The effect of vascular constriction on umbilical venous pulsation

OBJECTIVES

Umbilical venous pulsation is an important sign of hemodynamic compromise, but is also found under normal physiological conditions. Mathematical modeling suggests that vascular compliance is a determinant for pulsation, and we tested this by studying velocity pulsation at three sites on the umbilical vein.

METHODS

In a cross-sectional study of 279 low-risk pregnancies (20-40 weeks' gestational age) blood flow velocity in the umbilical vein was determined before, within and after the umbilical ring in the fetal abdominal wall, and the incidence and magnitude of pulsation (the difference between the maximum and minimum velocity during a pulse, and pulsatility index) were noted. Based on the fact that the vessel cross-sectional area is an important determinant of compliance, we measured the diameter and time-averaged maximum velocity to reflect variation in diameter and compliance at the three sites.

RESULTS

The incidence of umbilical venous pulsation was higher at the umbilical ring in the abdominal wall (242/279, 87%, 95% CI 82-90) than in the cord (43/198, 22%, 95%CI 16-27) or intra-abdominally (84/277, 30%, 95% CI 25-36) (P < 0.001). When pulsation was observed intra-abdominally, the pulsatility was not different from that at the umbilical ring (P = 0.16). However, the lowest pulsatility was found in the cord vein (P < 0.0001), where the largest vein diameter was found.

CONCLUSION

The high incidence of venous pulsation at the umbilical ring where diameter and compliance are low supports the suggestion that local compliance is an important factor influencing pulsation in fetal veins.

Investigations on the influence of helminth parasites on vaccination of chickens against Newcastle disease virus under village conditions

Prevalence studies have shown that almost 100% of free-range chickens are infected with a wide range of parasites. The infections are mostly subclinical in nature, resulting in production losses and occasionally mortality. Newcastle disease (ND) on the other hand, results in high mortality rates during epidemics. ND is a limiting factor for increasing poultry production in many tropical countries, where frequent reports indicate vaccination failures. The aim of our study was to investigate the influence of helminths on the antibody response after vaccination against Newcastle disease of free-range chickens naturally infected with parasites. Sixty chickens were divided into six groups, of which three were vaccinated against ND with a live De Soto vaccine, while the other three remained non-vaccinated. One group within the vaccinated groups and the one within the non-vaccinated group was kept naturally infected with helminth parasites, while the other two groups in each set were dewormed with fenbendazole and niclosamide, and one of each of these groups was subsequently infected with Ascaridia galli. After vaccination, all the groups were followed for 5 weeks and their antibody titres were determined weekly using a HI test. All the birds were finally challenged 4 weeks after vaccination with a virulent velogenic ND virus obtained from a field outbreak. All the vaccinated chickens seroconverted and had high antibody levels after 3 weeks, but these dropped to low levels at 4 weeks after vaccination. After challenge, the antibody titres rose in the dewormed groups but not in the parasite-infected groups. After 5 weeks, all the parasite-infected animals had significantly lower antibody titres than the dewormed animals. All the vaccinated chickens survived the challenge infection, emphasizing the importance of the cellular immune response. Further studies are needed to examine the effects of the parasitic infection on protection against ND over a longer period.

Relation between insulin and aortic stiffness: a population-based study

Recent studies have suggested that a high pulse wave velocity (PWV), a measure of aortic stiffness, may be a stronger risk factor for cardiovascular disease (CVD) than a high blood pressure (BP). The relation between insulin, believed to play an important role in the development and clinical course of high BP, and PWV is not yet clear. Therefore, we decided to examine the relationship between insulin and PWV in a large population-based study. The study population consisted of a random sample of 1213 women and 1207 men (age range, 41-72 years) without a history of myocardial infarction or stroke. Fasting insulin was determined together with conventional risk factors for CVD. PWV was recorded transcutaneously by a mechanical electrical principle with one transducer positioned over the left common carotid artery, and another over the left femoral artery. In univariate analysis, insulin was highly significantly related to PWV (standardized regression coefficient: 0.0669+/-0.0051; P<0.001). In multivariate analysis, controlling for all well-established predictors of PWV, such as age, systolic BP or mean BP and pulse pressure, sex, and heart rate, as well as controlling for conventional risk factors for CVD and use of BP-lowering drugs, the level of insulin remained a significant predictor of PWV (standardized regression coefficient: 0.0122+/-0.0048; P=0.012). In conclusion, the present study found that a higher insulin level was related to a higher PWV. This indicates that hyperinsulinaemia may affect BP and risk of CVD by increasing aortic stiffness.

