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Objectives This study targeted public health nurses in a Japanese municipality that had newly adopted the core components of the Finnish system to provide continuous support to families with children until preschool. It sought to analyze changes in their perceptions for activities in maternal and child health care before and after the adoption.Methods Relevant data were collected through semi-structured focus group interviews, following an interview guide, conducted from September to October 2020. The study protocol was approved by the Ethics Committee of Osaka City University in Japan.Results A total of 12 public health nurses participated. Prior to the adoption of the system modelled on Finnish practice, these nurses were dedicated to addressing the risks regarding families with children (especially those at high risk) through continuous engagement. However, they were hesitant to proactively engage with families at lower risk as non-continuous, one-off engagements resulted in a patchwork response. After the system was adopted, the nurses became aware of the trust cultivated with families under their care, which included those at lower risk, that enabled them to respond to the changing needs flexibly. The nurses recognized that they had acquired the capability to notice the subtle signs of changes, engage more proactively with the families under their care, and deliver the necessary preventive interventions at an early stage. They also demonstrated joy and satisfaction derived from the growth of children and mothers under their care, as well as keen awareness of the need to improve their professional skills, even though they were busy.Conclusion These findings indicate that the continuous support system modelled on the core components from Finland enables public health nurses to proactively engage with families at lower risk and deliver preventive interventions at an early stage. The system also motivated Japanese public health nurses who found greater pleasure in their work.

Objectives The aims of this study were to investigate perceived childcare burdens among mothers with an inter-pregnancy interval of less than 12 months, and to identify the factors associated with those perceptions.Methods Anonymous, self-administered questionnaires on inter-pregnancy intervals, the Edinburgh postnatal depression scale (EPDS), and the childcare emotion scale were distributed to mothers who visited one of three health and welfare centers in City A for three-month well-baby checkups. Six hundred eighty-five subjects were classified into four groups according to their inter-pregnancy interval (12 months apart; ≥12 months but24 months apart; ≥24 months apart; and a group with no siblings), and they was used to analyze associations between the timing of pregnancy and the mothers' perceptions of their childcare burdens. Chi-squared tests, a one-way analysis of variance, the Kruskal-Wallis test, and linear regression analyses were used for analysis.Results The inter-pregnancy interval was12 months in 35 of the 685 respondents, ≥12 months but24 months in 114 respondents, and ≥24 months in 194 respondents. There were 342 respondents in the no-siblings group. Linear regression analyses disclosed some factors associated with the subordinate items of the childcare emotion scale. "Feeling restricted by childcare duties" is significantly correlated to inter-pregnancy interval (P=.032), family composition (P=.014), time of sleeping (P=.010), and night wake-up time (P=.001). "Feeling of burden because of the child's attitude and behavior" was significantly related to inter-pregnancy interval (P.001), mother's age (P=.003), time of sleeping (P=.009), and night wake-up time (P=.002). "Anxiety about the child's growth" was significantly related to inter-pregnancy interval (P.001), mother's age (P=.016), and gestational age (P.001). In addition, the group with gestation intervals of less than 12 months had significantly higher numbers of women in single-parent households (P=.005), who were unmarried (P=.007), had only a junior high school education (P=.0027), and were 24 years old or younger (P.001).Conclusion The pregnancy interval is significantly related to the "Feeling restricted by childcare duties," "Feeling of burden because of the child's attitude and behavior," and "Anxiety about the child's growth," even after adjusting the influence of other factors. In addition, the results of this study demonstrated that mothers in the12 months group were more likely to be in a single-parent household, unmarried, with low educational attainment, and were 24 years old or younger. The results suggest that greater support is needed for these mothers.

The new West Japan Twins and Higher Order Multiple Births Registry was established by recruiting young twins and multiple births and by referrals from public health centers in the 1990s. The participants included in the survey comprised over 7800 twins and 4241 higher order multiples, and their families. Specifically, the present registry contains one of the largest triplet samples in the world. For these twins and multiples, data on year of delivery, mode of delivery, gestational age, intrapartum complications, longitudinal physical measures, motor milestones, cerebral palsy and feeding methods were obtained from records in the Maternal and Child Health Handbooks and schools. Participating mothers were asked to indicate family structure, parental educational history, maternal sleeping time, maternal health condition, maternal and paternal age at multiple delivery, complications during pregnancy, handedness of multiples and age at menarche of multiples. However, the zygosity differed among the various collaborating public health centers according to factors such as the time of investigation. Follow-up questionnaires have been mailed out every 3–4 years for longitudinal studies. This article describes the goals of this registry, recruitment of multiples and the focus of the study. The goals of this registry are not only to conduct research on human genetics and maternal and child health, but also to contribute to providing appropriate information for families with multiples.

