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Biomedical subjects

M Joffe

Publications and source records attributed to M Joffe.

At least 55 records · Page 3Linked to original sources
PubMed1996

Decreased fertility in Britain compared with Finland.

BACKGROUND: There has been much interest in the apparent decrease in semen quality. Because the evidence for such a decrease is open to criticism, a different type of evidence is needed. Finland seems to have escaped this decrease, as well as other disorders of the male reproductive tract, notably testicular cancer. If there has been a true decrease, the implications for fertility are unknown. METHODS: The most sensitive functional measure of fertility is time to pregnancy (TTP); this can be studied retrospectively at group level with a high degree of validity. To test the hypothesis that Finnish men are more fertile than British men, TTP distributions from published Finnish studies and data from Britain were compared. Two comparisons were made: a pair of antenatal studies, and a pair of cross-sectional studies. FINDINGS: In both comparisons, fertility was statistically significantly greater in Finland than in Britain. The findings did not seem to be due to methodological problems; in particular, the results could not be attributed to differences in frequency of intercourse, since this would have had the opposite effect on sperm concentration and on TTP. INTERPRETATION: The previously reported difference in sperm counts between Finland and elsewhere in northwest Europe (including Britain) is probably not artefactual, suggesting that the reported world-wide decline in semen quality is also real. Reasons for the "Finnish exception" may include maternal smoking, which used to be lower in Finnish women than elsewhere, and which might affect developing make offspring.

Adult↗
PubMed1996

The standard primipara as a basis for inter-unit comparisons of maternity care.

OBJECTIVE: To assess the suitability of the standard primipara (a subset of the obstetric population that has relatively low risk or intervention and of adverse outcome) for making inter-unit comparisons of indicators of the process and outcome of maternity care. DESIGN: Inter-unit comparison of 10 indicators of obstetric intervention and adverse outcome derived from routinely collected computerised data held on the St Mary's Maternity Information System. SETTING: Fifteen maternity units in the former North West Thames Region. PARTICIPANTS: 15,463 primiparae who were delivered in 1992. MAIN OUTCOME MEASURES: Proportion of primiparae within the standard definition; degree to which standard primiparae are associated with lower rates of intervention and adverse outcome, as compared to other primiparae. RESULTS: Within the database, 42.6% of all primiparae were found to be standard, with rates varying between units from 25.9% to 57.7%. As expected, the standard primiparous woman is at less risk of intervention or adverse outcome than other primiparae. All but one component variable of the standard definition is a significant risk factor for at least four of the 10 indicators. Statistically significant differences in indicator rates are seen between standard and nonstandard primiparae within units. Within the standard group, significant differences in rates of intervention and adverse outcome are seen between units. Units with relatively high levels of intervention within the higher risk nonstandard group also have relatively high levels of intervention within the standard group. CONCLUSIONS: Use of the standard primipara, rather than the whole obstetric population, as the basis for inter-unit comparisons of maternity care will control for the substantial difference in case mix seen in different units, thereby increasing the validity of those comparisons. The technique has the additional benefit of clarifying the relationship between everyday clinical decision making and a unit's performance in comparative indicator reports. The approach must be combined with a separate study of the other groups in the case mix, such as multiparae and high risk primiparae. Additional nonoverlapping groups, homogeneous in terms of risk factors, should be defined and used to extend the basis on which comparisons may be made.

Adult↗
PubMed1995

A time to pregnancy questionnaire designed for long term recall: validity in Oxford, England.

STUDY OBJECTIVE: To establish the degree of validity of data on time to pregnancy, derived retrospectively using a short questionnaire. DESIGN: Information from the questionnaire was compared with data that had been collected concurrently from the same individuals. SETTING AND PARTICIPANTS: Questionnaires were mailed to 1647 women who continue to be followed up by the Oxford Family Planning Association contraceptive study, and a further 424 were approached for personal interview. Response rates were 91% and 79% respectively. MAIN RESULTS: Matching was successful in 91% of pregnancies. Median recall time was 14 years (interquartile range, 11-16 years). At the group level, remarkably good agreement was found between the two sources of information, presented as cumulative percentage distributions of live births. The findings were at least as good with longer recall (> 14 years) as with shorter recall. Digit performance was present to a limited degree. At the individual level, some misclassification was evident, which has implications for statistical power. For detection of clinical infertility (no conception within 12 months), the sensitivity was in the range 67%-91%, and the specificity was 92%-96%. Variations with format, duration of recall, age at delivery, year of birth, parity, social class, smoking habit, last contraceptive method, and outcome (live birth or not) were generally small, and were not statistically significant. CONCLUSIONS: Time to pregnancy is a sensitive way of assessing reproductive function in either sex. Valid data at a group level can be derived retrospectively, with a long duration of recall, using a short questionnaire.