Eletriptan for the treatment of migraine in patients with previous poor response or tolerance to oral sumatriptan

To determine the tolerability and efficacy of eletriptan in patients who had discontinued oral sumatriptan due to lack of efficacy or intolerable adverse events (AEs) during previous clinical treatment (not a controlled trial). Eletriptan is a potent, selective 5-HT1B/1D receptor agonist with beneficial pharmacokinetic properties compared with sumatriptan. In a double-blind, parallel group, placebo-controlled multicentre study, patients with and without aura (n = 446) were randomized to 40 mg eletriptan (E40, n = 188), 80 mg eletriptan (E80, n = 171) or placebo (n = 87) for treatment of up to three migraine attacks. Two-hour headache response, based on first-dose, first-attack data, was 59% for eletriptan 40 mg, 70% for eletriptan 80 mg, and 30% for placebo (P < 0.0001 for both doses of eletriptan vs. PBO; P < 0.05 for E80 vs. E40). Onset of action was rapid, with 1-h headache response rates significantly superior for E40 and E80 vs. placebo (40%, 48%, 15%; P < 0.0005). Both E40 and E80 were significantly superior to placebo, based on first-dose, first-attack data, for 2-h pain-free response (35%, 42%, and 7%; P < 0.0001). Both E40 and E80 demonstrated significant consistency of response, with headache relief rates at 2 h on at least two of three attacks in 66% and 72% vs. 15% on placebo (P < 0.001). AEs were mild to moderate in severity and dose related. The most commonly reported AEs included nausea, vomiting, asthenia, and chest symptoms. E40 and E80 produce an effective response in patients who had previously discontinued treatment with sumatriptan due to lack of efficacy or side-effects.

Trends in incidence and case fatality rates of acute myocardial infarction in Denmark and Sweden

OBJECTIVE

To compare the incidence and case fatality of acute myocardial infarction in Denmark and Sweden.

DESIGN

A cohort study, linking the national registries of hospital admissions and causes of death in the two countries.

PATIENTS

All admissions and deaths with acute myocardial infarction as primary or secondary diagnosis were extracted (Denmark, 1978 to 1998; Sweden, 1987 to 1999).

MAIN OUTCOME MEASURES

The incidence was estimated using the first acute myocardial infarct for each patient. Case fatality was estimated in the first 28 days after acute myocardial infarction, including prehospital deaths. All rates were adjusted for age.

RESULTS

The incidence of myocardial infarction and the case fatality declined significantly among all subgroups of patients. Case fatality was higher in Denmark early in the study period (1987-1990) than in Sweden. The odds ratios (OR) ranged from 1.28 to 1.50 in the four age groups. In 1994-1999, the prognosis of patients younger than 75 years did not differ. Patients aged 75-94 years still fared worse in Denmark (OR 1.21, 95% confidence interval 1.17 to 1.27). Women aged 30-54 years had a worse prognosis than men in both Denmark and Sweden (OR associated with male sex 0.85 and 0.90, respectively). In contrast, for patients older than 65 years, women had a better prognosis than men. This difference in the effect of sex with age was significant (p < 0.0001) and did not change over time.

CONCLUSIONS

Case fatality after acute myocardial infarction was notably higher in Denmark than in Sweden in 1987-1991, but in the later periods the prognosis was comparable in the two countries.

Arthroscopic treatment of impingement of the ankle reduces pain and enhances function

A consecutive series of 105 patients with a median age of 35 (16-62) years who were operated on with arthroscopic resection for impingement of the ankle using standardized technique without distraction is presented. All patients complained of painful dorsiflexion and had failed to respond to conservative treatment. A total of 177 diagnoses were found, soft tissue impingement or synovitis in 89, anterior bony impingement in 44, chondral lesion in 20, loose bodies in 16 and osteoarthritis in eight. At follow-up after 2 years, 65 patients were pain free while 28 patients had experienced reduction of pain. Gait was improved in 30/41 patients and 22 resumed sporting activities. The results were graded excellent in 67, good in 25, fair in six and poor in seven patients. There were four deep infections and one synovial fistula in this series. The deep infections all responded well to arthroscopic synovectomy and intravenous antibiotics. In one patient persistent symptoms were recorded. Ankle arthroscopy yielded good results in the treatment of anterior impingement of the ankle as it effectively reduced pain and enhanced function.