Background: There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment. Aim: To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors. Methods: This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses. Results: Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14-4.25 cm and 0.18-0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length. Conclusion: Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight. This work was supported by the Academy of Finland (grant number #266592). The Australian Twin Registry is supported by a Centre of Research Excellence (grant ID 1079102) from the National Health and Medical Research Council administered by the University of Melbourne. The Boston University Twin Project is funded by grants (#R01 HD068435 #R01 MH062375) from the National Institutes of Health to K. Saudino. The Carolina African American Twin Study of Aging (CAATSA) was funded by a grant from the National Institute on Aging (grant 1RO1-AG13662-01A2) to K. E. Whitfield. The CATSS-Study is supported by the Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework grant no 340-2013-5867, grants provided by the Stockholm County Council (ALF-projects), the Swedish Heart-Lung Foundation and the Swedish Asthma and Allergy Association's Research Foundation. Colorado Twin Registry is funded by NIDA funded center grant DA011015, & Longitudinal Twin Study HD10333; Author Huibregtse is supported by 5T32DA017637 and 5T32AG052371. Since its origin the East Flanders Prospective Survey has been partly supported by grants from the Fund of Scientific Research, Flanders and Twins, a non-profit Association for Scientific Research in Multiple Births (Belgium). Data collection and analyses in Finnish twin cohorts have been supported by ENGAGE - European Network for Genetic and Genomic Epidemiology, FP7-HEALTH-F4-2007, grant agreement number 201413, National Institute of Alcohol Abuse and Alcoholism (grants AA-12502, AA-00145, and AA-09203 to R J Rose, the Academy of Finland Center of Excellence in Complex Disease Genetics (grant numbers: 213506, 129680), Centre of Excellence in Research on Mitochondria, Metabolism and Disease (FinMIT, grant 272376), the Academy of Finland (grants 100499, 205585, 118555, 141054, 265240, 263278 and 264146 to J Kaprio and grant 266286 and 314383 to K Pietilainen), the Finnish Diabetes Research Foundation, Novo Nordisk Foundation, Helsinki University Central Hospital and University of Helsinki. K Silventoinen is supported by Osaka University's International Joint Research Promotion Program. Gemini was supported by a grant from Cancer Research UK (C1418/A7974). Anthropometric measurements of the Hungarian twins were supported by Medexpert Ltd., Budapest, Hungary. Korean Twin-Family Register was supported by the Global Research Network Program of the National Research Foundation (NRF 2011-220-E00006). Longitudinal Israeli Study of Twins was funded by the Starting Grant no. 240994 from the European Research Council (ERC) to Ariel Knafo. The Michigan State University Twin Registry has been supported by Michigan State University, as well as grants R01-MH081813, R01-MH0820-54, R01-MH092377-02, R21-MH070542-01, R03-MH63851-01 from the National Institute of Mental Health (NIMH), R01-HD066040 from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD), and 11-SPG-2518 from the MSU Foundation. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH, the NICHD, or the National Institutes of Health. PETS was supported by grants from the Australian National Health and Medical Research Council (grant numbers 437015 and 607358 to JC, and RS), the Bonnie Babes Foundation (grant number BBF20704 to JMC), the Financial Markets Foundation for Children (grant no. r 032-2007 to JMC), and by the Victorian Governments Operational Infrastructure Support Program. The Quebec Newborn Twin Study acknowledges financial support from the Fonds Quebecois de la Recherche sur la Societe et la Culture, the Fonds de la Recherche en Sante du Quebec, the Social Science and Humanities Research Council of Canada, the National Health Research Development Program, the Canadian Institutes for Health Research, Sainte-Justine Hospital's Research Center, and the Canada Research Chair Program (Michel Boivin). The Twins Early Development Study (TEDS) is supported by a program grant (MR/M021475/1) from the UK Medical Research Council and the work on obesity in TEDS is supported in part by a grant from the UK Biotechnology and Biological Sciences Research Council (31/D19086). The West Japan Twins and Higher Order Multiple Births Registry was supported by Grant-in-Aid for Scientific Research (B) (grant number 15H05105) from the Japan Society for the Promotion of Science. Netherlands Twin Register acknowledges the Netherlands Organization for Scientific Research (NWO) and MagW/ZonMW grants 904-61-090, 985-10-002, 912-10-020, 904-61-193, 480-04-004, 463-06-001, 451-04-034, 400-05-717, Addiction-31160008, Middelgroot-911-09-032, Spinozapremie 56-464-14192; VU University's Institute for Health and Care Research (EMGO +); the European Research Council (ERC - 230374), the Avera Institute, Sioux Falls, South Dakota (USA).

Background Stepfamilies remain poorly understood in Japanese society, and the support needs of stepfamily mothers are unclear. This study aimed to identify characteristics of stepfamilies and maternal mental health as compared with non-stepfamilies in Japan to utilize as a primary resource for providing effective support through community-based health care for stepfamilies. Methods From December 2011 to July 2012, we conducted this questionnaire survey with mothers at 3- and 4-month checkups for infants. The response rate was 75.1%. The sample for analysis included responses of 2246 mothers, excluding single mothers. Results Respondents comprised 47 (2.1%) stepfamilies and 2199 (97.9%) non-stepfamilies. There were significantly higher rates of parents with not more than a high school education and ≥3 children among stepfamilies compared with non-stepfamilies. Stepfamily mothers had significantly higher rates of feeling a lack of economic resources, absence of participation in childbirth education classes, smoking during pregnancy, and unplanned pregnancy. Furthermore, they also had significantly higher rates of depression and a lack of confidence in the parent role. Maternal depression was associated with factors such as maternal age, self-perceived health, stress level, confidence in breastfeeding, confidence in the parent role, and number of children. Conclusions These findings suggest that stepfamilies exhibit many characteristics related to social disadvantage and problems with community-based health care in Japan. Healthcare providers should be aware of stepfamily mothers’ support needs and should put in place a support system for stepfamilies. Moreover, compared with non-stepfamily mothers, stepfamily mothers have a significantly higher prevalence of depression. However, stepfamily composition does not necessarily increase the risk of maternal depression. Therefore, healthcare providers should put in place a system for obtaining more thorough information about stepfamilies and conduct an early assessment to identify their support needs.

Background: Twins and triplets fall behind singletons in cognitive and physical development. We analysed whether these differences are modified by family social position. Methods: IQ, height, body mass index (BMI) and elbow flexion, handgrip and knee extension strength were measured in Swedish men born between 1951 and 1976 during the conscription examination at 17 to 20 years of age. Information from Swedish registers on all siblings and parental socio-economic position were linked to these measures. Together, the measures were available for 1 140 329 singletons, 19 755 twins and 207 triplets. The data were analysed using regression analyses and fixed-effect models which compare twins and triplets with their singleton brothers. Results: Twins and triplets had slightly lower IQ, height, BMI and muscle strength than did singletons both at the population level as well as when compared with their singleton brothers. Although the differences between twins and triplets were small, they were largest in families with lower socio-economic position. We also found larger differences in IQ among the sons of mothers born before 1940. Conclusions: Twins and triplets fall slightly behind singletons in cognitive and physical development, even in early adulthood, but twins and triplets show no major differences. These differences are largest in families in a low socio-economic position. Our results underscore the importance of the postnatal environment in the development of twins and triplets and suggest that their parents, especially those in a low socio-economic position, need special support.

