In this paper we discuss the Russian adult health crisis and its implications. Although some hope that economic growth will trigger improvements in health, we argue that a scenario is more likely in which the unfavorable health status would become a barrier to economic growth. We also show that ill health is negatively affecting the economic well-being of individuals and households. We provide suggestions on interventions to improve health conditions in the Russian Federation, and we show that if health improvements are achieved, this will result in substantial economic gains in the future.
AIMS: The most commonly used indicator of fertility, the period total fertility rate (TFR(p)), tends to underestimate actual fertility when women delay childbearing. The objective of this study was to examine to which extent fluctuations in Danish fertility rates result from changes in timing of births and, thus, whether the conventional TFR(p) is a distorted indicator of fertility quantum. In addition, we investigated whether such changes in timing explained the observed regional differences in the TFR(p) in Denmark. METHODS: The study applied age-, period-, county-, and parity-specific data from the Danish Fertility of Women and Couples Dataset, 1980-2001. We evaluated fluctuations in period fertility rates by the tempo-adjusted TFR(') - a proposed variant of the conventional TFR(p) taking period changes in timing of births into account. Tempo-effects were given by the difference between TFR(p) and TFR(') , and these period measures were compared to actual cohort fertility. RESULTS: Mean age at childbearing increased with more than 3 years over the period 1980-2001 leading to considerable differences between TFR(p) and TFR(' ) . A tempo-effect of up to 0.347 children per woman was observed. Comparisons with actual cohort fertility showed consistency with the TFR('). However, tempo-adjustment did not attenuate observed regional differences. CONCLUSION: This study indicates that the conventional TFR(p) consistently underestimates the fertility quantum in periods characterized by changes in timing of births, and that the TFR(' ) generally provides good indication of actual cohort quantum for the period in question. Considerable tempo-effects were observed within counties; however, differences between regions were not explained by changes in timing of births.
Hellin's law states that if the twinning rate is w, then the triplet rate is w2, the quadruplet rate is w3, and so forth. The opinion of today is that Hellin's law holds only approximately. In this study the inaccuracy of Hellin's law is studied and the discrepancies are explained mathematically. In our earlier studies we built linear models for the twinning rate. Because most of the mothers are younger than 40 years of age and because in this age interval the twinning rate depends linearly on age, linear regression methods have been applied. Hellin's law suggests using the square-root transformation of the triplet rate r. Statistical arguments speak in favor of using the arcsin square root of r transformation. We discuss both transformations. Despite the fact that Hellin's law is only approximate, the arcsin transformation proves valuable. The transformed triplet rate can be modeled in a way similar to the twinning rate. We consider secular data from Finland for 1881-1990 and from Sweden since 1751. Using Hellin's law, we compare the triplet rates and the twinning rates and study the time trends of the observed twinning and triplet rates. The data are standardized. Our theoretical results are applied to multiple maternity data for Finland. Using maternal age as the regressor, we build a linear model for the twinning rate and for the arcsin-transformed triplet rate. This analysis shows a decreasing linear time trend in the triplet series for the period 1881-1950 but not in the twinning series. The triplet rate has an increasing trend after 1960, which seems to be mainly caused by artificial induction of ovulation.
Few reports on population-based studies of birth rate among epilepsy patients have been published. In most previous studies, fertility has been lower among epilepsy patients than in the rest of the population. However, conflicting results have also been reported. Because of small samples and selective material, the generalizability of these results is also limited. The authors conducted a population-based cohort study of birth rate (1985-2001) in a nationwide Finnish cohort of patients with newly diagnosed epilepsy and a population-based reference cohort. All patients (n = 14,077) approved as eligible for reimbursement for antiepileptic medication from the Social Insurance Institution of Finland (KELA) for the first time between 1985 and 1994 were identified from the KELA database. A reference cohort (n = 29,828) was identified from the Finnish Population Register Center, with frequency-matching on age. Information on follow-up status and livebirths were also obtained from the Finnish Population Register Center. The birth rate was lower in patients with epilepsy than in the reference cohort among both men (hazard ratio = 0.58, 95% confidence interval: 0.54, 0.62) and women (hazard ratio = 0.88, 95% confidence interval: 0.83, 0.93). There were a clear decreasing trend by age at observation in men with epilepsy and a moderate decreasing trend by age at start of follow-up in women with epilepsy.
