intensive care (i.e., in the late 1950s and early 1960s) for 7 years. Although only 177 children born at less than 34 weeks gestation survived, the study documented the increased risk of cognitive and motor impairment as a function of decreasing gestational age (Hack et al., 1993 McCormick et al., 1980). It highlighted the need for neurodevelopmental follow-up of populations born preterm, especially as the emergence of neonatal intensive care and high-risk obstetric care dramatically reduced gestational age-specific mortality rates but not preterm birth rates (see Chapters 1, 2, and 10). The history of neonatal intensive...

Study and Inform Public Policy

A second aspect of public policy is that it can be used to potentially reduce preterm birth rates and improve health outcomes for infants. Public policies have the potential to reduce the rates of preterm birth and improve outcomes for children and families through the financing of health care, the organization of care and improvements in the quality of care, and other social policies. Better measures of the quality of health care need to be developed to enable quality improvement efforts and guide public policy. However, effective public policies will require a better understanding of the determinants of preterm birth.

Evidence Of Genetic Influences On Preterm Delivery

The available literature has provided some evidence of familial and intergenerational influences on low birth weight or preterm birth (Bakketeig et al., 1979 Carr-Hill and Hall, 1985 Khoury and Cohen, 1987 Porter et al., 1997 Varner and Esplin, 2005). A population-based cohort study of data from birth certificates and fetal death certificates from the state of Georgia between 1980 and 1995 suggest that the recurrence of preterm delivery contributes to a notable portion of all preterm births, especially for the shortest gestations (Adams et al., 2000). Analysis of the data from the live birth cohort of the 1988 U.S. National Maternal and Infant Health Survey demonstrated a strong familial aggregation of low birth weight and preterm birth in both white and African-American populations (Wang et al., 1995).

Disparities in Infertility Treatment

In an effort to assess whether racial-ethnic or socioeconomic disparities exist in infertility, impaired fecundity, or infertility treatment, Bitler and Schmidt (2006) analyzed data from the National Survey of Family Growth. The authors reported that infertility was more common for Hispanic, non-Hispanic black, and non-Hispanic women of other races than for non-Hispanic white women. In addition, results suggested disparities by educational attainment. Non-college educated women were more likely to experience problems with infertility and impaired fecundity than women with 4-year college degrees. Despite a higher likelihood of fertility problems for minority and socioeconomically disadvantaged women, these women were less likely to have ever received infertility treatment. Further, state-level infertility insurance mandates (currently in place in 15 states) did not ameliorate these disparities. Within a population of women receiving ART services in the military health care system,...

Tetrahydrobiopterin as a Therapeutic Target

We cannot exclude the possibility that the pulmonary changes in the hph-1 mice occur at the transition from birth to neonatal life, or that BH4 has a particularly critical role in lung development. As such, BH4 deficiency may have a more important role in the pathogenesis of persistent pulmonary hypertension of the newborn rather than adult pulmonary hypertension. As discussed earlier, eNOS is known to play a critical role in lung development, as revealed in a recent study showing alveolar capillary dysplasia in eNOS-KO mice 29 . Furthermore, mice lacking 6-pyruvoyl-tetrahydropterin synthase (PTPS), the second enzyme in the synthetic pathway for BH4, die from an undefined cause within 48 hours following birth 18,76 . A recent study in lambs has shown that the normal foetal pulmonary endothelium has high levels of BH4 and NO production but BH4 levels fall postnatally, with evidence of eNOS uncoupling and the production of reactive oxygen species in addition to NO 55 . The data suggest...

Agricultural Chemicals

Berkowitz and colleagues (1996) reported the only case-control study that matched for potential confounding variables (maternal age, race, and prepregnancy body mass index) and analyzed other potential confounders in a group of New York women who gave birth between 1990 and 1993. They found no significant differences in first-trimester maternal serum DDE levels for women who delivered preterm (n 20) compared with those for women who delivered at term (n 20).