Support services in Denmark for parents of children who are deaf or hard of hearing--a national survey

To collect parents' evaluation of support services in Denmark, questionnaires were distributed to parents of children who are deaf or hard of hearing. Some few results and conclusions are picked out in the article below. Parents' comments show some recurrent features: counselling must be offered and should be offered immediately after confirmed diagnosis, there is a need for psychological support at an early time, for qualified advisers, for written information to be distributed, and for co-operation between advisers of the family.

EuroBionet: a pan-European biomonitoring network for urban air quality assessment

EuroBionet, the 'European Network for the Assessment of Air Quality by the Use of Bioindicator Plants', is an EU-funded cooperative project currently consisting of public authorities and scientific institutes from 12 cities in 8 countries. In 2000, the bioindicator plants tobacco (Nicotiana tabacum Bel W3), poplar (Populus nigra 'Brandaris'), spiderwort (Tradescantia sp. clone 4430), Italian rye grass (Lolium multiflorum italicum) and curly kale (Brassica oleracea acephala) were exposed to ambient air at 90 monitoring sites according to standardised methods. Visible injuries and growth parameters were assessed and the accumulation of toxic substances in leaves determined. The exposure of tobacco resulted in a gradient with low levels of ozone-induced foliar injury in N and NW Europe, and medium to high values in the southern and central regions. The results of heavy metal and sulphur analyses in rye grass samples generally showed low to very low sulphur and low to medium heavy metal concentrations in leaves. In some cities, however, local hot spots of heavy metal contamination were detected. Analyses of the PAH contents in curly kale leaves gave low to medium values, with locally elevated levels at traffic-exposed sites.

Chlamydial genovar distribution after community wide antibiotic treatment

Major outer membrane protein sequences, determined from Chlamydia-positive eye swab samples collected in 2 Egyptian villages, were used to analyze the epidemiology of trachoma in an endemic setting. Samples were collected during the 1999 Azithromycin in Control of Trachoma trial, in which residents of villages were mass treated with either oral azithromycin or topical tetracycline and were followed up for nearly 2 years. Three genovar families (A, Ba, and C) and 12 genovars were detected, with 2 genovars (A1 and Ba1) comprising almost 75% of the samples. The presence of >1 genovar within households was common, with > or =24% of households having >1 genovar. Evidence consistent with reinfection and persistence as mechanisms of communitywide continued presence of trachoma was provided by data for individuals infected with rare genovars.

[Accelerated course in hip arthroplasty]

INTRODUCTION

The aim of the study was to assess the results of a well-defined rehabilitation programme after hip arthroplasty.

METHODS

The effects of a revised, optimised, perioperative care programme with continuous epidural analgesia, oral nutrition, and physiotherapy were assessed in 60 patients before intervention and 60 patients after intervention.

RESULTS

The hospital stay was reduced from nine to six days (p < 0.01), there were fewer complications and less need for rehabilitation after discharge (p < 0.05) in the intervention group.

CONCLUSION

A clinical programme focusing on pain relief, oral nutrition, and rehabilitation may reduce the stay in hospital and improve recovery after hip arthroplasty.

Women with a history of placental abruption: when in a subsequent pregnancy should special surveillance for a recurrent placental abruption be initiated?

BACKGROUND

It is common to admit to hospital or start intensive ambulatory antenatal care of pregnant women with a previous placental abruption using the gestational age of the previous placental abruption as a starting point. In some instances, close surveillance may be commenced much earlier. There is no consensus when in a subsequent pregnancy such measures should be initiated.

OBJECTIVE

The analyses aimed at the prevention of complicated (preterm, small for gestational age, or perinatal death) recurrent placental abruptions, assessing at which time in a subsequent pregnancy special surveillance should start in order to anticipate and prevent a recurrence.

DESIGN

A cohort study based on the Medical Birth Registry of Norway. Calculation of gestational age specific risks of placental abruption in a second pregnancy and estimation of when to initiate surveillance in order to reduce an increased risk of recurrent placental abruption to the initial level of initial abruption in the second pregnancy.

RESULTS

In women with a complicated (preterm, small for gestational age, or perinatal death) first delivery, the risks of an initial and recurrent complicated placental abruption in the second pregnancy were 7/1000 and 33/1000, respectively (relative risk 4.9). To reduce the recurrence risk in a second pregnancy to 7/1000, special surveillance six weeks prior to the gestational age of the initial abruption would be necessary. In women with an uncomplicated first delivery, the risks in the second pregnancy of an initial and recurrent complicated abruption were 3 and 19/1000, respectively (relative risk 7.1). To reduce the recurrence risk to 3/1000, surveillance at least 12 weeks prior would be necessary.

