Publications
135 results found
Joffe M, Bisanti L, Apostoli P, et al., 1999, Time to pregnancy and occupational lead exposure, International Symposium on Environment, Life-Style and Fertility, Publisher: SCAND J WORK ENV HEALTH, Pages: 64-65, ISSN: 0355-3140
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- Citations: 7
Bonde JP, Joffe M, 1999, Environment, life-style & fertility - Preface, SCANDINAVIAN JOURNAL OF WORK ENVIRONMENT & HEALTH, Vol: 25, Pages: 3-3, ISSN: 0355-3140
Kolstad HA, Bisanti L, Roeleveld N, et al., 1999, Time to pregnancy for men occupationally exposed to styrene in several European reinforced plastics companies, International Symposium on Environment, Life-Style and Fertility, Publisher: SCAND J WORK ENV HEALTH, Pages: 66-69, ISSN: 0355-3140
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- Citations: 11
Joffe M, 1999, Methods for obtaining valid data on time to pregnancy among men and women, SCANDINAVIAN JOURNAL OF WORK ENVIRONMENT & HEALTH, Vol: 25, Pages: 8-9, ISSN: 0355-3140
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- Citations: 8
Raitio A, Järvelin MR, Joffe M, et al., 1998, Trends and international comparisons in infertility in circumpolar areas., Int J Circumpolar Health, Vol: 57, Pages: 123-132, ISSN: 1239-9736
Infertility is an increasing problem for both individuals and societies. The number of couples seeking treatment for infertility is increasing each year, and public interest seems to be rising along with the new treatment methods and the improving results. Male infertility is also of great interest now that several studies suggest a deterioration in the quality of semen in many countries, Finland being an exception. The assisted reproductive technologies have improved tremendously since the first child conceived by in vitro fertilization was born in 1978. The new techniques include e.g. intrauterine insemination (IUI), gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), intracellular sperm injection (ICSI) and various combination treatments. These treatments are costly and both physically and emotionally stressful, and the success rate varies according to the aetiology of infertility, the age of the woman treated and the method used. More information is needed about the aetiology and incidence of fertility disorders as well as about the availability of treatment in the circumpolar areas and the couples' opinions of treatment. Our own study population, which was drawn form the northern Finland birth cohort for 1966, provides an outstanding opportunity to study these issues, since data are available for the whole life course of the individuals, dating back to prenatal life.
Larsen SB, Joffe M, Bonde JP, 1998, Time to pregnancy and exposure to pesticides in Danish farmers, OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, Vol: 55, Pages: 278-283, ISSN: 1351-0711
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- Citations: 34
Joffe M, Sutcliffe J, 1997, Developing policies for a healthy environment, HEALTH PROMOTION INTERNATIONAL, Vol: 12, Pages: 169-173, ISSN: 0957-4824
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- Citations: 11
Joffe M, 1997, Time to pregnancy: A measure of reproductive function in either sex, OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, Vol: 54, Pages: 289-295, ISSN: 1351-0711
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- Citations: 101
Joffe M, 1997, Time to pregnancy: a measure of reproductive function in either sex. Asclepios Project., Occup Environ Med, Vol: 54, Pages: 289-295, ISSN: 1351-0711
INTRODUCTION: Growing evidence of reproductive effects associated with occupational and environmental agents has created the need for research with sensitive and well validated methods. There is a complex relation between manifest effects and underlying pathogenic processes. Conceptions will on average tend to be delayed in a population exposed to an agent that causes embryonic damage, an increase in germ cell mutations, or decreased fertility. STUDYING TIME TO PREGNANCY: Time to pregnancy can be used to measure the degree of delay in conceiving, across the whole continuum of biological fertility, in either men or women. The distribution of time to pregnancy largely reflects a sorting process, as the more fertile couples become progressively less well represented with the passage of time. The basic research strategy is comparison of the time to pregnancy within groups defined by their exposures, allowing for potential confounding factors relating not only to the study subject but also to his or her partner. MEASUREMENT AND VALIDITY: Prospective and retrospective methods are available, and each has strengths and weaknesses. Prospective studies have some theoretical advantages, but have unrepresentative populations and problems of feasibility and cost. Retrospective assessment of time to pregnancy is feasible with a short questionnaire, without intruding into sensitive areas of respondents' lives, with good validity at the group level, and without the necessity of large populations. Potential biases have been identified that can be minimised by careful design and analysis; the principal remaining problem is difficulty in obtaining exposure data retrospectively.