Evaluation of Body Composition

Nome Dos Componentes Microscopio

Most of our knowledge on the body composition of preterm infants is derived from body carcass analyses of stillborn preterm infants. The first values were reported in 1877, and thus far 169 infants have been analyzed 3 . However, not all analyzed fetuses can be considered for reference material because gestational age, and time and cause of death were either not reported or may not have been accurately obtained. Nevertheless, more recent studies using various technologies have confirmed the chemical analysis data and validated the interest in the evaluation of intrauterine reference values of whole body composition and in the determination of the postnatal nutritional requirements for preterm infants. With the exception of the composition of a 4-year-old male who died of tuberculous meningitis, no data on whole body chemical analyses are available from birth until adulthood and our knowledge during the first year of life is derived from indirect methods 4, 5 .

Public Safety and Public Health Outcomes

More logical to believe teenage birth rates rise because of irresponsible sex practices that increase when men are in short supply, rather than the mere presence of many men who have been released from prison). In addition, ethnographic work in Durham confirms that the distorted ratio of young women to sexually desirable male partners has distorted the patterns of sexuality in these places.

Perinatal Mortality of Infants Born at the Limit of Viability

Categorization varies from region to region and even among health care providers at the same institution. A willingness to resuscitate a very immature infant who has a transient heart beat or gasp at delivery changes the classification of that infant from a fetal death to an infant death. This type of change in how an infant is classified has only a small impact on the preterm birth rate (because so many more infants are born after 26 weeks gestation), but could contribute substantially to rising U.S. Infant Mortality Rates. The use of perinatal mortality rates (the number of deaths of infants with gestational ages greater than 20 weeks 1,000 total births) may be a more useful measure of the outcomes of very preterm infants, since it includes infants who are stillborn and infants who die immediately after birth. Marked regional variations in the management and the rates of survival of infants born at the lower limit of viability and variations in the methods used to estimate...

Memory and Unconscious

The discovery of the implicit memory alongside the explicit, declarative one raises the question of a dual memory system with different brain circuits and functions. This then suggests the idea of a dual unconscious system operating in a person from birth this would contain in particular the infant's experiences immediately before birth, particularly its mother's rhythms and voice, especially the tone of the voice, which the fetus memorizes, and intersubject relations in the infant's first 2 years, which have to be relegated to the implicit memory, since the amygdala, which governs our emotions and plays a role in the implicit memory, matures very early, while the hippocampus, essential for the explicit memory, takes at least two years 50 . The child's emotional and affective experiences, fantasies, and defenses in its first 2 years have therefore necessarily to be filed in the implicit memory. These are the building blocks of the early unconscious which cannot be repressed as the...

Pediatric Growth Abnormalities

The primary skeletal toxicity following pediatric irradiation is growth abnormality. Growth abnormalities can be broadly grouped into loss of stature and problems associated with asymmetric growth. The human skeleton grows from birth until late puberty. The growth of the long bones takes place in the epiphyseal (growth) plate. As with several other stem-cell based systems (skin, gut, mucosa, etc.) which contain rapidly dividing cells, cells from the proliferative zone of the growth plate are especially sensitive to radiation injury. Following irradiation of pediatric patients, bone growth retardation occurs beginning at doses as low as 10 Gy, but doses above 15 Gy result in larger and more lasting deficits in stature.44

Theoretical Model of Longevity Extension in Social Species

Improved health and increased longevity in societies sets in motion a self-perpetuating system of longevity extension. This positive feedback relationship is based on the demographic tenet that (all else being equal) increased survival from birth to sexual maturity reduces the number of children desired by parents (15). Because of the reduced drain of childbearing and child rearing, parents with fewer children remain healthier longer and thus raise healthier children. The higher survival rate of these children fosters yet further reductions in fertility. Greater longevity of parents also increases the likelihood that they can contribute as grandparents to the fitness of both their children and their grandchildren. And, the self-reinforcing cycle continues.

Reptation Theory of Pulsed Electrophoresis and Trapping Electrophoresis

In the history of the still-young technique of pulsed electrophoresis experimental, theoretical, and numerical progress are increasingly intermingled. The first key to this field can be traced to theoretical letters of Lerman and Frisch and Lumpkin and Zimm (1,2), who remarked that long flexible chains like chromosomal DNA cannot migrate in gels as random coils, and suggested a reptative-like motion in which chains thread their way among fibers like a snake among roots. They also predicted that large DNA chains orient in the field, and for the first time, made the connection between this orientation and the saturation of the mobility that causes the failure of conventional gel electrophoresis techniques. The idea of fighting this orientation by periodically changing the field appeared for the first time about two years later, in the founding experimental work of Schwartz and Cantor (3), giving birth to the pulsed electrophoresis technique. Detailed developments of the reptation ideas...

