Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes

AIMS/HYPOTHESIS

We studied the progression of diabetic retinopathy during pregnancy in women with type 2 diabetes.

METHODS

Fundus photography was performed at median 10 (range 6-21) and 28 (27-37) gestational weeks in 80 of 110 (73%) consecutively referred pregnant women with type 2 diabetes. Diabetic retinopathy was classified in five stages. Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of macular oedema on at least one eye between the two examinations. Macular oedema was defined as retinal thickening and/or hard exudates within a diameter of 1,500 microm in the macula area.

RESULTS

Diabetic retinopathy, mainly mild, was present in 11 (14%) women in early pregnancy. Median duration of diabetes was 3 years (range 0-16 years). At baseline, HbA(1c) was 6.4% (1.0) (mean [SD]), systolic BP 121 (13) and diastolic BP 72 (9) mmHg. Prior to pregnancy, 22 (28%) women had been on insulin treatment. During pregnancy 74 women (93%) were treated with insulin and 11 (14%) with antihypertensive medication. Progression of diabetic retinopathy was observed in 11 (14%) women. Progression was mainly mild, but one woman with poor glycaemic control and uncontrolled hypertension progressed from mild retinopathy to sight-threatening retinopathy with proliferations, clinically significant macular oedema and impaired vision in both eyes. Progression of diabetic retinopathy was associated with a longer duration of diabetes (p = 0.03) and insulin treatment before pregnancy (p = 0.004).

CONCLUSIONS/INTERPRETATION

Despite a low risk of progression of retinopathy in pregnant women with type 2 diabetes, sight-threatening deterioration did occur.

Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes

AIMS

To determine the progression of diabetic retinopathy in pregnant women with diabetes offered tight glycaemic and blood pressure control.

METHODS

A prospective study of 102 (87%) out of 117 consecutive pregnant women with Type 1 diabetes for median 16 years (range 1-36) and HbA(1c) 6.7% (4.9-10.8) in early pregnancy. Fundus photography was performed at 8 and 27 weeks. Retinopathy was classified in five stages. Diabetic macular oedema was classified as present in a mild form or as clinically significant macular oedema (CSMO). Progression was defined as at least one stage of deterioration of retinopathy and/or development of macular oedema in at least one eye. Sight-threatening progression was defined as loss of visual acuity>or=0.2 on Snellen's chart or laser treatment performed during pregnancy due to proliferative retinopathy or CSMO.

RESULTS

Diabetic retinopathy was present at inclusion in at least one eye in 64 (63%) women and proliferative retinopathy and macular oedema were present in nine and 16 women, respectively. Progression of retinopathy occurred in 28 (27%) women. Sight-threatening progression occurred in six women; in three, visual acuity deteriorated and four required laser treatment. Sight-threatening progression was associated with presence of macular oedema (P=0.007), impaired visual acuity (P=0.03) and higher blood pressure (P=0.016) in early pregnancy, but not with HbA1c, decline in HbA1c, or prevalence of severe hypoglycaemia.

CONCLUSIONS

Loss of visual acuity and the need for laser treatment during diabetic pregnancy remain clinical problems associated with presence of macular oedema, visual impairment and higher blood pressure in early pregnancy.

Bilateral torsion of the testicles in a newborn

We describe a case of bilateral torsion of the testes in a full term neonate.

[Patient satisfaction and duration of breast feeding]

INTRODUCTION

Only two out of three Danish women follow the recommendations for duration of breast-feeding given by The Danish National Board of Health, which recommend it as the sole source of nutrition for at least the first four months of life. The present study was carried out to investigate the influence of patient satisfaction on the duration of breast-feeding.

MATERIAL AND METHODS

Based on an earlier investigation into the satisfaction of primiparas with the public health service during pregnancy, delivery, and the puerperium, 145 women were interviewed by telephone about the period in which their child was fed solely by mother's milk. Mothers of twins and those who had had an elective caesarean or whose child had been transferred to the neonatal care unit were excluded. Data from the patient satisfaction study and data on the delivery retrieved from a local obstetric database were related to the duration of breast-feeding.