CONCLUSION

The increased recurrence rate would necessitate increased awareness in terms of special surveillance in the second pregnancy. In pregnancies at risk of a recurrent placental abruption, monitoring up to three months before the gestational age of the initial abruption is necessary.

The Danish Multiple Sclerosis Registry. History, data collection and validity

The Danish Multiple Sclerosis Registry was formally established in 1956 but started operating in 1949 with a nationwide prevalence survey. Since then, the Registry has continued collecting data on new and old cases of multiple sclerosis (MS) or suspected MS from multiple sources. The Registry reclassifies cases according to standardized diagnostic criteria (currently those of Poser et al). A total of 14,441 cases fulfilling the diagnostic criteria had been registered at the most recently completed follow-up by 1 January 1997; 10,851 had onset from 1948 to 1996 and 3560 before 1948. The completeness has formerly been estimated at about 90%, higher for cohorts with older onset and lower for cohorts with onset close to follow-up. The estimated validity of the diagnosis for autopsy cases classified as definite MS in the Registry is 94%. A long-term nationwide Registry has proved to be a valuable instrument for monitoring incidence and prevalence, analysing survival, performing genetic analysis, providing unselected patient samples for clinical analyses, performing case-control studies and prospective studies and estimating the need for treatment and care.

The development of high venous velocity at the fetal umbilical ring during gestational weeks 11-19

OBJECTIVE

To determine the occurrence of high venous velocities at the umbilical ring in the normal early second trimester, based on the assumption that a narrow umbilical ring may cause obstruction and increased venous blood velocity at the abdominal wall.

DESIGN

Cross-sectional study.

SETTING

Hospital antenatal clinic.

POPULATION

One hundred and one low risk singleton pregnancies specifically recruited for the study.

METHODS

Ultrasound was used at 11-19 weeks to determine the diameter and velocity in the umbilical vein at the fetal end of the cord and at the inlet through the abdominal wall. Outcome measures 10th, 50th and 90th centiles were estimated for the time-averaged maximum velocity in the cord and at the abdominal inlet. The increase of velocity as the blood entered the abdominal wall was calculated in percent of the velocity in the cord.

RESULTS

During weeks 11-12 there was hardly any difference between blood velocity in the umbilical vein at the umbilical ring and that in the cord. From week 13 onwards it was increasingly common to find blood acceleration at the umbilical ring of 50-500%. Velocity increment >50% was found in 0/12 fetuses (0%) at 11-12 weeks, 5/20 (25%) at 13-14 weeks, and in 21/28 (75%) at 17-19 weeks.

CONCLUSIONS

Blood velocity is higher in the umbilical vein at the abdominal wall than the cord, particularly after 13 weeks of gestation. If acceleration of blood velocity at the umbilical ring is a sign of a narrow inlet, it seems that a progressive tightening occurs during the second trimester.

Ultrasound assessment of the fetal foramen ovale

OBJECTIVES

Based on the assumption that the horizontal area between the fetal foramen ovale valve and the atrial septum (the outlet) represents the limiting structure for the foramen ovale flow, our objective was to determine the normal size of this section during the second half of pregnancy.

METHODS

One hundred and thirty-eight women with low-risk singleton pregnancies were examined in a cross-sectional study between 18 and 42 weeks of gestation. Using ultrasound imaging and M-mode, the area and diameter between the foramen ovale valve and the atrial septum were determined in a four-chamber view of the fetal heart above the foramen ovale limbus. The inferior vena cava cross section and right atrial width were also determined.

RESULTS

The mean foramen ovale width increased from 3 mm at 18 weeks to 6 mm at term. Correspondingly, the horizontal area grew from 15 to 50 mm2. The mean ratio between this area and the area of the inferior vena cava fell from 1 at 18 weeks to 0.5 at term. The ratio between the transverse width of the foramen ovale and the right atrium remained at average 0.45-0.50 until 32 weeks, when a slight reduction was observed towards term.

CONCLUSIONS

Normal values for the horizontal cross section and transverse diameter of the foramen ovale outlet were established for the second half of pregnancy. In particular, the horizontal transverse diameter and its ratio to the right atrial width are easy to determine, and use of these measurements is thus suggested for the assessment of the fetal foramen ovale.