Joffe M, 1997, Disorders of spermatogenesis in Finland - Is this a period effect, and if so, why?, BRITISH MEDICAL JOURNAL, Vol: 314, Pages: 1042-1042, ISSN: 0959-8138
Joffe M, 1996, Activation of estrogen receptors, SCIENCE, Vol: 274, Pages: 1285-1285, ISSN: 0036-8075
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- Citations: 3
Joffe M, 1996, Declining sperm count - Recent decline nay be relatively late stage of long term process, BRITISH MEDICAL JOURNAL, Vol: 313, Pages: 44-44, ISSN: 0959-8138
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- Citations: 1
Lang H, Joffe M, 1996, Home versus hospital delivery - Good quality evidence is lacking, BRITISH MEDICAL JOURNAL, Vol: 312, Pages: 1673-1674, ISSN: 0959-8138
Joffe M, 1996, Decreased fertility in Britain compared with Finland, LANCET, Vol: 347, Pages: 1519-1522, ISSN: 0140-6736
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- Citations: 63
Cleary R, Beard RW, Chapple J, et al., 1996, The standard primipara as a basis for inter-unit comparisons of maternity care., Br J Obstet Gynaecol, Vol: 103, Pages: 223-229, ISSN: 0306-5456
OBJECTIVE: To assess the suitability of the standard primipara (a subset of the obstetric population that has relatively low risk or intervention and of adverse outcome) for making inter-unit comparisons of indicators of the process and outcome of maternity care. DESIGN: Inter-unit comparison of 10 indicators of obstetric intervention and adverse outcome derived from routinely collected computerised data held on the St Mary's Maternity Information System. SETTING: Fifteen maternity units in the former North West Thames Region. PARTICIPANTS: 15,463 primiparae who were delivered in 1992. MAIN OUTCOME MEASURES: Proportion of primiparae within the standard definition; degree to which standard primiparae are associated with lower rates of intervention and adverse outcome, as compared to other primiparae. RESULTS: Within the database, 42.6% of all primiparae were found to be standard, with rates varying between units from 25.9% to 57.7%. As expected, the standard primiparous woman is at less risk of intervention or adverse outcome than other primiparae. All but one component variable of the standard definition is a significant risk factor for at least four of the 10 indicators. Statistically significant differences in indicator rates are seen between standard and nonstandard primiparae within units. Within the standard group, significant differences in rates of intervention and adverse outcome are seen between units. Units with relatively high levels of intervention within the higher risk nonstandard group also have relatively high levels of intervention within the standard group. CONCLUSIONS: Use of the standard primipara, rather than the whole obstetric population, as the basis for inter-unit comparisons of maternity care will control for the substantial difference in case mix seen in different units, thereby increasing the validity of those comparisons. The technique has the additional benefit of clarifying the relationship between everyday clinical decision making and
Joffe M, 1995, The first author repues, American Journal of Epidemiology, Vol: 141, ISSN: 0002-9262
Joffe M, Villard L, Li Z, et al., 1995, A time to pregnancy questionnaire designed for long term recall: validity in Oxford, England., J Epidemiol Community Health, Vol: 49, Pages: 314-319, ISSN: 0143-005X
STUDY OBJECTIVE: To establish the degree of validity of data on time to pregnancy, derived retrospectively using a short questionnaire. DESIGN: Information from the questionnaire was compared with data that had been collected concurrently from the same individuals. SETTING AND PARTICIPANTS: Questionnaires were mailed to 1647 women who continue to be followed up by the Oxford Family Planning Association contraceptive study, and a further 424 were approached for personal interview. Response rates were 91% and 79% respectively. MAIN RESULTS: Matching was successful in 91% of pregnancies. Median recall time was 14 years (interquartile range, 11-16 years). At the group level, remarkably good agreement was found between the two sources of information, presented as cumulative percentage distributions of live births. The findings were at least as good with longer recall (> 14 years) as with shorter recall. Digit performance was present to a limited degree. At the individual level, some misclassification was evident, which has implications for statistical power. For detection of clinical infertility (no conception within 12 months), the sensitivity was in the range 67%-91%, and the specificity was 92%-96%. Variations with format, duration of recall, age at delivery, year of birth, parity, social class, smoking habit, last contraceptive method, and outcome (live birth or not) were generally small, and were not statistically significant. CONCLUSIONS: Time to pregnancy is a sensitive way of assessing reproductive function in either sex. Valid data at a group level can be derived retrospectively, with a long duration of recall, using a short questionnaire.
