Trends in the incidence, rate and treatment of miscarriage-nationwide register-study in Finland, 1998-2016

STUDY QUESTION: What changes have occurred in the incidence of miscarriage, its treatment options, and the profile of the women having miscarriages in Finland between 1998 and 2016? SUMMARY ANSWER: The annual incidence of registry-identified miscarriage has declined significantly between 1998 and 2016, and non-surgical management has become the dominant treatment. WHAT IS KNOWN ALREADY: Miscarriage occurs in 8-15% of clinically recognized pregnancies and in similar to 30% of all pregnancies. Increasing maternal age is associated with an increasing risk of miscarriage. The treatment of miscarriage has evolved significantly in recent years: previously, surgical evacuation of the uterus was the standard of care, but nowadays medical and expectant management are increasingly used. STUDY DESIGN, SIZE, DURATION: We conducted a nationwide retrospective cohort study of 128381 women that had experienced a miscarriage that was managed in public healthcare between 1998 and 2016 in Finland. PARTICIPANTS/MATERIALS, SETTING, METHODS: We used the National Hospital Discharge Registry for the data. Women aged 15-49 years that had experienced their first miscarriage during the follow-up period and had miscarriage-related diagnoses during their admission to public hospital were included in the study. Miscarriages were defined by the 10(th) Revision of the International Statistical Classification of Diseases and related Medical Problems (ICD-10) diagnostic codes O02*, O03* and O08*. Women with ectopic, molar and continuing pregnancies and induced abortions were excluded. Treatment was divided into surgical and non-surgical treatment using the surgical procedure codes. MAIN RESULTS AND THE ROLE OF CHANCE: The annual incidence of registry-identified miscarriage has declined from 6.8/1000 15-49-year-old women in 1998 to 5.0/1000 in 2016 (P <0.001). Also, the incidence rate of registry-identified miscarriage (i.e. the proportion of miscarriages of registry-identified pregnancies [i.e. deliveries, induced abortions, and miscarriages]) has declined from 112/1000 15-49-year-old pregnant women in 1998 to 83/1000 in 2016 (P <0.001). The largest decrease in this proportion occurred among women over 40 years of age, among whom 26.5% of registry-identified pregnancies in 1998 ended in miscarriage compared to that of 16.4% in 2016. The proportion of missed abortion has increased (30.3 to 38.8%, P <0.001) whereas that of blighted ovum has decreased (25.4 to 12.8%, P <0.001). The proportion of registry-identified miscarriages seen among nulliparous women has increased from 43.7 to 49.6% (P <0.001). Mean age at the time of miscarriage remained at 31 years throughout the study. Altogether, 29% of all miscarriages were treated surgically and 71% underwent medical or expectant management. The proportion of surgical management has decreased from 38.0 to 1.6% for spontaneous abortion, from 60.7 to 9.4% for blighted ovum and 70.9 to 11.2% for missed abortion between 1998 and 2016. LIMITATIONS, REASONS FOR CAUTION: This study includes only women with registry-identified pregnancies, i.e. women who were treated in public hospitals. However, the number of women treated elsewhere is presumed to be small. Neither can this study estimate the number of women having spontaneous miscarriage with no hospital contact. WIDER IMPLICATIONS OF THE FINDINGS: Both the annual incidence and incidence rate of miscarriage of all registry-identified pregnancies has decreased, and non-surgical management has become the standard of care. These findings are of value when planning allocation of healthcare resources and at individual level considering fertility and miscarriage questions. We speculate that improving ultrasound diagnostics explains the increasing proportion of missed abortion relative to other types of miscarriage. More investigation is needed to examine potential risk factors, complications and morbidity associated with miscarriages.Peer reviewe

On Associativity Equations in Dispersionless Integrable Hierarchies

We discuss the origin of the associativity (WDVV) equations in the context of quasiclassical or Whitham hierarchies. The associativity equations are shown to be encoded in the dispersionless limit of the Hirota equations for KP and Toda hierarchies. We show, therefore, that any tau-function of dispersionless KP or Toda hierarchy provides a solution to associativity equations. In general, they depend on infinitely many variables. We also discuss the particular solution to the dispersionless Toda hierarchy that describes conformal mappings and construct a family of new solutions to the WDVV equations depending on finite number of variables.Comment: 16 pages, LaTe

Changes in surface solar radiation in Northeastern Spain over the past six centuries recorded by tree-ring δ13C.