[Tirofiban (Aggrastat). A non-peptide glycoprotein IIb/IIIa receptor inhibitor]

Platelet aggregation and thrombus formation on a ruptured atherosclerotic plaque plays an important role in the pathogenesis of acute coronary syndromes. Activation of glycoprotein IIb/IIIa receptors (GP-receptors) on the surface of platelets is the final common pathway which leads to the binding of fibrinogen and crosslinking of platelets to form the white thrombus. Antiplatelet therapy reduces the risk of ischaemic complications in patients with acute coronary syndromes. Recently, the GP-receptor antagonists have been introduced. They inhibit the binding of fibrinogen to the GP-receptors and thus prevent platelet aggregation. Tirofiban is a low molecular, intravenously administered GP-receptor antagonist, which in combination with unfractionated heparin in several controlled studies has been shown to decrease morbidity and mortality in patients with unstable angina pectoris and non-Q-wave infarction and, in patients subsequently undergoing percutaneous coronary intervention.

Ansatz for dynamical hierarchies

Complex, robust functionalities can be generated naturally in at least two ways: by the assembly of structures and by the evolution of structures. This work is concerned with spontaneous formation of structures. We define the notion of dynamical hierarchies in natural systems and show the importance of this particular kind of organization for living systems. We then define a framework that enables us to formulate, investigate, and manipulate such dynamical hierarchies. This framework allows us to simultaneously investigate different levels of description together with their interrelationship, which is necessary to understand the nature of dynamical hierarchies. Our framework is then applied to a concrete and very simple formal, physicochemical, dynamical hierarchy involving water and monomers at level one, polymers and water at level two, and micelles (polymer aggregates) and water at level three. Formulating this system as a simple two-dimensional molecular dynamics (MD) lattice gas allows us within one dynamical system to demonstrate the successive emergence of two higher levels (three levels all together) of robust structures with associated properties. Second, we demonstrate how the framework for dynamical hierarchies can be used for realistic (predictive) physicochemical simulation of molecular self-assembly and self-organization processes. We discuss the detailed process of micellation using the three-dimensional MD lattice gas. Finally, from these examples we can infer principles about formal dynamical hierarchies. We present an ansatz for how to generate robust, higher-order emergent properties in formal dynamical systems that is based on a conjecture of a necessary minimal complexity within the fundamental interacting structures once a particular simulation framework is chosen.

Defense of the ansatz for dynamical hierarchies

Gross and McMullin [Artificial Life, 7, 355-365] criticize the conclusions of our article on dynamical hierarchies [Artificial Life, 7, 329-353]. In this note we respond to their criticisms. After clarifying our ansatz, we argue that the simulations presented by Gross and McMullin present no evidence against the ansatz, in part because their simulations use a different simulation framework, and in part because their simulations are no less complex than ours. We also clarify why the micelles in our simulations are third-order emergent structures, and why we emphasize realism in our simulation.

Sex, social class, and estimating IQ: middle-class male subjects rate themselves most intelligent

153 sociology students specified parental occupation and job status before estimating their own and their parents' overall IQ. Male subjects, as predicted, gave a higher mean self-estimated score to themselves than did female subjects (113 vs 106). Fathers were awarded higher IQ scores than mothers (114 vs 107). Male subjects who had mothers in a higher social class gave themselves the highest mean score.

Predicting preeclampsia in the second pregnancy from low birth weight in the first pregnancy

OBJECTIVE

To evaluate the effect of low birth weight adjusted for gestational age in first pregnancies on preeclampsia in second pregnancies and to estimate the proportion of preeclampsia in second pregnancies attributable to histories of LBW for gestational age.

METHODS

We conducted a cohort study based on linked data from the Medical Birth Registry of Norway, which covered all births in 1967-1992.

RESULTS

Women who delivered infants under the third percentile birth weight were three times more likely to have initial or recurrent preeclampsia in second pregnancies than those who delivered infants at or above the tenth percentile. After adjusting for maternal age, year of birth, interpregnancy interval, education, chronic hypertension, diabetes mellitus, and change of partner, the increased risk persisted. Birth weight below the tenth percentile in the first delivery accounted for 10% of the total cases of preeclampsia in the second pregnancy and 30% of recurrent cases.