Joffe M, Chapple J, Beard RW, 1995, Making routine data adequate to support clinical audit. Data collection should be integrated with patient care., BMJ, Vol: 310, ISSN: 0959-8138
Williams JG, 1995, Making routine data adequate to support clinical audit. "Routine" is inadequately defined., BMJ, Vol: 310, Pages: 665-666, ISSN: 0959-8138
Joffe M, Li Z, 1994, Male and female factors in fertility., Am J Epidemiol, Vol: 140, Pages: 921-929, ISSN: 0002-9262
Fertility is affected by the age of the female partner, but not that of the male partner, in the age ranges within which most attempts at conception occur. However, the literature on the effect of the smoking status of each partner is inconclusive. As part of a longitudinal study representative of all people born in Britain in 1958, 11,407 people were interviewed in 1991, of whom 3,132 female and 2,576 male cohort members had had or fathered at least one pregnancy. The outcome measure was the time to pregnancy of the first pregnancy (live births only), and the antecedent variables were the cohort member's age at that time and both partner's smoking habits and educational levels. Unadjusted analysis demonstrated that both the time to pregnancy and clinical subfertility were associated with higher maternal but not paternal age and with the smoking habits and educational levels of both parents. Multivariate analysis showed that paternal smoking failed to enter the model if the educational variables were also included. Findings were similar in the two separate analyses on male and female cohort members. This study confirms previous findings on the relative importance of maternal and paternal age in this age range. Maternal smoking affects fertility, but earlier reports of an apparent effect of paternal smoking may be due to confounding with socioeconomic status.
JOFFE M, CHAPPLE J, PATERSON C, et al., 1994, WHAT IS THE OPTIMAL CESAREAN-SECTION RATE - AN OUTCOME BASED STUDY OF EXISTING VARIATION, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 48, Pages: 406-411, ISSN: 0143-005X
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- Citations: 26
Joffe M, Li Z, 1994, Association of time to pregnancy and the outcome of pregnancy., Fertil Steril, Vol: 62, Pages: 71-75, ISSN: 0015-0282
OBJECTIVE: To examine the relationship of subfertility with miscarriage, low birth weight, and preterm delivery. DESIGN: Comparison of time to pregnancy distributions between pregnancies that had different outcomes. Three comparisons were made: (a) miscarriages with live births; within live births, (b) low birth weight infant (up to 2,500 grams) or not low birth weight; (c) preterm birth (37 weeks or less) or not preterm. Cox regression was used to adjust for covariates. POPULATION: All first pregnancies were analyzed from the National Child Development Study, a large survey of young adults aged 33 years, which is nationally representative of the British-born population. MAIN OUTCOME MEASURES: The distribution of the time taken to conceive (time to pregnancy), miscarriage, birth weight, and preterm delivery. RESULTS: Pregnancies that ended in miscarriage tended to take 23% longer to conceive, after adjustment for the other variables. Pregnancies that resulted in preterm delivery tended to take 15% longer to conceive. There was no statistically significant association with low birth weight. CONCLUSIONS: Delay in time to conception is a risk factor for poor obstetric outcome, irrespective of medical intervention.