RESULTS

The mean duration of breast-feeding only was four months with no association to the women's satisfaction with the public health service in general. There was, however, an association between the period of breast-feeding only and satisfaction with issues dealing specifically with breast-feeding. In women who had had an oxytocin infusion breast-feeding was more often well-established. No other event during labour related to the initiation or duration of breast-feeding. There was an insignificant trend towards more use of a pacifier or formula supplementation in the first days in women, who did not initiate breast-feeding. It is unknown whether this is a cause or a consequence.

DISCUSSION

The initiation of breast-feeding is influenced by the woman's satisfaction with the public service in matters relating to breastfeeding. In other ways, it is a process that is difficult to disturb.

[Feeling of illness after hysterectomy. Women's own assessment]

INTRODUCTION

The aim of the study was to investigate the time interval from the operation to no feeling of illness at all in a population of women, who had undergone a total abdominal or vaginal hysterectomy.

MATERIAL AND METHODS

Data on 361 women who had had a total abdominal or vaginal hysterectomy during the period, 1.1.1998 to 31.3.1999 were collected from a regional database. Those born before 1.1.1940, presented with a genital malignancy, had a diagnosis of genital prolapse, or received surgery in addition to the hysterectomy were excluded. Four months after the hysterectomy, all the women were sent a questionnaire asking about the time of returning to work and the complete absence of any feeling of illness. This information was related to selected perioperative data. Women who had had a total abdominal hysterectomy were not statistically comparable with those who had had a vaginal hysterectomy.

RESULTS

A total of 313 women participated (87%). After a total abdominal hysterectomy, 92%, 80%, and 35% had a subjective feeling of illness at four, six, and ten weeks, respectively. The median duration of feeling ill was nine weeks. The figures after a vaginal hysterectomy were 85%, 71%, and 18%, with a median duration of feeling ill of seven weeks. Only peroperative blood loss and the presence of postoperative complications related statistically to the duration of feeling ill.

CONCLUSION

The interval between the operation and no feeling of illness at all after a total abdominal or vaginal hysterectomy is longer than was formerly believed. Further investigation is recommended.

Labor pain in relation to fetal weight in primiparae

AIM OF STUDY

To investigate the association between fetal weight and the experience of labor pain in primiparae.

METHODS

All primiparae who gave birth at the department of obstetrics, Herning Central Hospital, from 1 September 1998 to 30 April 1999 completed a visual analogue scale (VAS) on the second day after delivery. Pain was scored in the first, the second, and the "repair" stage of labor, respectively, and finally a score was performed for total labor evaluation.

RESULTS

139 primiparae were included. Mean age was 27 years (range 16-40 years), mean fetal weight was 3562g (range 2400-5050g). There was no relationship between fetal weight and pain score. Neither was there any relationship between pain score and maternal age, body mass index (BMI), duration of second stage of labor or the need for instrumental delivery. The score in the stage of perineal repair was significantly lower than in the other stages of labor.

CONCLUSION

The experienced pain during labor among primiparae is not influenced by fetal weight.

Adenocarcinoma of the small intestine mistaken as a primary ovarian cancer

A case of primary adenocarcinoma of the small intestine metastazing to the ovary is described. The patient was erroneously thought to suffer from a primary ovarian malignancy. To avoid unnessessary surgery, severe gastrointestinal symptoms in a patient thought to have an ovarian cancer should warn the surgeon against a possible gastrointestinal cancer.

Changes in yearling rhesus monkeys' relationships with their mothers after sibling birth

The birth of a new sibling is believed to signify an abrupt and important transition in a young primate's relationship with its mother-one that is of potential importance from at least three theoretical perspectives: attachment theory, parent-offspring conflict theory, and dynamic assessment models. This study examines changes in relationships between free-ranging yearling rhesus monkeys (Macaca mulatta) and their mothers concomitant with the birth of the mother's next infant, and tests predictions derived from each theoretical perspective. We observed 31 yearling rhesus on Cayo Santiago, Puerto Rico, 3 months before and 3 months after their siblings' births, using focal animal sampling methods. Changes in measures related to mother-yearling interaction and yearling distress were examined using repeated-measures analysis of variance. After sibling birth, mothers and yearlings abruptly reduced amounts of time in contact and increased amounts of time at a distance and out of sight of one another. Mothers and yearlings played approximately equal roles in bringing about decreases in proximity, and yearlings took the primary roles in bringing about decreases in contact. Rates of maternal aggression toward yearlings increased immediately and markedly after birth, possibly providing yearlings with early cues regarding subsequent decreased levels of maternal care. There were no marked increases in overt signs of yearling distress (e.g., vocalizations or tantrums) following the births. We conclude that yearlings generally acquiesced to reduced levels of care, responding behaviorally with increased independence and maturity. In this sense, our study provides preliminary support for dynamic assessment models over attachment theory and parent-offspring conflict theory models.

