human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys . Prevalence estimates in Europe range from 4 to 24 per 10,000 births , depending on definition , with higher rates reported from the United States . Relatively little is known about potential risk factors , but a role for endocrine-disrupting chemicals ( EDCs ) has been proposed . Objective Our goal was to eluci date the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals , use of folate supplementation during pregnancy , and vegetarianism . Design We design ed a case – control study of 471 hypospadias cases referred to surgeons and 490 r and omly selected birth controls , born 1 January 1997–30 September 1998 in southeast Engl and .  Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism . We used a job exposure matrix to classify occupational exposure . Results In multiple logistic regression analysis , there were increased risks for self-reported occupational exposure to hair spray [ exposed vs. nonexposed , odds ratio ( OR ) = 2.39 ; 95 % confidence interval ( CI ) , 1.40–4.17 ] and phthalate exposure obtained by a job exposure matrix ( OR = 3.12 ; 95 % CI , 1.04–11.46 ) . There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy ( OR = 0.64 ; 95 % CI , 0.44–0.93 ) . Vegetarianism was not associated with hypospadias risk . Conclusions Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that anti and rogenic EDCs may play a role in hypospadias .  Folate supplementation in early pregnancy may be protective To evaluate the hypothesis of a common etiology for cryptorchidism and hypospadias , we conducted two case-control studies nested in a nationwide cohort in Sweden , using record linkage between the Inpatient and Birth Registries . Cases were 2,782 and 1,220 boys operated for cryptorchidism or hypospadias , respectively . Five matched controls per case were r and omly selected . Pregnancy and perinatal data were prospect ively recorded in the Birth Registry . Data were modeled through conditional logistic regression . Both cryptorchidism ( odds ratio ( OR ) = 2.22 ) and hypospadias ( OR = 2.75 ) were positively associated with other congenital malformations and inversely with maternal parity ( OR = 0.77 and 0.52 , respectively , for parity 4 + compared with primiparae ) . There is evidence that being born small-for-gestational-age and before the 33rd gestational week have a greater-than-additive effect with respect to both cryptorchidism ( OR = 6.19 vs 1.72 expected ) and hypospadias ( OR = 4.39 vs 2.60 expected ) compared with non-small-for-gestational-age boys born at term . Hypospadias was positively associated with severe preeclampsia ( OR = 2.11 ) . We conclude that the etiologies of the two conditions are partly shared BACKGROUND Several previous studies suggested increased risk of craniosynostosis among infants born to women who smoked . METHODS This study used data from the National Birth Defects Prevention Study , a multi-state , population -based case-control study of infants delivered from 1997 - 2003 . Nonmalformed , liveborn controls were selected r and omly from birth certificates or birth hospitals . Data from maternal telephone interviews were available for 531 cases and 5008 controls . RESULTS Smoking during the first month of pregnancy was not associated with craniosynostosis . Smoking later in pregnancy was associated with increased risk , but only among mothers who smoked at least one pack/day . For example , during the second trimester , the odds ratio for smoking < 5 cigarettes/day was 1.0 ( 95 % confidence interval [ CI ] 0.6 , 1.8 ) , but the odds ratio ( OR ) for smoking 15 or more cigarettes/day was 1.6 ( 95 % CI 0.9 , 2.8 ) , after adjustment for maternal age , education , race-ethnicity , sub-fertility , parity , folic acid supplement intake , body mass index , and study center . Among women who did not smoke , adjusted odds ratios suggested that secondh and smoke exposure at home , but not at work/school , was associated with modestly increased risk ; the OR for home exposure was 1.3 ( 95 % CI 0.9 , 1.9 ) . Results followed a similar pattern for some , but not all , specific suture types , but numbers for some groupings were small . CONCLUSIONS The results suggest moderately increased risk of craniosynostosis among mothers who were the heaviest smokers and who continued to smoke after the first trimester . Results are somewhat equivocal , given that most confidence intervals included one Increased maternal body mass index , maternal smoking , and alcohol exposure during pregnancy have been inconsistently reported as potential risk factors for renal birth defects .  