Joffe M, 1994, Variation in caesarean section rates. What difference does it make., BMJ, Vol: 308, ISSN: 0959-8138
Joffe M, 1994, Recent initiatives by the European Union., BMJ, Vol: 308, Pages: 610-611, ISSN: 0959-8138
Joffe M, 1993, Future of European community (EC) activities in the area of public health: European public health alliance, Health Promotion International, Vol: 8, Pages: 53-61, ISSN: 0957-4824
This paper, prepared by the European Public Health Alliance, explores the future of EC activities in the health area, and how Article 129, the new public health chapter in the Maastricht Treaty, may best be interpreted and put into effect, once the Treaty has been ratified.The reference in Article 129 to 'major health scourges, including drug dependence' implies the need to set priorities. These should go be the principal killing diseases, and include the many other factors which have a major impact on wellbeing, such as risk factors and especially the socio-economic environment.The selection of major health scourges should be inclusive rather than restricted. The primary selection principle for setting priorities should be policy-relevance-i.e. that an important health problem can be addressed by one or more actual or potential Community policy areas.Health Protection has historically been highly beneficial, and is especially applicable to Article 129, with its accent on health protection requirements forming a constituent part of the Community's other policies. The new chapter provides an opportunity for important initiatives, for example re-introduction of the Nutrition Programme, linked with other EC policy areas, especially the Common Agricultural Policy.A senior Commission member should be made responsible for all public health activities, who will be visible and accountable. The Council of Health Ministers should take over certain areas currently dealt with by other departments. The budgetary allocation for activities relating to public health should be greatly increased. © 1993 Oxford University Press.
Joffe M, Villard L, Li Z, et al., 1993, Long-term recall of time-to-pregnancy., Fertil Steril, Vol: 60, Pages: 99-104, ISSN: 0015-0282
OBJECTIVE: To validate two versions of a short self-completion questionnaire on time-to-pregnancy. DESIGN: Information from the questionnaire was compared with concurrently collected data from the same individuals. POPULATION: Questionnaires were sent to 1,647 women who continue to be followed up by the Oxford Family Planning Association Contraceptive Study. Replies were received from 1,498, a response rate of 91.0%. Successful matching was achieved with 1,392 pregnancies that met the study criteria and that had values of time-to-pregnancy in both data sources. Median recall time was 14 years (interquartile range, 11 to 16 years). MAIN OUTCOME MEASURES: At the group level, the frequency distributions of time-to-pregnancy from the two sources are presented as cumulative percentages. At the individual level, the distribution of discrepancies between the sources is tabulated separately for each value of time-to-pregnancy, and accuracy of detection of clinical subfertility is presented (sensitivity and specificity). RESULTS: At the group level, remarkably good agreement was found between the two sources of information. Digit preference was present to a limited degree. There were no important differences between the two questionnaire versions. At the individual level, some misclassification was evident. For the detection of clinical infertility, sensitivity was 79.9% and specificity was 94.9%. CONCLUSIONS: Short, self-completion questionnaires are remarkably accurate for assessing time-to-pregnancy at a group level. Individual-level misclassification is frequent, but detection of clinical subfertility is fairly accurate.
Joffe M, 1993, Health protection and the European Community., BMJ, Vol: 306, Pages: 1629-1630, ISSN: 0959-8138
Joffe M, 1993, Citizens' action for public health., World Health Forum, Vol: 14, Pages: 53-55, ISSN: 0251-2432
The European Public Health Alliance aims to ensure broad participation in health-related policy-making and to contribute to the promotion of public health. The origins of the Alliance and the ways in which it relates to official bodies are outlined below.
Joffe M, 1992, Influence of early life on later health., BMJ, Vol: 304, ISSN: 0959-8138
Joffe M, 1992, Validity of exposure data derived from a structured questionnaire., Am J Epidemiol, Vol: 135, Pages: 564-570, ISSN: 0002-9262
It is often convenient to obtain occupational exposure information directly from employees. However, there is little published evidence on the validity of such data. Information from a short, pre-coded, structured questionnaire, administered by non-expert interviewers, was compared with information derived from management in five factories in the printing and plastics industries in England in 1986. Values of sensitivity ranged from 24% to 85% for eight different exposures, and specificity was at least 67% for seven of the eight agents. Those exposures which were described in chemically specific terms tended to have relatively higher specificities but lower sensitivities. Male workers' reports tended to have higher sensitivity but lower specificity compared with those of female workers. Workers who had been employed in the company for more than 10 years were no more accurate than their colleagues. Subjects who reported a phase of subfertility or at least one miscarriage did not have a higher proportion of false positives than the population as a whole, indicating an absence of reporting bias. Major improvements are highly desirable, especially to reduce underreporting of exposures. The use of workers' own names for agents may improve reporting.
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