Congenital methylmalonic acidaemia and aciduria

The infants with this abnormality are ill from birth with vomiting, failure to thrive, severe metabolic acidosis, ketosis and mental retardation. Anaemia, if present, is normocytic and normoblastic. The condition may arise as a result of a functional defect in either the mitochondrial methylmalonyl coenzyme A (CoA) mutase or its cofactor ado-cobalamin (Figure 5.2). Mutations in the methylmalonyl CoA mutase are not responsive, or only poorly responsive, to treatment with cobalamin. Two disorders result in cobalamin-responsive methylmalonic acidaemia. In Cb (cobalamin) 1A disease, there is failure of reduction of Cob(III) (Cbl3+) alamin or Cob(II) (Cbl2+) alamin to Cob(I) (Cbl1+) alamin in mitochondria in Cb1B disease there is a defect of an adenosyltransferase required for synthesis of ado-cobalamin (Figure 5.2). A proportion of the infants with CbIA and Cb1B respond to cobalamin in large doses, whereas the others are unresponsive. In those who do not respond to cobalamin, the enzyme...

Childhood Obesity Project

Growth from birth to age 2 years, a marker of later obesity risk, was chosen as the primary outcome variable. In addition, a variety of further variables are measured, including detailed data on diet, lifestyle and behavior, biochemical and endocrine markers, markers of renal function, and others (fig. 5). Randomization and data collection are performed via the internet based on uniform electronic case report forms, using specially developed information technology architecture with a central database and 12 remote data entry stations as well as dedicated software that enables secure data protection. Mechanisms for quality assurance have also been established. Data input and transfer to the central database are supervised by a contract research organization participating in the project.

The use of health statistics

At a health centre, for example, each service unit should collect and display statistics on high priority problems. The section of the clinic, which treats sick patients, could, for example, show cases of acute diarrhoea in a simple graph so that comparisons can be made day by day, week by week, and month by month. These statistics may alert the staff of the institution to sudden changes in the number of cases of a particular disease and it could provide some assessment of the performance of the services. The child welfare clinic should display the number of children they have immunized to show both the uptake over time (by comparing vaccination and birth rates) and the proportion completing the course (by indicating the numbers entering and finishing the programme).

Sources for Further Study

New York Alfred A. Knopf, 1983. Skinner published his autobiography in three separate volumes, listed as the three previous titles. The first describes his life from birth, through his college years, to his entering Harvard University for graduate study in psychology. The Shaping of a Behaviorist presents his years at Harvard and his rise to national prominence. A Matter of Consequences begins with his return to Harvard as a professor in the late 1940's.

History of Case Studies

Psychology has been heavily influenced by the natural sciences. Since the natural sciences gave birth to the scientific method a particular technique for gaining knowledge which includes the testing of hypotheses in ways that can be verified it is not surprising that psychology adopted a modified version of the scientific method that could be applied to the study of people and other organisms. It soon became apparent, however, that not all situations lend themselves to study by an experiment. Thus, it was important for alternative methodologies to be developed and used. The case study is an outgrowth of this quest to find alternative methods for studying complex phenomena.


The fact that the diet supplementation with folic acid or folic acid-containing multivitamins may substantially reduce the population prevalence of four groups of congenital disorders, i.e., neural tube defects, cardiovascular, urinary tract, and limb deficiencies, represents an important breakthrough in prevention of congenital disorders. Although more data are needed to further confirm this and investigate the possibility of reduction of other birth defects, such as pyloric stenosis, the impact of folic acid on the prevalence of congenital disorders is in agreement with the fact that (1) mothers who give birth to a child with neural tube defects have mildly elevated blood and amniotic fluid levels of homocysteine, (2) hyperhomocys-teinaemia and or lack of methionine can induce neural tube defects in animal experiments, (3) low maternal folate status appears to be a risk factor for neural tube defects, (4) vitamins of B group including folate folic acid are important in homocysteine...