Adult↗
PubMed1994

Male and female factors in fertility.

Fertility is affected by the age of the female partner, but not that of the male partner, in the age ranges within which most attempts at conception occur. However, the literature on the effect of the smoking status of each partner is inconclusive. As part of a longitudinal study representative of all people born in Britain in 1958, 11,407 people were interviewed in 1991, of whom 3,132 female and 2,576 male cohort members had had or fathered at least one pregnancy. The outcome measure was the time to pregnancy of the first pregnancy (live births only), and the antecedent variables were the cohort member's age at that time and both partner's smoking habits and educational levels. Unadjusted analysis demonstrated that both the time to pregnancy and clinical subfertility were associated with higher maternal but not paternal age and with the smoking habits and educational levels of both parents. Multivariate analysis showed that paternal smoking failed to enter the model if the educational variables were also included. Findings were similar in the two separate analyses on male and female cohort members. This study confirms previous findings on the relative importance of maternal and paternal age in this age range. Maternal smoking affects fertility, but earlier reports of an apparent effect of paternal smoking may be due to confounding with socioeconomic status.

Adult↗
PubMed1994

Association of time to pregnancy and the outcome of pregnancy.

OBJECTIVE: To examine the relationship of subfertility with miscarriage, low birth weight, and preterm delivery. DESIGN: Comparison of time to pregnancy distributions between pregnancies that had different outcomes. Three comparisons were made: (a) miscarriages with live births; within live births, (b) low birth weight infant (up to 2,500 grams) or not low birth weight; (c) preterm birth (37 weeks or less) or not preterm. Cox regression was used to adjust for covariates. POPULATION: All first pregnancies were analyzed from the National Child Development Study, a large survey of young adults aged 33 years, which is nationally representative of the British-born population. MAIN OUTCOME MEASURES: The distribution of the time taken to conceive (time to pregnancy), miscarriage, birth weight, and preterm delivery. RESULTS: Pregnancies that ended in miscarriage tended to take 23% longer to conceive, after adjustment for the other variables. Pregnancies that resulted in preterm delivery tended to take 15% longer to conceive. There was no statistically significant association with low birth weight. CONCLUSIONS: Delay in time to conception is a risk factor for poor obstetric outcome, irrespective of medical intervention.

Abortion, Spontaneous↗
PubMed1994

What is the optimal caesarean section rate? An outcome based study of existing variation.

STUDY OBJECTIVE: To investigate the consequences of different levels of caesarean section (CS) rate in terms of fetal and maternal outcomes. DESIGN: Comparison of outcome variables between four categories of maternity units stratified according to CS rates. Data were collected concurrently. SETTINGS: All 17 maternity units in one health region. SUBJECTS: Data for the perinatal mortality analysis: all 221,867 deliveries in 1983-87 (excluding severe malformations) (1462 deaths); maternity information analysis system: all 36,727 women with singleton pregnancies who delivered in 1988. OUTCOME MEASURES: Perinatal mortality, Apgar scores at one and five minutes, onset of respiration after one minute, postnatal transfusion, postnatal infection, thromboembolism, low haemoglobin concentration at discharge, and puerperal psychosis were determined. RESULTS: Teaching hospitals with an increased proportion of high risk cases had the highest CS rate, but the other three categories were found to serve comparable populations. Perinatal mortality showed a birthweight specific pattern--for very low birthweight infants, but not for other deliveries, mortality rates were lower in units with higher CS rates. Apgar scores showed no trend, but the onset of respiration after one minute was significantly more frequent in units with a CS rate of less than 10%. Increased maternal postnatal blood transfusion was associated with higher CS rates but no trend was observed for the other maternal variables. CONCLUSIONS: CS rates in general maternity units should be 10 to 12% or lower in the singleton population as a whole, but a more interventionist approach is indicated for very low birthweight infants. If confirmed, these recommendations could easily be incorporated into clinical audit.

Apgar Score↗
PubMed1993

Long-term recall of time-to-pregnancy.

