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Zeitlin J.,French Institute of Health and Medical Research | Zeitlin J.,University Pierre and Marie Curie | Szamotulska K.,National Research Institute of Mother and Child | Drewniak N.,French Institute of Health and Medical Research | And 10 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2013

Objective To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery. Design Analysis of aggregate data from routine sources. Setting Nineteen European countries. Population Live births in 1996, 2000, 2004, and 2008. Methods Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models. Main outcome measures Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour. Results Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35-36 weeks of gestation than at 32-34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births. Conclusions There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth. © 2013 The Authors. BJOG: An International Journal of Obstetrics & Gynaecology published by John Wiley and Sons on behalf of the Royal College of Obstetricians and Gynaecologists.


Ahring K.,Kennedy Center | Dokoupil K.,Ludwig Maximilians University of Munich | Gokmen-Ozel H.,Hacettepe University | Lammardo A.M.,University of Milan | And 5 more authors.
European Journal of Clinical Nutrition | Year: 2011

Background: Only limited data are available on the blood phenylalanine (Phe) concentrations achieved in European patients with phenylketonuria (PKU) on a low-Phe diet.Objective: A survey was conducted to compare blood Phe control achieved in diet-treated patients with PKU of different age groups in 10 European centres.Methods: Centres experienced in the management of PKU from Belgium, Denmark, Germany, Italy, The Netherlands, Norway, Poland, Spain, Turkey and the United Kingdom provided retrospective audit data of all patients with PKU treated by diet over a 1-year period. Standard questions were used to collect median data on blood Phe concentrations, percentage of blood Phe concentrations below upper target reference ranges and frequency of blood Phe sampling.Results: Data from 1921 patients on dietary management were included. Blood Phe concentrations were well controlled and comparable across centres in the early years of life. The percentages of blood Phe concentrations meeting each centre's local and national target ranges were 88% in children aged up to 1 year, 74% for 1-10 years, 89% for 11-16 years and 65% for adults (>16 years). The frequency of home blood sampling, compared with local and national recommendations for monitoring Phe concentrations, appeared to decline with age (from approximately 100% in infancy to 83% in teenagers and 55% in adults).Conclusions: Although blood Phe control generally deteriorated with age, some improvement was observed in adolescent years across the 10 European centres. The blood Phe control achieved seemed comparable in many of the European centres irrespective of different dietary treatments or national policies. © 2011 Macmillan Publishers Limited All rights reserved.


Bouvier-Colle M.-H.,University Pierre and Marie Curie | Mohangoo A.D.,Applied Scientific Research | Gissler M.,Finnish National Institute for Health and Welfare | Gissler M.,Nordic School of Public Health | And 4 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2012

Objective To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. Design Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. Setting Twenty-five countries in the European Union and Norway. Population Women giving birth in participating countries in 2003 and 2004. Methods Application of a common collection of data by selecting specific International Classification of Disease codes from the 'Pregnancy, childbirth and the puerperium' chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. Main outcome measures Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. Results In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100 000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). Conclusions Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended. © 2012 RCOG.


Witek P.,Military Institute of Medicine | Zielinski G.,Military Institute of Medicine | Szamotulska K.,National Research Institute of Mother and Child | Witek J.,National Research Institute of Mother and Child
Endokrynologia Polska | Year: 2012

Introduction: Hypercortisolaemia is the cornerstone of Cushing's disease (CD). It leads to the occurrence of typical somatic symptoms as well as cardiovascular and metabolic complications, which significantly increase morbidity and mortality and decrease quality of life in CD. Material and methods: A prospective study included 36 patients with CD who were assessed in terms of duration of their disease symptoms as well as the incidence of: arterial hypertension, glucose intolerance and diabetes, overweight, obesity and decreased bone mineral density (BMD). The relation was assessed between these particular complications and their impact on the efficacy of surgical treatment for CD. Results: The prevalence in the study group of arterial hypertension was 79%, and diabetes was 16.7%, whereas the proportion of pre-diabetic states was 33%. 36.1% of patients fulfilled the criteria of obesity and an additional 44% were overweight. Decreased BMD was reported in 72.2% of patients. There was a confirmed relationship between the duration of CD symptoms and the occurrence of overt diabetes (p < 0.01) and any type of glucose homeostasis alterations (p = 0.04). In this studied group with CD, there was also an association demonstrated between the occurrence of arterial hypertension and overweight or obesity (p = 0.03). Simultaneously, there was no relationship between the duration of symptoms or the presence of particular organ complications and the efficacy of surgical treatment for CD. Conclusions: Longer duration of CD is associated with a higher risk of glucose intolerance and/or diabetes. The overweight/obesity presented in the majority of patients increases the risk of secondary hypertension in CD. However, the efficacy of transsphenoidal surgery does not depend directly on either disease duration or type of occurring complications.