Heikkila, Kauko/0000-0002-9256-8028; McAdams, Tom/0000-0002-6825-3499; Ordonana, Juan R./0000-0001-7779-6017; Siribaddana, Sisira/0000-0001-5821-2557; Tan, Qihua/0000-0003-3194-0030; Skytthe, Axel E/0000-0002-8629-4913; Hjelmborg, Jacob/0000-0001-9630-9149; Kaprio, Jaakko/0000-0002-3716-2455; Loos, Ruth J F/0000-0002-8532-5087; ONCEL, Sevgi YURT/0000-0002-0990-292X; Fagnani, Corrado/0000-0001-5771-7772; mangino, massimo/0000-0002-2167-7470; Colodro-Conde, Lucia/0000-0002-9004-364X; Kandler, Christian/0000-0002-9175-235X; ROMERA, JUAN FRANCISCO SANCHEZ/0000-0002-5405-6216; Montgomery, Grant W/0000-0002-4140-8139; Medland, Sarah E/0000-0003-1382-380X; Christensen, Kaare/0000-0002-5429-5292; Aliev, Fazil/0000-0001-8357-4699; Huibregtse, Brooke M./0000-0003-0977-7249; Busjahn, Andreas/0000-0001-9650-6919; Tan, Qihua/0000-0003-3194-0030; Sund, Reijo/0000-0002-6268-8117; Kremen, William/0000-0002-8629-5609; Pahlen, Shandell/0000-0003-0753-4155; Rasmussen, Finn/0000-0001-7915-7809; Franz, Carol/0000-0002-8987-1755; Pedersen, Nancy/0000-0001-8057-3543; Aaltonen, Sari/0000-0002-2873-4263; Hotopf, Matthew/0000-0002-3980-4466; Rebato, Esther/0000-0003-1221-8501; Kyvik, Kirsten Ohm/0000-0003-2981-0245; Rijsdijk, Fruhling/0000-0003-4762-2803; Silventoinen, Karri/0000-0003-1759-3079 WOS: 000391277600001 PubMed: 27964777 Human height variation is determined by genetic and environmental factors, but it remains unclear whether their influences differ across birth-year cohorts. We conducted an individual-based pooled analysis of 40 twin cohorts including 143,390 complete twin pairs born 18861994. Although genetic variance showed a generally increasing trend across the birth-year cohorts, heritability estimates (0.69-0.84 in men and 0.53-0.78 in women) did not present any clear pattern of secular changes. Comparing geographic-cultural regions (Europe, North America and Australia, and East Asia), total height variance was greatest in North America and Australia and lowest in East Asia, but no clear pattern in the heritability estimates across the birth-year cohorts emerged. Our findings do not support the hypothesis that heritability of height is lower in populations with low living standards than in affluent populations, nor that heritability of height will increase within a population as living standards improve. Suomen Akatemia [266592] Suomen Akatemia 266592 Karri Silventoinenr The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Background: Chest circumference (CC) is suggested to be a good indicator of early life nutrition, but little is known on the heritability of CC. Thus we analysed the effects of genetic and environmental factors on the development of CC in Japanese infants. Methods: CC was measured longitudinally from birth until 1 year of age in a cohort of 211 monozygotic and 160 dizygotic complete Japanese twin pairs born in 1989–2002. The data were analysed using applications of structural linear equation modelling for twin data. Results: No sex-specific differences in the variance components were found. Environmental factors unique to each twin explained the major part of the variation of CC at birth whereas environmental factors shared by co-twins were more important at 1–3 months of age. From 3 months of age, the effect of genetic factors become steadily stronger and they explained the majority of the variation at 1 year of age. Strong genetic continuity in the development of CC was found, but also new sets of genes were activated during the first year of life. The origin of the environmental part of the variation could be tracked before 3 months of age. A substantial part of common and specific environmental factors affecting CC affected also birthweight. Conclusions: CC is sensitive to intrauterine environmental factors, but these effects diminish during the first year of life, at least if postnatal environment is good. CC can be a useful indicator when identifying newborns who have suffered suboptimal pre-natal conditions.

We analyzed the characteristics associated with the growth in height of Japanese triplets from birth to 12 years of age. The study included 376 mothers and their 1,128 triplet children, who were born between 1978 and 2006. Data were collected through a mailed questionnaire sent to the mothers asking for information recorded in medical records. For these births, data on triplets' length and height growth, gestational age, sex, parity, maternal age at delivery, and maternal height were obtained from records in the Maternal and Child Health Handbooks and records in the school which children receive health check-ups. The height deficit of the triplets compared to the general population of Japan remained between 2% and 5% until 12 years of age. Moreover, at 12 years of age, the differences of height between the general population and triplets were approximately -3.6 cm for male and -4.4 cm for female. Maternal height showed the strongest contribution to height of triplets from 6 to 12 years of age. In conclusion, triplets remain shorter than singletons until 12 years of age.

目的：国内において報告されてきた笑いの効果を身体面，精神面の二方向から概観し，看護の場で笑いを用いる有効性を提示することを目的とした．方法：引用文献の検索には，医学中央雑誌刊行会から，“笑い”or“ユーモア”をキーワードとして1980年以降，2009年5月までで検索を行い，29件採用した．また，国際誌はPubMedを用い，2000年以降，2009年5月までの文献からキーワード“laughter”and“effect”で検索し，20件を採用した．結果：笑いの身体面の効果としては，笑い体験によるNK細胞活性ならびにアレルギー反応などの免疫系に関して効果があったという報告が最も多く，その他疼痛緩和，血糖上昇抑制作用があることが報告されていた．また笑いの精神的効果として，ストレスコーピング，不安ならびに緊張の緩和などの効果が報告されていた．結論：笑いは，身体面と精神面両方での効果が期待できる．しかし，看護ケアとして笑いの効果を検討した研究は少なく，今後，看護師による笑いに関する介入研究の成果が期待される．

We analyzed the genetic architecture of prepubertal development of relative weight to height in 216 monozygotic and 159 dizygotic complete Japanese twin pairs (52% girls). Ponderal index at birth (kg/m(3)) and body mass index (BMI, kg/m(2)) from 1 to 11 years of age were used. Additive genetic factors explained the major proportion (52-74%) of the variation of BMI from 1 to 11 years of age. Environmental factors common to both co-twins also showed some effect (7-28%), but at most ages this was not statistically significant. Strong genetic tracking was found for BMI from 1 to 11 years of age, but there was also evidence for a persistent effect of common environmental factors. Our results suggest that the genetic architecture of BMI development in the Japanese population is generally similar to that found in previous twin studies in Caucasian populations.

We analyzed the characteristics associated with the growth in length and height of Japanese triplets from birth to 6 years of age and present the growth charts for them. The study included 354 mothers and their 1,061 triplet children, who were born between 1978 and 2006. Data were collected through a mailed questionnaire sent to the mothers asking for information recorded in medical records. For these births, data on triplets' length and height growth, gestational age, sex, parity, and maternal age at delivery were obtained from records in the Maternal and Child Health Handbooks, which is provided by the authorities after a report of pregnancy. Birth length showed the strongest contribution to height of triplets from 1 to 6 years of age. In addition, birthweight was also a significant contributing factor to height from 1 to 3 years of age. Compared to the 50th percentile of the growth standard for the general population of Japan, the length and height deficit of the triplets was approximately 15% at birth (male, –7.0 cm; female, –7.0 cm), decreased within the first year of age, and fluctuated between 2 and 5% until 6 years of age (male, –3.7 cm; female, –3.3 cm). In conclusion, triplets have lower birth length and subsequent height than singletons. In spite of the catch-up growth during the first year of life, they are behind singletons even in mid-childhood. This study provides height growth curves for triplets.

This study was performed using population-based data to analyze whether motor development in early life is different between singletons and twins in Japan. For better comparison and investigation, we divided the 2 groups into a group with a birthweight of 2.5 kg or greater (subgroup A) and a group with a birthweight of less than 2.5 kg (subgroup B), respectively. We analyzed the database of medical check-ups for children aged 3 years between April 2001 and July 2004. They received medical checkups at 4 months, 1.5, and 3 years of age. Children who were suspected of having neurological abnormality or disability were referred to specialists and excluded from the database. The data of 14,132 children were analyzed. Among these, 13,040 (92.3%) children were singletons in subgroup A, 75 (0.5%) were twins in subgroup A, 866 (6.1%) were singletons in subgroup B and 151 (1.1%) were twins in subgroup B. The mean age at achieving milestones was slower in twins of subgroup A for each developmental outcome than singletons of subgroup A, and the difference between twins and singletons was significant after adjustment for rolling over. On the contrary, after adjusting for a confounding factor (gestational age), singletons of subgroup B attained motor development facilitating walking independently slower than twins of subgroup B. There were different tendencies in the results regarding the motor development of subjects of subgroup A and that of subjects of subgroup B.