[Vaginal hysterectomy in non-prolapsed uterus]

AIM OF STUDY

To describe the results of vaginal removal of the non-prolapsed uterus in women conventionally operated on abdominally or with the assistance of laparoscopy.

MATERIAL AND METHODS

At the departments of gynaecology, Herning Central Hospital and Holstebro Central Hospital, approximately one third of all hysterectomies are performed vaginally. All records of women, who had had a vaginal hysterectomy on a non-prolapsed uterus over a nineteen-month period, were reviewed retrospectively. Women, who had additional surgery, were excluded.

RESULTS

One-hundred and thirteen patients entered. In one patient (1%) the vaginal hysterectomy was converted to an abdominal one. One fourth of the women had a uterus weighing more than 200 grams. The median operation time was 58 minutes; 73% bled less than 200 ml. Half of the women were discharged from hospital on the third postoperative day or earlier; 90% on the fifth postoperative day or earlier. During operation three accidental bladder lesions occurred, and four women needed an additional haemostatic operation. Postoperatively, 10 women (9%) suffered from a haematoma or an abscess in the vaginal vault.

CONCLUSIONS

Vaginal hysterectomy on the non-prolapsed uterus is an operation that should be offered to a large group of women, who today are operated on abdominally or with laparoscopic assistance. The operation is quick and the patients are discharged after a few days. No advanced equipment is needed. Some women will, however, suffer from a haematoma in the vaginal vault.

Interventions during labor in relation to height in obese women

The aim of the study was to investigate, whether height is a predictor of interventions during labor in obese women. Therefore the relationship between height and interventions during labor was investigated in 661 obese women delivering a single child in vertex presentation. Diabetic mothers were excluded. As a result there was a trend towards more medical inductions in tall women, but without reaching statistical significance. No other differences were found. We conclude, that short stature is not a major predictor of interventions during labor in Danish, obese women.

[Influence of fetal weight on outcome of prolonged pregnancy]

The aim of the study was to compare the influence of foetal weight on the outcome of a prolonged pregnancy. The study group consisted of all women delivered after a prolonged pregnancy at the Dept. of Obstetrics, Herning Central Hospital, during the period from 1.1.1993 to 31.3.1999, stratified by foetal weight. Five-hundred and eighty women were included. Women who gave birth to a child with birthweight less than 3.5 kg were more frequently given oxytocin infusions, and more children were transferred to the neonatal care unit. Heavy children weighing at least 4.5 kg were more frequently delivered by Cesarean section. In all groups very few children had low Apgar scores. When comparing the study population to a population of women giving birth after a completely normal pregnancy, significantly more grade 3-4 perineal ruptures and intrumental deliveries were found in the study group. In conclusion, foetal weight seems to be a poor predictor of the outcome after prolonged pregnancy. Prolonged pregnancy is associated with more instrumental deliveries and perineal ruptures.

[Cancer of the endometrium following radiotherapy of cervical cancer]

We describe three cases of women who have been treated with radiotherapy for cervical cancer and then many years later develop cancer of the uterine endometrium. Apparently there may be active endometrium left in the uterus after radiotherapy, for which reason we recommend combined hormone therapy with oestrogen and progesterone.

The influence of prepregnancy body mass index on labor complications

BACKGROUND

To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy.

MATERIAL AND METHODS

From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications.

RESULTS

High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index.

CONCLUSIONS

Overweight (25.0<=BMI<30.0) and obesity (BMI>=30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.