Population pyramid

The age and sex structure of the population is often displayed in the form of a histogram showing the percentage distribution of each sex at 5-year age intervals. In the past, the shape of this diagram was roughly pyramidal in all parts of the world the base, representing the youngest age group, tapering to a narrow peak in the oldest age group. In developing countries, the shape of the pyramid is determined by the high birth rate and high child death rate in these communities (Fig. 2.1a) with a broad base and a rapid tapering off in the older age groups. In more developed countries, the population pyramid shows more gradual decline, indicating the relatively older population with a low death rate in childhood (Fig. 2.1b).


Ziegler I would like to make two comments regarding the Stettler study. As Dr. Koletzko pointed out, the subjects were studied as infants in Iowa. Although they had a totally different objective, we collaborated with a group in Philadelphia in a telephone follow-up study when the subjects were young adults. We asked the participants about their current weight and height. So their weights are self-reported, with all the reservations one has to have about that. The data showed that overweight status in adulthood was associated with weight gain during the first week of life and with weight gain from birth to 112 days of age, but not from 8 to 112 days of age. We have to conclude that it is really the weight change during the first week of life that predicted later obesity. Now that brings me to my second comment. There is an association between the weight change during the first week of life and later obesity. It does not imply or prove causality, and if there is no causality...

Myotonic Dystrophy

Myotonic dystrophy (DM), also known as Steinert's disease, is a progressive muscular dystrophy caused by an expansion in the number of copies of a CTG repeat in the 3' untranslated part of the DM kinase gene on chromosome 19. The repeat copy number varies from 5 to 37 in normal individuals and from 50 to several thousands in people affected with the disease. Similar to fragile X, intermediate repeat numbers result in an unstable, premutation state mildly affected mothers can give birth to severely affected offspring with the congenital form of the disease.


Like Malaysia and Sri Lanka, the countries reported in this volume also use multifaceted approaches to lower their MMRs, with high availability of skilled birth attendants and supportive facilities where women can go for management of complications being two very prominent features. Targeting resources to increase such availability in geographic areas with high MMRs, as well as intervening with a mechanism that triggers awareness and use of care specifically in cases of high risk or obstetric complications, has proved a successful strategy in Honduras. Reaching an MMR of approximately 100 with only 54 percent of women being aided by a skilled birth

Common pitfalls

Health personnel, in particular whether auxiliary staff or traditional birth attendants have been included, may also account for discrepancies between countries. Although the WHO definition of skilled health personnel (1) is widely used, this only includes a qualitative measure the need for training to result in proficiency. give birth to a live child and exclude fetal deaths and stillbirths, which will give a false positive outcome in terms of ANC.

Race and Ethnicity

Preterm birth rates vary substantially by race and ethnicity in the United States (Martin, 2005). As discussed in Chapter 1, there are significant inter- and intragroup variations in the risk of premature birth. For example, in 2003 the preterm birth rates among Hispanics ranged from 11.7 percent for Mexicans to 13.8 percent for Puerto Ricans. Preterm birth rates also varied by nativity and duration of residence. In 2003, the preterm birth rate was 13.9 percent for foreign-born blacks but 18.2 percent for U.S.-born African Americans (Martin et al., 2005). Even the duration of residence seems to have an effect on preterm birth rates. A study in California found that long-term Mexican immigrants who had lived in the United States for more than 5 years were more likely to deliver preterm infants than newcomers who had lived in the United States for 5 years or less (Guendelman and English, 1995). In general, the literature examining potential causes of racial and ethnic disparities in...

Treatment Options

Services for children from birth to two years of age provide special education as well as access to specialists in the areas of speech and physical therapy, psychology, medicine, and nursing. Assistive technology, physical adaptations, and case management are also offered. Medical management, monitoring, and consultation may be the responsibility of a developmental pediatrician.