Background:The occurrence of multiple births has been recognized as a risk factor for child maltreatment. However, few population-based studies have examined the relationship between multiple births and child maltreatment. This study aimed to evaluate the degree of risk of child maltreatment among singletons and multiple births in Japan and to identify factors associated with increased risk.Methods:Using population-based data, we analyzed the database of records on child maltreatment and medical checkups for infants aged 1.5 years filed at Nishinomiya City Public Health Center between April 2007 and March 2011. To protect personal information, the data were transferred to anonymized electronic files for analysis.Results:After adjusting by logistic regression for each associated factor and gestation number, multiples themselves were not associated with the risk of child maltreatment. However, compared with singletons, multiples had a significantly higher rate of risk factors for child maltreatment, including low birth weight and neural abnormality. Moreover, compared with mothers of singleton, mothers of twins had a significantly higher rate of poor health, which is a risk factor of child maltreatment.Conclusion:Multiples were not associated with the risk of child maltreatment. However, compared with singletons, multiples and their mothers had a significantly higher rate of risk factors of child maltreatment.

This study was performed to determine the rates of breastfeeding among singletons, twins and triplets in Japan, and identify factors associated with the decision to breastfeed or bottle-feed. We analyzed a database of medical check-up of infants aged 3 to 6 months between April 2001 and July 2004 in Nishinomiya City in Japan. This medical check-up is given to almost 100% of infants in Japan and the data of 15,262 infants were analyzed. Among these, 14,963 (98.0%) were singletons, 290 (1.9%) were twins and 9 (0.1%) were triplets. Exclusive breast-feeding was chosen by 6680 (43.8%) mothers, mixed-feeding by 4645 (30.4%) mothers, and bottle-feeding with formula milk only by 3900 (25.6%) mothers. The rate of exclusive breastfeeding among twins or triplets was significantly lower than among singleton babies: 4.1% among twins or triplets, and 44.7% among singletons. Moreover, twins and triplets were independently associated with a higher rate of bottle-feeding: the odds ratio indicated that mothers who had twins or triplets were 2.44 times more likely to choose bottle-feeding with formula milk only than those who had singletons. Sucking ability at birth was associated with a higher rate of bottle-feeding: the odds ratio indicated that mothers who had infants with poor sucking ability at birth were 1.56 times more likely to choose bottle-feeding as those who had infants with normal sucking ability.

The aims of this study were to identify factors associated with birthweight, birth length and head circumference for triplets, and analyze these body size parameters at birth, especially head circumference, according to gestational age. The subjects of this study were 370 mothers and their 1109 triplet children (excluding one stillborn infant) who were born between 1978 and 2002. The gestational age proved to be the strongest contributing factor to birthweight, birth length and head circumference of the triplets. Moreover, sex was a significant factor affecting birthweight, birth length and head circumference. Male neonates had a higher birthweight, longer birth length and greater head circumference than female neonates. Birth order in triplets also had a significant effect on birthweight and head circumference. Lower birth- order neonates had a higher birthweight and greater head circumference. An effect of maternal pregravid body mass index (BMI) on both birth- weight and birth length was observed. The birthweights of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 weighed an average of 150 g more than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2, and the birth length of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 averaged 1.5 cm longer than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2. Concerning head circumference, the median head circumference of male neonates was approximately 0.5 cm longer than female neonates. Compared to singleton neonates, the median head circumference of triplets was almost the same.

BACKGROUND: The purpose of this study was to analyze the characteristics of the physical growth of twins in childhood and to present growth charts of Japanese twins. METHODS: The subjects consisted of 2029 pairs of normally developed Japanese twins. Growth data were obtained by mailed or hand-distributed questionnaires. Factors that affect body weight and height/length at selected ages were analyzed by stepwise regression analysis. Selected percentiles o body weight, height/length, and body mass index were calculated according to sex, and growth curves were drawn using a spline function. The size deficit of the twins compared to the standards for the general population of Japan was calculated. RESULTS: Gestational age, parity, zygosity, and birth order affected physical growth in varying degrees, although the overall effects themselves were small and mostly disappeared by one year of age. Growth charts of the twins present growth at selected percentiles from birth to 6 years of age according to sex. The size deficit of the twins was largest at birth: more than 20% for weight and approximately 6% for length compared to the 50th percentile of the standard for the general population of Japan. These deficits decreased rapidly in the first 6 to 12 months, and were found to be as low as 0-2% at 4 to 6 years of age. CONCLUSION: Growth charts specifically for twins are needed, at least for the first 1 to 3 years of age but not beyond the age of 6 years.

The purpose of this study was to clarify the characteristic child-rearing problems for mothers of multiple children who conceived after infertility treatment as compared to mothers of multiple children who conceived spontaneously. The subjects were 990 mothers of multiple children: 359 who conceived after infertility treatment and 631 who conceived spontaneously. Mothers who conceived after infertility treatment were more delighted when informed of a multiple pregnancy than those who conceived spontaneously. In addition, with respect to anxiety during twin pregnancies, mothers of twins who conceived after infertility treatment showed lower rates of anxiety about nursing the infants and economic concerns than those of twins who conceived spontaneously. However, after delivery, mothers who conceived after infertility treatment showed a higher rate of depressive symptoms than those who conceived spontaneously. After adjusting for each associated factor using logistic regression, the risk of depressive symptoms in mothers who conceived after infertility treatment was significantly associated with disabled multiple children and the methods for alleviating stress. The odds ratio indicated that mothers with at least one disabled child were twice as likely to have depressive symptoms as mothers with no disabled children. Furthermore, the odds ratio indicated that mothers who used no methods for alleviating stress were twice as likely to have depressive symptoms than those who did.

Length and weight in infancy are associated with neurodevelopment, but less is known about growth in other anthropometric measures. In this study we analyzed how the development in length, weight, head circumference, and chest circumference over infancy is associated with motor development in early childhood, using a twin study design. Information on physical development over infancy and the age at achievement of eight developmental milestones over early childhood was collected for 370 Japanese twin pairs. Linear mixed models were used to analyze how physical development is associated with motor development between individual twins, as well as within twin pairs, adjusting the results for shared maternal and postnatal environmental factors. Delayed motor development was associated with smaller body size over infancy, and we also found some suggestive evidence that it was associated with catch-up growth as well. When studying the associations within twin pairs discordant for motor development, similar associations were found. However, chest circumference showed the most robust association within discordant twin pairs. Smaller body size and rapid catch-up growth are associated with delayed motor development. When studying these associations within twin pairs and thus adjusting the results for gestational age as well as many other maternal and postnatal environmental factors, chest circumference showed the most robust association. Chest circumference, rarely used in developed countries, can offer additional information on prenatal conditions relevant for further motor development not achieved by more traditional anthropometric measures.