A preliminary description of responses of free-ranging rhesus monkeys to brief capture experiences: behavior, endocrine, immune, and health relationships

A cohort of free-ranging rhesus monkeys has been followed since birth in 1994 on the island of Cayo Santiago, Puerto Rico. At 3 years of age, subjects were trapped and blood samples were collected after capture and prior to release the following day. Blood samples were processed for natural cytotoxicity toward xenogeneic tumors, phenotyping, and plasma hormones. Intestinal parasites were determined from fresh stool samples collected during trapping. Data were also available from the previous year for antibody titers to latent viruses prevalent in this population. Behavioral traits of each monkey were characterized using a previously developed trait scale for rhesus monkeys. Natural cytotoxicity toward both K562 and Raji targets declined from capture until release the following day. Plasma cortisol rose and plasma prolactin and growth hormone fell during the period of captivity; a rise in insulin was significant. It was expected that individual differences in behavioral traits might predict immune and hormone levels at the time of capture or changes in these parameters during the capture period. Although behavioral adjectives tended to cluster along three orthogonal dimensions (Insecurity, Irritability, and Sociability), they bore no relationship to the physiological parameters collected acutely (in vitro immune and endocrine parameters). The individual difference markers of gender and maternal rank were not related to the magnitude of the observed changes in these in vitro parameters, either. However, an in vivo measure (CMV titer) was related to individual differences in Irritability. It was concluded that the magnitude of the stress associated with capture overwhelmed the individual difference effects.

[Premenopausal vulvar basocellular carcinoma]

A case of vulvar basocellular carcinoma in a 49-year-old woman is presented. The treatment of choice is local excision and the prognosis in general is excellent. The importance of taking biopsies from atypical vulvar lesions is underlined.

Histocompatibility antigen studies in women with recurrent miscarriages and Müllerian uterine anomalies

OBJECTIVE

To determine whether the HLA alleles DR1, DR3, DR4 and DR10 which have been suggested to be risk markers for unexplained recurrent miscarriages also play a part in women with recurrent miscarriages with Müllerian uterine fusion anomalies.

STUDY DESIGN

HLA-DR typing was undertaken in 28 women with recurrent miscarriage who had been surgically treated for Müllerian anomalies and in 360 controls. In the study group, outcome of pregnancies after surgery was correlated to the results of the HLA typing.

RESULTS

In the study group, 61% were positive for HLA-DR1, -DR3, -DR4 or -DR10 compared with 65% of the controls (not significantly different). Among patients positive for these HLA risk markers, 64% of the pregnancies after surgery miscarried compared with 13% in those negative (P<0.005, RR for miscarriage=4.8, 95% CI= 1.3-18.0).

CONCLUSION

The proposed risk HLA markers for unexplained recurrent miscarriage also seem to display a negative impact on pregnancy outcome in patients with recurrent miscarriages with Müllerian uterine anomalies.

[Delivery of extremely large infants]

The purpose of this retrospective study was to find out if more effort should be applied to the diagnosis of extremely large infants, with a birth weight of 5,000 grams or more, and if elective caesarean section can be recommended. In the Department of Obstetrics, Herning Central Hospital, Denmark, 67 mothers delivered an infant with a birth weight of 5000 g or more over a ten year period. This index group was compared with a matched group with infants of normal weight. The result showed significantly more caesarean sections in the index group (24% versus 5%, p = 0.002). Shoulder dystocia and Duchenne-Erb's palsy were more frequent as well. Sixteen percent in the index group were admitted to the paediatric department, but the Apgar scores were not significantly lower. Except for one, all the infants showed complete recovery. In conclusion, elective caesarean section can not be generally recommended for an estimated birthweight exceeding 5,000 g, if a trained obstetrician is present at delivery.

Fathers of persons with mental illness: a preliminary study of coping capacity and service needs

Issues faced by fathers coping with the mental illness of an adult child represent an unexplored dimension of service needs. A preliminary exploratory study found that a group of 25 such fathers manifested important indicators of emotional stress that were largely unrecognized and unacknowledged. They also demonstrated typical patterns of healing that were different from those experienced by their wives. The paper reports findings that suggest that fathers employ more isolating strategies, and suggests service approaches that might be more fruitful in responding to these serious needs.