More women of fertile age are long-term survivors of cancer. However, population-based data on birth rates of female cancer survivors are rare.
A total of 42,691 women = 45 years with a history of cancer were identified from the Swedish Multi-Generation Register and the Swedish Cancer Register, for whom relative birth rates were calculated as compared to the background population, ie, standardized birth ratios (SBRs). Independent factors associated with reduced birth rates among cancer survivors were estimated using Poisson modeling.
Compared to the background population, cancer survivors were 27% less likely to give birth (SBR = 0.73, 95% confidence interval [CI] = 0.72-0.75). Large difference in SBRs existed by cancer site, with high SBRs for survivors of melanoma skin, thoracic, head and neck, and thyroid cancers, and low SBRs for reproductive, breast, brain and eye, and hematopoietic cancer survivors. Parity status at diagnosis affected fertility: women who already had a child at the time of diagnosis were less likely to give birth (SBR = 0.50, 95% CI = 0.48-0.53) than were nulliparous women (SBR = 0.87, 95% CI = 0.85-0.90). Multivariate analysis showed that cancer site (reproductive organs), age at onset of cancer (
(1) To provide percentile tables and graphs of birth weight by gestational age and by gender, for singleton and twin liveborn neonates. (2) To determine changes in birth weight relative to gestational age over the study period.
Data on 556,775 singletons and 12,125 twins, born alive in Alberta from 1985 through 1998, were obtained from Alberta Registries - Vital Statistics. Mean birth weights for individual and grouped years were compared by independent two-tailed t-tests. Linear trends in birth weight over the 14-year period were obtained using one-way analyses of variance.
Four tables and corresponding graphs showing birth weight for gestational age by gender for 21 through 44 completed weeks gestation provide data for the 1st to 99th percentile. Changes in birth weight for the combined gestational ages included an increase for singletons (male, F 17.6, p
OBJECTIVE: The aim of the study was to evaluate the importance of increased use of assisted reproduction technologies (ART) for the fertility trends in the Czech Republic. DATA AND METHODS: Comparative analysis based on demographic and ART data was used. Demographic data have been published by EUROSTAT and the Czech Statistical Office. ART data have collected by ESHRE. FINDINGS: In the 1990s a trend towards later childbearing contributed greatly to the decline in total fertility rate (TFR) in the Czech Republic. Recently, recuperation of delayed births has resulted in the increase of TFR to 1.5 children per woman which is considered to be a critical minimum level. The highest increase in fertility rates occurred in the age group of 35-39, in which the contribution of ART treatments usually is greatest. Moreover, a substantial increase of multiple births has been registered. In 2005 the estimated share of children born after ART in the Czech Republic (3%) was close to countries with the highest share (Nordic countries, Belgium or Slovenia). However, the Czech Republic registered only half the number of ART cycles per million inhabitants than in those countries. Contrary to Nordic countries the Czech Republic faced an extremely low TFR of 1.28 children per woman. As the estimation of average number of cycles suggests, the need for fertility treatment has not been met in the Czech Republic yet. Moreover, due to the continuous postponement of childbearing to higher women s age, demand for ART treatment will be even higher in the near future and will probably result in the need of more than 2 500 cycles per million inhabitants in the Czech Republic. CONCLUSIONS: Spreading of ART is particularly relevant in the countries caught in the low fertility trap as higher impact on fertility trends could be expected. In the Czech Republic there is a chance to get over the critical level of TFR if comprehensive population policy including the improved access to ART based on well-considered strategy with explicit aim to optimize the quality of health care was accepted. However, from the demographic perspective the risk of further delay of childbearing encouraged by ART treatment should be taken into account while making these decisions.