Attendance at Birth

By 1997 Honduras had moved to having skilled attendance for the majority of its estimated 191,000 annual births. According to the national epidemiology and family health survey (ENESF), during the five-year period 1992-96, approximately 54 percent of women giving birth had a skilled attendant, while 39 percent were attended at home by a traditional birth attendant and 7 percent received no assistance whatsoever (ENESF 1997). Nearly all births with skilled attendance took place in hospitals and were attended by physicians. Less than 1 percent of births occurred at home with a skilled attendant. Approximately 2 percent occurred in birthing centers. In 1998 approximately 2 percent of births took place in birthing centers (Honduran MOH 1999). These centers provide basic essential obstetric care, generally have transport available in case of emergencies, and are staffed by a professional nurse with special training in obstetrics. They are less expensive to maintain than hospitals and bring...


The pitfalls discussed above are also the limitations of this indicator. For example, in some settings there is ambiguity over the definition of skilled health personnel, and births attended by trained traditional birth attendants and private health providers are included in the numerator. It is therefore essential to state which definition is used in each instance, since a change in definition may create difficulties in comparability over time.


In considering the interplay between the use of formal birthing services and the decrease in the MMR, two questions emerge What factors contributed to the slow but steady increase in demand for birthing services from 46 percent in 1987-91 (ENESF 1992) to the point where slightly more than half of women now have skilled attendance during delivery (54 percent) And given that 54 percent is still a relatively low level of skilled attendance, how has the MMR Birthing centers (with their bEOC) are an approach to increasing skilled attendance that should improve the timeliness of referrals for obstetric emergencies. As mentioned above, the first birthing center was constructed in 1985 by 1997 approximately 4,000 births (2 percent of all births) were occurring in these centers (Honduran MOH 1999). The numbers may be relatively small, but it should be noted that many of these birthing centers lie in remote areas with high maternal mortality, areas where women are disinclined to go to a...


In a prospective study where all dental injuries occurring from birth to the age of 14 were registered, it was found that 30 of children had sustained injuries to the primary dentition and 22 to the permanent dentition1. These statistics are age-related. In the primary dentition, the prevalence of injuries ranges from 31 to 40 in boys and from 16 to 30 in girls. In the permanent dentition, the prevalence of dental trauma in boys ranges from 12 to 33 compared with 4 to 19 in girls. Most injuries affect the maxillary incisors and in the majority of cases, only one tooth is affected. An increased overjet with prominent incisors and incompetent lips have been found to be predisposing factors.

Multiple Pregnancy

The Human Fertilisation and Embryology Authority (HFEA) legislates the number of embryos transferred at IVF in the UK and restricts the maximum number to three. There is evidence, however, that transferring only two embryos would reduce the multiple birth rate, without reducing the woman's chance of a pregnancy (Templeton & Morris, 1998). Older age, tubal infertility, longer duration of infertility and a higher number of previous attempts at IVF are all associated with a significantly decreased chance of a birth and of multiple births. As many PGD patients have proven fertility, a two-embryo transfer might be recommended. In general frozen thawed transfers carry about half the rate of success of fresh embryo transfers. It is very unlikely that substantial numbers of unaffected embryos would be obtained which would warrant cryopreservation, so fresh transfer of three embryos is favoured.

Temporal Variation

Another way to decrease persistence is to increase the stochasticity in the model. One way would be to introduce temporal variation by making b and d random variables. Such variation would be exemplified by weather in real populations. Some years, winters are mild and survival and reproduction are high. Other years, winters are harsh and survival and reproduction are poor. To incorporate this phenomenon into our simple model, suppose that the mean birth and death rates are again 0.5, but the values of the birth rate and the death rate at a particular time t are selected from a statistical distribution, say a beta distribution. That is, each year, new values of b and d are selected from a beta distribution.

Family Factors

To achieve relatively low mortality with substantial numbers of home births attended by TBAs or relatives, families need to be able to access emergency care when complications arise. Both the 1992 and 2000 studies show maternal deaths continue to occur because the woman and her family delay in seeking care. Delays complicate the management of the obstetrical emergencies at health facilities. As reported above, distance and lack of transport were rarely unavoidable factors. Therefore the reasons for referral delay or non-


While recent cautions about vaginal delivery following previous Cesarean delivery have resulted in fewer attempts at subsequent vaginal birth, uterine rupture following previous Cesarean is still a recognized complication of subsequent pregnancies. In contrast to the gradual onset of pre-eclampsia, uterine rupture is an acute, often catastrophic, event generally occurring in labor