[Habitual abortion. A review of etiology, diagnosis and treatment with emphasis on immunonological factors]

Almost 1% of women who attempt pregnancy will experience recurrent miscarriage. The majority of traditionally accepted causes of recurrent miscarriage lack proper documentation and the evidence for the majority of treatments is sparse. An increased level of midfollicular phase luteinizing hormone seems to be associated with some cases of recurrent miscarriage. Many autoantibodies are found with increased frequency in women with recurrent miscarriage, and they seem to be associated with an increased risk of adverse pregnancy outcome. This may indicate that the autoantibodies per se or associated immunological phenomena are risk factors for the condition. Polygenically determined immunological phenomena seem to play an important role. Treatment of recurrent miscarriage by anticoagulation, allogeneic lymphocyte immunization or intravenous immunoglobulin is under evaluation in controlled trials.

Obesity as a predictor of postpartum urinary symptoms

BACKGROUND

To investigate the relationship between pre-pregnancy obesity, and urinary symptoms, especially urinary incontinence, before, during, and 6-18 months after delivery.

METHODS

Body Mass Index extracted from obstetric records. Postal questionnaire. MATERIAL AND SETTING: One hundred and eight women with Body Mass Index of at least 30 kg/m2 delivered at the Obstetric Department, Herning Central Hospital, October 1994 to September 1995. As control served 108 matched, normal weight women delivering during the same period.

RESULT

Response rate was 83%. Stress incontinence, urgency and the feeling of having a hygienic problem was significantly more common after delivery in both groups, but at any time significantly more common among obese women. Urge incontinence was a numerically small problem after delivery.

CONCLUSION

Obesity is a potent risk factor for several urinary symptoms after pregnancy and delivery, and a substantial number of women still have problems 6-18 months postpartum.

The influence of infant birth weight on post partum stress incontinence in obese women

One hundred ninety four women with a Body Mass Index (BMI) of at least 30 kg/m2 who were delivered vaginally between 01 10 93 and 30 09 95 at the obstetric department, Herning Central Hospital, were sent a postal questionnaire about stress incontinence. The response rate was 89.2%. In the heavy birth weight group (n = 4000 g or more) stress incontinence increased from 10.6% before pregnancy to 34.0% post partum. In the low birth weight group 6.9% suffered from stress incontinence before pregnancy increasing to 30.6% post partum. There was no difference in the reporting of mixed or urge incontinence between the two groups.

[Prolapse of the salpinx after hysterectomy]

Prolapse of the fallopian tube through the vaginal vault is a rare, but possible complication after hysterectomy, and a tubal prolapse may be mistaken as granulation tissue or an adenocarcinoma. A possible treatment is vaginal extirpation with simultaneous laparoscopy. A case is presented and the relevant literature is reviewed.

[Violence towards pregnant women]

The current literature concerning violence against pregnant women is reviewed. The prevalence of battering during pregnancy is estimated to be between one and ten percent, and the problem is most often hidden from the medical staff. In one fourth of the cases, violence increases during pregnancy, and usually the violent episodes are a continuation of the couple's habitual way of life. An episode of battering per se is only in extreme situations dangerous for the pregnancy, but serves as a marker of negative social events, e.g. unemployment, smoking, emotional instability etc., which increases the risk of an adverse pregnancy outcome. Furthermore, the violent husband may extend the battering to the child after delivery. It is concluded, that all medical personnel dealing with pregnant women should be aware of the high prevalence of battering during pregnancy. If battering is detected, the pregnancy may be at risk, but the main problem is the social issue and the later consequences for the child. The general practitioner is central in the long-term approach to these cases.