PubMed | NHS National Services Scotland, General Directorate of Public Health, National Research Institute of Mother and Child, Finnish National Institute for Health and Welfare and 6 more.
Type: Journal Article | Journal: European journal of public health | Year: 2016

International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting.We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance.516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring.Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance.


Cattaneo A.,Institute for Maternal and Child Health IRCCS Burlo Garofolo | Burmaz T.,Institute for Maternal and Child Health IRCCS Burlo Garofolo | Arendt M.,Initiativ Liewensufank and National Breastfeeding Committee | Nilsson I.,Danish Committee for Health Education | And 6 more authors.
Public Health Nutrition | Year: 2010

Objective To assess progress in the protection, promotion and support of breast-feeding in Europe.Design Data for 2002 and 2007 were gathered with the same questionnaire. Of thirty countries, twenty-nine returned data for 2002, twenty-four for 2007.Results The number of countries with national policies complying with WHO recommendations increased. In 2007, six countries lacked a national policy, three a national plan, four a national breast-feeding coordinator and committee. Little improvement was reported in pre-service training; however, the number of countries with good coverage in the provision of WHO/UNICEF courses for in-service training increased substantially, as reflected in a parallel increase in the number of Baby Friendly Hospitals and the proportion of births taking place in them. Little improvement was reported as far as implementation of the International Code on Marketing of Breastmilk Substitutes is concerned. Except for Ireland and the UK, where some improvement occurred, no changes were reported on maternity protection. Due to lack of standard methods, it was difficult to compare rates of breast-feeding among countries. With this in mind, slight improvements in the rates of initiation, exclusivity and duration were reported by countries where data at two points in time were available.Conclusions Breast-feeding rates continue to fall short of global recommendations. National policies are improving slowly but are hampered by the lack of action on maternity protection and the International Code. Pre-service training and standard monitoring of breast-feeding rates are the areas where more efforts are needed to accelerate progress. © 2010 The Authors.


Mohangoo A.D.,Applied Scientific Research | Buitendijk S.E.,Applied Scientific Research | Szamotulska K.,National Research Institute of Mother and Child | Chalmers J.,NHS National Services Scotland | And 5 more authors.
PLoS ONE | Year: 2011

Background: The first European Perinatal Health Report showed wide variability between European countries in fetal (2.6-9.1‰) and neonatal (1.6-5.7‰) mortality rates in 2004. We investigated gestational age patterns of fetal and neonatal mortality to improve our understanding of the differences between countries with low and high mortality. Methodology/Principal Findings: Data on 29 countries/regions participating in the Euro-Peristat project were analyzed. Most European countries had no limits for the registration of live births, but substantial variations in limits for registration of stillbirths before 28 weeks of gestation existed. Country rankings changed markedly after excluding deaths most likely to be affected by registration differences (22-23 weeks for neonatal mortality and 22-27 weeks for fetal mortality). Countries with high fetal mortality ≥28 weeks had on average higher proportions of fetal deaths at and near term (≥37 weeks), while proportions of fetal deaths at earlier gestational ages (28-31 and 32-36 weeks) were higher in low fetal mortality countries. Countries with high neonatal mortality rates ≥24 weeks, all new member states of the European Union, had high gestational age-specific neonatal mortality rates for all gestational-age subgroups; they also had high fetal mortality, as well as high early and late neonatal mortality. In contrast, other countries with similar levels of neonatal mortality had varying levels of fetal mortality, and among these countries early and late neonatal mortality were negatively correlated. Conclusions: For valid European comparisons, all countries should register births and deaths from at least 22 weeks of gestation and should be able to distinguish late terminations of pregnancy from stillbirths. After excluding deaths most likely to be influenced by existing registration differences, important variations in both levels and patterns of fetal and neonatal mortality rates were found. These disparities raise questions for future research about the effectiveness of medical policies and care in European countries. © 2011 Mohangoo et al.


PubMed | Reykjavik University, Copenhagen University, National Research Institute of Mother and Child, Finnish National Institute for Health and Welfare and 5 more.
Type: | Journal: BMC pregnancy and childbirth | Year: 2016