What Is Osteoporosis

Density and the quality of the bone itself.5 The bone density can be measured and quantified as grams of mineral per volume of bone. The bone quality in turn is determined by the bone architecture, turnover, damage and mineralization. Peak bone mass is the amount of bone at the end of skeletal growth, and bone mass will then decrease throughout life.5 Peak bone mass in men tends to be greater than that in women because men have larger bones and current techniques for measurement do not correct completely for this size difference.4 Although the term 'osteoporosis' implies loss of bone density, this may not be the case. For example, men who are hypogonadotropic from birth may never have developed optimal bone density in the first place, so a low bone density is not related in them to loss of bone, but lack of development. Androgens are necessary for the maintenance of bone mass in adult males, but estrogens are also necessary. These are produced in men by the aromatase conversion of...


The incidence of eclampsia in the United Kingdom and the United States is approximately 5 per 10,000 births (Atrash et al., 1990 Douglas and Redman, 1994). However, at teaching hospitals in Africa, the eclampsia rate is reported around 50 per 10,000 deliveries (Adze et al., 2001 Majoko and Mujaji, 2001), likely an effect of home births and late medical care. Contemporary maternal mortality rates of eclampsia are under 2 in

Functional Outcomes

Later functional outcomes can be expressed in terms of the highest educational level achieved and the transition to adulthood. A study that linked data from the Swedish Medical Birth Registry with the National Service Enrollment Register found that not only did 18- to 19-year-olds born from 1973 to 1975 with birth weights of less than 1,500 grams have higher rates of CP (odds ratio 55.4), mental retardation (odds ratio 1.7), myopia (odds ratio 3.3), and severe hearing impairment (odds ratio 2.5) but they also tended to leave the school system early (odds ratio 1.6) (Ericson and Kallen 1998). Hack and colleagues (2002) found that fewer 20-year-olds born from 1977 to 1979 with birthweights less than 1,500 grams than controls who had normal birth weights graduated from high school or earned general equivalency diplomas (74 and 83 percent, respectively) and that fewer men attended 4-year colleges (16 and 44 percent, respectively). These differences persisted even when the data for those...

Medical Problems

One obvious significant and gender-specific health care issue is the need for adequate gynecological and obstetric services. At least 6 of female prisoners are pregnant when they are arrested. Since not all prisons and jails test all women, the prevalence of pregnancy is likely higher. For example, studies have found that about 18 of female inmates had given birth at some point during a past or present incarceration (Acoca, 1998 BJS, 1999b National Institute of Justice, 2000 Women's and Children's Health Policy Center, 2000).

Anatomic Networks

Important questions regarding the role of a neurodevelopmental disturbance in the induction of altered phenotypes of GABA cells are when and how such changes become manifest during the life cycle in individuals who carry the susceptibility genes for schizophrenia and bipolar disorder. One possibility is that the GABA cells are abnormal from birth however, the clinical observation that most subjects with schizophrenia are relatively normal during childhood and early adolescence argues against this possibility. It is important to emphasize, however, that studies in rat suggest that the cortical GABA system continues to develop until the equivalent of early adolescence 258-262 . Taking these observations together, a second possibility is that the GABA cells are relatively normal during childhood when they are also relatively immature, but become abnormal as their maturation process is completed. A vulnerability gene or genes associated with schizophrenia or bipolar disorder could...

Kellys legacy

One quick search through the worldwide web of the early twenty-first century can provide an extensive view into the revolution that Kelly brought into being with one book, as well as the many branches of disciplines using constructive philosophy as their basis. Kelly did something more complex than simply giving birth to other psychological trends or theories. His basic system spawned a far-reaching network of other construct theoreticians and practicing clinicians. It was as if he created the design of a building that set a standard for numerous variations of that architecture possibly for generations to come. Centers throughout the world are dedicated to personal construct psychology. As of 2004, the major centers and organizations around the world that were dedicated to personal construct psychology in the United States and abroad included, North American Personal Construct Network (NAPCN) European Personal Construct Association (EPCA) yet another testimony to the fact that perhaps...