The low incidence of the most severe renal anomaly , bilateral renal agenesis or hypoplasia ( RA/H ) , has limited the ability to study this fatal defect . Using data from the National Birth Defects Prevention Study , a multicenter case-control study , the authors explored potential relations between RA/H and maternal body mass index , smoking , alcohol , and caffeine exposures . Data available for 75 infants with RA/H born between 1997 and 2003 and for r and omly selected control infants without known birth defects ( n = 868 ) were assessed by a model adjusted for folic acid use , all four exposures of interest , and study center . Bilateral RA/H was associated with a body mass index of greater than 30 kg/m(2 ) prior to pregnancy ( adjusted odds ratio ( aOR ) = 1.92 , 95 % confidence interval ( CI ) : 1.00 , 3.67 ) , smoking during the periconceptional period ( aOR = 2.09 , 95 % CI : 1.08 , 4.03 ) , and binge drinking during the second month of pregnancy ( aOR = 3.64 , 95 % CI : 1.19 , 11.1 ) . These results support the need for further exploration into the potential mechanisms by which such exposures could interfere with early fetal kidney formation result ing in OBJECTIVE To evaluate the differences in  cigarette smoking prevalence rates in Brazil between 1989 and 2008 . METHODOLOGY We calculated absolute and relative differences in smoking prevalences , overall and stratified by gender , age , place of residence , educational level and birth cohort . Data were obtained from r and om sample s from two National Household Surveys ( 1989,n=39,969 ; 2008,n=38,461 ) . GLM models were specified to obtain estimates and assess whether differences in proportions of smokers differed by categories of the stratification variables . RESULTS Adjusted absolute and relative differences in smoking prevalence rates between 1989 and 2008 were , respectively , -12.4 % and -41.0 % . Individuals aged 15 - 34 years and those with 9 or more years of education presented larger relative declines than their counterparts ( p(s)≤0.001 ) . After stratification by birth cohort , men presented larger reductions than women , only in the absolute scale ( p(s)≤0.001 ) , with the exception of the youngest birth cohort ( i.e.,1965 - 1974 ) . CONCLUSIONS In Brazil , several tobacco control measures have been adopted since 1986 , in particular increasing taxation of tobacco products and strong health warnings , which may have contributed to the marked decline in smoking prevalence . It is important to underst and the evolution of the tobacco epidemic to propose new actions to prevent initiation and encourage cessation among those who started/continued smoking & NA ; To determine whether the risk of having an infant with anencephaly or spina bifida is greater among obese women than among average‐weight women , we compared 307 Atlanta‐area women who gave birth to a liveborn or stillborn infant with anencephaly or spina bifida ( case group ) with 2,755 Atlantaarea women who gave birth to an infant without birth defects ( control group ) . The infants of control women were r and omly selected from birth certificates and frequency‐matched to the case group by race , birth hospital , and birth period from 1968 through 1980 . After adjusting for maternal age , education , smoking status , alcohol use , chronic illness , and vitamin use , we found that , compared with average‐weight women , obese women ( pregravid body mass index greater than 29 ) had almost twice the risk of having an infant with spina bifida or anencephaly ( odds ratio = 1.9 ; 95 % confidence limits = 1.1 , 3.4 ) . A woman 's risk increased with her body mass index : adjusted odds ratios ranged from 0.6 ( 95 % confidence limits = 0.3 , 2.1 ) for very underweight women to 1.9 for obese women This study examines the association between  oral clefts  and first trimester maternal lifestyle factors based on prospect i ve data from the Danish National Birth Cohort . The cohort includes approximately 100,000 pregnancies . In total 192 mothers gave birth to child with an oral cleft during 1997–2003 . Information on risk factors such as smoking , alcohol consumption , tea , coffee , cola , and food supplements was obtained during pregnancy for these and 828 r and omly selected controls . We found that first trimester maternal smoking was associated with an increased risk of oral clefts ( odds ratio ( OR ) : 1.50 ; 95 % confidence interval ( CIs ) : 1.05 , 2.14 ) . Although not statistically significant , we also saw associations with first trimester consumption of alcohol ( OR : 1.11 ; CIs : 0.79 , 1.55 ) , tea ( OR : 1.31 ; CIs : 0.93 , 1.86 ) , and drinking more than 1 l of cola per week ( OR : 1.40 ; CIs : 0.92 , 2.12 ) . Furthermore supplementation with ≥400 mcg folic acid daily during the entire first trimester ( OR : 0.75 ; CIs : 0.46 , 1.22 ) suggested an inverse associated with oral clefts , similar to our results on coffee drinking . No effects were found for smaller doses of folic acid , vitamin A , B6 or B12 in this study . The present study found an association between oral clefts and smoking and , although not conclusive , supports an association of oral cleft with alcohol Objective . Maternal risk factors for hypospadias are poorly defined , and there is debate about temporal trends in hypospadias