Previous studies have shown that socioeconomic position is inversely associated with stillbirth risk, but the impact on national rates in Europe is not known. We aimed to assess the magnitude of social inequalities in stillbirth rates in European countries using indicators generated from routine monitoring systems.Aggregated data on the number of stillbirths and live births for the year 2010 were collected for three socioeconomic indicators (mothers educational level, mothers and fathers occupational group) from 29 European countries participating in the Euro-Peristat project. Educational categories were coded using the International Standard Classification of Education (ISCED) and analysed as: primary/lower secondary, upper secondary and postsecondary. Parents occupations were grouped using International Standard Classification of Occupations (ISCO-08) major groups and then coded into 4 categories: No occupation or student, Skilled/ unskilled workers, Technicians/clerical/service occupations and Managers/professionals. We calculated risk ratios (RR) for stillbirth by each occupational group as well as the percentage population attributable risks using the most advantaged category as the reference (post-secondary education and professional/managerial occupations).Data on stillbirth rates by mothers education were available in 19 countries and by mothers and fathers occupations in 13 countries. In countries with these data, the median RR of stillbirth for women with primary and lower secondary education compared to women with postsecondary education was 1.9 (interquartile range (IQR): 1.5 to 2.4) and 1.4 (IQR: 1.2 to 1.6), respectively. For mothers occupations, the median RR comparing outcomes among manual workers with managers and professionals was 1.6 (IQR: 1.0-2.1) whereas for fathers occupations, the median RR was 1.4 (IQR: 1.2-1.8). When applied to the entire set of countries with data about mothers education, 1606 out of 6337 stillbirths (25%) would not have occurred if stillbirth rates for all women were the same as for women with post-secondary education in their country.Data on stillbirths and socioeconomic status from routine systems showed widespread and consistent socioeconomic inequalities in stillbirth rates in Europe. Further research is needed to better understand differences between countries in the magnitude of the socioeconomic gradient.


Statkiewicz M.,Center of Oncology of Poland | Maryan N.,Medical Center for Postgraduate Education | Lipiec A.,Center of Oncology of Poland | Grecka E.,National Research Institute of Mother and Child | And 5 more authors.
Prostate | Year: 2014

BACKGROUND The increased activity of the Sonic Hedgehog (SHH) pathway has been demonstrated in many types of cancer including prostate cancer (PCa). It has been shown that SHH pathway is involved in tumor angiogenesis and in regulation of metabolism of cancer stem cells. The increased activity of the SHH pathway is responsible for generation and maintenance of the multidrug resistance in cancer cells. A key role in the development of this insensitivity to cytotoxic drugs play ATP-binding cassette (ABC) transporters. METHODS SHH encoding plasmid was stably transfected into PCa cell lines DU145 and LNCaP. The expression of SHH was silenced by shRNA and the level of SHH was tested by quantitative (q)PCR and western blot methods. The effect of SHH overexpression in cells after treatment with paclitaxel was measured by MTT assay, crystal violet assay and flow cytometry. The level of 44 ABC transporters was estimated by qPCR. RESULTS Expression of exogenous SHH protein in DU145 and LNCaP cell lines enhanced their resistance to paclitaxel along with increased expression of ABC transporters transcripts. Paclitaxel treatment further enhanced the expression of increased ABC transporters transcripts in cells overexpressing SHH. CONCLUSIONS Overexpression of SHH enhances PCa cell lines resistance to paclitaxel. Higher level of SHH leads to increase in ABC transporters expression in a manner dependent on paclitaxel. © 2014 Wiley Periodicals, Inc.


Szostak-Wegierek D.,Medical University of Warsaw | Szamotulska K.,National Research Institute of Mother and Child | Maj A.,National Food and Nutrition Institute
Kardiologia Polska | Year: 2011

Background: Autopsy and ultrasonographic studies reveal atheromatous lesions in many young subjects. The progression of these changes depends on the presence of cardiovascular risk factors. Some studies have suggested that coronary risk may depend also on birthweight. Aim: To estimate the relationship between carotid intima-media thickness (CIMT), atherosclerosis risk factors and birthweight in young males. Methods: The study group consisted of 110 males aged 27-32 years, born after 36 weeks of gestational age. We took their anthropometric measurements, performed blood tests, and measured blood pressure and right CIMT. Results: Subjects with CIMT > 0.6 mm (n = 30), in comparison with the group with CIMT ≤ 0.6 mm (n = 80), had significantly lower mean birthweight (3,224 g vs 3,556 g, p = 0.001), lower mean serum HDL-cholesterol level (1.19 vs 1.36 mmol/L, p = 0.012), higher TC/HDL ratio (4.36 vs 3.71, p = 0.009), higher fasting serum glucose level (5.48 vs 5.28 mmol/L, p = 0.045), higher HbA1c (5.63 vs 5.40%, p = 0.044), and slightly higher (at the border of statistical significance) insulin resistance index HOMA-IR (2.56 vs 2.25, p = 0.074). In the group with CIMT > 0.6 mm, metabolic syndrome was more prevalent (43.3% vs 22.5%, p = 0.031). Adjustment either for body mass index or waist circumference, and for HDL--cholesterol level or TC/HDL ratio or fasting glucose level or HbA1c or HOMA-IR did not remove the negative effects of lower birthweight on the risk of CIMT > 0.6 mm as well as the adjustment for the presence of metabolic syndrome. Conclusions: The CIMT value in young males is independently related both with birthweight and disturbances of carbohydrate and lipid metabolism. Copyright © Polskie Towarzystwo Kardiologiczne.

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