Objectives: It is important to note that until now most of the Japanese government services for maternal welfare and child-rearing are for mothers of first children. However, as the number of children increases, the burden of care increases. Therefore, this study aimed to determine the factors that affect child-rearing uneasiness of mothers with their first child and those with two or more children, by analyzing data obtained from mothers at the 3-month health checkup after delivery in Japan. Study design: Cross-sectional design Methods: From April 2005 to December 2009, 2552 infants underwent health checkups designed for infants. The questionnaire included the following maternal factors: maternal age at delivery, birth order, fatigue, disturbed sleep, anorexia, depression, low energy, loneliness, uneasiness, irritation, large gap between reality and perception, financial anxiety, child-rearing support, individuals who can provide advice concerning child-rearing. Results: It was found that in the first child group, maternal uneasiness was affected by fatigue (OR=3.843), disturbed sleep (OR=2.155), mothers’ loneliness (OR=3.016), feeling a large gap between reality and perception (OR=2.875), feeling irritated (OR=2.093) and financial worry (OR=2.493) and experience of child’s sickness (OR=1.259). On the other hand, in the second or later child group, maternal uneasiness was affected by fatigue (OR=3.781), mothers’ loneliness (OR=3.321), feeling irritated (OR=2.397) and financial worry (OR=2.675), experience of child’s sickness (OR=1.390) and mothers’ deliveries pathologies (OR=1.396). Conclusions: It is likely that maternal uneasiness with the first child and with the second or later child was affected same factors except a few factors. In Japan, efforts to create a society where parents can give birth and raise children without worry have started. It is very important for families with children to be able to choose and utilize support and services suited to them.

This study investigated the prevalence of depression and health problems in caregivers for the disabled elderly at home, and identified factors associated with the risk of depression. Four hundred thirty-four caregivers for disabled elderly persons in a suburban city were surveyed by in-home interviews. Two hundred ten non-caregivers were also interviewed as an age and gender-matched control group. Overall, 16.8% of caregivers met the DSM-III-R criteria for major depression and 10.6% met the criteria for depressive disorders not otherwise specified, for a total of 27.4% meeting the criteria for affective disorders, while 8.6% of controls met the criteria for depressive disorders not otherwise specified. The prevalence of major depression in caregivers was associated with mental problems and ADL limitations of the elderly. Moreover, non-cooperation by other family members or relatives contributed to an increase in the prevalence of depression. Caregivers who met the criteria for major depression had a higher frequency and longer duration of upper respiratory infections than other caregivers or controls, and showed greater fatigue than the other caregivers or controls. Approximately 90% of caregivers who met the criteria for major depression had also insomnia. Overall, it was shown that caregivers who met the criteria for major depressin had not only emotional distress but also higher morbidity.

Twins and triplets fall behind singletons in cognitive and physical development. We analysed whether these differences are modified by family social position.IQ, height, body mass index (BMI) and elbow flexion, handgrip and knee extension strength were measured in Swedish men born between 1951 and 1976 during the conscription examination at 17 to 20 years of age. Information from Swedish registers on all siblings and parental socio-economic position were linked to these measures. Together, the measures were available for 1,140,329 singletons, 19,55 twins and 207 triplets. The data were analysed using regression analyses and fixed-effect models which compare twins and triplets with their singleton brothers.Twins and triplets had slightly lower IQ, height, BMI and muscle strength than did singletons both at the population level as well as when compared with their singleton brothers. Although the differences between twins and triplets were small, they were largest in families with lower socio-economic position. We also found larger differences in IQ among the sons of mothers born before 1940.Twins and triplets fall slightly behind singletons in cognitive and physical development, even in early adulthood, but twins and triplets show no major differences. These differences are largest in families in a low socio-economic position. Our results underscore the importance of the postnatal environment in the development of twins and triplets and suggest that their parents, especially those in a low socio-economic position, need special support.

We aimed to analyze the characteristics of development of relative weight in Japanese triplets from birth until 12 years of age. Data were collected through a mailed questionnaire sent to mothers of triplets asking for information recorded in medical records. Altogether we had information on 1,061 triplet children of 354 mothers born between 1978 and 2006. For these births, data on triplets’ height and weight growth, gestational age, sex, parity, and maternal age at delivery were obtained from records in the maternal and child health handbooks and records from the schools where children receive health check-ups. In addition, information on maternal height and weight was obtained. Triplets have a lower ponderal index at birth and lower body mass index (BMI) compared with the general population until 12 years of age, except for the period during 1 and 3 years of age. Moreover, birth weight had the strongest contribution to BMI of triplets until 6 years of age. After 9 years of age, maternal BMI was a significant factor affecting BMI of triplets.

This study was conducted to investigate the prevalence rates of handicaps in twins and triplets. The subjects were 252 twins and 287 triplets. The following results were obtained. 1) The prevalence rates of the handicapped were 8.7 per 100 triplets, and 4.4 per 100 twins. The risk of producing at least one handicapped child was approximately 22% in triplet pregnancy and 9% in twin pregnancy. This means that one in 4 or 5 sets of triplets had at least one handicapped child, as did one in 11 pairs of twins. 2) Cerebral palsy was the most frequent handicap in twins and triplets. The risks of producing a child with cerebral palsy were 2.0% and 3.1% in twins and triplets, respectively. 3) The prevalence rates of congenital anomalies (congenital heart disease, limb anomalies, and others) were 2.4% in twins and 4.5% in triplets. Approximately 45% of the handicaps in twins and triplets resulted from congenital anomalies. 4) The prevalence rate of the handicapped in twins and triplets was not associated with maternal age, but was associated with the years of delivery in triplets, and was higher in babies with shorter gestation periods.