prevalence . We examined select maternal characteristics as possible risk factors for hypospadias among male offspring and evaluated yearly prevalence rates in Washington State . Methods . We performed a population -based , case-control study using linked birth-hospital discharge data from Washington State for 1987–1997 and prevalence data for 1987–2002 . All cases of hypospadias were identified on the basis of International Classification of Diseases , Ninth Revision , codes from the birth hospitalization ( N = 2155 ) . Five control subjects were r and omly selected for each case subject from the remaining singleton births , frequency matched according to year of birth ( N = 10775 ) . Maternal and infant characteristics were ascertained from the birth certificate . Logistic regression was used to calculate odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) . Yearly prevalence was determined by dividing the total number of hypospadias cases by the number of male singleton live births for each year . Results . The risk of delivering an affected male infant increased with advancing maternal age ; relative to women < 20 years of age , those > 40 years of age were at greatest risk ( OR : 1.70 ; 95 % CI : 1.17–2.48 ) . Infants of nonwhite women were generally at decreased risk . Infants born to women with preexisting diabetes mellitus were at greater risk than those born to women without diabetes ( OR : 2.18 ; 95 % CI : 1.03–4.60 ) ; however , this was not observed for infants born to women with gestational diabetes . The birth prevalence of hypospadias in 2002 was 5.0 cases per 1000 male births , not significantly different from that in 1987 . Conclusion . Older maternal age , white race , and preexisting diabetes were associated with increased risk of hypospadias among male offspring . The prevalence of hypospadias in Washington State did not increase significantly between 1987 and 2002 The prevalence at birth of  gastroschisis  , a rare abnormality of the abdominal wall , appears to have increased over the past decade . To characterize risk factors that might explain this increase , birth certificates for Washington State residents were compared for 62 infants born with gastroschisis during the years 1984 to 1987 and 617 r and omly selected unaffected infants matched for birth year . After simultaneously adjusting for 14 potential risk factors , 4 factors stood out . Infants born during January , February , or March were at greater risk than 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys . Prevalence estimates in Europe range from 4 to 24 per 10,000 births , depending on definition , with higher rates reported from the United States . Relatively little is known about potential risk factors , but a role for endocrine-disrupting chemicals ( EDCs ) has been proposed . Objective Our goal was to eluci date the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals , use of folate supplementation during pregnancy , and vegetarianism . Design We design ed a case – control study of 471 hypospadias cases referred to surgeons and 490 r and omly selected birth controls , born 1 January 1997–30 September 1998 in southeast Engl and .  Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism . We used a job exposure matrix to classify occupational exposure . Results In multiple logistic regression analysis , there were increased risks for self-reported occupational exposure to hair spray [ exposed vs. nonexposed , odds ratio ( OR ) = 2.39 ; 95 % confidence interval ( CI ) , 1.40–4.17 ] and phthalate exposure obtained by a job exposure matrix ( OR = 3.12 ; 95 % CI , 1.04–11.46 ) . There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy ( OR = 0.64 ; 95 % CI , 0.44–0.93 ) . Vegetarianism was not associated with hypospadias risk . Conclusions Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that anti and rogenic EDCs may play a role in hypospadias .  Folate supplementation in early pregnancy may be protective To evaluate the hypothesis of a common etiology for cryptorchidism and hypospadias , we conducted two case-control studies nested in a nationwide cohort in Sweden , using record linkage between the Inpatient and Birth Registries . Cases were 2,782 and 1,220 boys operated for cryptorchidism or hypospadias , respectively . Five matched controls per case were r and omly selected . Pregnancy and perinatal data were prospect ively recorded in the Birth Registry . Data were modeled through conditional logistic regression . Both cryptorchidism ( odds ratio ( OR ) = 2.22 ) and hypospadias ( OR = 2.75 ) were positively associated with other congenital malformations and inversely with maternal parity ( OR = 0.77 and 0.52 , respectively , for parity 4 + compared with primiparae ) . There is evidence that being born small-for-gestational-age and before the 33rd gestational week have a greater-than-additive effect with respect to both cryptorchidism ( OR = 6.19 vs 1.72 expected ) and hypospadias ( OR = 