Placebo-controlled trial of treatment of unexplained secondary recurrent spontaneous abortions and recurrent late spontaneous abortions with i.v. immunoglobulin

The aim of this trial was to investigate whether infusions of i.v. immunoglobulins (Ig) to women with secondary recurrent spontaneous abortions and recurrent second trimester spontaneous abortions can increase the rate of successful pregnancy. In a prospective, double-blind, placebo-controlled trial, infusions of i.v. Ig (Nordimmun) or placebo were given during pregnancy to 34 women with a history of either unexplained recurrent spontaneous abortion subsequent to a birth or including at least one second trimester miscarriage. The success rate was 52.9% in the i.v. Ig group compared with 29.4% in the placebo group (not significantly different, therapeutic gain 23.5%, 95% confidence interval -8.6 to 55.7%). No changes in autoantibody concentrations or major lymphocyte subsets were induced by i.v. Ig treatment. In conclusion, an expected 55% therapeutic gain of i.v. Ig in recurrent spontaneous abortion could not be confirmed using the treatment regimen tested. However, to determine whether the trend of therapeutic gain of i.v. Ig in these women may be statistically significant, a larger trial is in progress.

The possible role of ultrasound in early cervical cancer

The value of preoperative ultrasonography to detect lymph node metastases in patients with early cervical carcinoma (stage IB-IIA) was investigated in 111 patients. Comparison was made between ultrasound and the operative histopathologic findings in 109 patients and with fine-needle biopsy in 2 patients. The positive predictive value was 71%, and the negative predictive value was 84%. Sensitivity was 23%, specificity was 98%. Lymph node metastases were found in 19% (21 patients) by operative histopathologic examination; these patients received subsequent radiotherapy. The rest, 92 patients with no lymph node metastases at Meigs' operation, were followed by abdominal and transvaginal ultrasonography as well as clinical examination at 6, 9, 12, 18, 24, 36, and 48 months postoperatively to detect recurrences. The recurrence rate was 9.8%. Ultrasound alone detected only one recurrence in an asymptomatic patient. We conclude that ultrasonography is not reliable in the preoperative detection of lymph node metastases. Moreover, ultrasound examination presents no advantage over clinical examination in early detection of asymptomatic recurrent cervical cancer after radical hysterectomy.

A comparison of survival and side effects in two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa

The study compares survival and complications during two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa. Group A included 128 patients operated during the years 1983-87. In that period 5 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Group B included 135 patients operated during the years 1988-91. In that period 7 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Considering stage 1b separately, the frequency of operation was raised from 52 (123/237) to 87% (128/148). A 5-years crude survival rate of 85% and 88% was observed in the two groups. The mortality rate was zero in both periods and no fistulae occurred. There were no significant increase in morbidity or length of hospitalization. In the elderly patients over sixty years a significant increase in minor postoperative complications and hospitalization more than 2 weeks were seen. The conclusion is that the frequency of radical hysterectomy as treatment of cervical cancer stage Ib can be raised from 52% to 87% without any noticeable influence on survival or complication rate.

[Effect of uterine fibromas on pregnancy]

The recent published journal reports concerning the influence of uterine myomas on pregnancy are reviewed. The prevalence of uterine myomas in pregnancy is 0.1-5%, and less than half of the cases can be diagnosed by clinical investigation alone. The previous belief that continuous growth of myomas occurs during pregnancy seems incorrect. Most myomas grow during the first trimester, whereafter only few continue to enlarge. The most often recognized complication during pregnancies with uterine myomas is abdominal pain. About ten percent will suffer from this. Treatment is with non-steroidal anti-inflammatory drugs, which are extremely effective. In resistant cases epidural blockade may be used. Placental abruption is possibly more common among women with myomas that have direct contact to the placenta, and there is a trend towards shorter pregnancies in women with myomas. Further investigation on these subjects is required. No other complications are consistently reported more frequently among women with myomas than among those without. Myomectomy during pregnancy should only be performed in extreme cases. The value of myomectomy before conception to avoid pregnancy complications is doubtful, if no other pathology is present.