This study aimed to identify the breast-feeding rate and associated factors and to get better understanding on the mother's sentiment towards child rearing due to differences in feeding methods. This information can be used as primary sources providing effective support through community-based health care for mothers and infants.The study was carried out in Osaka city from April 2005 to December 2009. Data from the health-checkup records on infants aged 3-5 months were used after excluding any personal information. The data used included feeding methods (exclusive breast-feeding, mixed-feeding, and bottlefeeding), gestational age, multiple pregnancy status, gender, birth weight, use of an incubator, and birth year. Moreover, the data included the following maternal factors: planned or unplanned nature of pregnancy, smoking and drinking status during pregnancy, presence or absence of pregnancy-induced hypertension, maternal age at delivery, working status, presence or absence of financial anxiety, presence or absence of child-rearing support, presence or absence of individuals who can provide advice concerning child rearing, and sentiments of mothers during child rearing.From April 2005 to December 2009, 2552 infants underwent health checkups designed for infants. Of these, data on 2476 children, excluding 61 infants with unknown feeding methods and 15 infants aged 6 months, were used for analyses. The results showed that 56.6%, 28.7%, and 14.7% of children received exclusive breast-feeding, mixed-feeding, and bottle-feeding, respectively. Infant feeding methods were significantly associated with the birth year: in recent years, a decrease in the number of mothers who chose to bottle-feed their infants was observed. Furthermore, the feeding methods were associated with multiple births, birth weight, maternal smoking status during pregnancy, and maternal age at delivery. The results revealed that mothers who chose to breast-feed exclusively enjoyed child rearing at a significantly higher rate of 93.4%00, compared to 88.4%0 of mothers who chose to bottle-feed or mixed-feed.The study revealed that among infants aged from 3 to 5 months, 57% and 15% were exclusively breast-fed and bottle-fed, respectively; additionally, the proportion of bottle-fed infants declined every year. A significantly larger number of exclusively breast-feeding mothers enjoyed child rearing than the bottle-feeding or mixed-feeding mothers. These feeding methods were associated with multiple births, birth weight, maternal smoking status during pregnancy, and maternal age at delivery.

The West Japan Twins and Higher Order Multiple Births Registry was established in the 1990s by recruiting young twins and multiples and through referrals from public health centers. To date, over 7,000 twins and 4,300 higher order multiple births and their families have been registered in the survey, and it includes one of the largest triplet samples in the world. Follow-up questionnaires are also mailed every 2 to 3 years as part of longitudinal survey studies. This article describes the goals of the registry, the recruitment of multiples, and the overall focus of the study. The goals of the registry are not only to provide data for research on human genetics and maternal and child health, but also to provide appropriate information for families with multiples.

Chest circumference (CC) is suggested to be a good indicator of early life nutrition, but little is known on the heritability of CC. Thus we analysed the effects of genetic and environmental factors on the development of CC in Japanese infants.CC was measured longitudinally from birth until 1 year of age in a cohort of 211 monozygotic and 160 dizygotic complete Japanese twin pairs born in 1989-2002. The data were analysed using applications of structural linear equation modelling for twin data.No sex-specific differences in the variance components were found. Environmental factors unique to each twin explained the major part of the variation of CC at birth whereas environmental factors shared by co-twins were more important at 1-3 months of age. From 3 months of age, the effect of genetic factors become steadily stronger and they explained the majority of the variation at 1 year of age. Strong genetic continuity in the development of CC was found, but also new sets of genes were activated during the first year of life. The origin of the environmental part of the variation could be tracked before 3 months of age. A substantial part of common and specific environmental factors affecting CC affected also birthweight.CC is sensitive to intrauterine environmental factors, but these effects diminish during the first year of life, at least if postnatal environment is good. CC can be a useful indicator when identifying newborns who have suffered suboptimal pre-natal conditions.

WOS:000309095700009 We analyzed the characteristics associated with the growth in weight of Japanese triplets from birth to 12 years of age. The study included 376 mothers and their 1,128 triplet children, who were born between 1978 and 2006. Data were collected through a mailed questionnaire sent to the mothers asking for information recorded in medical records. For these births, data on triplets' weight growth, gestational age, sex, parity, maternal age at delivery, maternal height, and maternal body mass index were obtained from records in the Maternal and Child Health Handbooks and records in the school where children receive health check-ups. The weight deficit of the triplets compared to the general population of Japan remained between 10% and 17% until 12 years of age. Moreover, at 12 years of age, the differences of weight between the general population and triplets were approximately -4.75 kg for boys and -6.00 kg for girls. Very low birth weight had the strongest contribution to body weight until 8 years of age. After 8 years of age, maternal body mass index was a significant factor affecting the weight of triplets until 12 years of age.

Genetic factors explain a major part of the variation of adult stature, but little is still known on the genetics of growth, especially in non-Caucasian populations.To analyse the quantitative genetics of pre-pubertal growth in Japanese children.Data from birth until 11 years of age were collected on 349 complete twin pairs based on previously recorded height measures. The data were analysed using two different multivariate models by the Mx statistical package.No major sex differences were found and thus boys and girls were analysed together. Since 1 year of age, genetic factors explained from 42-71% and environmental factors shared by co-twins from 14-33% of the variation of height. Genetic continuity of height was high and 75% of the genetic variance was shared since 1 year of age. Environmental factors affecting height showed weaker correlations between early and late childhood than genetic factors.Growth from early to late childhood is largely regulated by the same set of genes. However, also environmental factors shared by co-twins are important for growth. Identifying specific environmental factors affecting growth has potentially important public health implications, even in an affluent society such as Japan.

We analyzed whether motor development in early life is different between singletons and triplets in Japan. The motor development was reported by mothers by postal questionnaire for 1,121 triplet children and in regular health check-ups for 13,906 singleton children. Children who were suspected of having neurological abnormality or disability were excluded from the analysis. The ages of milestone achievements were significantly higher in triplets for each outcome compared to singletons. Further, after adjustment for gestational age, birthweight, and birth length, the differences were significant for maintaining head, sitting alone and standing holding on. In children with birthweight of 2 kg or more, the ages of milestone achievements were significantly higher in triplets for each outcome compared to singletons, except walking holding on. Moreover, after adjustment for the confounding factors, the differences were significant for sitting alone and walking independently. On the contrary, singletons attained motor development facilitating crawling, walking holding on, and walking independently slower than triplets among those children with birthweight of 2 kg or less after adjustment for gestational age. In conclusion, triplets are overall at higher risk for the delay of gross motor milestones as compared to singletons independently of birth-related factors. In contrast, among children with a birthweight of less than 2 kg, singletons showed slower motor development than triplets after adjusting for gestational age. There is an obvious need to apply developmental standards that consider at least both multiple birth status (singleton, twin or triplet) and birthweight.

This research was conducted to determine the prevalence of recognition of child maltreatment among mothers with children aged 12 or under, and to identify associated factors in order to prevent child maltreatment.The subjects of this study were 3,000 women extracted by systematic random sampling of mothers of 6,790 children who had had four-month health check-ups in Nishinomiya city. The response rate was 57.5%. After excluding mothers with children aged 13 years and over, the study sample included 1,471 mothers with children aged 12 or under. A questionnaire survey was conducted by mail. Recognition of child maltreatment by mothers was assessed with a question that asked the mother if she was sometimes aware that she had potentially abused her child, and, if yes, what kind of acts had she performed.There were 333 mothers (22.6%) who answered "yes" to the question "Are you sometimes aware that you have potentially abused your child?" These mothers reported emotional or physical aggression toward their children. Results of logistic regression showed that recognition of child maltreatment was associated with existence of a child whom the mother felt difficulty in cherishing, number of children, maternal poor health, higher scores of STAI trait anxiety and disabled children. Mothers reported difficulties in child-rearing for more than one child as the main reason behind existence of a child whom the mother felt difficulty in cherishing.These findings suggested that mothers with more than one child need more support in order to prevent child maltreatment.