4.39 vs 2.60 expected ) compared with non-small-for-gestational-age boys born at term . Hypospadias was positively associated with severe preeclampsia ( OR = 2.11 ) . We conclude that the etiologies of the two conditions are partly shared BACKGROUND Several previous studies suggested increased risk of craniosynostosis among infants born to women who smoked . METHODS This study used data from the National Birth Defects Prevention Study , a multi-state , population -based case-control study of infants delivered from 1997 - 2003 . Nonmalformed , liveborn controls were selected r and omly from birth certificates or birth hospitals . Data from maternal telephone interviews were available for 531 cases and 5008 controls . RESULTS Smoking during the first month of pregnancy was not associated with craniosynostosis . Smoking later in pregnancy was associated with increased risk , but only among mothers who smoked at least one pack/day . For example , during the second trimester , the odds ratio for smoking < 5 cigarettes/day was 1.0 ( 95 % confidence interval [ CI ] 0.6 , 1.8 ) , but the odds ratio ( OR ) for smoking 15 or more cigarettes/day was 1.6 ( 95 % CI 0.9 , 2.8 ) , after adjustment for maternal age , education , race-ethnicity , sub-fertility , parity , folic acid supplement intake , body mass index , and study center . Among women who did not smoke , adjusted odds ratios suggested that secondh and smoke exposure at home , but not at work/school , was associated with modestly increased risk ; the OR for home exposure was 1.3 ( 95 % CI 0.9 , 1.9 ) . Results followed a similar pattern for some , but not all , specific suture types , but numbers for some groupings were small . CONCLUSIONS The results suggest moderately increased risk of craniosynostosis among mothers who were the heaviest smokers and who continued to smoke after the first trimester . Results are somewhat equivocal , given that most confidence intervals included one Increased maternal body mass index , maternal smoking , and alcohol exposure during pregnancy have been inconsistently reported as potential risk factors for renal birth defects .  The low incidence of the most severe renal anomaly , bilateral renal agenesis or hypoplasia ( RA/H ) , has limited the ability to study this fatal defect . Using data from the National Birth Defects Prevention Study , a multicenter case-control study , the authors explored potential relations between RA/H and maternal body mass index , smoking , alcohol , and caffeine exposures . Data available for 75 infants with RA/H born between 1997 and 2003 and for r and omly selected control infants without known birth defects ( n = 868 ) were assessed by a model adjusted for folic acid use , all four exposures of interest , and study center . Bilateral RA/H was associated with a body mass index of greater than 30 kg/m(2 ) prior to pregnancy ( adjusted odds ratio ( aOR ) = 1.92 , 95 % confidence interval ( CI ) : 1.00 , 3.67 ) , smoking during the periconceptional period ( aOR = 2.09 , 95 % CI : 1.08 , 4.03 ) , and binge drinking during the second month of pregnancy ( aOR = 3.64 , 95 % CI : 1.19 , 11.1 ) . These results support the need for further exploration into the potential mechanisms by which such exposures could interfere with early fetal kidney formation result ing in OBJECTIVE To evaluate the differences in  cigarette smoking prevalence rates in Brazil between 1989 and 2008 . METHODOLOGY We calculated absolute and relative differences in smoking prevalences , overall and stratified by gender , age , place of residence , educational level and birth cohort . Data were obtained from r and om sample s from two National Household Surveys ( 1989,n=39,969 ; 2008,n=38,461 ) . GLM models were specified to obtain estimates and assess whether differences in proportions of smokers differed by categories of the stratification variables . RESULTS Adjusted absolute and relative differences in smoking prevalence rates between 1989 and 2008 were , respectively , -12.4 % and -41.0 % . Individuals aged 15 - 34 years and those with 9 or more years of education presented larger relative declines than their counterparts ( p(s)≤0.001 ) . After stratification by birth cohort , men presented larger reductions than women , only in the absolute scale ( p(s)≤0.001 ) , with the exception of the youngest birth cohort ( i.e.,1965 - 1974 ) . CONCLUSIONS In Brazil , several tobacco control measures have been adopted since 1986 , in particular increasing taxation of tobacco products and strong health warnings , which may have contributed to the marked decline in smoking prevalence . It is important to underst and the evolution of the tobacco epidemic to propose new actions to prevent initiation and encourage cessation among those who started/continued smoking & NA ; To determine whether the risk of having an infant with anencephaly or spina bifida is greater among obese women than among average‐weight women , we compared 307 