Articles: mortality.
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Sixty-four pregnancies in 41 women with biopsy proven lupus nephritis between 1965 and 1991 were analysed to record fetal and maternal outcome and identify risk factors for poor outcome. Of 65 fetuses, 22 (34 per cent) were lost (including therapeutic abortions), 19 (30 per cent) were live born but premature (less than or equal to 36 weeks gestation) and 24 (37 per cent) were term. Fetal loss after 20 weeks gestation was 19 per cent. ⋯ Comparison of pregnancies occurring before or after diagnosis was made by renal biopsy failed to show any significant difference in fetal outcome. Pregnancies occurring after the diagnosis of glomerulonephritis were associated with a significantly lower incidence of maternal hypertension, early hypertension, severe hypertension and increased proteinuria. The presence of the circulating lupus anticoagulant was clearly associated with a significantly high fetal loss rate although the incidence of maternal complications did not differ significantly between mothers positive or negative for lupus anticoagulant.
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Nationally available data on teenage fertility, family planning care and mortality were analysed to determine the relationship between teenage conception, availability of abortion and family planning care, and an indicator of socioeconomic disadvantage--the Standardized Mortality Ratio (SMR). In the 14 regions of England the strongest correlate of teenage conception and of the proportion of teenage conceptions aborted was female all-causes SMR. High levels of provision of NHS abortion services and uptake of family planning clinic care did not significantly reduce teenage fertility. Provision of traditional family planning services obviously plays an important role in preventing teenage pregnancy, but innovation in this service coupled with a concerted effort to reduce social disadvantage might have a greater impact on teenage fertility in England.
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To determine the association of baseline cardiorespiratory fitness to all-cause mortality across the range of blood glucose levels. ⋯ Age-adjusted death rates increased with higher levels, of fasting blood glucose. Regardless of glycemic status, fit men had lower age-adjusted all-cause death rates than their less fit counterparts. For men with fasting blood glucose greater than or equal to 7.8 mM or physician-diagnosed non-insulin-dependent diabetes mellitus (NIDDM), the age-adjusted death rates per 10,000 person-yr of follow-up in unfit and fit subjects were 82.5 and 45.9, respectively. The age-adjusted relative risk of death due to all causes was significantly elevated in the lower-fitness group within each of three glycemic status levels: fasting blood glucose less than 6.4 mM; relative risk (RR) = 1.93 (95% confidence interval [95% CI] 1.15-3.26); fasting blood glucose 6.4-7.8 mM; RR = 3.42 (95% CI 2.27-5.15); and fasting blood glucose greater than or equal to 7.8 mM or with NIDDM, RR = 1.80 (95% CI = 1.25-2.58). Multivariate analyses, controlling for risk factors of mortality (age, resting systolic blood pressure, serum cholesterol, body mass index, family history of heart disease, follow-up interval, and smoking habit) showed a higher risk of death due to all causes for unfit compared with fit men. Multivariate risks of death associated with low fitness, compared with higher fitness (RR), in the three glycemic status groups were: fasting blood glucose less than 6.4 mM, RR = 1.38 (95% CI 1.09-1.74); fasting blood glucose 6.4-7.8 mM, RR = 1.61 (95% CI 0.91-2.86); and fasting blood glucose greater than or equal to 7.8 mM or with NIDDM, RR = 1.92 (95% CI 0.75-4.90).
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A case-control study of fatal venous thromboembolism in young women is described. Sixty women aged between 16 and 39 who died from thromboembolism in England and Wales between 1986 and 1988 were included in the study. Two living controls matched for age and marital status were sought from the records of the general practitioner with whom each case was registered. ⋯ These risks are considerably smaller than those observed in previous studies. The observed risk may be low because the dosage of oestrogen in modern oral contraceptive preparations has been reduced, but it may also be because the cases of fatal venous thromboembolism included in this study represent only a small proportion of all cases of venous thrombeombolism; a disease which is rarely fatal in young women. These results cannot necessarily be extrapolated to nonfatal venous thromboembolism.
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Seasonal variations in the proportion of preterm births in Japan from January 1979 to December 1983 are analysed using a traditional method of time-series analysis, which divides the variation in a series into trend, seasonal variation, other cyclic change, and remaining irregular fluctuations. It is shown that the proportion of preterm births in Japan have a clear seasonal periodicity with two peaks in summer and winter. Analysis of seasonality by period of gestation shows that interesting differences in kurtosis and skewness exist between summer and winter, i.e. the summer increase in preterm births was characterized by an increase of skewness which means an extension of the lower part of the distribution. ⋯ Theoretical simulations based on actual birth data in Japan over the period, are carried out to examine how season of conception could influence seasonal variations in the proportion of preterm births. Results show that, at least for first births, seasonality in conception rates could be one explanatory factor for the observed seasonal variation in proportions of preterm births. Another analysis reveals that conception in May and June are more likely to result in preterm births in Japan.