CONCLUSION

A history of low birth weight adjusted for gestational age is associated significantly with subsequent occurrence as well as recurrence of preeclampsia. These findings are consistent with the hypothesis of a shared etiologic factor or recurrent pathophysiologic mechanism for preeclampsia and fetal growth restriction. A history of fetal smallness for gestational age is found in a substantial proportion of all cases of preeclampsia and thus seems to be important in the etiology of preeclampsia.

[Clinical studies on glycoprotein IIb/IIIa receptor antagonist]

Platelet activation plays a major role in the pathophysiology of acute coronary syndromes (ACS), and inhibition of platelet function is the basic pharmacological treatment of ACS. Platelet membrane glycoprotein IIb/IIIa inhibitors, a new class of potent antiplatelet agents, have been used in the treatment of ACS, as well as in the prevention of complications after percutaneous coronary interventions. The aim of this article is to describe the potential possibilities of platelet inhibition and to review the pharmacology of glycoprotein IIb/IIIa inhibitors, the results of the clinical trials with these agents, and their current use in the pharmacological treatment of ACS and in relation to percutaneous coronary intervention.

[Acute myocardial infarction in Denmark. Incidence development and prognosis during a 20-year period]

INTRODUCTION

The paper describes the epidemiology of acute myocardial infarction in Denmark. The study provides statistics on mortality, incidence and case-fatality for 1996 and the time trend since 1978. The results are compared to the results from the international MONICA study.

METHOD

The analyses are based on national population-based registers on causes of death and hospital admissions.

RESULTS

The mortality from ischaemic heart disease has declined considerably. The study confirms that the decline in mortality can be ascribed to a decrease in incidence as well as a decrease in case fatality. In the period 1985-1996 the incidence decreased by 3.5% per year for men and 2.5% for women. Mortality rates within 28 days after admission to hospital with MI was almost constant until 1988 following which there was a significant drop. Despite the improved prognosis for MI patients, one quarter die before admission to hospital, and one quarter die within one year after an MI.

DISCUSSION

The incidence rates of MI based on the national population-based registers are consistent with the results from the Danish MONICA study. The reduction in incidence rates is a little smaller than the results in the Danish part of the MONICA study, whereas the marked reduction in case-fatality found in this study is not in agreement with the results from MONICA. This discrepancy is not yet understood. The declining trend in case fatality started in 1988 and may be related to the introduction of thrombolysis and acetylsalcylic acid treatment.

[Active and passive smoking among personnel at the Bispebjerg Hospital 1992-1999]

The purpose of this study was to describe changes in smoking behaviour and exposure to passive smoking among hospital employees at a large Danish University Hospital (Bispebjerg Hospital) from 1992 until 1999 as part of a program toward a smoke-free hospital. The study was based upon three cross-sectional self-administered questionnaires surveys carried out among all employees at the hospital--approximately 4000 persons--in October 1992, April 1997 and April 1999, participation rates being 84, 80 and 76 percent. During the seven year period the smoking rate has decreased from 46% to 32% among male and 40% to 33% among female employees. A decrease in smoking rate was found among all subgroups of employees. Among male employees the rate of heavy smokers has decreased from 25 to 16%, among female employees this decrease is lacking, the rate of heavy smokers being 15% during the whole period. The numbers of employees exposed to passive smoking all day or most of the day has changed from 39% to 25% from 1992 until 1999. Among the smokers 30%--8% of all employees--responded that they would not be able to manage without smoking tobacco during working hours. This answer is most commonly found among heavy smokers, smokers with short or no education and smokers who smoke at any time of day. It is concluded that even though there has been a reduction in the smoking rate, the exposure to passive smoking among employees at the hospital still is unacceptably high. Based upon these results it has been decided that Bispebjerg Hospital is smoke-free for all employees from the 1st of January 2000. There is a need for initiatives for the smokers, who can't manage work without smoking.

Smoking, hemoglobin concentration and pregnancy-induced hypertension

The aim of the study was to assess the effect of cigarette smoking on first- to second-trimester change in hemoglobin (Hb) concentration and the presence of pregnancy-induced hypertension (PIH). In smokers and non-smokers the mean difference between the first- and second-trimester Hb concentration was 1.5-1.6 and 1.3 g/dl, respectively (p < 0.0001). The incidence of PIH among smokers and non-smokers was 4.0 and 7.5%, respectively (p < 0.0001). The risk of PIH increased with increasing second-trimester Hb. After adjustment for factors including previous pregnancies, maternal age and weight gain by logistic regression analysis, the increased Hb declined and the decreased incidence of PIH in smokers persisted.