Although solar radiation at the surface plays a determinant role in carbon discrimination in tree rings, stable carbon isotope chronologies (δ13C) have often been interpreted as a temperature proxy due to the co-variability of temperature and surface solar radiation. Furthermore, even when surface solar radiation is assumed to be the main driver of 13C discrimination in tree rings, δ13C records have been calibrated against sunshine duration or cloud cover series for which longer observational records exists. In this study, we use different instrumental and satellite data over northeast Spain (southern Europe) to identify the main driver of tree-ring 13C discrimination in this region. Special attention is paid to periods in which the co-variability of those climate variables may have been weaker, such as years after large volcanic eruptions. The analysis identified surface solar radiation as the main driver of tree-ring δ13C changes in this region, although the influence of other climatic factors may not be negligible. Accordingly, we suggest that a reconstruction of SSR over the last 600 years is possible. The relation between multidecadal variations of an independent temperature reconstruction and surface solar radiation in this region shows no clear sign, and warmer (colder) periods may be accompanied by both higher and lower surface solar radiation. However, our reconstructed records of surface solar radiation reveals a sunnier Little Ice Age in agreement with other δ13C tree-ring series used to reconstruct sunshine duration in central and northern Europe

Qualitative and Quantitative Evidence on the True Local Welfare Costs of Forest Conservation in Madagascar: Are Discrete Choice Experiments a Valid ex ante Tool?

Protected areas may impose local welfare costs through the enforcement of use restrictions. Predicting their welfare impacts before their establishment could help with the design of compensation schemes. Discrete choice experiments (DCEs) are increasingly used for ex ante evaluations but their validity is largely untested in low-income settings. Using a case study of a new REDD+ (Reducing Emissions from Deforestation and forest Degradation) project in eastern Madagascar, we explore the validity of DCEs in two ways: (i) whether the estimates of welfare costs derived from DCE are affected by respondents’ prior experience of conservation (ii) whether DCE results have high theoretical and content validity. We surveyed households who have varying degrees of experience of restrictions to swidden agriculture. We also qualitatively debriefed a sub-sample of respondents to better understand their thought processes. Latent class analysis shows that DCE outcomes vary with conservation experience. Households more experienced with forest protection are less willing to trade-off rights to clear forest for swidden agriculture with any compensatory interventions whereas less experienced households highly favor support for alternative agricultural techniques and a secure right to clear one hectare of forest. Although the results show apparent non-attendance to some attributes (e.g., cash payments), qualitative debriefings suggest that respondents infact do expect relatively low or no utility from the given attributes and hence have theoretically valid preferences. Similarly, the DCE has generally high content validity. Although DCE can elicit current preferences in this context, using ex ante DCE to estimate the welfare costs of such a long-term intervention requires caution. We conclude that it is difficult to robustly estimate compensation in advance of an intervention, there is therefore a need to rethink conservation approaches, and the feasibility of achieving fair compensations for conservation-imposed restrictions

Kin recognition and step-paternal investment: the effect of childhood co-residence duration

Evolutionarily relevant nepotistic kin investment requires reliable kin detection. Evolutionary scholars have argued that childhood co-residence is one of the most important indirect cues for kinship. While childhood co-residence duration has been found to correlate with kin investment in intragenerational studies (i.e., among siblings), intergenerational investigations considering the association between childhood co-residence duration and kin investment have been scarce. Here, we investigate whether the investment of biological and stepfathers is correlated with childhood co-residence duration. We used data from adolescents and adults (aged 17–19, 27–29, and 37–39 years) from the German Panel Analysis of Intimate Relationships and Family Dynamics (Pairfam), wave 2, collected in 2010–2011. Paternal investment was measured as financial and practical help, emotional support, intimacy, and emotional closeness. We found that while stepfathers invested less than biological fathers, both biological and stepfathers’ investments increased with increased childhood co-residence duration in most measures. Financial help correlated with childhood co-residence in stepfathers but not in biological fathers who helped financially more than stepfathers regardless of childhood co-residence duration. Emotional support, intimacy, and emotional closeness were correlated with childhood co-residence in both biological fathers and stepfathers. Practical help did not correlate with co-residence in either father. Thus, our results partially support the hypothesis that childhood co-residence duration serves as a kin detection cue and directs intergenerational altruism.</p

The interplay of grandparental investment according to the survival status of other grandparent types

Inclusive fitness theory predicts that grandparental investment in grandchildren aims to maximise their inclusive fitness. Owing to an increasing overlap between successive generations in modern affluent populations, the importance of grandparental investment remains high. Despite the growing literature, there is limited knowledge regarding how the survival status of different grandparent types influences each other's investment in grandchildren. This question was studied by using the Involved Grandparenting and Child Well-Being Survey, which provided nationally representative data of English and Welsh adolescents aged 11-16-years. We applied Bayesian structural equation modeling (BSEM) where grandparental investment in grandchildren was modelled using multi-indicator unobserved latent variable. Our results showed that maternal grandmothers' investment was increased by having a living maternal grandfather but not vice versa. Having a living maternal grandmother was also associated with decreased investment of paternal grandparents while the opposite was not found. These findings indicate that the association between the survival status of other grandparents and the focal grandparents' investment varies between grandparent types