Objectives: Previous studies have shown strong genetic influence to head circumference (HC), but still little is known on the development of genetic etiology of HC in infancy, especially in non-Caucasian populations. Thus, we decided to analyze the genetics of HC growth in Japanese infants. Methods: Longitudinal measures of HC were available from birth to 13 months of age in 206 monozygotic and 156 dizygotic complete twin pairs. Genetic modeling for twin data was used. Results: We found only little evidence for sex-specific differences in the genetics of HC and thus analyzed boys and girls together. After 5 months of age the heritability of HC was high, but before that age also a substantial common environmental component was present. Not only strong genetic persistence for HC was found but also a new genetic variation emerged. New environmental variation shared by co-twins affecting HC was found until 3 months of age, and this effect was further transmitted until 1 year of age. Conclusions: HC and its growth are strongly genetically regulated. Largely, the same genetic factors affect the variation of HC at different ages, and new genetic variation emerged during the first year of life. Knowledge on the genetic component in the variation of HC may help to design tools for defining abnormal growth of HC in population-based screenings for related disorders. Am. J. Hum. Biol., 2011. © 2011 Wiley-Liss, Inc.

Seven calystegins were isolated from the whole plant of Hyoscyamus niger . They are calystegins A 3 , A 5 , A 6 , B 1 , B 2 , B 3 , and N 1 . The structure of new calystegin A 6 was determined as 1α,2β,7α-trihydroxy- nor -tropane, and another new calystegin N 1 was elucidated to be a trihydroxy- nor -tropane alkaloid with a bridgehead NH 2 group in the place of a bridgehead OH group in calystegin B 2 . Very interestingly, on storage for a half year in a refrigerator, approximately 40% of calystegin N 1 was nonenzymically converted into calystegin B 2 . Calystegin N 1 was a weaker inhibitor of glycosidases compared to calystegin B 2 but with the same inhibitory spectrum. However, calystegin N 1 inhibited porcine kidney trehalase in a noncompetitive manner, whereas calystegin B 2 inhibited this enzyme in a competitive manner.

The purpose of this survey was to study anxiety and associated factors in the mothers of twins or triplets as compared with the mothers of singleton children.The subjects were 130 mothers of twins or triplets aged 3 or under and 860 mothers of similarly aged singleton children. The Japanese version of State-Trait Anxiety Inventory (STAI) was used to evaluate their anxiety states.1. Mothers of twins or triplets showed significantly higher STAI state anxiety scores than those of singleton children. However, there was no significant difference in STAI trait anxiety between mothers with twins or triplets and those with singleton children. 2. Mothers of twins or triplets showed greater anxiety during pregnancy than those of singleton children. There were also higher rates of cases where stress could not be alleviated in mothers of twins or triplets than in those with singleton children. STAI state anxiety of mothers was associated with anxiety during pregnancy, anxiety for future child-rearing, problems with stress alleviation, maternal health conditions, poor sleeping conditions and having siblings.This study indicated a tendency for mothers of twins or triplets to show greater anxiety as compared with those having singleton children. It is important to improve the child-rearing environment to reduce anxiety felt by mothers of twins or triplets.

Dibutyltin diazide has proven to be potential in nucleophilic ring opening of a variety of oxiranes to give 1,2-azido alcohols in less than four hours (DMF at 60 °C) in fair to excellent yields.

This study was performed to determine the rates of breast-feeding and/or bottle-feeding in mothers of twins, triplets and higher order multiple births compared to those in mothers of singletons, and identify factors associated with decision as to breast-feed or bottle-feed.The subjects were 1,529 mothers of twins aged 6 months-6 years and 258 mothers of triplets and higher order multiple births (higher multiples) aged 6 months-6 years (234 mothers of triplets, 20 mothers of quadruplets, 4 mothers of quintuplets). Also, 1,300 subjects were recruited as a control group from mothers of singletons aged 6 months-6 years. Information regarding feeding methods, including exclusive breast-feeding, mixed-feeding and bottle-feeding with formula milk only, and duration of breast-feeding (in months) was collected.There were significantly higher rates of bottle-feeding in mothers of twins and higher multiples than in mothers of singletons. Duration of breast-feeding in mothers who chose exclusive breast-feeding or mixed-feeding for twins and higher multiples was significantly shorter than those for the singletons. The feeding methods for the twins or higher multiples were not associated with prematurity or low birth weight. However, after adjusting for each associated factor using logistic regression analysis, the decision to bottle-feed was significantly associated with non-cooperation of the husband in childrearing and degree of anxiety that mothers felt when informed of a multiple pregnancy. The odds ratio indicated that mothers who received no cooperation from the husband for childrearing were 1.83 times more likely to choose bottle-feeding as those who received cooperation. Further, the odds ratio indicated that mothers who felt greater anxiety when informed of a multiple pregnancy were 1.73 times more likely to choose bottle-feeding as those who did not feel much anxiety.This study found that establishment and continuation of breast-feeding for twins, triplets and higher order multiple births are much more difficult than for singletons. Further, cooperation of the husband in childrearing and the degree of maternal anxiety when informed of a multiple pregnancy are significant factors affecting the decision to breast-feed or bottle-feed for twins, triplets or higher order multiple births.

Though twinning rates have been rapidly increasing in Japan, the problem of zygosity misclassification at birth has been paid little attention. By analysing four independent samples, the authors found that at a constant rate about 25-30% of monozygotic twins were misclassified as dizygotic twins at birth. This percentage is in very good accordance with that of monozygotic twins having dizygous placenta. Generally the obstetricians informed twins' parents about their children's zygosity. The number of placentas, as informed by obstetricians, was very strongly associated with zygosity. Concluding, even now many monozygotic twins in Japan may be misclassified as dizygotic at birth by obstetricians based solely on the number of placenta.

The purpose of this survey was to study child-rearing problems and necessary community welfare and health services in the families with twins or triplets as compared with families with singleton children.The subjects were 205 mothers of twins or triplets aged less than 6 and 911 mothers of similarly aged singleton children.1. Concerning maternal feeling when informed of a pregnancy, a significant difference was observed between the mothers with twins or triplets and the mothers with singleton children: 1.3% of the mothers with singleton children were not delighted when informed of a pregnancy, while the rate for mothers with twins or triplets was 12.4%. Mothers of twins or triplets showed significantly greater anxiety when informed of a pregnancy, and also after delivery, greater anxiety for child-rearing. 2. Mothers of twins or triplets were more likely to feel they could not get information regarding pregnancy and child-rearing. 3. There were higher rates of child-rearing problems with regard to economic burden, attending a hospital when a child become ill, shortage of hands for medical examinations or preventive injections, going out with children, shortage of cooperators for child-rearing, lack of time and difficulty for feeding methods for twins or triplets. 4. Community welfare and health services that mothers of twins or triplets wished for were an allowance for child-rearing in 77.0% of cases, helper or baby-sitter for medical examinations or preventive injections in 59.8%, and meeting for mothers of multiple children in 52.0%.This study indicated a tendency for mothers of twins or triplets to show greater anxiety during pregnancy, greater anxiety for child-rearing after delivery, and harder to get information regarding pregnancy and child-rearing as compared with those having singleton children. Mothers of twins or triplets had more child-rearing problems with regard to shortage of cooperators, economic burden and feeding methods for plural infants.

