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Reproductive events are associated with important physiologic changes, yet little is known about how reproductive factors influence long-term health in women. Our objective was to assess the relation of reproductive characteristics with all-cause and cause-specific mortality risk.
The analysis was performed within the European Investigation into Cancer and Nutrition prospective cohort study, which enrolled >500,000 women and men from 1992 to 2000, who were residing in a given town/geographic area in 10 European countries. The current analysis included 322,972 eligible women aged 25-70 years with 99 % complete follow-up for vital status. We assessed reproductive characteristics reported at the study baseline including parity, age at the first birth, breastfeeding, infertility, oral contraceptive use, age at menarche and menopause, total ovulatory years, and history of oophorectomy/hysterectomy. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality were determined using Cox proportional hazards regression models adjusted for menopausal status, body mass index, physical activity, education level, and smoking status/intensity and duration.
During a mean follow-up of 12.9 years, 14,383 deaths occurred. The HR (95 % CI) for risk of all-cause mortality was lower in parous versus nulliparous women (0.80; 0.76-0.84), in women who had ever versus never breastfed (0.92; 0.87-0.97), in ever versus never users of oral contraceptives (among non-smokers; 0.90; 0.86-0.95), and in women reporting a later age at menarche (≥15 years versus <12; 0.90; 0.85-0.96; P for trend = 0.038). Conclusions Childbirth, breastfeeding, oral contraceptive use, and a later age at menarche were associated with better health outcomes. These findings may contribute to the development of improved strategies to promote better long-term health in women. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0484-3) contains supplementary material, which is available to authorized users.
Age at menarche, Age at menopause, Breastfeeding, Mortality, Oral contraceptives, Parity
Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study
Melissa A. Merritt,corresponding author Elio Riboli, Neil Murphy, Mai Kadi, Anne Tjønneland, Anja Olsen, Kim Overvad, Laure Dossus, Laureen Dartois, Francoise Clavel-Chapelon, Renee T. Fortner, Verena A. Katzke, Heiner Boeing, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Domenico Palli, Sabina Sieri, Rosario Tumino, Carlotta Sacerdote, Salvatore Panico, H. Bas Bueno-de-Mesquita, Petra H. Peeters, Eiliv Lund, Aurelie Nakamura, Elisabete Weiderpass, J. Ramon Quiros, Antonio Agudo, Esther Molina-Montes, Nerea LarraNaga, Miren Dorronsoro, Lluis Cirera, Aurelio Barricarte, asa Olsson, Salma Butt, Annika Idahl, Eva Lundin, Nicholas J. Wareham, Timothy J. Key, Paul Brennan, Pietro Ferrari, Petra A. Wark, Teresa Norat, Amanda J. Cross, and Marc J. Gunter
The recent availability of efficacious prevention interventions among stable couples offers new opportunities for reducing HIV incidence in sub-Saharan Africa. Understanding the dynamics of HIV incidence among stable couples is critical to inform HIV prevention strategy across sub-Saharan Africa.
We quantified the sources of HIV incidence arising among stable couples in sub-Saharan Africa using a cohort-type mathematical model parameterized by nationally representative data. Uncertainty and sensitivity analyses were incorporated.
HIV incidence arising among stable concordant HIV-negative couples contribute each year, on average, 29.4% of total HIV incidence; of those, 22.5% (range: 11.1%-39.8%) are infections acquired by one of the partners from sources external to the couple, less than 1% are infections acquired by both partners from external sources within a year and 6.8% (range: 3.6%-11.6%) are transmissions to the uninfected partner in the couple in less than a year after the other partner acquired the infection from an external source. The mean contribution of stable HIV sero-discordant couples to total HIV incidence is 30.4%, with most of those, 29.7% (range: 9.1%-47.9%), being due to HIV transmissions from the infected to the uninfected partner within the couple. The remaining incidence, 40.2% (range: 23.7%-64.6%), occurs among persons not in stable couples.
Close to two-thirds of total HIV incidence in sub-Saharan Africa occur among stable couples; however, only half of this incidence is attributed to HIV transmissions from the infected to the uninfected partner in the couple. The remaining incidence is acquired through extra-partner sex. Substantial reductions in HIV incidence can be achieved only through a prevention approach that targets all modes of HIV exposure among stable couples and among individuals not in stable couples.
stable couples, sources of infection, HIV incidence, Sub-Saharan Africa, demographic and health surveys, mathematical model
Sources of HIV incidence among stable couples in sub-Saharan Africa
Hiam Chemaitelly,1 Susanne F Awad,1 James D Shelton,2 and Laith J Abu-Raddad§,1,3,4
The purpose of this study is to evaluate similarities and differences in gut bacterial measurements and stability in the microbial communities of three different types of samples that could be used to assess different niches of the gut microbiome: rectal swab, stool, and normal rectal mucosa samples. In swab-stool comparisons, there were substantial taxa differences with some taxa varying largely by sample type (e.g. Thermaceae), inter-individual subject variation (e.g. Desulfovibrionaceae), or by both sample type and participant (e.g. Enterobacteriaceae). Comparing all three sample types with whole-genome metagenome shotgun sequencing, swab samples were much closer to stool samples than mucosa samples although all KEGG functional Level 1 and Level 2 pathways were significantly different across all sample types (e.g. transcription and environmental adaptation). However, the individual signature of participants was also observed and was largely stable between two time points. Thus, we found that while the distribution of some taxa was associated with these different sampling techniques, other taxa largely reflected individual differences in the microbial community that were insensitive to sampling technique. There is substantial variability in the assessment of the gut microbial community according to the type of sample.
Inter-niche and inter-individual variation in gut microbial community assessment using stool, rectal swab, and mucosal samples
Roshonda B. Jones,#1 Xiangzhu Zhu,#2 Emili Moan,3 Harvey J. Murff,2 Reid M. Ness,4 Douglas L. Seidner,5 Shan Sun,1 Chang Yu,4 Qi Dai,2 Anthony A. Fodor,1 M. Andrea Azcarate-Peril,6 and Martha J. Shrubsolecorresponding author2