Executive Summary

A second common factor is the high availability of facilities that can provide basic and essential obstetric care. As with the skilled birth attendants, the ratio of these facilities to population is typically higher than the World Health Organization's recommended levels, and in some cases, such as in Honduras, Indonesia, and Zimbabwe, birthing centers or maternity waiting homes augment the standard health facilities. This high level of coverage with both facilities and skilled birth attendants is consistent with the findings in the historically successful countries, Malaysia and Sri Lanka. Another difference between the places in the present case studies and the historically successful countries is the financing of services. While services were free to families in Malaysia and Sri Lanka, costs of safe motherhood services can now be substantial and a major deterrent to use. Remedies to reduce cost, such as insurance, have proved only partially successful. Bolivia's insurance program...


The main results were a series of seven case studies, a synopsis of which follows this summary chapter. These case studies have built on the delivery configurations derived from analysis of the historical case studies of rural China, Malaysia, and Sri Lanka (table 1.1). That analysis signaled possible factors leading to the countries' successes (Koblinsky, Campbell, and Heichelheim 1999). But whereas the prominent factors (shown in table 1.3) were found almost consistently in the three historical case studies, they are not in the new case studies. For example, in all the historical and present case studies, there is high availability of both skilled birth attendants and birthing facilities, but not all the present cases have strong policy guiding their programs, and only one holds its medical personnel accountable. High availability of skilled birth attendants located near the home, especially where home births are traditional High availability of birthing facilities

Bolivia 19962000

Health care costs in Bolivia were assumed to be a major impediment to the use of services, such as a skilled birth attendant and a hospital for birthing. To overcome this barrier and reduce the MMR of 390 per 100,000 live births (INE and MI 1994), a national health insurance plan has been phased in to cover the costs of services vital to the reduction of maternal and infant mortality. In July 1996 the Bolivian government implemented the National Maternal and Child Health Insurance (MCHI) Program, with the main objective, as the name implies, of increasing coverage of maternal and child care. For pregnant women and babies, the insurance covered prenatal, labor and delivery, and postpartum and newborn care, including cesarean sections and coverage for other obstetrical emergencies. On December 31, 1998, the government created the Basic Health Insurance (BHI) to augment the MCHI, with explicit coverage of complications of pregnancy, delivery, and postpartum, including postabortion care,...

Emotions and Memory

Work at the level of the brain, promoting growth factors or the secretion of various molecules, including glutamate, in response to environmental stimuli. These substances can be of great relevance in modulating the plasticity of the central nervous system, and the responses can explain the fact that neonates and children live their emotions more intensely than do adults and are able to activate autoregulatory processes of these emotions. The primary sense of Self, which is organized right from birth, belongs more to the emotional sphere than to the cognitive one. Early trauma, such as abandonment, physical and psychological violence, abuse and stress of various types, can create the conditions for a lifelong tendency to sadness, depression, anger and resentment. A mother's contentment with her neonate and physical skin-to-skin contact convey feelings and emotions that can enhance the production of growth factors and the release of oxy-tocin and other substances that reduce infantile...

Incisural sclerosis

Earle et al. (1953) used suction to remove mesial temporal structures as a treatment for drug-resistant complex partial seizures and described the frequent occurrence (100 of 157 cases) of sclerotic lesions in the medial tip of the temporal lobe (uncus). They called this pathology 'incisural sclerosis' to indicate that it arose from herniation of the medial border of the anterior temporal lobe over the tentorium causing ischemic lesions (through compression of branches of the anterior choroidal and posterior cerebral arteries). The postulation that this event occurred during moulding of the head in the normal birth process was supported by experimental studies on fetal brains. The ischemic lesion was seen as the focal pathology responsible for the epileptic focus. This view was very influential for 20-30 years. It was rejected by Falconer (1968) on the grounds that (1) postmortem studies in neonates did not reveal this pattern of pathology (Veith, 1960) (2) the lack of correlation of...

Pregnancy And Childbirth

Pregnancy And Childbirth

If Pregnancy Is Something That Frightens You, It's Time To Convert Your Fear Into Joy. Ready To Give Birth To A Child? Is The New Status Hitting Your State Of Mind? Are You Still Scared To Undergo All The Pain That Your Best Friend Underwent Just A Few Days Back? Not Convinced With The Answers Given By The Experts?

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