OBJECTIVE: To validate two versions of a short self-completion questionnaire on time-to-pregnancy. DESIGN: Information from the questionnaire was compared with concurrently collected data from the same individuals. POPULATION: Questionnaires were sent to 1,647 women who continue to be followed up by the Oxford Family Planning Association Contraceptive Study. Replies were received from 1,498, a response rate of 91.0%. Successful matching was achieved with 1,392 pregnancies that met the study criteria and that had values of time-to-pregnancy in both data sources. Median recall time was 14 years (interquartile range, 11 to 16 years). MAIN OUTCOME MEASURES: At the group level, the frequency distributions of time-to-pregnancy from the two sources are presented as cumulative percentages. At the individual level, the distribution of discrepancies between the sources is tabulated separately for each value of time-to-pregnancy, and accuracy of detection of clinical subfertility is presented (sensitivity and specificity). RESULTS: At the group level, remarkably good agreement was found between the two sources of information. Digit preference was present to a limited degree. There were no important differences between the two questionnaire versions. At the individual level, some misclassification was evident. For the detection of clinical infertility, sensitivity was 79.9% and specificity was 94.9%. CONCLUSIONS: Short, self-completion questionnaires are remarkably accurate for assessing time-to-pregnancy at a group level. Individual-level misclassification is frequent, but detection of clinical subfertility is fairly accurate.

Adult↗
PubMed1993

Propranolol treatment of albuterol poisoning in two asthmatic patients.

The cases of two asthmatic adolescents who overdosed on albuterol are presented. Both patients were tremulous, tachycardic, and hypokalemic. Both were treated successfully with IV propranolol. Neither patient developed bronchospasm. The toxicity of albuterol overdoses and its treatment are discussed.

Adolescent↗
PubMed1993

A two-year retrospective study of accidental pediatric albuterol ingestions.

A two-year retrospective review of accidental albuterol ingestions in children less than 12 years old was performed to assess overdose toxicity and to investigate a dose-effect relationship. One hundred twelve exposures were located. Seventeen cases were excluded owing to coingestants, leaving 95 cases for evaluation. Twenty-nine children (30%) remained at home without intervention or telephone followup because of an ingestion of less than 0.6 mg/kg. Twenty-eight patients (30%) were followed at home by telephone (12 of whom received ipecac). Dosages ranged from 1 to 27 mg, with dose/weight ratios of 0.1 to 1.9 mg/kg. Two children experienced transient mild symptoms (irritability, brief nausea, and vomiting). The remaining 26 children were asymptomatic. Thirty eight cases (40%) were treated in an emergency department. Ingestions ranged from 2 to 96 mg, with dose/weight ratios of 0.3 to 6.3 mg/kg. Ages ranged from one to 11 years. Transient restlessness or irritability was observed in 16 patients, tachycardia in 15, tremors in six, and a widened pulse pressure in one. No serious events occurred in this series, and no patient required treatment beyond gastrointestinal decontamination. For ingestions of 0.6 mg/kg or less, treatment at home with observation may be sufficient. For larger ingestions, eg, greater than 0.6 mg/kg, consideration should be given to direct medical evaluation and gastrointestinal decontamination.

Accidents, Home↗
PubMed1993

Citizens' action for public health.

The European Public Health Alliance aims to ensure broad participation in health-related policy-making and to contribute to the promotion of public health. The origins of the Alliance and the ways in which it relates to official bodies are outlined below.

Community Participation↗
PubMed1992

Validity of exposure data derived from a structured questionnaire.

It is often convenient to obtain occupational exposure information directly from employees. However, there is little published evidence on the validity of such data. Information from a short, pre-coded, structured questionnaire, administered by non-expert interviewers, was compared with information derived from management in five factories in the printing and plastics industries in England in 1986. Values of sensitivity ranged from 24% to 85% for eight different exposures, and specificity was at least 67% for seven of the eight agents. Those exposures which were described in chemically specific terms tended to have relatively higher specificities but lower sensitivities. Male workers' reports tended to have higher sensitivity but lower specificity compared with those of female workers. Workers who had been employed in the company for more than 10 years were no more accurate than their colleagues. Subjects who reported a phase of subfertility or at least one miscarriage did not have a higher proportion of false positives than the population as a whole, indicating an absence of reporting bias. Major improvements are highly desirable, especially to reduce underreporting of exposures. The use of workers' own names for agents may improve reporting.

Age Factors↗