Matrilateral bias of grandparental investment in grandchildren persists despite the grandchildren's adverse early life experiences

Evolutionary theory predicts a downward flow of investment from older to younger generations, representing individual efforts to maximize inclusive fitness. Maternal grandparents and maternal grandmothers (MGMs) in particular consistently show the highest levels of investment (e.g. time, care and resources) in their grandchildren. Grandparental investment overall may depend on social and environmental conditions that affect the development of children and modify the benefits and costs of investment. Currently, the responses of grandparents to adverse early life experiences (AELEs) in their grandchildren are assessed from a perspective of increased investment to meet increased need. Here, we formulate an alternative prediction that AELEs may be associated with reduced grandparental investment, as they can reduce the reproductive value of the grandchildren. Moreover, we predicted that paternal grandparents react more strongly to AELEs compared to maternal grandparents because maternal kin should expend extra effort to invest in their descendants. Using population-based survey data for English and Welsh adolescents, we found evidence that the investment of maternal grandparents (MGMs in particular) in their grandchildren was unrelated to the grandchildren's AELEs, while paternal grandparents invested less in grandchildren who had experienced more AELEs. These findings seemed robust to measurement errors in AELEs and confounding due to omitted shared causes

Lineage-based differences in grandparental investment according to adverse early life experiences of grandchildren

Evolutionary theory predicts a downward flow of investments from older to younger generations that represents individuals’ efforts to maximize their inclusive fitness. Maternal grandparents and maternal grandmothers in particular have been consistently found to show the highest investment (e.g., time, care and resources) in their grandchildren. However, grandparental investment may depend on varying social and environmental conditions affecting the development of children, modifying the benefits and costs of grandparental investment. Using population-based survey data of English and Welsh adolescents, the present study investigates whether grandparental investment responds to adverse early life experiences (AELEs) of grandchildren. In contrast to current literature that considers grandparental investment in response to AELEs from the perspective of increased investment to meet the increased need, we predict that higher number of AELEs are associated with reduced grandparental investment as increased AELEs tend to reduce the reproductive value of grandchildren. Moreover, we predict that those grandparents who already invest less (i.e., paternal grandparents) react more strongly to elevated AELEs compared to those grandparents who invest the most (i.e., maternal grandparents and maternal grandmothers in particular). We found support for our predictions that maternal grandparents (maternal grandmothers in particular) showed investment in grandchildren that was unrelated to their grandchildren’s AELEs. In contrast, paternal grandparents reduced their investment in grandchildren in cases of increased AELEs. These findings were largely robust to measurement error in the of AELEs and confounding due to omitted shared causes.</p

The impact of full-thickness rotator cuff tear on shoulder function and quality of life in patients who sustain a proximal humerus fracture—a prospective cohort study

Publisher Copyright: © 2021 The Author(s)Background: Only few studies have investigated the impact of rotator cuff integrity on patients with proximal humerus fracture (PHF). We aimed to determine if the presence of a rotator cuff tear impairs shoulder function and health-related quality of life (HRQoL) after nonsurgically treated PHF. Methods: Sixty-seven patients with PHF were recruited prospectively in a cohort. Presence of a full-thickness rotator cuff tear was determined by ultrasound examination. After 6 and 12 months, Constant-Murley Score; Disability of the Arm, Shoulder and Hand; the Visual Analog Scale; EuroQol-5 Domain; and the 15D scores were compared between the patients with a rotator cuff tear and patients with an intact rotator cuff. Results: The prevalence of a full-thickness rotator cuff tear was 34%. After 12 months, the mean Constant-Murley Score was 65.7 (standard deviation 16.3) in the intact rotator cuff group vs. 53.9 (16.0) in the rotator cuff tear group (mean diff. 11.8, 95% confidence interval 2.5; 21.2) and was found to be a clinically relevant difference. A significantly lower HRQoL was found on the EuroQol-5 Domain score after 12 months in the rotator cuff tear group with a median score of 1 (interquartile range 0.23) in the intact rotator cuff group vs. 0.75 (interquartile range 0.34) in the rotator cuff tear group (P = .03). In the remaining outcome measures, no statistically significant between-group differences were detected. Conclusion: Rotator cuff tear in older adults with nonsurgically treated PHF may be considered a prognostic factor for poorer shoulder function and HRQoL. This knowledge can support the planning of treatment.Peer reviewe