HLA class II alleles confer susceptibility to recurrent fetal losses in Danish women

HLA-DR and -DQ typings were performed by a combination of RFLP and PCR-SSP techniques in 234 Danish women with at least three consecutive unexplained fetal losses (recurrent fetal losses) and 360 controls and the DRB1, DQA1 and DQB1 alleles were deduced. In the total group of patients, the frequency of no DRB1-DQA1-DQB1 haplotype was significantly increased compared with controls. In the subgroup of 97 women with four or more fetal losses (multiple fetal loss group), the frequency of women carrying the DRB1*0101, DQA1*0101, DQB1*0501; DRB1*0102, DQA1*0101, DQB1*0501 and DRB1*0103, DQA1*0101, DQB1*0501 haplotypes or the DRB1*0301, DQA1*0501, DQB1*0201 haplotype were significantly increased compared with controls (RR = 2.1; pc < 0.05 with regard to former three haplotypes combined and RR = 2.2; pc < 0.05 for the latter). The frequency of women with at least one of the four haplotypes was significantly (p < 0.002) increased with the number of previous fetal losses in the women's history. Analysis of the DQA1 and DQB1 phenotypes in women with at least four fetal losses showed that DQA1*0501 and DQB1*0501 were increased compared with controls (RR = 1.9; pc < 0.05 and RR = 2.2; pc < 0.025, respectively). Analysis of DRB1-DQA1-DQB1/DRB1-DQA1-DQB1 genotypes suggested that genotypes comprising both DQA1*0501 and DQB1*0501 alleles (in trans) exhibited a higher RR for experiencing at least four fetal losses (RR = 3.4, p = 0.002) than each of the alleles did alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Responses of free-ranging rhesus monkeys to a natural form of social separation. I. Parallels with mother-infant separation in captivity

Observations of 23 free-ranging rhesus monkey infants on Cayo Santiago, Puerto Rico, indicated that mothers' first postpartum estrous periods were marked by large increases in the amount of time infants were separated from their mothers, by disturbances in mother-infant relationships, and by increases in infant distress behavior. When their mothers resumed mating, most infants showed signs of agitation; a few briefly showed indications of depression. Male infants responded to their mothers' resumption of mating by playing more, whereas females engaged in less play and more allogrooming. The results suggest (a) that basic parallels exist between the behavioral responses of rhesus infants to their mothers' resumption of mating in the field and to forcible separation from their mothers in captivity and (b) that early separation experiences may play a role in the normal development or manifestation of sex differences in behavior.

[School children's knowledge of, need for and use of contraception before and after the AIDS campaigns. Sexual activity and contraception habits]

The purpose of the present investigation was to evaluate changes in contraceptional habits or sexual activity among adolescents as a consequence of the AIDS-campaigns. In 1986 and 1993 all pupils in their ninth school year in the municipality of Viborg answered an identical questionnaire concerning the mentioned subjects. Both in 1986 and 1993 one third had had sexual intercourse, and one seventh had had their sexual debut before the age of 15. There were significantly more condom users at the first coitus in 1993 and fewer pill users. The proportion of unprotected intercourse did not differ. More pupils had had experience using condoms in 1993, but, as in 1986, nearly half of the girls had used coitus interruptus or safe periods. The proportion of girls who had had intercourse within a week of answering the questionnaire increased from 26% to 42%, indicating a more sexually active population of girls. It is concluded that the increased sexual activity, the fewer pill users and the persisting large proportion of un- or low-protected intercourse may result in more unintended pregnancies. The coincident use of pill and condom should be encouraged.

[School children's knowledge of, need for and use of contraception before and after the AIDS campaigns. Knowledge and sources of information]

The purpose of the present paper was to investigate the influence of the AIDS-campaigns on adolescents' knowledge of contraception and pregnancy and their sources of information. All pupils in their ninth school year in the municipality of Viborg answered an identical questionnaire in 1986 and 1993, dealing with the mentioned subjects. In 1986, 539 questionnaires were included, in 1993, 391. In 1986, sexually inexperienced boys had lesser knowledge than the rest. This could not be shown in 1993. Although their knowledge was not optimal, the pupils in 1993 answered better than the 1986-pupils. They had the same informational sources, but in 1993, the school was mentioned as an important source by nearly all. The mother, on the contrary, had decreasing importance as a source of information. Two thirds were generally satisfied by the sexual information given by the school. Experienced boys were significantly more often unsatisfied. It is concluded that the condom-orientated AIDS-campaigns have not in general decreased the knowledge of contraception and pregnancy among adolescents. Their knowledge is, however, not optimal. The school is extremely important as an informational source, especially if the importance of the parents decreases. This implies that fewer of those adolescents, who have left school, have adult support in dealing with sexual problems.