Atlanta‐area women who gave birth to a liveborn or stillborn infant with anencephaly or spina bifida ( case group ) with 2,755 Atlantaarea women who gave birth to an infant without birth defects ( control group ) . The infants of control women were r and omly selected from birth certificates and frequency‐matched to the case group by race , birth hospital , and birth period from 1968 through 1980 . After adjusting for maternal age , education , smoking status , alcohol use , chronic illness , and vitamin use , we found that , compared with average‐weight women , obese women ( pregravid body mass index greater than 29 ) had almost twice the risk of having an infant with spina bifida or anencephaly ( odds ratio = 1.9 ; 95 % confidence limits = 1.1 , 3.4 ) . A woman 's risk increased with her body mass index : adjusted odds ratios ranged from 0.6 ( 95 % confidence limits = 0.3 , 2.1 ) for very underweight women to 1.9 for obese women This study examines the association between  oral clefts  and first trimester maternal lifestyle factors based on prospect i ve data from the Danish National Birth Cohort . The cohort includes approximately 100,000 pregnancies . In total 192 mothers gave birth to child with an oral cleft during 1997–2003 . Information on risk factors such as smoking , alcohol consumption , tea , coffee , cola , and food supplements was obtained during pregnancy for these and 828 r and omly selected controls . We found that first trimester maternal smoking was associated with an increased risk of oral clefts ( odds ratio ( OR ) : 1.50 ; 95 % confidence interval ( CIs ) : 1.05 , 2.14 ) . Although not statistically significant , we also saw associations with first trimester consumption of alcohol ( OR : 1.11 ; CIs : 0.79 , 1.55 ) , tea ( OR : 1.31 ; CIs : 0.93 , 1.86 ) , and drinking more than 1 l of cola per week ( OR : 1.40 ; CIs : 0.92 , 2.12 ) . Furthermore supplementation with ≥400 mcg folic acid daily during the entire first trimester ( OR : 0.75 ; CIs : 0.46 , 1.22 ) suggested an inverse associated with oral clefts , similar to our results on coffee drinking . No effects were found for smaller doses of folic acid , vitamin A , B6 or B12 in this study . The present study found an association between oral clefts and smoking and , although not conclusive , supports an association of oral cleft with alcohol Objective . Maternal risk factors for hypospadias are poorly defined , and there is debate about temporal trends in hypospadias prevalence . We examined select maternal characteristics as possible risk factors for hypospadias among male offspring and evaluated yearly prevalence rates in Washington State . Methods . We performed a population -based , case-control study using linked birth-hospital discharge data from Washington State for 1987–1997 and prevalence data for 1987–2002 . All cases of hypospadias were identified on the basis of International Classification of Diseases , Ninth Revision , codes from the birth hospitalization ( N = 2155 ) . Five control subjects were r and omly selected for each case subject from the remaining singleton births , frequency matched according to year of birth ( N = 10775 ) . Maternal and infant characteristics were ascertained from the birth certificate . Logistic regression was used to calculate odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) . Yearly prevalence was determined by dividing the total number of hypospadias cases by the number of male singleton live births for each year . Results . The risk of delivering an affected male infant increased with advancing maternal age ; relative to women < 20 years of age , those > 40 years of age were at greatest risk ( OR : 1.70 ; 95 % CI : 1.17–2.48 ) . Infants of nonwhite women were generally at decreased risk . Infants born to women with preexisting diabetes mellitus were at greater risk than those born to women without diabetes ( OR : 2.18 ; 95 % CI : 1.03–4.60 ) ; however , this was not observed for infants born to women with gestational diabetes . The birth prevalence of hypospadias in 2002 was 5.0 cases per 1000 male births , not significantly different from that in 1987 . Conclusion . Older maternal age , white race , and preexisting diabetes were associated with increased risk of hypospadias among male offspring . The prevalence of hypospadias in Washington State did not increase significantly between 1987 and 2002 The prevalence at birth of  gastroschisis  , a rare abnormality of the abdominal wall , appears to have increased over the past decade . To characterize risk factors that might explain this increase , birth certificates for Washington State residents were compared for 62 infants born with gastroschisis during the years 1984 to 1987 and 617 r and omly selected unaffected infants matched for birth year . After simultaneously adjusting for 14 potential risk factors , 4 factors stood out . Infants born during January , February , or March were at greater risk than 
    Output:
    