Background Numerous birth weight standards for twins have been reported in western countries, whereas little is in Japan. The aim of this study is to present birth weight, birth length, chest circumference, and head circumference references, clarifying features related to these body size parameters, and to compare our birth weight references with recent report of birth weight norms of Japanese twins using the vital statistics. Methods The subjects consisted of 1,061 twin pairs in total, with birth years ranging from 1968 through 1990. Data was obtained from the Twins Protocol Questionnaire, which asked for information about twins' growth and development in infancy, and the "Maternal and Child Health Handbook," which was presented by Ministry of Health and Welfare. Statistical means, standard deviations, and selected percentiles by gestational age were calculated and smoothed using data that contained at least gestational age and one of the four items. Results Birth weight was significantly lighter than that of singletons when three additional parameters, especially chest and head circumference, were not measured. Gestational age was correlated with weight, length, chest circumference, and head circumference, in that order, for both sexes. Compared with singletons, birth weight difference in twins was marked and slight difference was observed as to length, whereas no difference was observed as to chest and head circumference. The present results as to birth weight were consistently similar to the birth weight norms of twins using vital statistics in Japan. Conclusion Growth standards for twins, especially as to birth weight, are essential to understand and evaluate intrauterine growth of twins.

This study was conducted to assess the birth weight and height in triplets, and to identify associated factors.The subjects were 371 sets of triplets (1,113 triplets), who were born after 1986. Data on birth weight, birth height, gender, birth order, mode of delivery, gestational age, maternal weight gain at delivery, and infertility treatment were obtained. Pregravidic body mass index (BMI) was computed to evaluate maternal physique.Mean triplet birth weight was 1,763.3 +/- 420.6 g and mean birth height was 42.2 +/- 3.36 cm. Overall, 96% were low birth weight newborn, 24.4% were very low birth weight newborn, and 4.9% had less than 1,000 g weight. The triplet birth weight was significantly associated with gender (malefemale), sex combination (opposite-sexed setssame-sexed sets), mode of delivery (vaginal deliverycaesarean section), and pregravidic body mass index (BMI) (more than 26.0 kg/m2less than 19.8 kg/m2). There was a significant correlation coefficient between maternal weight gain at delivery and birth weight. The triplet birth height was significantly associated with gender (malefamale), sex combination (opposite-sexed setssame-sexed sets), and pregravidic BMI (more than 26.0 kg/m2less than 19.8 kg/m2). Moreover, the birth height was associated with maternal weight gain at delivery and infertility treatment.The birth weight and birth height in triplets are much lower than those for singletons and twins. Triplet birth weight is associated with gender, birth order, pregravidic body mass index, mode of delivery, and maternal weight gain at delivery, taking into account gestational age. Birth height is associated with gender, pregravidic body mass index, and infertility treatment.

An investigation was conducted on the influence of genetic and lifestyle factors related to the determination of eating behavior of human beings. The objective was to obtain information about lifestyle factors that may help health professionals intervene in terms of the prevention of diet-related diseases.The subjects were 180 pairs of adult twins aged over thirty, comprising of 134 monozygotic (MZ) and 46 dizygotic (DZ) pairs. Every subject was given an interview concerning dietary habits, food preference, food intake, as a part of medical examination. The intake of food containing salt and fat, the intake of food meals, the frequency of daily meals, and the frequency of eating 18 sorts of food were assessed on an individual basis, with a questionnaire on nutrition. The expected and observed values of intrapair concordance rates were calculated, and compared within each zygosity, using the chi-square test.Significant differences between the expected and observed for intrapair concordance rates were shown with monozygotic twins, regarding every category of question. Comparing MZ pairs who had lived apart before their twenties with the other MZ pairs, the latter had a tendency to show significant differences between the expected and observed values of intrapair concordance rate, regarding every category of question. In each case, the observed values were higher than the expected values.The study implied that both genetic and lifestyle factors influence the determinants of eating behavior of human beings. This finding shows the importance of understanding individual characteristics of food preference and eating behavior for intervention regarding lifestyle factors for prevention of diet-related diseases.

The purpose of this survey was to study childcare problems in the families with twins as compared with singletons.The subjects were 234 mothers of twins and 200 mothers of singletons, all born after 1994.1. Mothers of twins showed significantly higher anxiety during pregnancy compared with those having singletons. There was no significant difference in prevalence of anxiety for infant health between the two groups, but the mothers of twins showed significant higher rate for childcare after delivery, economy, or childcare of other brothers and sisters. 2. Mothers who felt shortage of time for childcare were more frequent in the twin group than in the singleton group. 3. Mothers of twins showed significant more severe fatigue (physical and mental) as compared with those having singletons. They also reported significantly poorer sleeping conditions. In particular, the average sleeping time for mothers of twins was 6.54 hours a day, while for those of singletons, it was 7.32 hours. 4. Mothers of twins who did not receive assistance from fathers for childcare reported more severe physical and mental fatigue than those of twins who were given such help.This study indicated a tendency for mothers of twins to show more severe fatigue, poorer sleeping condition and a greater shortage of time for childcare as compared with those having singletons.

Background. Twins and triplets are at higher risk of cerebral palsy than singletons. This study investigated the degree of risk for cerebral palsy in twins, triplets and quadruplets, and identified factors associated with the increased risk. Methods. The subjects were recruited from the Kinki University Twin and Higher Order Multiple Births Registry. Results. The subjects were 705 twins pairs (1410 twins), 96 sets of triplets (287 triplets excluding one infant death), and 7 sets of quadruplets (27 quadruplets excluding one infant death), who were born after 1977. The prevalence of cerebral palsy was 0.9% among 1410 twins, 3.1% among 287 triplets, and 11.1% among 27 quadruplets. Furthermore, the risks of producing at least one child with cerebral palsy were 1.5%, 8.0%, 42.9% in twin, triplet, quadruplet pregnancies, respectively. After adjusting for each associated factor using logistic regression, the risk of cerebral palsy was significantly associated with decrease in gestational age and asphyxia. The odds ratio indicated that infants whose gestational age was

Dibutyltin diazide has proven to be potential in nucleophilic ring opening of a variety of oxiranes to give 1,2-azido alcohols in less than four hours (DMF at 60 °C) in fair to excellent yields.